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AY Renal > Renal Physiology > Flashcards

Renal Physiology Flashcards

1
Q

What is osmolarity?

A

Concentration of osmoticaly active particles present in a solution

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2
Q

Equation for osmolarty

A

Osmolarity = (molar conc) x (no. of osmotically active particles)

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3
Q

What is tonicity?

A

The effect a solution has on cell volume

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4
Q

What is used to measure body fluid compartments?

A

Tracers

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5
Q

What is osmotic concentration of both ECF and ICF?

A

300 mosmol/l

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6
Q

What is fluid shift?

A

Movement of water between the ICF and ECF in response to an osmotic gradient

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7
Q

What alters the composition & volume of ECF?

A

The kidneys

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8
Q

Where is Na+ mainly present ECF or ICF?

A

ECF

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9
Q

What percentage of the body’s potassium is intracellular?

A

95%`

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10
Q

How does salt imbalance manifest?

A

Changes in ECF volume

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11
Q

What are the 3 functional mechanisms of the kidney?

A

Filtration
Reabsorption
Secretion

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12
Q

Which is more superior efferent arteriole or afferent arteriole?

A

Efferent

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13
Q

What are 2 different types of nephron?

A

Juxtamedullary (20%)

Cortical (80%)

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14
Q

What makes up the inner layer of the Bowman’s capsule?

A

Podocytes

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15
Q

What is urine?

A

Modified filtrate of the blood

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16
Q

What is the function of macula densa cells?

A

Sense distal tubules flow and releae paracrines to alter afferent arteriole diameter

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17
Q

What are the 3 filtration barriers within the glomerulus?

A

Glomerular Capillary Endothelium
Basement membrane
Slit processes of podocytes

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18
Q

What forces comprise net filtration pressure?

A

Glomerular capillary blood pressure
Capillary oncotic pressure
Bowman’s capsule hydrostatic pressure
Bowmans capsule oncotic pressure

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19
Q

What is GFR?

A

The rate at which protein free plasma is filtered from the glomeruli into the Bowman’s capsule per unit time

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20
Q

What is a normal GFR?

A

approx. 125ml/min`

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21
Q

What is the major determinant of GFR?

A

Glomerular capillary fluid (lood) pressure

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22
Q

What is the extrinsic mechanism of controlling FR?

A

Sympathetic control via baroreceptor reflex

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23
Q

What intrinsic mechanisms regulate GFR?

A

Tubuloglomerular feedback mechanism

Myogenic mechanism

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24
Q

What affect doe increased arterial BP have on blood flow into the glomerulus?

A

Increased arterial BP increases blood flow into the glomerulus

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25
Q

What effects does increased blood flow have on the pressures within the glomerulus?

A

Increased glomerular capillary blood pressure

increased net filtration pressure

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26
Q

What causes a decrease in glomerular capillary blood pressure? (physiologically)

A

Constriction of afferent arteriole

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27
Q

What effect does a decrease in blood flow have on GFR?

A

GFR decreases

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28
Q

How does a fall in blood volume result in reduced urine volume?

A

Fall in blood volume > decreased arterial BP > detected by aortic & carotid sinus baroreceptors > increased sympathetic activity > generalised arteriolar vasoconstriction > constriction of afferent arterioles
> decreased Glomerular BP > decreased GFR > Reduced urine volume

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29
Q

What is the myogenic mechanism?

A

If vascular smooth muscle is streatch (e.g. increase in arterial P) it contracts thus contricting the arteriole

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30
Q

What is tubuloglomerular feedback?

A

Involes JXGA

If GFR rises, more NaCl flows through the tubules leading to constriction of afferent arterioles

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31
Q

What is plasma clearance a measure of?

A

Hoe effectively the kidneys can ‘clean’ the blood of a substance

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32
Q

What effect does decreased capillary oncotic pressure (e.g. severely burned patients) have on GFR?

A

Increased GFR

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33
Q

For which substance does clearance = GFR?

A

Inulin

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34
Q

What is more commonly used instead of inulin to measure GFR?

A

Creatinine

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35
Q

Example of a substance that is filtered and completely reabsrbed and therefore not secreted?

A

Glucose

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36
Q

What can be said about a subtance if the clearance is

A

Te substance is reabsorbed

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37
Q

What can be said about a substance if the clearance > GFR?

A

The substance is secreted into tubule

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38
Q

What is PAH used clinically to measure?

A

Renal plasma flow

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39
Q

What is reabsorbed in the proximal tubule?

A 
Sugars 
Amino acids 
Phosphate 
Sulphate 
Lactate
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40
Q

What is secreted in the proximal tubules?

A 
H+
Hippurates 
Neurotransmitters
Bile pigments 
Uric acid 
Drugs toxins
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41
Q

What 3 mechanism allow resorption in the proximal tubules?

A

Primary active transport
Secondary active transport
Facilitated diffusion

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42
Q

Which transport mechanism at the basolateral membrane is essential for Na+ resorption?

A

Na-K-ATPase

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43
Q

What is Na co-transported with into the tubular cells fcrom the lumen?

A

Glucose

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44
Q

What percentage of salt & water is reabsorbed in the proximal tubule?

A

~67%

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45
Q

What other electrolyte reabsorption deos Na+ drive through the paracellular pathway?

A

Cl-

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46
Q

What tonicity is the tubular fluid as it leaves the proximal tubule?

A

Iso-osmotic

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47
Q

What is the function of the loop of Henle?

A

Generates a cortico-medullary concentration gradient

‘countercurrent multiplier’

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48
Q

What is being reabsorbed in the ascending limb of the loop of Henle?

A

Na + & Cl-

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49
Q

Hoe permeable is the ascending limb to water?

A

Relatively impermeable

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50
Q

How permeable is the descending lim to water?

A

Highly permeable

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51
Q

Which 3 ions are involved in the triple co-transporter?

A

Na
K
Cl

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52
Q

Which drugs block the triple co-transporter?

A

Loop diuretics

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53
Q

Does water enter or leave the descending limb?

A

Leaves my osmosis

54
Q

What is the osmolarity of fluid in the descending limb?

A

400 mosmol/L

55
Q

What is the osmolarity of the fluid in the thick ascending limb?

A

200 mosmol/L

56
Q

Is the fluid more concentrated in the ascending or descending limb?

A

Desending

57
Q

What contribues to approx. half of the medullary osmolarity?

A

The urea cycle

58
Q

What promotes urea absorption in the collecting duct?

A

ADH

59
Q

Where is 50% of urea reabsorbed?

A

Collecting duct

60
Q

Which part of the nephron is impermeable to urea?

A

Distal tubule

61
Q

Which type of nephron has vasa recta which run alongsid ethe long loop of henle?

A

Juxtamedullary nephrons

62
Q

What happens to blood osmolarity as it dips down into the medulla?

A

Blood osmolarity rises (water loss, solute gained)

63
Q

What happens to blood osmolarity as it rises back up into the cortex?

A

Blood osmolarity falls (water gained, solute lost)

64
Q

What are vasa recta capillaries freely permeable to?

A

NaCl & water (picks up water leaked out by DL)

65
Q

What effect does ADH have on water reabsorption?

A

Increases water reabsorption (DT & CD become more permeable)

66
Q

Which areas of the nephrons are affected by hormones?

A

Distal tubule & collecting duct (not proximal tubule & loop of Henle)

67
Q

What affect does aldosterone have on electrolytes in the kidneys?

A

Increased Na reabsorption

increased H+/K+ secretion

68
Q

What effect does atrial natriuretic hormone have on Na+ reabsorption?

A

ANH decreases Na reabsorption

69
Q

What effect does PTH have on electrolytes in the kidneys?

A

Increased calcium reabsorption

Decreased phosphate reabsorption

70
Q

What electrolytes are reabsorbed in the early distal tubule?

A

NaCl

71
Q

What electrolytes are reabsorbed in the late disal tubule?

A

Ca2+
Na+
K+

72
Q

What is secreted in the late distal tubule?

A

H+

73
Q

What influences the collecting ducts permeability to water & urea?

A

ADH

74
Q

Where in the hypothalamus is ADH synthesised?

A

Supraoptic & paraventricular nuclei

75
Q

Where is ADH stored?

A

Posterior pituitary

76
Q

When is ADH released?

A

When action potential down the nerves leads to calcium dependent exocytosis

77
Q

What receptor does ADH bind to?

A

Type 2 vasopressin receptor

78
Q

What is increased when ADH bind to vasopressin type 2 receptor?

A

intracellular cAMP

79
Q

Where are aquaporins found?

A

Apical membrane

80
Q

What are circulating levels of ADH dependent on?

A

The body’s hydration status

81
Q

Does an increase in ADH lead to more concentrated or dilutre urine?

A

Concentrated

82
Q

Does ADH affect the salt or solute concentration of urine?

A

No

83
Q

What are the 2 different types of diabetes insipidus?

A

Central diabetes insipidus

Nephrogenic diabetes insipidus

84
Q

What is central diabetes inspidus?

A

Unable to produce or secrete ADH

85
Q

What is nephrogenic diabetes insipidus?

A

Produce ADH as normal but does not affect target cells

86
Q

Symptoms of diabetes inspidus

A

Large volume of dilute urine

Constant thirst

87
Q

Treatment of central diabetes inspidus?

A

ADH replacement

88
Q

Treatment of nephrogenic diabetes inspidus

A

Drugs to reduce urine production

89
Q

What can diabetes insipidus be a side effect of?

A

Long term lithium therapy

90
Q

Which receptors sense the need for ADH release?

A

Hypothalamic osmoreceptors

Left atrial stretch receptors

91
Q

Does alcohol inhibit or stimulate ADH release?

A

Inhibit

92
Q

Does nicotine stimulate or inhibit ADH release?

A

Stimulates

93
Q

Where is aldosterone secreted from?

A

Adrenal cortex

94
Q

What does aldosterone do?

A

Stimulate Na+ reabsorption & K+ secretion

95
Q

Where is majority of K+ normally reabsorbed?

A

Proximal tubule (~90%)

96
Q

True/False? An increase in plasma K+ directly stimulates the adrenal cortex?

A

True

97
Q

Does a decrease in plasma Na+ promote secretion of aldosterone directly or indirectly?

A

Indirectly (via juxtoglomerular apparatus)

98
Q

Where is angiotensinogen produceed?

A

Liver

99
Q

Where is renin produced?

A

Kidney

100
Q

Where is ACE produced?

A

Lungs

101
Q

What is the action of renin?

A

Convert angiotensinogen to angiotensin I

102
Q

What is the action of ACE?

A

Convert angiotensin I to angiotensin II

103
Q

What effect does angiotensin II have on the adrenal cortex?

A

Stimulates release of aldosterone

104
Q

Actions of angiotensin II outside the kidneys?

A

Stimulates ADH release
Increases thirst
Causes arteriolar vasocontriction

105
Q

What role do macula dense cells play in RAAS system?

A

Sense reduced NaCl in the distal tubules and promote renin release

106
Q

What factors control renin release from granular cells in JXGA?

A

Reduced pressure in afferent arteriole
Macula densa cells
Increased sympathetic activity as a result of reduced BP

107
Q

What condition can be caused by abnormal increases in RAAS?

A

Hypertension

108
Q

How does congestive heart failure cause increased salt (& water) retention?

A

Failing heart > decreased CO & BP > low BP stimulates RAAS > increased salt retention

109
Q

Where is ANP/H produced?

A

The heart

110
Q

Where is ANP/H stored?

A

Atrial muscle cells

111
Q

What stimulates the release of ANP/H?

A

When atrial muscle cells are mechanically stretched due to an increase in the circulating plasma volume

112
Q

What are the actions of ANP/H?

A

Excretion of Na+ and diuresis (thus decreasing plasma volume > lower BP)

113
Q

How does an increased in ANP/H lead to an increase in the Na + and H2O filtered?

A

ANP/H has a negative effect on smooth muscle of afferent arterioles > vasodilation > increased GFR > increase in Na+ and H2O filtered

114
Q

What 2 mechanisms govern micturition?

A

The micturition reflex

Voluntary control

115
Q

Which receptors detect a full bladder?

A

Stretch receptors

116
Q

What is the pH of arterial blood?

A

7.45

117
Q

What is the pH of venous blood?

A

7.35

118
Q

What effect does acidosis have on the CNS?

A

Depression of the CNS

119
Q

Which dissociates completely strong or weak acids?

A

Strong acids

120
Q

What is the Henderson-Hasselbach equation used for?

A

Buffers

121
Q

What catalyses the conversion of carbon dioxide and water to carbonic acid?

A

Carbonic anhydrase

122
Q

Which organs controls the bicarbonate concentration?

A

Kidneys

123
Q

Which organ controls the carbon dioxide concentration?

A

Lungs

124
Q

How is bicarbonate reabsorbed in the proximal tubule?

A

Indirectly

125
Q

Why would the kidneys need to generate new bicarbonate?

A

To regenrate buffer stores depleted by an acid load

126
Q

When bicarbonate is low what does secreted H+ bind with?

A

Phosphate

127
Q

How can the amount of H+ excreted be measured?

A

As “titratable” acid

128
Q

How is ammonia made?

A

Glutamine breakdown by glutaminase

129
Q

Why gas ammonia diffuse across the apical membrane?

A

Because it is a gas

130
Q

What are the 3 effects of H+ secretion by the tubule?

A

Drives reabsoprtion of bicarbonate
Forms “acid-phosphate” - titratable acid
Forms ammonium ion

131
Q

Why is the vast majority of H+ secretion used for bicarb reabsorption?

A

To prevent generation of acidoses

AY Renal (15 decks)

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