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MAMS > Renal Physio > Flashcards

Renal Physio Flashcards

1
Q

most important role of the kidney

A

regulation of vol and composition of ECF

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2
Q

main functions of the kidney

A

reg vol and composition of ECF
excrete metab waste products
produce hormones and other circulating factors

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3
Q

each kidney contains ___ nephrons

A

1 million

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4
Q

nephron consists of ___

A

renal corpuscle

tubule

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5
Q

renal corpuscle contains?

A

glomerulus

Bowman’s capsule

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6
Q

ultrafiltrate

A

fluid in Bowman’s space free of cells and proteins

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7
Q

renal tubule

A

cont with Bowman’s capsule, narrow cylinder made of up a single layer of epithelial cells resting on a BM

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8
Q

path of ultrafiltrate

A 
tubule
CD
calyces
pelvis of kidneys
ureter
bladder
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9
Q

excretion rate=

A

filtration rate + secretion rate - reabsorption rate

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10
Q

layers of the filtration barrier

A

single celled cap epithelium with fenestrations
BM
single celled epithelial layer of Bowman’s capsule

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11
Q

what makes up the BM of the filtration barrier?

A

negatively charged glycoproteins

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12
Q

role of BM of filtration barrier

A

prevent large, neg charged solutes from crossing

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13
Q

podocytes

A

epithelial cells of the visceral layer of Bowman’s capsule

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14
Q

filtration slit

A

4nm spaces between pedicels of podocytes

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15
Q

what makes up the diaphragm of the filtration slits?

A

nephrin
podocin
lipid rafts

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16
Q

what size of molecules are rejected by the filtration barrier?

A

> 3.6 nm

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17
Q

what size of molecules are filtered by the filtration barrier?

A

<1 nm

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18
Q

kidneys receive what % of CO?

A

20%

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19
Q

average GFR

A

125ml/min

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20
Q

filtration fraction=

A

GFR/RPF

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21
Q

GFR=

A

Kf[(Pgc-Pbs)-(Pigc-Pibs)

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22
Q

filtration coefficient

A 
Kf
function of the permeability of the glomeruli and their SA
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23
Q

what can reduce the SA of the glomerulus?

A

contractions of podocytes and mesangial cells under the influence of AII or epi

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24
Q

oncotic pressure in bowman’s space=

A

0

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25
Q

how does the hydrostatic pressure change along the glomerular cap?

A

its relatively high at the afferent end and only changes slightly at the efferent end bc of low resistance

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26
Q

large filtration of water and retention of proteins leads to ____

A

progressive increase in oncotic pressure as fluid moves to the efferent end

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27
Q

reabsorption

A

movement of substances from tubular lumen to the peritubular cap

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28
Q

secretion

A

movement of substances from peritubular cap to the tubular lumen

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29
Q

where do most reabsorption of solutes and water take place?

A

proximal tubule

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30
Q

where does concentration and dilution of urine take place?

A

loop of Henle

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31
Q

where does fine tuning and hormone action take place?

A

distal tubule

collecting ducts

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32
Q

filtered load

A

amount of substance filtered per unit time

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33
Q

filtered load=

A

plasma conc x GFR

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34
Q

amount excreted per unit time=

A

urine conc x urine flow rate

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35
Q

if excreted

A

reabsorption

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36
Q

if excreted>filtered there is net ___ by the tubules

A

secretion

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37
Q

__% of filtered water is reabsorbed

A

99

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38
Q

2/3 of salt and water filtered at the glomerulus are reabsorbed at the ___

A

proximal tubule

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39
Q

most of the oxygen consumed by the kidneys is used for ___

A

energizing Na transport

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40
Q

what drives water reabsorption in the proximal tubule?

A

cont reabsorption of Na and Cl creates an increase in osmolality of the intracellular spaces

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41
Q

what drives water reabsorption in the descending limb of Henle?

A

high osmolality of the medullary interstitium

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42
Q

what part of the tubule is impermeable to water?

A

ascending limb

distal tubule

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43
Q

what regulates permeability of water at the CD?

A

ADH

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44
Q

how is glucose reabsorbed in the proximal tubule?

A

Na dependent transporters

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45
Q

SGLT2

A

low affinity/high capacity

1:1

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46
Q

SGLT1

A

high affinity/low capacity

2Na:1glc

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47
Q

where are SGLT2?

A

early PT

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48
Q

where are SGLT1?

A

late PT

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49
Q

how does glucose exit cells in the early segment of the PT?

A

GLUT2

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50
Q

how does glucose exit cells in the late segment of the PT?

A

GLUT1

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51
Q

what mechanism of transport is glucose transport?

A

Tm-limited mechanism

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52
Q

2 most important substances secreted by the tubules

A

H+

K+

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53
Q

where does most of the secretion of anions and cations take place?

A

late PT

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54
Q

clearance

A

rate at which a particular substance is removed by the kidneys from the blood

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55
Q

Cx=

A

urine conc x urine flow rate/plasma conc

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56
Q

if the clearance of a freely filtered substance is less than the clearance of inulin the substance is ____

A

reabsorbed

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57
Q

if the clearance of a freely filtered substance is greater than the clearance of inulin the substance is ____

A

secreted

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58
Q

the clearance of PAH measures the ___

A

renal plasma flow

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59
Q

the urine/plasma inulin ratio is an indicator of?

A

the fraction of filtered water that is reabsorbed throughout the tubular system

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60
Q

effect of afferent constriction on RBF

A

decreases RBF

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61
Q

effect of afferent constriction on Pgc

A

decreases Pgc

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62
Q

effect of efferent constriction on RBF

A

decreases RBF

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63
Q

effect of efferent constriction on Pgc

A

increases Pgc

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64
Q

effect of afferent dilation on RBF

A

increases RBF

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65
Q

effect of afferent dilation on Pgc

A

increases Pgc

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66
Q

effect of efferent dilation on RBF

A

increases RBF

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67
Q

effect of efferent dilation on Pgc

A

decreases Pgc

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68
Q

small constriction of the efferent arteriole causes what change in GFR?

A

small increases GFR

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69
Q

large constriction of the efferent arteriole causes what change in GFR?

A

decreases GFR

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70
Q

afferent dilation causes what change in GFR?

A

increases GFR

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71
Q

afferent constriction causes what change in GFR?

A

decreases GFR

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72
Q

myogenic response

A

afferent arteriole smooth muscle contracts when stretched and relaxes on decreased distending pressure

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73
Q

how is the myogenic response mediated?

A

stretch sensitive cation channels

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74
Q

AII causes

A

a preferential increase in efferent arteriolar resistance and prevents a fall in Pgc and GFR

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75
Q

tubuloglomerular feedback

A

refers to changes in GFR that can be induced by chnages in the flow rate of fluid perfusing macula densa cells at the end of the ascending loop of Henle

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76
Q

when is tubuloglomerular feedback important?

A

when renal pressure increases

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77
Q

what is the likely mechanism of tubuloglomerular feedback?

A

macula densa cells sense increase in NaCl and secrete adenosine or ATP in response

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78
Q

what receptor does adenosine bind to in the afferent arteriolar smooth muscle?

A

A1

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79
Q

what does adenosine cause?

A

vasoconstriction

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80
Q

volume contraction ___ the sensitivity of tubuloglomerular feedback

A

increases

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81
Q

volume expansion ___ the sensitivity of tubuloglomerular feedback

A

decreases

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82
Q

most important day to day regulation of renal hemodynamics

A

autoregulation

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83
Q

decrease in blood volume or bp leads to ____

A

sympathetic nerve activation

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84
Q

what receptor does NE interact with in the afferent arterioles?

A

alpha 1

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85
Q

what does NE cause?

A

afferent constriction

decreased RBF and GFR

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86
Q

sympathetic activation of beta 1 receptors on granular cells causes ___

A

release of renin

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87
Q

what stimulates renal prostaglandin production

A

NE

AII

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88
Q

what do prostaglandins do?

A

dampens vasoconstrictor effects of sympathetic NS and AII to prevent renal ischemia

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89
Q

what produces endothelin?

A

endothelial and mesangial cells

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90
Q

action of endothelin

A

vasoconstrictor of afferent and efferent arterioles

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91
Q

what produces NO?

A

endothelial and macula densa cells

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92
Q

action of NO

A

vasodilator released tonically in renal circulation

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93
Q

what stimulates release of NO?

A

expansion ECF vol
ATP
bradykinin
histamine

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94
Q

action of dopamine and ANP

A

vasodilators

increase RBF and GFR

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95
Q

how does ANP raise GFR without changing RBF?

A

dilates afferent arteriole

constricts efferent arteriole

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96
Q

glomerulotubular balance

A

when sodium balance is normal, Na+ and water reabsorption increase in parallel with an increase in GFR and Na load

97
Q

2 mechanisms of glomerulotubular balance

A

starling forces

increased filtration of organic solutes

98
Q

where does glomerulotubular balance take place?

A

PT
loop of Henle
DT

99
Q

what secretes ADH?

A

posterior pituitary/neurohypophysis

100
Q

where are AQP1?

A

PT

descending thin mib

101
Q

where are AQP7?

A

PT

102
Q

where are AQP2?

A

CD

103
Q

where are AQP3 and 4?

A

CD

104
Q

what AQP is inserted in the CD lumen due to ADH?

A

AQP2

105
Q

regulation of plasma osmolality and Na conc is achieved by ____

A

alterations in water intake and excretion

106
Q

osmotic stratification

A

progressive increase of interstitial osmolality from cortex to papilla

107
Q

where does creation of osmotic gradients mainly occur?

A

ascending limb of the loop of Henle

108
Q

where does urea recycling take place?

A

terminal inner medullary collecting duct

109
Q

effects of ADH

A

increased water reabsorption
increased IMCD urea reabsorption
increased salt reabsorption in the TAL
decreased vasa recta blood flow

110
Q

obligatory water loss

A

0.5L

required for the excretion of waste products

111
Q

aquaporins

A

water channels

homotetramers of integral membrane proteins

112
Q

binding of ADH to its receptor activates ___

A

adenylate cyclase via a G-protein
leads to formation of cAMP and phosphorylation of proteins
leads to incorporation of AQP2 into luminal membranes of the CD

113
Q

AII ___ ANP secretion

A

stimulates

114
Q

AII ___ ADH secretion

A

inhibits

115
Q

what is sensed in vol regulation?

A

ECV

116
Q

what is sensed in osmo regulation?

A

plama osmolality

117
Q

what are the vol regulation sensors?

A

baroreceptors

118
Q

what are the osmo regulation sensors?

A

osmoreceptors

119
Q

what are the vol regulation effectors?

A

RAAS
sympathetic NS
ANP
ADH

120
Q

what are the osmo regulation effectors?

A

ADH

thirst

121
Q

how much Na+ is in bone?

A

40%

122
Q

how much available Na is in the ECF?

A

90%

123
Q

effective circulating vol

A

unmeasured volume that reflects the extent of tissue perfusion

124
Q

major baroreceptors involved in sensing Na

A

central great arterial vessels
cardiac atria
afferent arterioles in kidneys

125
Q

decreased stretch in the afferent arteriole of the kidney stimulates ___

A

secretion of renin

126
Q

how are adjustments in Na secretion accomplished?

A

changes in filtered Na load

determined by GFR and Na reabsorption

127
Q

which parts of the tubule are load-dependent Na reabsorption

A

PT

TAL

128
Q

increases in Na tend to __ GFR

A

increase

129
Q

decreases in Na tend to __ GFR

A

decrease

130
Q

decreased Na/ECF vol causes arteriolar ___

A

vasoconstriction

131
Q

what is the method of Na entry into cells in the early PT?

A

cotransport with organic solutes

in exchange for H+

132
Q

what is the method of Na entry into cells in the late PT?

A

Na-H exchanger coupled with Cl-OH exchanger

133
Q

what is the method of Na entry into cells in the TAL?

A

Na is cotransported with K and Cl by the NKCC2 transporter

134
Q

what is the method of Na entry into cells in the early DT?

A

Na is cotransported with Cl by the NCC transporter

135
Q

what is the method of Na entry into cells in the late DT?

A

epithelial Na channel- ENaC

136
Q

what is the NCC transporter sensitive to?

A

thiazides

137
Q

what is the ENaC sensitive to?

A

amiloride

138
Q

what upregulates the ENaC channel?

A

aldosterone

139
Q

what stimulates secretion of ADH?

A

small increases in plasma osmolality

large reductions in ECF vol

140
Q

when are prostanoids released?

A

when ECF vol/Na increases

141
Q

action of prostanoids and NO

A

inhibit Na reabsorption in the TAL

142
Q

aldosterone

A

steroid hormone secreted by glomerulosa cells of the adrenal cortex

143
Q

renin

A

proteloytic enzyme secreted by the juxtaglomerular cells

cleaves angiotensinogen to produce AI

144
Q

functions of AII

A

stimulation of aldosterone secretion by the adrenal cortex
arteriolar vasoconstriction
stimulation of Na reabsorption by the PT
stimulation of ADH and thirst

145
Q

what cells does AII act on?

A

principal cells of the distal nephron

146
Q

early effects of activation of the aldosterone receptor

A

recruitment of the apical Na channel and the basolateral Na/K ATPase

147
Q

later effects of activation of the aldosterone receptor

A

increase synthesis of the apical Na channel and the basolateral Na/K ATPase

148
Q

3 inputs to the juxtaglomerular cells that increase renin secretion in response to ECF/Na depletion

A

sympathetic nerve activity
perfusion pressure
delivery of NaCl to the macula densa

149
Q

atrial natriuretic peptide

A

28 AA peptide produced and stored by cardiac myocytes

150
Q

actions of ANP

A

relaxes vascular smooth muscle
promotes NaCl and water excretion
increases GFR and Na filtered load
inhibits aldosterone secretion by the adrenal cortex
inhibits Na reabsorption by the CD
inhibits ADH secretion by the posterior pituitary

151
Q

urodilatin

A

32 AA peptide secreted by DT and CD

152
Q

urodilatin action

A

acts locally to inhibit Na reabsorption

153
Q

local factors that inhibit Na reabsorption

A

NO
prostanoids
kinins

154
Q

what is the most abundant cation in the body?

A

K+

155
Q

where is most of the body K located?

A

inside cells at a conc of 150 mEq/L

156
Q

where is most intracellular K?

A

muscle cells

some in RBCs, liver, bone

157
Q

normal range of plasma K

A

3.5-5 mEq/L

158
Q

roles of K+

A

cofactor for enzymes
regulator of muscle blood flow during exercise
sets cell membrane potential

159
Q

what activates the Na/K ATPase after ingestion of K+?

A

initial rise of plasma K
epi
insulin

160
Q

in acidotic states, a drop of 0.1 pH results in an increase of ___ plasma K+

A

0.6 mEq/L

161
Q

where is most of the filtered K reabsorbed?

A

PT

TAL

162
Q

how is K reabsorbed in the PT?

A

diffusion through the intercellular pathway

163
Q

how is K reabsorbed in the TAL luminal membrane?

A

NKCC2 transporter

164
Q

what inhibits NKCC2?

A

loop diuretics

165
Q

how is K transported at the TAL basolateral membrane?

A

K-Cl cotransport

K channels

166
Q

___ can secrete or reabsorb K+

A

distal segments

167
Q

principal cell role in K+ transport

A

secretion

168
Q

intercalated alpha cell role in K+ transport

A

mediates reabsorption

169
Q

where does K secretion mostly take place?

A

late distal and cortical collecting tubules

170
Q

what channels does K secretion involve?

A

ROMK
BK
KCl cotransport

171
Q

at the cellular level the 3 factors controlling the rate of K secretion are

A

activity of Na/K ATPase
electrochemical gradient for K movement across the apical membrane
permeability of the apical membrane to K

172
Q

how does hyperkalemia stimulate K secretion

A

stimulates Na/K ATPase
increases permeability of luminal membrane to K
induces aldosterone secretion

173
Q

how does a high flow rate promote K secretion?

A

deforms mechano sensitive central cilium of the principal cells
causes release of Ca
opens Ca sensitive K channels

174
Q

role of diuretics

A

increase rate of tubular flow through the distal nephron

175
Q

spironolactone

A

competitive inhibitor of aldosterone

176
Q

triamterene and amiloride

A

diuretic that inhibits lumenal Na channel in the distal nephron

177
Q

reabsorption of bicarb and secretion of bicarb require ____

A

secretion of H+ from body to urine

178
Q

2 mechanisms of H+ secretion

A

ion exchange

primary active H+ transport

179
Q

how is H+ transported in the PT?

A

Na-H and Na-NH4 exchange via the NHE3 transporter

180
Q

where does primary active H+ transport mainly occur?

A

collecting duct of distal nephron

181
Q

where is most of the filtered bicarb reabsorbed?

A

PT

182
Q

predominant urine buffers

A

phosphate

ammonia

183
Q

titratable acidity

A

total contribution of all buffers of pK’s in the neighborhood of physio urine pH

184
Q

titratable acidity accounts for __ of acid excretion in the urine

A

1/3

185
Q

how does the CD secrete NH3, NH4, H+

A

Rh-glycoproteins

186
Q

ammonium trapping

A

once NH3 is in the renal tubule cell it reacts with H+ to form NH4 which can’t permeate the cell

187
Q

acute response to acidosis

A

insertion of transporters

188
Q

chronic response to acidosis

A

transcription/translation of genes/mRNA for transporters and enzymes required for ammoniagenesis

189
Q

urinary net acid excretion NAE=

A

(Uta+UNH4-UHCO3)V

190
Q

what secretes endothelin-1

A

endothelial cells and PT cells

191
Q

what stimulates secretion of endothelin-1?

A

acidosis

192
Q

actions of endothelin-1

A

increase expression of NHE-3 and NBCe1

193
Q

what stimulates secretion of PTH?

A

acidosis

194
Q

actions of PTH

A

inhibits phosphate reabsorbtion by the PT so more of it is available as a buffer

195
Q

role of principal/granular cell in the distal nephron

A

carries out Na reabsorption

196
Q

role of intercalated cells

A

regulate acid-base status

197
Q

role of alpha intercalated cells

A

secrete H+ into the lumen

198
Q

role of beta intercalated cells

A

secrete HCO3-

199
Q

alpha intercalated cells are upregulated during ___

A

acidosis

200
Q

beta intercalated cells are upregulated during ___

A

alkalosis

201
Q

change in [H+] in resp acidosis

A

increase

202
Q

change in [H+] in resp alkalosis

A

decrease

203
Q

change in [H+] in metab acidosis

A

increase

204
Q

change in [H+] in metab alkalosis

A

decrease

205
Q

change in [HCO3-] in resp acidosis

A

increase

206
Q

change in [HCO3-] in resp alkalosis

A

decrease

207
Q

change in [HCO3-] in metab acidosis

A

decrease

208
Q

change in [HCO3-] in metab alkalosis

A

increase

209
Q

change in pCO2 in resp acidosis

A

increase

210
Q

change in pCO2 in resp alkalosis

A

decrease

211
Q

change in pCO2 in metab acidosis

A

decrease

212
Q

change in pCO2 in metab alkalosis

A

increase

213
Q

cause of HCO3- change in resp acidosis

A

increase pCO2 and renal compensation

214
Q

cause of HCO3- change in resp alkalosis

A

decrease pCO2 and renal compensation

215
Q

cause of HCO3- change in metab acidosis

A

HCO3- loss, H+ gain

216
Q

cause of HCO3- change in metab alkalosis

A

HCO3- gain, H+ loss

217
Q

cause of CO2 change in resp acidosis

A

impaired lung function

218
Q

cause of CO2 change in resp alkalosis

A

increased ventilation

219
Q

cause of CO2 change in metab acidosis

A

reflex resp compensation

220
Q

cause of CO2 change in metab acidosis

A

reflex resp compensation

221
Q

free water clearance

A

amount of solute-free water that the kidney can excrete per unit time

222
Q

CH2O=

A

V-Cosm

223
Q

when urine osmolarity= plasma osmolarity CH2O=

A

0

224
Q

what does negative free water represents ___

A

water reabsorbed by tubules rather than excreted

225
Q

osmolar clearance always ___ with the administration of diuretics

A

increases

226
Q

administration of a PT diuretic ___ free water clearance

A

increases

227
Q

administration of a DT loop diuretic ___ free water clearance

A

decreases

228
Q

renovascular hypertension

A

inappropriate release of renin due to renal stenosis

leads to hypertension

229
Q

Conn’s syndrome

A

excessive aldosterone production

leads to hypertension

230
Q

Liddle’s syndrome

A

excessive Na reabsorption

leads to hypertension

231
Q

main causes of kidney failure

A

diabetes

high bp

232
Q

where do osmotic diuretics act?

A

PT

233
Q

osmotic diuretic action

A

mannitol is filtered and remains in the tubule to decrease the difference btwn interstitium and tubule

234
Q

where do CA inhibitors act?

A

PT

235
Q

where do loop diuretics act?

A

TAL

236
Q

loop diuretic action

A

blocks NKCC2 channel

237
Q

where do thiazides act?

A

early DT

238
Q

thiazide action

A

blocks Na-Cl channel in early DT

239
Q

where do K sparing diuretics act?

A

late DT

MAMS (8 decks)

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