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Renal/Resp > Renal Physiology > Flashcards

Renal Physiology Flashcards

1
Q

What is teh central physiologic role of the kidneys

A

control volume and composition of the body fluids

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2
Q

What part of the total body water is intracellular fluid?

A

40% of body weight; 1/3 total body water

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3
Q

What is the percentage of total body water is extracellular fluid?

A

1/3 total body water (20% of body weight)

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4
Q

How is extracellular fluid divided up?

A

plasma 3L and interstitial fluid 11L

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5
Q

What is osmolarity?

A

mOsm/liter, concentration of osmotically active particles in total solution

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6
Q

What is osmolality?

A

expressed in terms of mOsm/kg, relatively dilute solutions, such as those found in the body, osmolality=osmolarity

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7
Q

What is the glomerular filtrate?

A

ultrafiltrate of plasma formed by net effect of Starling Forces to filter fluid out of the glomerular capillaries into Bowmans space

FF contains concentration of salts and organic as plasma

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8
Q

What is the equation for GFR?

A

GFR=Kf[(Pgc+Pibs)-(Pigc+Pbs)]
GFR=Kf[(Pgc-PiGc-Pbs)]
Kf=ultrafiltration coefficient- a product of hydraulic permeability and surface area of glomerulr capillary membrane

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9
Q

What is mechanism of GFR and RBF autoreg?

A

myogenic mechanism – intrinsic property of blood vessels. Stretch of vascular smooth muscle. Elicits contraction which elevates vascular resistance and maintian GFR constant

tubuloglomerular feedback –autoreg mechanism unique to the kidney. In response to an elevation of perfusion pressure, increased fluid is filtered leading to increased delivery of NaCl to macular densa

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10
Q

What is the myogenic mechanism?

A

intrinsic property of blood vessels. stretch of vascular smooth muscle

as experienced during an increase in arterial pressure

elicits contraction which elevates vascular resistance and maintain blood flow and GFR constant

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11
Q

What is the mechanism of tubuloglomerular feedback?

A

autoreulatory mechansim unique to kidney. In response to an elevation of perfusion pressure increased fluid is filtered leading to increase delivery of NaCl to macula densa. Increased delivery eleicts an increase in vascular resistance

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12
Q

What is macula densa feedback?

A

efferent arteriolar resistance increases leads to glomerular hydrostatic pressure decreases

afferent arteriolar resistance decreases and leads to decrease glomerular hydrostatic pressure

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13
Q

What does norepinephrine do to GFR?

A

decrease

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14
Q

What is epinephrine do to GFR?

A

decrease

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15
Q

What does endothelin do to GFR?

A

decrease

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16
Q

What does angiotensin II do to GFR?

A

no change or decrease

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17
Q

What does endothelial derived nitric oxide do to GFR?

A

increase

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18
Q

What does prostaglandin do to GFR?

A

increase

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19
Q

What are the three layers of glomerular filtration barrier?

A

capillary wall/endothelium
basement membrane
podocytes

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20
Q

What is the role of capillary wall in filtration barrier?

A

700 angstrom fenestrations

fenestrated, freely permeable to small molecules negatively charged glycoproteins in surface

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21
Q

What is the basement membrane for filtration barrier?

A

porous matrix of extracellular proteins including type IV collagen, laminin, fibronectin and other neg. charged proteins

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22
Q

What is the structure of podocytes in filtration barrier?

A

long finger-like processes with neg. charged proteins;

slit diaphragm components nephrin and P-cadherin

actin cytoskeleton is well suited to integrate different signaling pathway

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23
Q

What is the basic unit of the kidney?

A

the nephron

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24
Q

What is the role of the thin descening loop of henle?

A

reabsorption of water secondary to cortical-medullary osmotic gradient

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25
Q

What is the role of the thin ascending loop of henle?

A

impermeable to water, passive reabsorption of sodium, dilution of tubular fluid
permeable to urea, urea is secreted

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26
Q

What is the role of ultrastructure and transport characteristic of thick ascending loop of Henle?

A

reabsorbs 25% of filtered Na+ by the Na+/K+/2Cl- transport

lumen positive potential drives paracellular reabsorption of sodium, potassium, magnesiuma nd calcium

impermeable to water, dilutes tubular fluid

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27
Q

What is the mechanisms of sodium, chloride, and potassium transports in thick ascending loop of Henle?

A

transporter for all of them on tubular lumen side blocked by lupe diuretics

sodium/hydrogen ion tranporter

Cl- leaks into intersitial fluid
Na+/K+ ATPase

28
Q

What is the cellular ultrastructure and transport characteristics of early distal tubule?

A

Reabsorbs Na+/Cl-/Ca2+/Mg2+

not permeable to water
thiazide-sensitive segment

utilize Na+/Cl- transporter
Na/K ATPase
Cl- leak

29
Q

What is the cellular ultrastructure and transport characteristics of the principal cells of late distal tubule and cortical collecting duct?

A

reabsorbs Na+, secretes K+

regulated by aldosterone

water permeability regulated by ADH

reabsorption of sodium and secretion of potassium blocked by K-sparing diuretic

30
Q

What is ENaC?

A

epithelial sodium channel on apical membrane of principal cells

31
Q

What is the cellular ultrantructure and transport charcteristics of medullary collecting duct?

A

reabsorbs Na+

ADH-stimulated water reabsorption

urea reabsorption in medullary CD

32
Q

What is the role of aldosterone?

A

acts in principal cells of late distal tubule and collecting duct

increases Na+ reabsorption, increases K+ secretion

33
Q

What is the role of angiotensin II?

A

acts primarily in proximal tubule

increases Na+ and water reabsorption, increase H+ secretion

34
Q

What is the role of antidiuretic hormone?

A

acts in principal cells of late distal tubule and collecting duct, inner medullary collecting duct

increase water reabsorption

35
Q

What is the role of atrial natriuretic peptide?

A

acts in distal tubule and collecting duct

decrease Na+ reabsorption

36
Q

What is the role of parathyroid horomone?

A

in proximal tubule decreases PO4— reabsorption

in thick ascending loop of henle and distal tubule increases Ca2+ reabsorption

37
Q

What is the filtration barrier select for?

A

size selective: more permeable to small molecules

charge selective: more permeable to positively charged molecules (proteins generally are negatively charged)

38
Q

What is the appearance of the coretex?

A

granular in appearance and homogenous in consistency. LInear arrays of tubules extending into cortex are called medullary rays

39
Q

What is the appearance of medulla?

A

striated appearance and consists of 6-18 renal pyramids. Apex or tip of a renal pyramid is called a renal papilla

40
Q

What is the apex or tip of the renal pyramid called?

A

renal papilla

41
Q

What is the kidney lobe?

A

macroscopic subdivision consisting of a renal pyramid and its surrounding cortex. In adult kidneys, lobar structure is usually indistinct externally as well as internally

42
Q

What is a kidney lobule?

A

a microscopic subdivision consisting of a medullary ray and cortical tissue on either side. tubules of these nephrons connect with the collecting ducts within medullary rays

43
Q

What is a capsule?

A

consists mainly of fibrous connective tissue and surrounds the kidney. The parenchyma is not subdivided by septa

44
Q

What is the vasculature of the kidney?

A

20-25% of CO/minute

renal artery -> lobar -> interlobar -> arcuate ->interlobular -> afferent arteriole

45
Q

What is the microvasculature of the 2 capillary systems?

A

glomerulus afferent arteriole -> globerulus -> efferent arteriole ->

tubular plexus - supplies tubules of the cortical nephrons ->

vasa recta - long capillary loops supplying tubules of juxtamedullary nephrons ->

venule

46
Q

What is renal tubule?

A

epithelial-lined tubule that varies in size, shape, and fuction along its length

47
Q

What is the funciton of the nephron, a filter and fluid modifier?

A

kidney produces an ultrafiltrate of the blood, but it recycles many components

48
Q

What si teh primarily forma development , a nephron consists of?

A

renal corpuscle
proximal tubule
loop of henle
distal tubule [collecting ducts not included]

49
Q

What is if primarily froma functional viewpoint a nephron consists of what?

A

renal corpuscle, proximal tubule, loop of henle, distal tubule and collecting duct

whole structure is also called a uriniferous tubule

50
Q

What are the four components of the renal corpuscle?

A

glomerulus

visceral layer of the renal capsule (bowman’s)

parietal layer of renal capsule

mesangium

51
Q

What is the renal corpuscle viewed at the EM level?

A

renal corpuscle(small body) is a spherical, double layered sac (renal capsule) that surrounds a network of capillaries

vascular pole where the arterioles enter and exit and a urinary pole that is continuous with proximal convoluted tubule

52
Q

What is the glomerulus?

A

a network of capillary loops supplied and drained by an arteriole

afferent (supplying) arteriole is larger in diameter than efferent arteriole, creates pressure differntial driving glomerular filtration

53
Q

What is the structure of bowman’s capsulle?

A

a double layered epithelial sac surrounding hte glomerulus

outer or parital layer is a simple squamous epithelium
visceral layer is also a simple epithelium composed of cells called podocytes

space between teh two epithelial layers is called urinary space; continuous with proximal tubule

54
Q

What is the role of the capillary endothelium?

A

dicountinuous, pores are freely permeable to water and solutes and moderately permeable to 8-16 kD molecules negative charge bc coated with glycocalyx

55
Q

What is the role of the basement membrane?

A

primary barrier that prevents protein from entering the glomerular filtrate

56
Q

What is the role of the visceral layer of bowman’s capsule?

A

consists of epithelial cells called podocytes bc of their prmary and secondary processes (pedicles)

space between pedicles is called filtration slit and is bridged by an electron dense filtration slit diaphragm, a modified adherens junction consisting of the protein nephrin

57
Q

What is the function of the glomerular mesangium?

A

physical support
regulation of glomerular blood flow
turnover of glomerular basement membrane

specialized pericyte/smooth muscle cells
contain receptors for ANP and angiotensin II

58
Q

What is the role of convoluted portion of the proximal tubule and structure associated?

A

begins at the urinary pole and located in cortex

  • substantial reabsorption
  • cuboidal/columnar cells with granular cytoplasm and basal nuclei
  • apical brush border w/glycocalyx obscures lumen
  • lysosomes and apical vesicles
  • numberous mito at base of cell provide energy for transport
  • complex lateral interdigitations between epithelial cells make lateral cell membranes indistinguishable
59
Q

What is the renal intersitium?

A

space between tubules
interstitial tissue is found in renal cortex and medulla

interstitium components:

  • interstitial connective tissue
  • interstitial cells in cortex and medulla
60
Q

What is the endocrine functions I: JG apparatus?

A

renin producing JG cells
-specialized smooth muscle cells in wall of afferent arteriole
extraglomerular mesangial alctis cells
-connected to JG cells via gap junctions
macula densa
-columnar cells of distal convoluted tubule
-detects Na2+ and Cl- concentrations for JG cells resulting in alterations of filtration rate and auto-reg of blood volume

61
Q

What does erythropoietin do/

A

upreg mitosis of RBC precursor
upreg release of RBC from marrow
probably produced by cortical interstitial cells
production stim by high altitude, hemorrhage and impaired pulm function

62
Q

What is acute kidney injury?

A

clinical picture-oliguria unexpected weight gain or edema, increased toxins in blood
prognosis depennds on severity, tx, age

63
Q

What is end-stage renal disease?

A

irreversible injury->end-stage renal disease ->uremai+hematuria

glomerular injury, autosomal dominant polycystic disease, others

64
Q

How do you quantifying urine flow rate?

A

UF=urine volume/time of collection

65
Q

What is renal clearance equation?

A

Cx=(Ux*UF)/Px

Cx=clearance of substance X
Ux= urine conc. of substance X
UF=urine flow rate
Px=plasma conc of substance x

66
Q

What is the equation for osmotic clearance and free water clearance?

A

Cosm=(Uosm*V)/Posm

Ch20=UF-Cosm

67
Q

What is the quantifying renal excretion?

A

excretion rate of X= Ux*UF

Ux=urine concentration fo substance X

UF=urine flow rate

Renal/Resp (22 decks)

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