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AU17: Physiology > Renal I > Flashcards

Renal I Flashcards

1
Q

T/F: Renal function is dynamic (constantly changing).

A

True

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2
Q

What are the two major functions of the kidneys?

A
  1. Regulation of water/salt balance

2. Removal of metabolic waste, drugs, other chemicals

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3
Q

What are two secondary functions of the kidneys?

A
  1. Gluconeogenesis

2. Produce hormones - erythropoietin, renin, 1,2,5 dihydroxyvitamin D

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4
Q

T/F: The kidney directly filters the majority of the water in the body.

A

False

Very small amount but affects the other compartments

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5
Q

T/F: Acute end stage renal disease requires hemodialysis.

A

False

Chronic

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6
Q

ESRD patients have a reduced ability to eliminate __________ and excess nitrogen is converted to ________.

A

nitrogenous waste (urea); ammonium

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7
Q

What happens as a result of excess ammonium?

A

Blood is alkalized -> increased pH in the oral cavity

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8
Q

What are some manifestations of renal disease in oral health?

A
  1. Ammonia breath
  2. Gingival enlargement
  3. Xerostomia
  4. Tooth problems: premature loss, narrow pulp, necrosis under fillings/crowns
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9
Q

What are some contraindications for ESRD patients?

A
  1. Nephrotoxic drugs

2. Increased bleeding

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10
Q

The kidney consists of an outer ________ and an inner _______.

A

cortex; medulla

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11
Q

What is the functional unit of a kidney?

A

Nephron

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12
Q

The cortex is made up of mostly _______, while the medulla contains more _______.

A

glomeruli; tubules

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13
Q

What happens to blood in the cortex?

A

Blood is filtered

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14
Q

What happens in the renal medulla?

A

concentration and collection of urine

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15
Q

The renal corpuscle is made of the ________ and the ________.

A

glomerulus and capsule

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16
Q

What structures does the filtrate go through after exiting the renal corpuscle?

A

Proximal convoluted tubule -> Henle’s loop -> distal convoluted tubule -> collecting duct

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17
Q

What are the two types of neurons that differ in their position and length?

A
  1. Superficial or cortical nephrons

2. Juxtamedullary nephrons

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18
Q

What are the three renal processes?

A
  1. Filtration
  2. Secretion
  3. Reabsorption
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19
Q

What is involved in the filtration process?

A

Water passes from blood into Bowman’s space -> water is filtered in glomerular capillaries

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20
Q

How much of the plasma entering the glomerulus is filtered?

A

15-20%

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21
Q

Where does the blood leaving the glomerular capillaries flow to?

A

Peritubular capillaries (vasa recta)

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22
Q

Describe the process of secretion.

A

Substances transported from blood in peritubular capillaries into the tubular fluid

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23
Q

During reabsorption substances are transported from __________ into the __________.

A

tubular fluid; blood in peritubular capillaries

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24
Q

T/F: Secretion and absorption occur throughout the length of the tubules.

A

True

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25
Q

What happens to the remaining tubular fluid at the end of the collecting duct?

A

It is excreted

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26
Q

Filtration occurs in the _______ and collection of the filtrate occurs in the ________.

A

glomerulus; renal capsule

Together make up renal corpuscle

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27
Q

T/F: There is smooth muscle in the afferent and efferent arterioles to regulate blood flow through the glomerulus.

A

True

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28
Q

How does the juxtaglomerular apparatus (JGA) regulate kidney function?

A

Secretes renin which regulates blood pressure and therefor glomerular blood flow

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29
Q

T/F: Blood flow through the glomerulus is regulated by the sympathetic nervous system.

A

True

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30
Q

The proximal convoluted tubule drains the ________.

A

renal capsule

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31
Q

The distal convoluted tubule drains the _________.

A

loop of Henle

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32
Q

Where in the nephron do the strongest diuretics act?

A

loop of Henle

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33
Q

T/F: 2/3 of filtered salt and water will reabsorb in the proximal convoluted tubule.

A

True

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34
Q

Where is all filtered glucose and amino acids reabsorbed?

A

Proximal convoluted tubule

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35
Q

What are the three segments of the loop of Henle?

A
  1. Thin descending limb
  2. Thin ascending limb
  3. Thick ascending limb
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36
Q

T/F: The loop of Henle produces a concentrated filtrate.

A

False

Dilute filtrate

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37
Q

Where in the nephron does the regulation of calcium take place?

A

Distal convoluted tubule

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38
Q

T/F: Each collecting duct collects fluid from a single nephron.

A

False

Collects from multiple nephrons

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39
Q

T/F: Sodium, potassium, and water are all regulated in the collecting duct.

A

True

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40
Q

What is renal clearance?

A

Rate of excretion of solute through the kidney/unit of time

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41
Q

_________ is the amount of blood that is filtered by the kidney.

A

Glomerular filtration rate (GFR)

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42
Q

What three criteria allow for renal clearance to be used to measure GFR?

A
  1. Substance is freely filtered in glomerulus
  2. Substance is not secreted
  3. Substance is not reabsorbed
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43
Q

What are normal kidney GFR values in males and females?

A

Male: 90-140 ml/min

Female: 125 ml/min

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44
Q

______ and ______ can be used to measure renal clearance.

A

Insulin and creatinine

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45
Q

What do insulin and creatinine have in common that allow them to be used to measure renal clearance?

A

freely filtered, and not secreted or reabsorbed

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46
Q

If creatinine levels are greater than ___, the patient requires dialysis.

A

10

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47
Q

________ around the capillaries in the glomerulus form filtration slits.

A

Podocytes

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48
Q

T/F: Glucose, salts, and amino acids are freely filtered.

A

True

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49
Q

T/F: Filtrate is full of cells and protein.

50
Q

T/F: Solutes over 42 A are not filtered.

51
Q

T/F: If a solute is negatively charged, it is more easily filtered.

A

False

Negatively charged basal lamina can repel negatively charged solutes

52
Q

Differences in ________ between the blood in capillaries and fluid in the capsule allows for filtration.

53
Q

The hydrostatic pressure in the capillaries is _______ than that in the capsule.

54
Q

What is oncotic pressure?

A

Pressure due to solutes in fluid

55
Q

The oncotic pressure in the capillaries is _______ than that in the capsule.

56
Q

T/F: Renal blood flow varies with systemic blood pressure changes.

A

False

Renal blood flow and GFR remain fairly constant

57
Q

What are the two primary mechanisms for auto regulation of kidney function?

A

Myogenic and tubuloglomerular feedback

Both intrinsic

58
Q

How does the myogenic mechanism regulate kidney function?

A

Constriction/dilation of afferent and efferent arterioles

59
Q

How does the tubuloglomerular feedback system work?

A

Feedback from juxtaglomerular apparatus adjusts afferent arteriol diameter and thus GFR

60
Q

T/F: An increase in GFR will increase NaCl in tubular fluid.

61
Q

Describe the tubuloglomerular feedback loop.

A

Increase GFR -> increase in NaCl in tubular fluid and at macula dense -> increased resistance in afferent arterioles -> decrease in GFR

62
Q

What are some extrinsic factors that regulate GFR and RBF?

A
  1. Diet
  2. Dehydration/hemorrhage
  3. Symp nervous system
  4. Angiotensin II, aldosterone, natriuretic peptide
63
Q

What is the difference between trans cellular and paracellular transport in the tubules?

A

Transcellular: through tubular cells

Paracellular: between tubular cells

64
Q

_________ results from solutes being carried by water in paracellular transport.

A

Solvent drag

65
Q

The rate of osmosis in the tubules can be regulated by _______.

A

aquaporins

66
Q

Where does the majority (50%) of sodium reabsorption happen?

A

Proximal tubule

67
Q

Where does sodium reabsorption not occur?

A

Descending limb of loop of Henle

68
Q

Glucose and amino acids are reabsorbed in the proximal tubule using ________.

A

symporters with Na+

69
Q

How does the proximal tubule keep [Na+] low ?

A

Active transport on the basal side

70
Q

How do water and solutes move in the proximal tubule?

A

Paracellular transport

71
Q

Na+ reabsorption occurs in conjunction with ________ reabsorption using a _________.

A

bicarbonate; Na+/H+ antiporter

72
Q

T/F: The proximal tubule has transporters for many organic anions and cations associated with many drugs.

A

True

Transporteres have low specificity and can be saturated

73
Q

By the end of the proximal tubule, ____ of Na+, Cl-, and water are reabsorbed.

74
Q

K+ and divalent cations are reabsorbed in the proximal tubule by _______.

A

Solvent drag

75
Q

T/F: All amino acids and glucose are reabsorbed in the proximal tubule.

76
Q

How is bicarbonate reabsorbed in the proximal tubule?

A

Na+/H+ transporter

77
Q

In the loop of Henle, ____ of filtered NaCl and ____ of water is absorbed.

78
Q

T/F: The descending limb of the loop of Henle is permeable to salt, but impermeable to water.

A

False

Permeable to water, but impermeable to salt

79
Q

T/F: Reabsorption in the descending and ascending thin limbs of the loop of Henle is passive.

80
Q

In what part of the loop of Henle is fluid diluted?

A

Ascending thick limb

81
Q

What molecules are pulled across the apical membrane via a symporter in the ATL?

A

Na+, 2Cl-, and K+

82
Q

T/F: Paracellular transport of ions in the loop of Henle is due to solvent drag.

A

False

Cations diffuse along electrical gradient because tubular fluid becomes positive when Cl- is reabsorbed

83
Q

T/F: Fluid leaving the loop of Henle is hyposmotic.

84
Q

How is hyperosmotic urine formed?

A

Renal countercurrent mechanism establishes osmotic gradient to reestablish hyper osmotic urine in the collecting duct

85
Q

Antidiuretic hormone will have effect on which part of the nephron?

A

Will cause more reabsorption of water in the collecting duct

86
Q

What would happen in the collecting duct if ADH is not present?

A

Too much water will be excreted

87
Q

T/F: Osmolarity of the blood leaving the kidney to the veins is normal.

88
Q

About ___ of the filtered NaCl is reabsorbed in the initial distal tubule.

89
Q

About ___ of the filtered NaCl is reabsorbed in the late distal tubule and collecting duct together.

90
Q

T/F: Cells in the early distal tubule have s NaCl symporter in the apical membrane and a Na+ K+ ATPase in the basolateral membrane.

91
Q

What are the two types of cells in the late distal tubule and collecting duct?

A
  1. Principal cells: reabsorb Na+ and secrete K+

2. Intercalated cells: acid-base balance

92
Q

Vasopressin/ADH is released from the _______.

A

Posterior pituitary

93
Q

When is ADH stimulated?

A
  1. High osmolality of body fluids
  2. Decrease in blood volume
  3. Decrease in blood pressure
94
Q

Low pressure baroreceptors in the ________ and __________ respond to decrease in blood volume by stimulating ADH.

A

left atrium and large pulmonary vessels

95
Q

High pressure baroreceptors in the _________ and _________ respond to a decrease in blood pressure by stimulating ADH.

A

aortic arch and carotid sinus

96
Q

How does ADH stimulate the reabsorption of water into the blood?

A

Increases aquaporins in apical membrane of collecting duct

97
Q

Diuresis (low ADH) would lead to _______ urine.

98
Q

Antidiuresis (high ADH) would lead to ________ urine.

A

concentrated

99
Q

What is the goal of the renin-angiotensin-aldosterone system?

A

Increase reabsorption of sodium and water

Combat volume contraction

100
Q

What would stimulate the kidney to produce renin?

A

Low fluid volume in the nephron

  1. Drop in perfusion pressure
  2. Decreased NaCl delivery to macula densa
  3. Symp input to JG cells
101
Q

What does renin do?

A

Converts angiotensinogen to angiotensin I

102
Q

What converts angiotensin I into angiotensin II?

A

ACE (happens in lungs)

103
Q

What are the affects of angiotensin II?

A
  1. Vasoconstriction
  2. Release of ADH
  3. Increase sympathetics
  4. Aldosterone secretion
104
Q

What is the result of aldosterone secretion?

A

NaCl and water resorption in the collecting duct -> increased blood pressure/volume

105
Q

When are natriuretic peptides secreted?

A

When the heart dilates -> volume expansion

106
Q

Atrial natriuretic peptides come from the _____, and brain natriuretic peptides come from the _______.

A

atria; ventricles

107
Q

What are the effects of natriuretic peptides?

A
  1. Vasodilation of afferent arterioles
  2. Vasoconstriction of efferent arterioles
  3. Inhibition of renin, aldosterone, and ADH
108
Q

The net effect of natriuretic peptides is to _______.

A

increase the excretion of water -> lower BP/blood volume

109
Q

Na+ resorption ill ______ BP, while Na+ secretion will ________ BP.

A

increase; decrease

Water will follow the solutes

110
Q

What is euvolemia?

A

Normal blood volume

111
Q

When attempting to lower blood volume due to volume expansion, where will the biggest effect take place?

A

Proximal convoluted tubule: drops from 2/3 NaCl reabsorption to 1/2

TAL and DT actually increase reabsorption

112
Q

Hyperkalemia (too much K+) will _________ muscles.

A

depolarize

113
Q

Hypokalemia will ________ muscles.

A

hyperpolarize

114
Q

Changes in ___ can cause cardiac arrhythmias.

115
Q

Kidneys typically excrete _____ of ingested K+.

116
Q

T/F: Roughly 2/3 of K+ is reabsorbed in the proximal tubule.

A

True

Paracellular solvent drag

117
Q

How is K+ reabsorbed in the thick ascending limb?

A

Na+K+Cl- symporter

Paracellular (not solvent drag)

118
Q

Which cells in the distal tubule/collecting duct secrete K+?

A

Principal cells via ATPase

119
Q

Which cells in the distal tubule/collecting duct reabsorb K+?

A

Intercalated cells

120
Q

An increase in plasma K+ would stimulate _______ which activates principal cells.

A

aldosterone

121
Q

Higher flow rate in the tubules would lead to an increase in Na+ ________ and an increase in K+ ________.

A

reabsorption; secretion

122
Q

Where in the nephron is K+ regulation occurring?

A

distal tubule and collecting duct

AU17: Physiology (12 decks)

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