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Physiology > Renal Physiology > Flashcards

Renal Physiology Flashcards

0
Q

What is the net gain of water per day?

A

Zero: Fluid gained per day = fluid lost per day

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1
Q

What do you call the maintenance of the internal environment compatible with life?

A

Homeostasis

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2
Q

Which organ system contributes to homeostasis by adjusting water and electrolyte levels?

A

Renal System: mainly by producing urine

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3
Q

What is urine?

A

Urine is an ultrafiltrate of blood

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4
Q

Waste product from Proteins

A

Urea

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5
Q

Waste product from Purines

A

Uric Acid

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6
Q

Waste product from Muscles

A

Creatinine

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7
Q

Waste product from RBCs

A

Bilirubin

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8
Q

Excretion of variable amounts of water and sodium; Involved in RAAS

A

Blood pressure regulation

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9
Q

Excretion of excess acids and bases

A

Regulation of Acid- Base balance

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10
Q

Increases RBC production in response to hypoxia

A

Production of Erythropoeitin (EPO)

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11
Q

Produces glucose during the starvation state

A

Gluconeogenesis

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12
Q

Location of Kidney

A

T12-L3

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13
Q

Weight of Kidney

A

150g

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14
Q

Highly-fenestrated, responsible for GFR

A

Glomerular Capillaries

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15
Q

Supplies O2 & glucose to the tubular cells

A

Peritubular Capillaries

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16
Q

Secretes Erythropoietin (EPO)

A

Interstitial Cells

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17
Q

Hairpin loop-shaped peritubular capillaries of the juxtaglomerular nephrons that participate in countercurrent exchange

A

Vasa Recta

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18
Q

Capacity of the Urinary Bladder

A

600ml

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19
Q

Urge to urinate

A

150ml

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20
Q

Reflex contraction of the Urinary Bladder

A

300ml

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21
Q

Bladder muscle

A

Detrusor muscle

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22
Q

Internal Urethral Sphincter

A

Involuntary

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23
Q

External Urethral Sphincter

A

Voluntary

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24
Q

Functional and Structural Unit of Kidney

A

Nephron

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25
Q

of Nephrons per kidney

A

1 million

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26
Q

75% of nephrons

A

Cortical Nephrons

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27
Q

25% of nephrons

A

Juxtamedullary Nephrons

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28
Q

Location of Cortical Nephrons

A

Renal Cortex

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29
Q

Location of Juxtamedullary Nephrons

A

Corticomedullary Junction

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30
Q

Loops of Cortical Nephrons

A

Short

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31
Q

Loops of Juxtamedullary Nephrons

A

Long

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32
Q

Capillary Network of Cortical Nephrons

A

Peritubular Capillaries

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33
Q

Capillary Network of Juxtamedullary Nephrons

A

Vasa Recta

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34
Q

The only capillaries in the body which drain into arterioles

A

Glomerular Capillaries

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35
Q

50x more permeable than skeletal muscle capillaries; Highly fenestrated with pores 8 nanometer in diameter

A

Capillary Endothelium

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36
Q

Capillary endothelium secretes:

A

Nitric Oxide & Endothelin-1

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37
Q

Have large spaces; With Type IV Collagen, Lainin, Agrin, Perlecan, Fibronectin

A

Basement Membrane

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38
Q

Found in between capillaries; Contractile, mediates filtration, take up immune complexes; Involved in Glomerular Diseases

A

Mesangial Cells

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39
Q

Cells of capillary endothelium

A

Podocytes

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40
Q

Parts of Podocytes

A

Foot processes

Filtration slits with filtration slit diaphragm

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41
Q

Filtration Slit Diaphragm is made up of:

A 
Nephrin
NEPH-1
Podocin
Alpha-actinin 4
CD2-AP
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42
Q

“Glomerular cells of the Afferent Arterioles”; At the walls of Afferent Arterioles; Secrete Renin

A

JG Cells

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43
Q

Found in the walls of the Distal Convoluted Tubule; Monitor Na+ concentration in the DT (and consequently, blood pressure)

A

Macula Densa

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44
Q

“Visceral Epithelium” of the kidney

A

Podocytes

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45
Q

“Parietal Epithelium” of the kidney

A

Bowman’s capsule

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46
Q

What are the filtration and charge barriers?

A

Endothelium
Basement membrane
Foot processes of Podocytes

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47
Q

What is the charge of this charge barrier and what does it block?

A

Negative

Prevents filtration of albumin and other negatively-charged proteins

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48
Q

Movement from Glomerular Capillaries to Bowman’s space

A

(Glomerular) Filtration

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49
Q

Movement from tubules to interstitium to peritubular capillaries

A

(Tubular) Reabsorption

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50
Q

Movement from peritubular capillaries to interstitium to tubules

A

(Tubular) Secretion

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51
Q

(Amount Filtered) - (Amount Reabsorbed) + (Amount Secreted)

A

Excretion

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52
Q

Amount filtered in the glomerular capillaries per unit time

A

GFR

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53
Q

Normal GFR

A

125ml/min or 180L/day

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54
Q

GFR/RPF

A

Filtration fraction

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55
Q

Filtered freely

A

20 angstrom or less

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56
Q

Not filtered at all

A

> 42 angstrom

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57
Q

Afferent Arteriole Dilatation

A

GFR increases

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58
Q

Afferent Arteriole Constriction

A

GFR decreases

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59
Q

Efferent Arteriole Dilation

A

GFR decreases

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60
Q

Efferent Arteriole Constriction (moderate)

A

GFR increases

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61
Q

Efferent Arteriole Constriction (severe)

A

GFR decreases

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62
Q

Increased GC Hydrostatic pressure

A

GFR increases

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63
Q

Increased GC Oncotic pressure

A

GFR decreases

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64
Q

Increased BS Hydrostatic pressure

A

GFR decreases

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65
Q

Increased Kf

A

GFR increases

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66
Q

What are the causes of decreased Kf?

A

Renal Diseases
DM
HPN

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67
Q

What is the cause of increased BS hydrostatic pressure?

A

Urinary Tract Obstruction

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68
Q

What are the causes of decreased GC hydrostatic pressure?

A 
Hypotension (Decreased arterial pressure)
ACE-I (Decreased efferent arteriole constriction)
Sympathetic Activity (Increased afferent arteriole constriction)
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69
Q

What are the hormones that will increase GFR?

A 
EDFR
PGE2
PGI2
Bradykinin
Glucocorticoids
ANP
BNP
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70
Q

Which hormone will preserve GFR?

A

Angiotensin II (preferentially constricts efferent arteriole)

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71
Q

Which hormone will increase Renal Blood Flow (RBF)?

A

Histamine
Dopamine
ANP
BNP

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72
Q

What is one possible effect of ACE-I in a patient with HPN secondary to Renal Artery Stenosis?

A

Renal Failure

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73
Q

(Renal Artery Pressure-Renal Vein Pressure) / Total Renal Vascular Resistance; Exhibits local autoregulation at BP between 75-160mmHg

A

Renal Blood Flow

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74
Q

What do you call massive sympathetic stimulation that results in massive vasoconstriction of the kidneys?

A

CNS Ischemic Response

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75
Q

“Constant sodium load delivered to distal tubule”; Primary Mechanism for Autoregulation of GFR

A

Tubuloglomerular Feedback

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76
Q

Vasoconstricts afferent arteriole

A

Adenosine

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77
Q

Vasodilates afferent arterioles

A

Nitric Oxide

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78
Q

“Percentage of solute reabsorbed is held constant”; Buffers effects of drastic GFR changes in urine output

A

Glomerulotubular Balance

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79
Q

Substance start to appear in the urine; Some nephrons exhibit saturation

A

Renal Threshold

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80
Q

All excess substance appear in the urine; All nephrons exhibit saturation

A

Renal Transport Maximum

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81
Q

Does not have Transport Maximum and Threshold

A

Gradient-time Transport

82
Q

Gradient-time Transport: Rate of transport is dependent upon:

A

Electrochemical gradient
Membrane permeability
Time

83
Q

“Workhorse of the Nephron”; With low columnar with extensive brush border (microvilli)

A

Proximal Convoluted Tubule

84
Q

Reabsorption in Proximal Convoluted Tubule

A

100% filtered Glucose and Amino Acids

66% NaCl and water

85
Q

Secretion in Proximal Convoluted Tubule

A

H+, organic acids, bases (Rapidly filtered and almost none reabsorbed)

86
Q

Which is more hypertonic relative to the other - fluid entering the PCT or fluid leaving the PCT?

A

None (isoosmotic reabsorption takes place)

87
Q

Thin segment lining of Loop of Henle

A

Simple squamous with no brush border and few mitochondria

88
Q

Thick segment lining of Loop of Henle

A

Simple cuboidal

89
Q

With graded osmolarity; Constant: 20% filtered water is reabsorbed and 25% Na, K, Cl is reabsorbed; H is secreted via Na-H countertransport

A

Loop of Henle

90
Q

Impermeable to solutes; Permeable to water

A

Descending Limb of Loop of Henle

91
Q

Impermeable to water; Permeable to solutes

A

Ascending Limb of Loop of Henle

92
Q

Contains juxtaglomerular apparatus, macula densa, juxtaglomerular cells (JG Cells), Lacis cells; Similar characteristics to thick segment of LH (relatively impermeable to water)

A

Early Distal Tubule (1st Part of the Distal Tubule)

93
Q

Contains principal cells, intercalated cells; Responsive to effects of Aldosterone

A

Late Distal Tubule (2nd Part of the Distal Tubule)

94
Q

Absorb Na (using ENaC channels) water and Secrete K

A

Principal Cells

95
Q

Absorb K and Secrete H

A

Intercalated Cells

96
Q

Where K sparing diuretics acts

A

ENaC Channels

97
Q

Site of regulation of final urine volume and concentration; Responsive to Vasopressin

A

Collecting Duct

98
Q

Maximum urine osmolality

A

1200mosm/L

99
Q

Minimum Urine Volume

A

500ml

100
Q

Increased by increased BP; Decreased by Afferent or Efferent Arteriole vasoconstriction

A

Peritubular Capillary Hydrostatic Pressure

101
Q

Increased by Plasma protein concentration and Filtration fraction

A

Peritubular Capillary Oncotic Pressure

102
Q

What happens to tubular reabsorption when Peritubular Capillary Hydrostatic Pressure increases?

A

Decreases

103
Q

What happens to tubular secretion when Peritubular Capillary Hydrostatic Pressure increases?

A

Increases

104
Q

What happens to tubular reabsorption when Peritubular Capillary Oncotic Pressure increases?

A

Increases

105
Q

What happens to tubular secretion when Peritubular Capillary Oncotic Pressure increases?

A

Decreases

106
Q

Site of Action of Aldosterone

A

Distal Tubule

107
Q

Site of Action of Angiotensin II

A

PCT
TAL
LH
DT

108
Q

Site of Action of Catecholamines

A

PCT
TAL
LH
DT/CD

109
Q

Site of Action of Vasopressin

A

DT

CD

110
Q

Site of Action of ANP/BNP

A

DT

CD

111
Q

Site of Action of Uroguanylin, Guanylin

A

PCT

CD

112
Q

Site of Action of Dopamine

A

PCT

113
Q

Site of Action of PTH

A

PCT
TAL
LH

114
Q

Effects of Aldosterone

A

Increase Na, water reabsorption

Increase K, H secretion

115
Q

Effects of Angiotensin II

A

Increase Na and water reabsorption

116
Q

Effects of Catecholamines

A

Increase Na, water reabsorption

117
Q

Effects of Vasopressin

A

Increase water permeability and reabsorption

118
Q

Effects of ANP and BNP

A

Decrease Na reabsorption

119
Q

Effects of Uroguanylin and Guanylin

A

Decrease Na, water reabsorption

120
Q

Effects of Dopamine

A

Decrease Na, water reabsorption

121
Q

Effects of PTH

A

Decrease Phosphate reabsorption
Increase Ca reabsorption
Stimulates 1 Alpha Hydroxylase

122
Q

What are the triggers for ADH secretion?

A

Increased Plasma Osmolarity
Decreased Blood Pressure
Decreased Blood Volume

123
Q

What is the effect of alcohol on ADH secretion?

A

Alcohol decreases ADH secretion

124
Q

Which hormone secreted by DT and CD acts similar to ANP?

A

Urodilatin

125
Q

Rate at which substances are removed (cleared) from plasma in the kidneys

A

Renal Clearance

126
Q

If a substance has a high clearance, what are the blood and urine level of this substance?

A

Low Blood level

High Urine level

127
Q

If a substance has a low clearance, what are the blood and urine level of this substance?

A

High Blood level

Low Blood level

128
Q

Which substance has the highest clearance?

A

Para-Amino Hippuric Acid (PAH)

129
Q

Which substances have the zero clearance?

A

Glucose, Amino Acids

130
Q

Which substances have a clearance that can be used to estimate GFR?

A

Inulin, Creatinine (BUN and Creatinine serum concentration may also be used)

131
Q

Which substances have a clearance that can be used to estimate Renal Blood Flow and Renal Plasma Flow?

A

Para-Amino Hippuric Acid (PAH)

132
Q

Substances that do not appear in the urine have a clearance of

A

Zero

133
Q

Substances filtered and partially reabsorbed have a clearance ? Than the GFR

A

Less

134
Q

Substances filtered and with net secretion have a clearance ? Than the GFR

A

More

135
Q

Clearance of Inulin is ? To that of the GFR

A

Equal

136
Q

How many liters of fluid per day passes thru the kidneys?

A

180L of fluid/day

137
Q

Percentage of filtered water that is reabsorbed

A

87-98.7%

138
Q

Plays major role in water reabsorption

A

Vasopressin and ADH

139
Q

Threshold of Glucose

A

200mg/100ml

140
Q

Maximum of Glucose

A

375mg/100ml

141
Q

Region between threshold and maximum

A

Splay

142
Q

Glucose transport from the lumen to PCT

A

SGLT-2 (Secondary Active Transport)

143
Q

Glucose transport form the PCT to the Peritubular Capillaries?

A

GLUT-1 and GLUT-2 (facilitated diffusion)

144
Q

Major role in electrolyte balance

A

Na

145
Q

Na is actively transported in all parts of the renal tubule EXCEPT

A

Descending limb of Loop of Henle

146
Q

Plasma K

A

4.2mEq/L

147
Q

Can cause Arrhythmias

A

Hyperkalemia

Hypercalcemia

148
Q

Can cause weakness

A

Hypokalemia

149
Q

First line of defense

A

Movement of K across ECF to ICF

150
Q

Factors that shift K into cells

A

Insulin
Aldosterone
B-Adrenergic Stimulation
Alkalosis

151
Q

Factors that shift K out of cells

A 
Insulin Deficiency
Addison's Disease
B-Adrenergic Blockade
Acidosis
Cell lysis
Strenuous Exercise
Increase ECF Osmolarity
152
Q

Increased Plasma K increases secretion via

A

Principal Cells

153
Q

Decreased Plasma K increases reabsorption via

A

Intercalated Cells

154
Q

Causes of Increased K secretion

A 
High K doet
Hyperaldosteronism
Alkalosis
Thiazide diuretics
Loop diuretics
Luminal anions
155
Q

Causes of decreased K secretion

A

Low K diet
Hypoaldosteronism
Acidosis
K sparing diuretics

156
Q

Plasma Ca

A

2.4mEq/L

157
Q

Can cause Tetany

A

Hypocalcemia

158
Q

Less calcium bound to plasma proteins

A

Hypercalcemia (Acidosis)

159
Q

More calcium bound to plasma proteins

A

Hypocalcemia (Alkalosis)

160
Q

Factors that alter renal calcium excretion: Decreased excretion

A

Increased PTH, Plasma Phosphate
Decreased ECF, BP
Metabolic Acidosis
Vit D3

161
Q

Factors that alter renal calcium excretion: Increased excretion

A

Increased ECF, BP
Decreased PTH, Plasma Phosphate
Metabolic Alkalosis

162
Q

Trio of Electrolytes: High H levels

A

Hypercalcemia

Hyperkalemia

163
Q

Transport maximum of phosphate

A

0.1mM/min

164
Q

Plasma Mg

A

1.8mEq/L

165
Q

Magnesium stored in the bones

A

50%

166
Q

Plasma Mg excreted daily

A

10%

167
Q

Percentage of water reabsorbed automatically before the collecting duct

A

87%

168
Q

If ADH levels are high, what happens to water reabsorption at the collecting duct?

A

High (more aquaporins inserted)

169
Q

If ADH levels are high, what happens to urine volume at the collecting duct?

A

Low (min:500ml/day)

170
Q

If ADH levels are high, what happens to urine concentration at the collecting duct?

A

High (max:1200mOsm/L)

171
Q

If ADH levels are low, what happens to water reabsorption at the collecting duct?

A

Low (less aquaporins inserted)

172
Q

If ADH levels are low, what happens to urine volume at the collecting duct?

A

High (max:20L/day)

173
Q

If ADH levels are low, what happens to urine concentration at the collecting duct?

A

Low (min:50mOsm/L)

174
Q

Provides the stimulus for water reabsorption

A

Countercurrent Mechanism

175
Q

Provides the opportunity for water reabsorption

A

ADH

176
Q

Countercurrent Multipliers

A

Loop of Henle

177
Q

Creates the Corticopapillary Osmotic Gradient in the Renal Interstitium

A

Countercurrent Multipliers

178
Q

Countercurrent Exchangers

A

Vasa Recta

179
Q

Maintains the Cirticopapillary Osmotic Gradient in the Renal Interstitium (prevents dissipation of gradient)

A

Countercurrent Exchangers

180
Q

Why is the Loop of Henle able to act as a countercurrent multiplier?

A

Countercurrent Flow (hairpin-loop shape)
Difference in permeability to water and electrolytes in the Ascending and Descending Wall
Na-K-2Cl pump in the TAL LH
Slow Flow in the LH

181
Q

What is the end result due to the countercurrent mechanism?

A

Corticopapillary Osmotic Gradient: 300mOsm/L as you enter the PCT, 1200mOsm/L at the tip of LH

182
Q

Why do you need a countercurrent exchanger?

A

Gradient would dissipate quickly if Na and Urea are removed quickly
Vasa Recta preserves this gradient basically by “rotating” Na, water and urea

183
Q

Contributes to the hyperosmolarity of the renal medulla

A

Urea Recycling

184
Q

Percentage of Renal Medullary Interstitial Osmolarity

A

50%

185
Q

Stimulated by ADH

A

Urea Receptors (UT-1)

186
Q

Osmolarity at the tip of LH

A

600-1200mOsm

187
Q

True or False: More urea reabsorbed, the more concentrated the renal interstitium becomes, the more concentrated the final urine is

A

True

188
Q

Found in the Anteroventral eall of 3rd Ventricle & Preoptic Nuclei

A

Thirst Center

189
Q

Control of Thirst: Increased thirst

A

Increase Osmolarity, Angiotensin
Decrease Blood Volume, BP
Dryness of mouth

190
Q

Control of Thirst: Decreased thirst

A

Increased Blood Volume, BP
Decreased Osmolarity, Angiotensin II
Gastric Distention

191
Q

Found in the pons

A

Micturition Center

192
Q

Micturition Center can be inhibited by

A

Cerebral Cortex

193
Q

Normal Plasma H

A

0.00004mEq/L

194
Q

Normal Plasma pH

A

7.4

195
Q

Systems that regulate H concentrations

A

Body Fluid Buffer Systems
Respiratory Center
Kidneys

196
Q

Mechanisms of Renal Regulation of Acid-Base Balance

A

Secretion of H
Reabsorption of filtered HCO3
Production of new HCO3

197
Q

Due to Decreased Ventilation

A

Respiratory Acidosis

198
Q

Due to Increased Ventilation

A

Respiratory Alkalosis

199
Q

Due to excess acid or loss of base

A

Metabolic Acidosis

200
Q

Due to loss of acid or gain of base

A

Metabolic Alkalosis

201
Q

Decreased HCO3; Increased Organic Anions to maintain electroneutrality

A

High Anion Gap Metabolic Acidosis (HAGMA)

202
Q

Decreased HCO3; Increased Chloride to maintain electroneutrality; Also called Hyperchloremic Metabolic Acidosis with Normal Anion Gap

A

Normal Anion Gap Metabolic Acidosis (NAGMA)

Physiology (12 decks)

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