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Physiology II > Renal I > Flashcards

Renal I Flashcards

1
Q

what are the indicators for TBW?

A

3H2O, 2H2O, antipyrine

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2
Q

what are the indicators for ICF?

A

none

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3
Q

what are the indicators for ECF?

A

22Na, Inulin, Mannitol

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4
Q

what are the indicators for Interstitial Fluid?

A

none

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5
Q

what are the indicators for intravascular fluid?

A

125 I-albumin, evans blue

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6
Q

equation for total blood volume

A

plasma volume/ (1-Hct)

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7
Q

what percent of adipocyte cells us fluid?

A

10%

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8
Q

what is the proper equation for a 100kg pt?

A

(70kg * 0.6)+(30kg * 0.1)= 42+3= 45L

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9
Q

If you adjusted your TBW for obesity then should you use the 40-20(of weight) rule or the 67% and 33%(of TBW) rule?

A

67% and 33% rule bc otherwise it will overestimate the compartments

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10
Q

where do most volume disturbances occur?

A

the ECF

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11
Q

how do the kidneys regulate body fluid volume?

A

controlling ECF by excreting Na and Water

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12
Q

what can the inability to maintain ECF volume cause?

A

hypervolemia- edema (7 L)

hypovolemia- decreased organ perfusion (3L)

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13
Q

what is the normal mOsm?

A

300 mOsm

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14
Q

Fluid moves in and out of capillaries via

A

starling forces

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15
Q

fluid moves in and out of cells via

A

osmotic forces

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16
Q

What are the 4 steps in a Darrow-Yannet Diagram?

A

what happens to volume of ECF compartment?
what happens to the mOsm of ECF compartment?
what happens to volume of ICF compartment?
what happens to mOsm of ICF compartment?

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17
Q

when you sweat do you lose more salt or water?

A

MORE WATER

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18
Q

what does hyponatremia cause in the brain

A

diffusion of H2O into brain lowering the mOsm inside brain (BRAIN SWELLING) within minutes

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19
Q

what happens within hours of hyponatremia after brain swelling

A

induces transport of Na,K, or solutes OUT OF CELLS (cause water diffusion out of cell)
increased expression of genes encoding intracell osmoles

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20
Q

do you want to correct hyponatremia slowly or quickly?

A

slowly <10mmol/L in 24-48hrs

quickly leads to osmotic demyelination (bc of direct cell damage)

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21
Q

what is the hormonal response to an increased plasma mOsm?

A

POSTERIOR PITUITARY increased ADH and AVP (agrinine vasopressin)
increase water reab in collecting ducts
HYPOTONIC SOLUTION

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22
Q

what is the hormonal response to a decrease in ECF volume?

A

RAAS activation
Na and water reab in renal tubules
ISOTONIC SOLUTION

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23
Q

what are the 3 factors that effect filtration?

A

properties of filtered molecules
properties of the glomerular filtration membrane
net filtration pressure

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24
Q

what are the 3 things that make up bowmans capsule membrane?

A 
capillary endothelium (with pores)
basement membrane (with negative charge)
podocyte (bowmans epithelium, with filtration slits)
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25
what is the functional unit of the kidney?
nephron
26
two main parts of the kidney
cortex (outside) | medulla (inside)
27
is the nephron in the cortex or the medulla?
it is in both
28
GFR of both kidneys?
125 mL/min | 180 L/day
29
how many times is the plasma volume filtered per day?
60 times per day
30
what % of volume filtered is reabsorbed?
99%
31
what is normal urine output per day?
1-2 L/day
32
what is dextran
exogenous polysaccarides of D-glucose that can be produced at different molecular weights and charges
33
what would happen if the negative charge on the basement membrane were lost?
then all charges would be easily filtered
34
do positive or negative charges have a harder time being filtered?
negative charged substances have a harder time being filtered
35
what are the 3 changes in the glomerular membrane that can effect filtration?
``` endothelial fenestrations (more open membrane) basement membrane thickens (harder to filter) loss of podocytes (lets bigger things through) ```
36
what is protein urea caused by?
loss of podocytes
37
NFP equation
(PGC-PBS)- (Onc pressure GC - Onc Pressure BC)
38
NFP positive
movement into bowmans space
39
NFP negative
movement into glomerular capillary
40
what two factors effect glomerular filtration rate
permeability of glomerular capillary (Kf) | Net filtration pressure (starling forces)
41
glomerular filtration rate definition
rate at which filtrate is formed by both kidneys per minute | key measure of renal health
42
of the 4 parts to NFP which is most important?
PGC- | high BP = more filtration
43
what is the first step in urine production?
glomerular filtration
44
what is the major difference between filtrate and plasma?
a normal healthy kidney (podocytes) will filter small amounts of protein in the filtrate plasma have lots of protein
45
clearance
how much of a substance can be removed from a certain amount of plasma volume in a given amount of time estimates GFR
46
what substance is the gold standard of GFR?
inulin
47
why is inulin ideal?
``` non toxic infusible freely filtered not reabsorbed, secreted, metabolized C inulin= GFR ```
48
is the clearance of inulin equal to GFR?
yes
49
what is the less good substance to measure GFR?
creatinine
50
why is creatinine used to measure GFR?
metabolite produced by creatine phosphate metabolism (no infusion needed) freely filterable not reabsorbed
51
what is the normal rate of production of creatinine?
50mg/day
52
is creatine secreted?
yes 10% but usually measurement is balanced out by error
53
how are plasma Creatinine (Cr) and GFR related?
inversely | a 50% reduction in GFR correlated to a 100% increase in plasma Cr
54
normal plasma Cr level
1mg/dL
55
at what plasma Cr do you have stage 4 CKD?
4mg/dL
56
if you decrease GFR by half what does that do to plasma Cr?
increased by 2
57
if you decrease GFR to 1/4 of normal what does that do to plasma Cr?
increased by 4
58
What if you donate a kidney and lose half of your nephrons? will your plasma Cr levels always be high?
no, they will gradually return to normal if you are a young healthy individual
59
Does GFR decline as you age?
yes -1mL/min/yr from age 40 for healthy person this is enough for proper filtraiton
60
what does CKD do to GFR?
accelerates the decline in GFR | lower GFR=higher mortality
61
GFR>90
CKD stage 1 | kidney damage with normal GFR
62
GFR 30-15
CKD stage 4
63
GFR <15 or dialysis
CKD stage 5 | kidney failure
64
clearance < GFR
reabsorbtion
65
clearance > GFR
secretion
66
clearance = GFR
no net secretion or re-absorption
67
is high renal blood flow for filtration or metabolism?
filtration | O2 consumption relative to RBF is not high O2 is not critical
68
what do the kidneys need O2 for?
to make ATP for transporting salts
69
CO
5-6L/min
70
Renal Fraction (RBF/CO)
20%
71
RBF
3.5mL/min/g (
72
filtration fraction (FF)
% plasma filtered into the renal tubules | = GFR/RPF) = 20%
73
what is the marker for renal plasma flow?
para-amino hippuric acid (PAH)
74
why is PAH an ideal marker of renal plasma flow?
majority excreted freely filtered 10mg/min highly secreted 50mg/min
75
If we constricted only the afferent arterial (AA) what would happen to:Blood Flow, Glomerular Capillary Hydrostatic Pressure (PGC), and GFR?
BF- decrease PGC- decrease GFR- decrease
76
If we constricted only the efferent arterial (EA) what would happen to:Blood Flow, Glomerular Capillary Hydrostatic Pressure (PGC), and GFR?
BF- decrease PGC- increase GFR- STABILIZES (tends to maintain the GFR)
77
If we dilated the AA what would happen to:Blood Flow, Glomerular Capillary Hydrostatic Pressure (PGC), and GFR?
BF- increase PGC- increase GFR- increase
78
If we dilated the EA what would happen to:Blood Flow, Glomerular Capillary Hydrostatic Pressure (PGC), and GFR?
BF- increase PGC- decrease GFR- decrease
79
what is the autoregulation range for RBF and GFR?
80-180mmHg MAP
80
what are the two ways the kidney protects RBF and GFR from changes in MAP?
``` neuroendocrine regulation (vasoconstrictors and dilators) intrinsic autoregulation of RBF ```
81
without these protective mechanisms what would happen if there was a 25% increase in BP?
25% increase in GFR and high workload on the kidneys
82
what two things regulate the autoregulation of the kidneys?
myogenic | JGA: tubuloglomerular feedback
83
angII, ADH/AVP effect on RBF
constrict EA decrease RBF countered in AA via NO and PG
84
ATP/adenosine effect on RBF
constrict AA decrease RBF release by macula densa during increased tubular flow
85
NO and Renal Prostaglandins effect on RBF
Dilate AA increase RBF helps keep GFR constant despite constrictors
86
myogenic mechanism of autoregulation
``` stretch vascular wall of vessel open Calcium channels contraction of smooth muscle in vessel minimizes changes in AA BF minimizes changes in GFR ```
87
where are granular cells located
on AA
88
when Na in distal tubule is high what does the nephron do?
lower GFR
89
what is the macula densa?
where the distal tubule comes into connection with the granular cells of the AA at the glomerulus
90
why is there no bowmans capsule colloid osmotic pressure?
there are no proteins in the filtrate

Physiology II (10 decks)

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