Renal Physiology Flashcards
Urea: waste product from
Proteins
Ultrafiltrate of blood
Urine
Uric acid: waste product from
Nucleic acid (PURINES)
Creatinine: waste product from
Muscle
Bilirubin: waste product from
Red Blood Cells
Hormone Metabolites
VMA (Vanillylmandelic acid)
Hormone Secretion
Calcitriol
Renin
Always pathologic finding in Urine
Albumin
Kidney: Location
T12 - L3
Kidney: Weight
150g
Parts of Kidney
Capsule -> Cortex -> Medulla -> Renal Papilla -> Renal Calyces (major and minor) -> Renal Pelvis
Highly fenestrated, responsible for GFR.
Only capillaries in the human body that leads to arterioles and not venule.
Glomerular Capillaries
Supplies O2 and glucose to the tubular cells
Peritubular Capilaries
Hairpin loop peritobular capillaries of juxtamedullary nephrons that participate in countercurrent exchange
Vasa Recta
Urinary Bladder Capacity
600mL
Urge to urinate
150 (25% of the total urine volume)
Reflex contraction of urinary bladder
300 (50% of total urine volume)
Bladder muscle
Detrusor Muscle
Cortical Nephrons Percentage: Location: Loops of Henle: Capillary Network:
Percentage: 75% of nephrons
Location: RENAL CORTEX
Loops of Henle: SHORT
Capillary Network: PERITUBULAR CAPILLARIES
Juxtamedullary Nephrons Percentage: Location: Loops of Henle: Capillary Network:
Percentage: 25% of nephrons
Location: CORTICOMEDULLARY JUNCTION
Loops of Henle: LONG
Capillary Network: VASA RECTA
Highly fenestrated; with pores of 8nm ( 80angstrom) in diamter.
Secretes: Nitric oxide and Endothelin 1
Capillary Endothelium
Cells of capillary membrane
Contains foot process and filtration slits
Visceral Epithelium
Podocytes
Found between capillaries
Involve in glomerular disease
Mesangial Cells
Nephrotic Syndrome
Edema
Proteinuria
Albuminemia - hypo
Lipidemia - hyper
Nephritic Syndrome
Oliguria
Hematuria
HTN
Azotemia = inc. BUN & inc. Crea
Glomerular cells of the AFFERENT ARTERIOLES
Secretes:
JuxtaGlomerular Cells
Secretes: Renin
Found in the walls of DISTAL CONVOLUTED TUBULE
Monitor:
Macula Densa
Monitor: sodium conc. in the DT
Acts on Proximal Convoluted Tubule
Carbonic anhidrase inhibitor: ACETAZOLAMIDE
Causes Metabolic Alkalosis Drug:
Loop Diuretics
Thiazides Diuretics
Adverse effects of Thiazide Diuretics:
"hyperGLUC" hyperGLCEMIA hyperLIPIDEMIA hyperURACEMIA hyperCALCIMIA
Potassium Sparring Diuretics:
Spinorolactone (Aldosterone antagonist)
Amiloride & Triamterine (Ep. Na channel blocker)
Na-K-2Cl Pump located
Why its impt?
Found: Thick ascending loop of Henle
Why 1. Involved in countertransport multiplier
2. Co-transport inhibited by loop diuretics (furosemide)
GFR; amt filtered in the glomerular capillaries per unit time
125mL / min or 180L / day
Albumin attracts sodium thus invites more water, this phenomenon is know as
Gibbs-Donnan Effect
What are the cause of dec. Kf?
Renal Disease
DM
HTN
What is the cause of inc. BS hydrostatic pressure?
Urinary Tract Obstruction (Ureterolithiasis)
What are the cause of dec. GC hydrostatic Pressure?
Hypotension ( dec. arterial prssure) ACE-1 (dec efferent arteriole constriction) Sympathetic Activity (inc. afferent arteriole constriction)
What are the hormones that will inc GFR?
Bradykinin EDRF PGE2 PGI2 Glucocorticoids ANP BNP
Which hormone will preserve GFR?
Angiotension II (preferentially constricts efferent arteriole)
Constant sodium load delivered to DISTAL TUBULE
Tubuloglomerular Feedback
Percentage of solute reabsorbed is held CONSTANT
Glomerulotubular Balance
What do you call massive sympathetic stimulation that resultsin massive vasoconstriction of the kidney?
CNS Ischemic Response
Some nephrons exhibit saturation
Renal Threshold
ALL nephrons exhibit saturation
Renal Transport Maximum
Which is more hypertonic relative to the other - the fluid entering the PCT or the fluid leaving the PCT?
ISOTONIC
Principal Cells
Secrete K
Absorb Na
H2O
Intercalated Cells
Secrete H
Absorb K
Active form of Vitamin D
1, 25 dihydroxycholecalciferol
Effects of aldosterone:
Inc Reabsorption:
Inc Secretion:
Inc Reabsorption: Na+ & H20
Inc Secretion: K+ & H+
Effects of PTH:
Dec reabsorption of phsphate
Inc. reabsorption of calcium
Stimulates 1 alpha hydroxylase
What are the triggers for ADH secretion
Inc Plasma Osmolarity
Dec BP
Dec Blood Volume
What is the effect of alcohol on ADD secretion?
Alcohol dec ADH secretion
Which hormone secreted by DT and CD acts similar to ANP?
Urodilatin
Responsible for urine volume and urine concentration
Vasopression (ADH)
Plasma K+
4.2 mEq/L
CREATES the Corticocapillary Osmotic Gradient
Countercurrent Multipliers
MAINTAINS the Corticopapillary Osmotic Gradient
Countercurrent Exchangers
Affects the anterior horn of the spinal cord
Aka Lougary Syndrome Paralysis
Amylotrophic Lateral Sclerosis
Thirst Center
AnteroVentral wall of the 3rd Ventricle
Preoptic Nuclei
Micturation center
PONS
pH compatible to life
6.8 - 8.0
High Anion Gap Metabolic Acidosis
Methanol Uremia DKA Propylene glycol & Paraldehyde Iron, Idiopathic, Isoniazide Lactic acidosis Ethylene glycol and ethanol Salicylic acid
Normal Anion Gap Metabolic Acidosis
Hematuria Azotemia (Uremia + SSx) RTA Diarrhea Ureteroenteric fistula Pancreaticoduodenal fistula