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Physiology II > Renal II > Flashcards

Renal II Flashcards

1
Q

why do we lose more K than Na

A

be the kidney has to exchange K to reabsorb Na and then try to recapture K

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2
Q

Where urea goes ____ also goes

A

water

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3
Q

without reabsorption how fast would we die?

A

2 hr

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4
Q

what drugs build up in patients with AKI or CKD?

A

morphine and pancuronium

bc they are cleared by kidney

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5
Q

where are drugs secreted on the nephron?

A

proximal tubule

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6
Q

is there only 1 nephron per collecting duct?

A

no multiple nephrons attach to one collecting duct

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7
Q

what does glomerulotubular balance accomplish?

A

minimizes the change in urine volume to prevent washout at increased GFR

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8
Q

how does high GFR stimulate more reabsorption

A

high GFR increased peritubular capillary oncotic pressure,

draws water towards it

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9
Q

what percent of the filtrate is always reabsorbed in the proximal tubule regardless of GFR?

A

67% of the filtrate

prevents large swings in urine volume and washout of the ECFV

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10
Q

what transporter is more important for Na and water reabsorb?

A

Na/K ATPase

between at PT interstitium side

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11
Q

how powerful are carbonic anhydrase inhibitors?

A

moderately

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12
Q

high distal flow rate = more or less K secretion?

A

more

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13
Q

tubular fluid/plasma concentration = 1

A

no reabsorption or secretion has occured in PT
OR
reabsorption of water has occurred at same rate in PT (Na)

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14
Q

tubular fluid/plasma concentration <1

A

more substance has been reabsorbed than water in the PT

AA, Glu, HCO3-

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15
Q

tubular fluid/plasma concentration >1

A

less substance has been reabsorbed than water in the PT

creatinine, urea, Cl

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16
Q

transport maximum (Tm or Tmax)

A

point at which increases in concentration of substance do not result in increase movement of substance across cell membrane
(it will not be reabsorbed thus excreted)

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17
Q

what is Tm determined by

A

saturation of limited number of transporters

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18
Q

filtered load equation

A

filtered load= P[conc] * GFR

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19
Q

do kidneys normally regulate plasma glucose?

A

NO

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20
Q

what is the main job/transporters in the descending LOH

A

concentrating segment
from 300- 600/1200
reabsorbs water AQP channels (regardless of ADH)
reabsorb/secrete urea

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21
Q

what do animals that survive in the desert have?

A

longer loops of henle

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22
Q

what does ADH do in the thick ascending limb of LOH

A

increase NKCC2 activity

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23
Q

what do you lose with Loop diuretics?

A

K and Calcium

VERY POWERFUL

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24
Q

what percent of reabsorb happens in proximal tubule

A

67%

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25
Q

what percent of reabsorb happens in thick ascending limb LOH

A

25%

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26
Q

what percent of reabsorb happens in distal tubule?

A

5%

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27
Q

what percent of reaborp happens in the distal cortical tubule/cortical collecting duct?

A

3%

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28
Q

do carbonic anhydrase inhibitors have a big effect in the thick ascending limb?

A

no bc only 10% of H secr/bicarb reab happen here

compared to 80% in the PT

29
Q

what diuretics are preferred for loosing bone older women?

A

thiazide bc they lower intracellular Na and help increase Ca reabsor here

30
Q

what channel does Calcium go through in the distal tubule?

A

TRP channel

31
Q

what increases the expression of the TRP channel?

A

PTH

Vitamin D

32
Q

how does vitamin D help retain calcium

A

regulates calbindin that traps calcium inside of the cell and prevents excretion

33
Q

what are the two main things that happen in the distal cortical tubule/cortical collecting duct

A

3% Na reab

regulation of K, H/HCO3

34
Q

what does aldosterone do in the DCT/CCD?

A

increases ENaC, Na/K ATPase, K channel

35
Q

what does ADH do in the DCT/CCD?

A

increases ENaC, and AQP channels

36
Q

amiloride

A

blocks ENaC,
potassium sparing
moderately powerful

37
Q

two cell types in the DCT/CCD?

A

principal cells

type A intercalated cells

38
Q

what happens at the type A cell?

A

K reabsor

H secret

39
Q

when is H/K ATPase activity increased?

A

hypokalemia

leads to alkalosis

40
Q

what does AngII do in the PT?

A

stimulates NHE, Na/HCO3, and NaKATPase

41
Q

what does PTH and FGF23 inhibit in the PT?

A

Na/Pi inhibition

42
Q

what stimualtes the Na/Pi in the PT?

A

Vitamin D

43
Q

what are SGLT2 inhibitors for>

A

lower blood glucose in pts with type 2 diabetes

44
Q

what is the role of ADH

A

adjust the conc of medullary intersitium
urinate or reabsorb water using urea
HYPOtonic solution

45
Q

how can we obtain such a wide range of urine Volume and Osm?

A

high osmolarity of medullary fluids

regulation of H2O reabsorb by ADH

46
Q

what are the two countercurrent systems?

A 
countercurrent multiplier (in LOH; creates gradient)
countercurrent exchanger (in vein; preserves the gradient)
47
Q

what does ADH respond to?

A

changes in plasma Na

via thirst and water transport

48
Q

what does RAAS respond best to?

A

changes in plasma volume

increases Na and H2O reabsorb at same rate and increases volume

49
Q

what does dehydration do to
plasma Na
plasma Osmo
Urine Osmo

A

Na- increase
plasma Osmo- increase
urine osmo- increase

50
Q

what does hypersecretion of ADH do to
plasma Na
plasma osmo
urine osmo

A

Na- decrease
plasma osmo- decrease
urine osmo- increase

51
Q

what does diabetes insipidus (ADH deficient) do to
plasma Na
plasma osmo
urine osmo

A

Na- increase
plasma osmo- increase
urine osmo- decrease

52
Q

what is RAAS opposed by?

A

ANP/BNP

53
Q

what is Reabsorption of Na controlled principally by?

A

RAAS bc it does not effect urea

ISOtonic volume

54
Q

what is the goal of ANP and BNP

A

oppose RAAS and lower ECFV via Na and water excretion

55
Q

what things increase Na excretion

A

ECF Na
ECF volume
natriuretic peptides (ANP/BNP)

56
Q

what things reduce Na excretion

A 
RAAS
ang II
aldosterone
sympathetic stimulation
ADH
57
Q

what does elevated K stimulate?

A

aldosterone

helps to reabsorb Na and secretes K

58
Q

hypokalemia number

A

<3.5mM

59
Q

hyperkalemia number

A

> 5.5mM

60
Q

what happens when plasma K is increased?

A

skeletal muscles increase K intake via Epi, aldosterone, insulin cascade
THEN kidneys can rev up excretion

61
Q

what is the major osmotic portion of the ICF

A

K

62
Q

what is plasma K mostly regulated by?

A

skeletal muscle

63
Q

what things push you towards hyperkalemia?

A

hyperosmolarity
exercise
cell lysis
acidosis

64
Q

what things push you towards hypokalemia?

A

insulin
beta agonists
aldosterone
alkalosis

65
Q

what can aldosterone blockade lead to?

A

hyperkalemia

66
Q

what is the drive for K to leave the principal cell in the collecting duct?

A

50mV difference in charge (negative in the lumen) driving the gradient

67
Q

how does high flow increase K secretion?

A 
bends cilia
activates PKD1&amp;2
and Ca entry
activates ROMK 
increased K secretion
68
Q

what things decrease K secretion?

A

ang II

low potassium diet

69
Q

what things increase K secretion?

A

high Na delivery to principal cells
aldosterone
high plasma K
high K diet

Physiology II (10 decks)

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