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Pathophysiology 4 > Renal: intro lecture > Flashcards

Renal: intro lecture Flashcards

1
Q

renal capsule

A

tight capsule embedded in fat

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2
Q

renal fascia

-role

A

fibrous tissue

-attaches kidney to posterior abdominal wall

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3
Q

hilum

A

renal blood vessels, nerves, lymphatics and ureter enter/exit kidneys

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4
Q

renal cortex

A

outer layer with glomeruli and convoluted tubules

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5
Q

renal medulla

A

inner section with tubules and collecting duct

-consists of pyramids

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6
Q

renal columns

A

from cortex through renal pyramids

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7
Q

minor calyx

A

pyramid apexes project into cavity–forms minor calyx

-recieves urine from collecting ducts through renal papilla

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8
Q

major calyx

A

joins to form the renal pelvis

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9
Q

renal pelvis

A

joins proximal end of ureter

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10
Q

which artery supplies blood to kidneys

A

renal arteries

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11
Q

which arteries supplies renal columns and pyramids

A

interlobar arteries

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12
Q

what feeds into the efferent arteriole

A

glomerular capillaries

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13
Q

what conveys blood to 2nd capillary bed

A

efferent arteriole

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14
Q

what subdivides into 4-8 glomerular capillaries

A

afferent arterioles

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15
Q

functional unit of the kidney

A

nephron

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16
Q

role of neprhon

A
  • FILTERS plasma at the glomerulus
  • REABSORBS and SECRETES substances at different tubular structures

-forms filtrate of protein-free plasma–>ultrafiltration

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17
Q

how many nephrones does each kidney have

A

about 1.2 million

-most in superficial cortical nephrons

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18
Q

juxtamedullary nephrons

A

close/deep in the medulla

-imp for concentrating urine and secreting renin

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19
Q

define filtration

A

movement of protein-free plasma across the glomerular membrane (hydrostatic pressure)

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20
Q

define tubular reabsoprtion

A

movement of fluid and solutes from tubular lumen to the peritubular capillaries

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21
Q

define tubular secretion

A

transfer of substances from peritubular capillaries to tubular lumen

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22
Q

define excretion

A

elimination of a substance in the final urine

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23
Q

bowen’s glomerular capsule

A

circular space b/w visceral and parietal epithelium
double layer cup

-contains PODOCYTES

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24
Q

Podocyte

A
  • foot like processes–form network of intercellular clefts called FILTRATION SLITS —which modulate filtration
  • part of the bowmans capsules inner membrane
  • filtration is most imp function of podocytes***
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25
Q

renal corpuscule consists of

A

glomerulus + bowmens capsule

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26
Q

describe direction of blood for:

-efferent and afferent arteriole

A

afferent goes into the glomerulus—to the glom caps

efferent goes OUT of glomerulus aka kidney

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27
Q

glomerulus blood supply

A

afferent arteriole

-drained by efferent arteriole

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28
Q

juxtaglomerular cells

A

specialized cells located around afferent arteriole where the arteriole enters the glomerulus

**secrete renin when BP in arteriole falls

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29
Q

juxtaglomerular apparatus role

A

controls renal blood flow (aka BP), glomerular filtration, and renin secretions occurs here***

formed by distal convoluted tubule and glomerular afferent arteriole

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30
Q

macula densa

A

specalized epithelial cells in distal convoluted tubule that detects [na] of fluid in tubule

—>so in response to high sodium— it can trigger contraction of the afferent arteriole–>reducing BF to glomerulus and reducing GFR

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31
Q

synth nitric oxide

A

vasodilator

glomerular endothelial cell

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32
Q

synth endothelin-1

A

vasoconstrictor

  • glomerular endothelial cell
  • regulates glomerular blood flow
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33
Q

direction of filtrate as it enters glomerulus

A

plsma filtrats from glomerulus–>glomerular basement membrane–>bowman space–>forming primary urine

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34
Q

mesangial cells

A

secrete mesangial matrix and lie b/w glomerular capillaries (also provides support)

-phagocytic properties–>rel inflamm cytokines and GF

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35
Q

If a person’s glomerular filtration membrane (visceral epithelium) has been injured, which structure would be affected?

A

podocytes

  • **these are the cells that make up the inner layer of glomerular filtration membrane
  • cells have foot like processes that adhere to basement membrane
  • covers glomerular capillaries
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36
Q

what is juxtaglomerular apparatus made of

-role?

A

juxtaglomerular cells and macula densa

–senses pressure and solute concentration

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37
Q

what are macula densa cells and where are they located

A

in the JGA

detect solute concentration

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38
Q

what is the vasa recta

A

network of capillaries that follows and surrounds the loop of henle

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39
Q

filtration rate

/day? and /min?

A

glomeruli filter 180L/day or 120ml/min (this is when we are born and healthy)
*slows down as we age

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40
Q

filtration rate directly related to?

A

renal blood flow

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41
Q

what is the primary force driving filtering

A

outward pressure

***BP entering the glomerulus aka renal blood flor

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42
Q

what counteracts the outward pressure in filtration

A

inwards pressure 2nd to hydrostatic pressure of fluid within the urinary space
AND
pressure from proteins left in capillaries—-bc they try to pull water back into circulation—–called colloidal osmotic pressure

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43
Q

net flitration pressure =?

A

outward - inward pressure

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44
Q

glomerulus is freely permeable to _____ and relatively impermeable to ____

A

perm to water and imperm to large colloids (plasma proteins)

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45
Q

where is 99% of filtrate reabsorbed

A

into peritubular capillaries and returned to the blood

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46
Q

favoring forces to filrtration

A

capillary hydrostatic pressure

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47
Q

opposing forces to filtration

A

oncotic pressure in capillary and hydrostatic pressure in Bowman capsule

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48
Q

kidneys get ______ ml blood/min

-how much of that is plasma?

A

1000-2000 ml

**600-700 ml=plasma aka renal plasma flow

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49
Q

peritubular capillaries

A

surround the PCT and DCT and loop of henle

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50
Q

vasa recta

A

network of capillaries for the juxtamedullary nephrons—- imp for formation of a concentrated urine

51
Q

GFR

A

filtration of plasma into Bowman’s space
20% of the renal plasma flow (120-140 ml/min)
-directly related to perfusion pressure in glomerular capillaries

52
Q

relationship b/w renal blood flow and MAP/vasc resistance

A

if MAP decreases= decrease in renal blood flow

if vasc resistance incrs=decrs in renal blood flow

53
Q

afferent arterioles remain open by?

A

prostaglandins

54
Q

efferent arteriole is kept slightly constricted by?

A

ACEI

55
Q

capillary hydrostatic pressure

  • define
  • relationship to glom filtration
A

primary force favoring filtration of water and solutes
-glomerular filtration is favored by this and opposed by oncotic pressure in capillary and hydrostatic pressure in the bowman capsule

56
Q

capillary oncotic pressure relationship to filtration

A

force opposing filtration

57
Q

bowmans capsule hydrostatic pressure relationship with filtration

A

opposing force of filtration

58
Q

interstitial hydrostatic pressure relationship to filtration

A

none

59
Q

opposing forces to filtratioin

A

capillary oncotic pressure

bowmans capsule hydrostatic pressure

60
Q

opposing forces to filtration

A

capillary hydrostatic pressure

61
Q

list the roles of kidneys

A

A WET BED

A–acid base balance

W–water balance– thru reabsorbtion and elimination
E—electrolyte balance
T—toxin removal

B—blood pressure control via hormonal effects—AGII, aldosterone and fluid balance
E—effects hormone production–>erythropoetin (stim RBC prod), renin and activation of vit d
D—detached bone? its for bone metabolism—Ca and Phosphorus metabolism

62
Q

renin

A

regulation of BP

63
Q

erythropoetin

A

prod of RBCs

64
Q

1,25 dihydroxyvitamin D3

A

metabolism of Ca

65
Q

aldosterone

A

regulator of BP

-too much= lose K+ and retain Na+—>retain water–>incr BP

66
Q

ADH

A

secretion makes DCT and collecting duct more permeable to water—so it goes back into the body

67
Q

if there is reduced salt intake or reduced volume—what happens

A

RAAS

  1. enzyme Renin converts Angiotension I—> II–>incrs BP by stimulation vasoconstriction
  2. ATII stimulates Aldosterone–>causes Na+ resorption (reabsorbed)
68
Q

where is ADH made

A

posterior pituitary

69
Q

whats required to convert ATI—> ATII

A

renin

70
Q

kidneys role with vit D?

A

kidneys hydroxylate 25 hydroxy Vit D3 to the active form of Vit D–> 25 hydroxy vit D3 aka Calcitriol

71
Q

what is the active form of vit D

A

25 hydroxy vit d3 or Calcitriol

72
Q

we use what to get a rough estimate of kidney functino

A

GFR

  • tells us how much is filtered over time
  • estimates % functioning nephrons
  • dependent on sex, age, body size, creatinine
  • cannot be measured directly tho—-we use creatinine/creatining clearance
73
Q

avg GFR
men
women

A

200 ml/day

men= 130ml/min
women=120ml/min

74
Q

GFR for kidney failure

A

<15

**dialysis is needed*

75
Q

what would be GFR be for kidney dz with normal GFR

A

> 90

76
Q

chronic conditions most commonly assoc with decr GFR?

A

htn (2nd mc)

dm (mcc)

77
Q

difference b/w severely impaired GFR (stage 4) and Kidney failure (stage 5)

A

stage 5–>actively ON dialysis and your GFR <15

stage 4–> preparation for dialysis or transplant but not dialysis yet…… and GFR 15-29

78
Q

renal autoregulation

  • what is it
  • what happens when systemic bp incrs
A
  • **regulation of renal blood flow and GFR
  • ->kidneys adjust dilation/constriction of afferent arterioles to counter changes in BP
  • ->intrinsic mechanism works over large range of BP—but can malfunction if you have kidney dz !!!!
  • as systemic BP increaes–afferent arterioles CONSTRICT—preventing an INCR in filtration pressure
  • ->prevents wide fluctuations in systemic arterial presure from being transmitted to glomerular capillaries
  • ->solutes and water excretion is constantly maintained—despite arterial pressure changes
79
Q

what happns when arterial pressure declines

A

glomerular perfusion increases

  • HOW?
  • ***** autoregulation Myogenic Mechanism (stretching)
  • ->stretch on the afferent arteriolar smooth muscle decreases—-arterioles relax
  • –>incr in arteriolar pressure decreases glomerular perfusion–>causes arteriole smooth muscles to contract
80
Q

what happens when Na filtration increases

A

GFR decreases
HOW??? Autoregulation: tubulo-glomerular Feedback

  • –>macula densa cells stimulate afferent arteriole vasoconstriction
  • –>when NA filtration decrs–>opposite occurs—>GFR increases
81
Q

neural regulation of kidneys

A

sympathetic NS–vasocontricts—>lowers GFR

Baroreceptor reflex–>vasoconstriction of afferent arterioles with activation of alpha 1 adrenoreceptors–>decrs GFR and glom perfusion

82
Q

changes in body position and/or exercise–affect on GFT

A

exercise or change in position–>activates renal sympathetic neurons–>causes mild vasoconstriction

83
Q

severe hypoxia affect on kidneys

A

hypoxia stimulates chemoreceptors—>decreases GFR by means of sympathetic stimulation

84
Q

RAAS

  • function
  • breakdown
  • when is renin released
A

renin-angiotensin-aldosterone-system

*incrs systemic arterial pressure and incrs NA reabsoprtion

RENIN–>enzyme formed and stored in afferent arterioles of Juxtaglomerulus apparatus

Renin released when theres decr BP in afferent arterioles, decr NACL [ ] in DCT, symp nerve stimulation or B-adrenergic receptors and release of prostaglandins–>forms angiotensin I (it is physiologically inactive without renin)

Angiotensin-converting-enzyme (ACE) helps convert AGI–>AGII

AGII–>stimualtes secretion of aldosterone by adrenal cortex–>AGII= POTENT VASOCONSTRICTOR!!!!!!!—>aldosterone stimulates ADH secretion and thirst

85
Q

most potent vasoconstrictor

A

AGII

86
Q

Natriuretic Peptides

A

Atrial Natriuertic peptides (ANP) and Brain Natriuertic peptides (BNP)

ANP–>secreted from myocardial cells in atria
BNP–>secreted from myocardial cells in ventricles

BOTH

  • inhibit Na and water absoprtion by renal tubules
  • inhibit secretion of renin and aldosterone
  • promote VASODILATION of afferent arterioles and CONSTRICTION of efferent arterioles
  • incrs urine formation–>leading to decr blood volume and BP—>promotes NA and water loss
87
Q

what can override renal autoregulation

A

extrinsic mechanisims—> neuronal and hormonal

NEURONAL
-large drop in BP–>sympathetic stimuation–>contraction of afferent arteriole–>reducing urine production–>activating RAAS–>to regulate BP and fluid balance

HORMONAL
-ANP can incr GFR–>ANP secreted if plasma volume increases–>which increaes urine output

88
Q

C-type natriuretic peptide

A

secreted from vascular endothelium and in the neprhon

causes vasodilation

89
Q

Urodilatin

A

secreted by DCT and collecting ducts

causes vasodilation, natriuetic and diruetic effects

90
Q

A patient has hypovolemic hyponatremia. Which of the following is involved in the reaction/response to this ?

A

RAAS

91
Q

what happens when bladder gets 250-300 ml of urine

A
  1. bladder contracts

2. internal urethral spinchter relaxes through activation of spinal reflex arc— aka the micturition reflex

92
Q

three major things urine formation required and define all three

A
  1. glomerular filtration –>movement of substances from the blood within the glomerulus into the capsular space
  2. tubular reabsorption–>movement of substances from tubular fluid back into the blood
  3. tubular secretion–>movement of substances from the blood into the tubular fluid
93
Q

renin release is triggered by

A

decrease in BP in afferent arterioles

94
Q

how many ML of urine does the bladder need to contract

A

250-300 ml

95
Q

Golmerular Filtration

A

blood moves from afferent arteriole–>into capillaries of glomerulus–>pressure INCRS–>this forces water and small molecules through glomeruluar wall and pores–>into the tubules–>where resoprtion and secretion occur
**simple diffusion of solutes from H–L concentration + osmosis

96
Q

how many ML of urine does the bladder need to contract

A

250-300 ml

97
Q

Golmerular Filtration what happens here

A

blood moves from afferent arteriole–>into capillaries of glomerulus–>pressure INCRS–>this forces water and small molecules through glomeruluar wall and pores–>into the tubules–>where resoprtion and secretion occur
**simple diffusion of solutes from H–L concentration + osmosis

98
Q

tubular resoprtion–what happens here

A

water, glucose, amino acids and ions needed are transported out of filtrate into tubule cell and then they enter the blood (capillaries)

99
Q

tubular secretion–what happens here

A

H+ K+ creatinine drugs are removed from pertibular blood and secreted by tubule cells into the filtrate

100
Q

how much glucose is usually retained

A

180 mg/dl

101
Q

what happens to creatinine in the tubules

A

since it is a waste producte– it is excreted

102
Q

Proximal convoluted tubule

-what happens here—- what is reabsorbed from filtrate and what is secreted into filtrate

A

REABSORBED FROM FILTRATE

  • NA (majority)
  • CL
  • K
  • water (ADH NOT required)
  • amino acids
  • glucose

SECRETED INTO FILTRATE

  • urea
  • H+
  • creatinine
  • *PH is adjusted here
  • *only surface covered with microvili for reabsoprtion
103
Q

what part of the nephron is the ONLY surface that contains microvili for reabsorption

A

PCT

104
Q

loop of henle

-what happens here (each loop)

A
  • osmotic gradient is created
  • countercurrent mechanism

DESCENDING LOOP
-allows water to pass from filtate into interstitial fluid—making a very concentrated filtrate

ASCENDING LOOP

  • reabsorbs NA and CL from filtrate into the interstitial fluid–>active transport
  • water is retained

**filtrate becomes more and more dilute as it enters the DCT

105
Q

distal convoluted tubule what happens here

A

reabsorbs: NACL, water (ADH is required here) , bicarb,

secretes/stays in filtrate: K and H

  • maintain blood PH and electrolyte balance
  • secretes drugs and toxins

**thiazide diuretics works here!!!

106
Q

collecting duct–what happens here

A

determines final urine volume by reabsorbing water (ADH REQUIRED) and secreting NA K H HCO3 from Filtrate

107
Q

what does the convoluted portion of DCT do?

A

helps dilute tubulr fluid

108
Q

what does the straight segment of DCT do

A

its permeable to water—– and is controlled by ADH

109
Q

what cells are in the CD

A

principal cells

  • they reabsorb water and sodium
  • secrete K+
110
Q

the primary function of the LOH is

A

establish a hyperosmotic state within the medullary instersitial fluid

111
Q

what part of nephron regulated acid-base balance and how does it do this

A

DCT

-excretes H+ and forms new bicarb

112
Q

what part of nephron maintains ph of filtrate

A

it is established in the DCT

113
Q

what part of the nephron is highly permeable to NA K and CL and less permeable to water and urea

A

thick ascending portion of the LOH

114
Q

ADH

  • controls?
  • roles in the nephron
  • if present, what hapens with urine
A

controls concentration of final urine

increases WATER permeability in last segement of DCT and along CD

-causes high amount of water reabsorption—>less urine volume

115
Q

% of urea excreted in urine and % relecyed in kidneys

A

50% urine
50% kidneys

  • urea=end product of protein metabolism
  • major constituent of urine
116
Q

role of catecholamines on the afferent arteriole

A

norepi and epi cause afferent arteriole to constrict–>decrs GFR and RBF

117
Q

what is renalase

A

horme made in kidney

-degrades catecholamines and regulates BP

118
Q

best blood test to monitor chronic not acute dz

A

plasma creatinine [ ]

119
Q

plasma cystatin C [ ] measures

A

progressive renal dysfunctin

-its a plasma protein that is freely filtered at glomerulus

120
Q

BUN levels– what happens during dehydreation

A

BUN incrs

121
Q

when do BUN levels rise

A

dehydration

kidney failure

122
Q

normal urine ph

A

5-6.5

123
Q

norma sp for urine

A

1.010

124
Q

define the following

  • diuresis
  • antidiruetics
  • anuria
  • oliguria
  • nocturia
  • polyuria
A

diuresis=incr production of urine

antidiurietcs=dim urine production

anuria=no urine production

oliguria = <400 cc/day aka decr urine output

nocturia= at least 3x urinating at night

polyuria= prod of more than 3L/day

Pathophysiology 4 (8 decks)

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