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Renal physiology, nephrology, electrolytes, acid base balance > Renal physiology > Flashcards

Renal physiology Flashcards

1
Q

In glomerular filtration system

A
  1. Basal lamina of glomerular capillary & podocytes fuse.
  2. The capillary has fenestrations (pores) in between the endothelial cells.
  3. The podocyte processes interdigitate
  4. Masangial cells play a key role
  5. Electrical charge of the membrane determine the nature of filtration.
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2
Q

Cells present in

Glomerular membrane

A
  1. Capillary endothelial cell
  2. Lacis cell (extraglomerular mesangial cells)
  3. JG cells
  4. Podocytes

Lacis cells are phagocytic in narure.
JG/juxtaglomerular cells are also known as “negative baroreceptors”

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3
Q

Juxtaglomerular apparatus’ cells and their location

A

JG cells: Tunica media of afferent arteriole
Lacis cells: At the junction between afferent and efferent arteriole
Macula densa (specialized epithelial cell): Distal tubule

JG cells secrete renin. They are epitheloid cells.

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4
Q

Contaction

Mesangial cells contraction

A
  1. Endothelin
  2. Angiotensin 2
  3. Prostaglandin F2
  4. Vasopressin
  5. Norepinephrine
  6. Histamine
  7. Platelet derived growth factor (PDGF)
  8. Thromboxane A2
  9. Platelet activating factor (PAF)
  10. Leukotriene C4, D4
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5
Q

Physiology

Mesangial cells relaxation

A
  1. ANP
  2. Dopamine
  3. PGE2
  4. cyclic AMP
  5. Endothelial derived relaxation factor (EDRF)
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6
Q

Physiology

Renin angiotensin aldosterone system regulates?

A
  1. Potassium balance
  2. Sodium balance
  3. Fluid volume
  4. Blood pressure
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7
Q

Factors that affect renin secretion

Stimulation

A
  1. Increased sympathetic activity vial renal nerves
  2. Increased circulating catecholamines
  3. Prostaglandins
  4. Diuretics (as they causes fall in GFR)
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8
Q

Factors that affect renin secretion

Inhibitory

A
  1. Increased sodium and chloride reabsorption across maculadensa
  2. Increased afferent arteriolar pressure
  3. Angiotensin 2
  4. Vasopressin
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9
Q

Increase

Renin secretion

conditions

A
  1. Sodium depletion
  2. Diuretics
  3. Hypotension
  4. Haemorrhage
  5. Upright posture
  6. Dehydration
  7. Cardiac failure
  8. Cirrhosis
  9. Constriction of renal artery or aorta
  10. Various psychological stimuli
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10
Q

Increase in

Renal blood flow

due to?

A
  1. ANP (vasodilation of afferent arterioles)
  2. Dopamine
  3. Bradykinine
  4. PGE2, PGI2
  5. Nitric oxide
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11
Q

When mean arterial BP falls below 50%….

A
  1. Autoregulation cannot compensate
  2. Raised circulatory aldosterone level
  3. Renal vasoconstriction occurs
  4. Urine output may cease

At BP below 80mmHg, autoregulation fails, GFR falls gradually, so oliguria or anuria occurs.
At BP above 180mg, autoregulation fails, GFR gradually raises with increasing BP to cause polyuria/diuresis.

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12
Q

Organs activating Renin angiotensin aldosterone system

A
  1. Kidney
  2. Liver
  3. Lung
  4. Adrenal cortex

ANP (atrial natriuretic peptide) inhibits renin angiotensin aldosterone system.

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13
Q

Renal function test

Glomerular function test

A
  1. eGFR
  2. GFR
  3. Serum creatinine
  4. Renal clearance
  5. Blood urea
  6. Urinary albumin
  7. Albumin/creatinine ratio
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14
Q

Renal function test

Tubular function test

A
  1. Water deprivation test
  2. Acid load test
  3. Urine Osmolarity/Specific gravity
  4. alpha2, beta2 microglobulin in urine
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15
Q

Renal function test

Urine

Low specific gravity

1.016 or less

A
  1. Compulsive polydipsia
  2. Diabetes insipidus
  3. Glomerulonephritis
  4. Pyelonephritis
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16
Q

Renal function test

Urine

Fixed specific gravity

Isothenuria (1.008-1.012)

A

Chronic renal failure

Specific gravity of urine is based on tubular function. In late stages of chronic renal failure, kidneys fail to concentrate or dilute urine, so urine specific gravity is same as that of plasma.

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17
Q

Renal function test

urine

High specific gravity

A
  1. Severe dehydration
  2. Diabetes mellitus (due to glycosuria)
  3. Nephrotic syndrome (due to proteinuria)
  4. Adrenal insufficiency
  5. Congestive heart failure
  6. Hepatic diseases
  7. Extra renal water losses (vomiting, fever, diarrhea etc.)
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18
Q

Renal function test

Markers of tubular damage

how to access kidney function?

A
  1. Cystatin C
  2. Beta2 microglobulin
  3. Uric acid
  4. Kidney injury molecule-1 (KIM-1)
  5. Neutrophil gelatinase associated lipocalin (NGAL)
  6. alpha1 macroglobulin
  7. Interleukin 18
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19
Q

What is Myogenic mechanism in autoregulation of Renal blood flow?

A

Renal afferent arterioles contract in response to stretch . Thus increased renal arterial pressure stretches the arterioles , which contract and increase resistance to maintain constant blood flow.

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20
Q

Renal function tests

Parameters needed to measure GFR

A
  1. Weight
  2. Height
  3. Age (falls in old age)
  4. Sex (10% less in females)
  5. Serum creatinine level
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21
Q

Physical examination of urine

Urine turns dark on standing in?

A
  1. Alkaptonuria
  2. Porphyria
  3. Metronidazole overdose
  4. Levodopa
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22
Q

Agents causing Mesengial cell relaxation?

A
  • ANP
  • Prostaglandin E2
  • cAMP
  • Dopamine
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23
Q

Hormones acting on Distal convoluted tubule ?

A
  1. Aldosterone
    2.ANP
    3.ADH
    4.Calcitriol
    5.PTH
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24
Q

Hormones acting on Proxinmal Convoluted Tubule ?

A
  1. PTH
  2. Angiotensin 2
  3. Dopamine
  4. Catecholamines
25
Q

Site of action of Aldosterone in kidney?

A

Distal Convoluted Tubule & Collecting Tubule

26
Q

Site of action of ADH in kidney?

A

DCT & CT

27
Q

Site of action of ANP in kidney?

A

DCT & CD

28
Q

Site of action of PTH in kidney?

A

PCT, DCT, Think ascending limb of loop of Henle

29
Q

Site of action of Epinephrine , nor epinephrine , Prostaglandin?

A

Afferent & Efferent arteriole

30
Q

Endocrine function of kidney?

A

Kidney secretes :
1. Erythropoietin
2. Renin
3. 1,25 D cholecaciferol
4. Thromboxane

31
Q

Metabolic function of kidney?

A
  1. Gluconeogenesis
  2. Transamination
  3. Deamination
32
Q

Substances completely reabsorbed by kidney?

A
  • Glucose
  • Amino acid
  • Proteins
  • Vitamins
  • Acetoacetate ions
33
Q

Partially reabsorbed by kidney?

A

Water & electrolytes
Keto acids
Urea
Uric acid
Na+,K+, Ca2+,Mg2+,PO4, HCO3-

34
Q

Substance not reabsorbed by kidney?

A

Inulin
Creatinine
Mannitol
Sucrose

35
Q

What is Myogenic mechanism in autoregulation of Renal blood flow?

A

Renal afferent arterioles contract in response to stretch. Thus increased renal arterial pressure stretches the arterioles, which contract and increase resistance to maintain constant blood flow.

36
Q

Most important buffer in blood?

A

Bicarbonate buffer

37
Q

Most important buffer in RBC?

A

Haemoglobin buffer

38
Q

Most important buffer in Plasma / ECF ?

A

Bicarbonate buffer

39
Q

Most important buffer in urine?

A

Ammonia buffer

40
Q

How kidney regulates acid base balance?

A

1.Secretion of H+
2. Reabsorption of filtered
HCO3-
3. Generation of new HCO3-

41
Q

Diuretics acting on PCT ?

A
  1. Osmotic diuretic
  2. Carbonic anhydrase inhibitor
42
Q

Diuretics acting on Collecting tubule?

A
  1. Aldosterone antagonist
  2. Na+ channel blocker
43
Q

Diuretics acting on Early distal tubule ?

A

Thiazide diuretics

44
Q

Diuretics acting on Thick ALLH ?

blocks NaCCK channels in thick ALLH

A

Loop diuretics

Example: Frusemide

45
Q

What is the limiting pH of urine?

SBA

A

4.5

46
Q

What is the countercurrent multiplier in nephron ?

A

Loop of henle

47
Q

What is the countercurrent exchanger in nephron ?

A

Vasa recta

48
Q

What are the functions of Mesangial cell ?

A
  1. uptake of immune complex
  2. Produce PG
  3. Have receptor for Angiotensin 2, ADH, Insulin like growth factor
49
Q

Renin secreted by which cell ?

A

JG cell

50
Q

What are the renal vasodilator ?

A

Mnemonic : BD তে PG NA
B: Bradykinin
D:Dopamine
PG: Prostaglandin
N: Nitric oxide
A: ANP

51
Q

Which cell lies in the central region of glomerulus?

A

Mesangial cell

52
Q

What are the characteristics of Mesangial cell?

A

/ Smooth muscle cell
/ Contractile
/ Vasoactive

53
Q

Location of JG cell?

A

Afferent arteriole ( in tunica media)

54
Q

Location of macula densa?

A

Distal tubule

55
Q

Location of Lacis cell?

A

At the Junction between afferent & efferent arteriole

56
Q

Physiological substance secreted by kidney ?

A
  1. Hydrogen ion
  2. Ammonia
  3. Potassium
57
Q

Source of Angiotensin converting enzyme ?

SBA

A

Lungs

58
Q

Source of Angiotensinogen?

A

Liver

59
Q

Source of Angiotensin 2?

A

Kidney

Renal physiology, nephrology, electrolytes, acid base balance (4 decks)

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