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Physio II (mine) > Renal I > Flashcards

Renal I Flashcards

1
Q

Functional Unit of the kidney

A

Nephron

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2
Q

The nephron does the work of making urine to remove waste and reabsorbing electrolytes to maintain the what?

A

ECF

Extra Cellular Fluid

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3
Q

Loss of how many nephrons pushes you towards kidney failure/uremia?

A

> 50%

Loss of nephrons makes it more difficult to filter the blood

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4
Q

Age of 40 does what with nephrons?

A

Decrease about 10% per decade or 1% per year

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5
Q

Age of 80 does what with nephrons?

A

-40%; 480K-720K

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6
Q

Net function of glomerulus?

A

Filters and hold capillary beds

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7
Q

Net function of proximal tubule?

A

Reabsorbs salts and drug secretion

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8
Q

New functions of descending LOH?

Loop of Henle

A

Reabsorbs water

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9
Q

What are the mid to late parts of the nephron?

A
  • Ascending loop of henle
  • Distal convoluted tubule
  • Collecting duct
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10
Q

Net functions of ascending LOH?

A

NaCl reabsorption

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11
Q

Net functions of collecting duct?

A

Adjusting water

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12
Q

Where does ANGII constrict?

A

Proximal tubule

Reabsorb for NaCl

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13
Q

Aldosterone and ADH effects what?

A

Collecting duct

Reabsorbs H2O and Urea

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14
Q

Drug secretion is done by what?

In the proximal tubule

A

OAT’s and OCT’s

Organic anion/cation transporters

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15
Q

Normal Plasma osmolarity

A

300 mOsm

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16
Q

The size of kidneys is only how much of the body mass?

A

0.5%

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17
Q

Kidney gets how much of the cardiac output?

A

20%

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18
Q

Calculation of RBF:

A

5L/min x 20% = 1L/min

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19
Q

Name the 9 steps of blood flow through kidney:

AIA-GEP-VIA

A

Arcuate artery
Interlobular artery
Afferent arteriole
Glomerulus
Efferent arteriole
Peritubular capillaries
Vasa recta
Interlobular vein
Arcuate vein

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20
Q

Why does such a small organ get such a large amount of blood flow?

A

For the process of filtration because ischemia causes problems in nephron

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21
Q

Where is there high pressure in the nephron and what is the function of that?

A

In the afferent arterial to the glomerulus

For filtration

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22
Q

What does the high pressure look like with hydrostatic and oncotic pressure?

A

Hydrostatic > oncotic

Pushes out to get filtered

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23
Q

Refresher: Hydrostatic pressure does what?

A

Pushes fluid out

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24
Q

Refresher: Onconic pressure does what?

A

Pulls fluid in

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25
Q

Where is there low pressure in the nephron and what is the function of that?

A

Efferent arterial and peritubular capillaries

Reabsorption of fluid

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26
Q

What does the low pressure look like with hydrostatic and oncotic pressure?

A

Oncotic > hydrostatic

Pulls fluid in to reabsorb

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27
Q

What does the vasa recta provide pressure wise?

A

Low pressure osmotic counter current

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28
Q

What is counter current flow?

A

In countercurrent flow, the two flows move in opposite directions.

Two tubes have a liquid flowing in opposite directions, transferring a property from one tube to the other. For example, this could be transferring the concentration of a dissolved solute from a high concentration flow of liquid to a low concentration flow.

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29
Q

Filtered load equation?

A

Plasma [x] x GFR

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30
Q

What does the filtered load equation tell you?

A

How much is actually filtered

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31
Q

What is the 3 layer barrier in the glomerulus that helps promote filtration and limit what is able to cross into the nephron?

A
  1. Fenestrated capillary endothelium
  2. Glomerular basement membrane
  3. Podocytes with filtration slits
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32
Q

What 3 things determine what crosses the membrane?

A
  1. Glomerular filtration membrane
  2. Size and charge of filtered molecules
  3. Net filtration pressure
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33
Q

What charge is the glomerular basement membrane?

A

Negative

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34
Q

When sizes are equal, what charge has a harder time being filtered?

A

Negative charged substances

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35
Q

When sizes are equal, which charge substances are easily filtered?

A

Positively charged substances

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36
Q

From easiest to hardest what is filterable: inulin, glucose, albumin, water, sodium, myoglobin, urea, hemoglobin

A

Urea, glucose, sodium, water, inulin, electrolyes

Myoglobin

Hemoglobin

Albumin

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37
Q

What is the major driving force of filtration?

A

High P GC (glomerular capillary hydrostatic pressure)

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38
Q

Net filtration pressure (NFP) equation?

A
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39
Q

Normal Values for NFP

A

(50-10)-(25-0)= 40-25= +15mmHg (positive = out pressure)

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40
Q

Why is there no Bowman’s capsule colloid osmotic pressure?

A

Shouldn’t filter proteins because they don’t make it into the capsule

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41
Q

If you increase P GC then what happens to the filtration?

A

Increase

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42
Q

What 2 factors do GFR come down to?

A
  1. Permeability glomerular capillary
  2. Net filtration pressure (starling forces)
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43
Q

Rate at which filtrate is formed by both kidneys per minute

A

Glomerular filtration rate (GFR)

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44
Q

What is the key measure of renal health?

A

GFR

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45
Q

GFR is passive process that is driven largely by what?

A

NFP (particularly high P GC)

NFP: Net filtration pressure

46
Q

What is the only thing that the glomerulus can not filter from plasma?

A

Proteins

47
Q

Is it practical to measure GFR by Kf or NFP?

A

No

48
Q

What represents how much of a substance can be removed from a certain amount of plasma volume in a given amount of time?

A

Clearance

Think volume of fluid = clearance. Not how much of the substance was removed.

49
Q

We can use clearance to estimate what?

A

GFR

50
Q

Clearance equation:

A

(U x UV) / P

Unit: mL/min

U= solute in urine
UV= volume of urine
P= solute in arterial plasma

51
Q

What is the gold standard to find renal clearance?

A

Inulin

52
Q

What are the 4 reasons why inulin is ideal for renal clearance?

A
  1. Non-toxic and infusible
  2. Freely filterable by the kidney
  3. Not reabsorbed, secreted, metabolized, synthesized or stored in any way
  4. Unable to alter GFR
53
Q

Clearance of inulin is equal to what?

A

GFR

54
Q

What are the 4 steps to use inulin in renal clearance?

A
  1. Infuse a substance into the pt
  2. Achieve steady plasma conc
  3. Collect urine and blood
  4. Calculate clearance
55
Q

What is the second best way to calculate renal clearance?

A

Creatinine

56
Q

What are the 5 reasons why creatinine is used for renal clearance?

A
  1. It’s a metabolite produced by creatinine phosphate metabolism (no infusion needed)
  2. In normal healthy person the rate of production is constant (rate of production=rate of excretion)
  3. Freely filterable by the kidney
  4. Not reabsorbed
  5. Small secretion into the nephron (~10%)
57
Q

What are the 3 steps to use creatinine for renal clearance?

A
  • Collect blood
  • Measure creatinine
  • Use prediction equation
58
Q

How is plasma Cr related to GFR?

A

Inversely

59
Q

Doubling plasma Cr represent what with GFR?

A

Large reductions

60
Q

A 50% reduction in GFR from 125 to 62.5 induces what to plasma Cr?

A

100% increase from 1 to 2

61
Q

Does GFR decline naturally with aging?

A

Yes

62
Q

Stage 1 CKD; kidney damage with normal GFR

A

> 90 GFR

63
Q

Stage 2 CKD; kidney damage with mild GFR

A

60-89 GFR

64
Q

Stage 3A CKD; mild to moderate GFR

A

45-59 GFR

65
Q

Stage 3B CKD; moderate GFR

A

30-45 GFR

66
Q

Stage 4 CKD; severe GFR

A

15-30 GFR

67
Q

Stage 5 CKD; kidney failure

A

<15 or dialysis GFR

68
Q

What is the normal value of GFR?

A

125

69
Q

GFR of both kidney in ml/min and L/day?

A

125 ml/min

180 L/day

70
Q

bout how much of volume filtered (GFR) is reabsorbed?

A

~99%

71
Q

What is the normal plasma volume (PV)

A

3L = filtered 60 x’s/day

72
Q

What is the calculation for RBF:

A

5-6L x 20% = 1000-1200ml/min

73
Q

How much RBF goes through the kidney when comparing body weight?

A

3.5mL/min/g (<0.5% Bodyweight)

74
Q

What is the % plasma filtered into the renal tubules?

A

Filtration fraction (FF)

75
Q

What is the FF equation?

A

GFR/ renal plasma flow (RPF)

76
Q

What is the FF:

A

125mL / 600mL/min=20%

77
Q

What is the normal renal plasma flow?

A

600 mL/min

78
Q

Is O2 a critical factor for regulating RBF?

A

No

79
Q

Is high RBF for filtration or metabolism?

A

Filtration, not metabolism

80
Q

If we constrict only the AA what would happen to RBF, PGC, GFR?

A

Everything decreases

81
Q

If we constrict only EA, what would happened to RBF, PGC, and GFR?

A
  • Decrease RBF
  • Increase PGC
  • Maintain GFR
82
Q

What does the kidney use to protect RBF and GFR from changes in MAP?

A

Neuroendocrine regulation and intrinsic autoregulation

83
Q

What is the normal MAP for kidney?

A

80-180mmHg

84
Q

What is neuroendocrine regulation?

A

Vasoconstrictors vs dilators

Can be impaired during disease (HTN)

85
Q

Neuroendocrine influences what?

A

RBF

86
Q

What does NE/Epi do to the RBF?

A

Decrease

Constrict

87
Q

Pain, stress, exercise, hemorrhage deals with what agent?

A

NE/Epi

88
Q

Primary affect of ANGII and ADH/AVP and where?

A

Constrictor on EA

89
Q

What does ANGII and ADH/AVP do to RBF?

A

Decrease

90
Q

Countered in AA via NO and PG is affected with what agent?

A

ANGII and ADH/AVP

91
Q

Adenosine (ATP) has what primary effect and where?

A

Constrictor on AA

92
Q

What does adenosine (ATP) cause in RBF?

A

Decrease

93
Q

Released of macula densa during increase tubular flow deals with what agent?

A

Adenosine (ATP)

94
Q

NO primary effect and where?

A

Dilation on AA and EA

95
Q

What does NO do to RBF?

A

Increase

96
Q

Sheer stress; helps keep GFR constant despite constrictors deals with what agent?

A

NO

97
Q

Renal prostaglandins primary effect and where?

A

Dilation on AA

98
Q

What does renal prostaglandins do to RBF?

A

Increase

99
Q

Helps keep GFR constant depsite constrictors deals with what agent?

A

Renal prostaglandins

100
Q

ANP primary affect and where?

A

Dilation on AA

Constriction on EA

101
Q

High atrial pressure deals with what agent?

A

Dilation of ANP

102
Q

Dopamine primary effect and where?

A

Dilation on AA and EA

103
Q

Dopamine causes what with RBF?

A

Increase

104
Q

Stretching the vascular wall of blood vessel will have a reflexive contraction explains what?

A

Myotonic mechanism

105
Q

The reflexive contraction in myogenic mechanism is a what property?

A

Intrinsic property of smooth muscle

106
Q

Each nephrons distal tubules (downstream), can communicate with the arterials of the glomerulus (upstream) to alter GFR explains what?

A

Tubuloglomerular feedback (TGF)

107
Q

When Na in distal tubules is high, what happens with the GFR?

A

Lower

108
Q

When Na in distal tubules is low, what happens to GFR?

A

Rises

109
Q

Tubuloglomerular feedback helps keep what in nephron constant, which helps maintain ECFV?

A

GFR and Na

110
Q

Renal triad of AKI is:

Acute Kidney Injury

A

Decrease in GFR
Decrease in urine output
Increase in BUN

111
Q

What is the first step of urine production?

A

Filtration

112
Q

Sevoflurance represents a theoretical risk for what?

A

AKI

Physio II (mine) (6 decks)

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