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physio 2 > renal physiology > Flashcards

renal physiology Flashcards

1
Q

in order for cells to survive, the composition of _______ must remain within well defined limits

A

extracellular fluid

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2
Q

organ that is the primary organ for stabilization of ion concentration and volume of extracellular fluid

A

kidney

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3
Q

organ that enables mammals to survive under conditions of highly variable access to water and salts

A

kidney

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4
Q

production of glucose

A

gluconeogenesis

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5
Q

importance of resorbing filtered substances in the kidney

A

to maintain a constant extracellular fluid osmolarity and volume

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6
Q

functions of the kidneys

A
  1. filter blood
  2. produce urine
  3. resorb from filtered substance
  4. excretion of metabolic wastes and xenobiotics
  5. water and acid-base balance – buffer ion into blood stream
  6. produce glucose
  7. endocrine things
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7
Q

3 hormones produced in the kidney

A
  1. calcitriol
  2. renin
  3. erythropoietin
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8
Q

stimulated by PTH in response to hypocalcemia

A

calcitriol

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9
Q

chemical name for calcitriol

A

1,25-(OH)2-D2

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10
Q

a hormone activator used for renal regulation of blood pressure and is an essential part of the RAA system

A

renin

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11
Q

trigger of erythropoietin

A

low tissue oxygen tension

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12
Q

location of the kidneys

A

adjacent to the upper abdominal wall

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13
Q

functional unit of the kidney

A

nephron

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14
Q

T/F

nephrons can regenerate themselves

A

FALSE – partially…cannot be replaced

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15
Q

type of nephron with short loop of henle that is supplied by the peritubular capillaries

A

cortical nephrons

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16
Q

nephron located near the cortex/medulla junction with extremely long loops of henle

A

juxtamedullary nephron

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17
Q

critical for urine concentration

A

long loops of henle

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18
Q

PART OF NEPHRON:

located in the renal cortex, consists of glomerulus and is surrounded by the Bowmans capsule

A

Malpighian body

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19
Q

PART OF NEPHRON:

longest part

A

Proximal tubules – has a convoluted and straight part

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20
Q

PART OF NEPHRON:
consists of a thick descending limb extending into the renal medulla, a thin descending limb, a thick descending limb (in nephrons with long loops), and a thick ascending limb

A

loops of henle

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21
Q

T/F

Distal tubules have both a straight and a convoluted part

A

TRUE

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22
Q

T/F

collecting ducts only extend through the renal cortex

A

FALSE – extend through the renal cortex and medulla

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23
Q

leading cause of death worldwide

A

ischemic heart disease

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24
Q

5-30% of patients undergoing cardiac or vascular surgeries will develop this

A

acute renal failure

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25
Q

interruption of blood supply to a tissue

A

ischemia

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26
Q

re-establishment of blood flow to a tissue

A

reperfusion

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27
Q

what are reactive oxygen species (ROS)

A

highly reactive molecules that damage DNA, lipids, and proteins

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28
Q

T/F

nephrons can regenerate

A

FALSE

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29
Q

T/F

tubular cells can regenerate

A

TRUE

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30
Q

T/F

brush border is lost during ischemia/reperfusion

A

TRUE

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31
Q

What is the first step in urine formation

A

filtration of large amounts of fluid through the glomerular capillaries into bowmans capsule

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32
Q

compact network of capillaries that retains cellular components and proteins

A

glomerulus

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33
Q

what does the glomerulus produce

A

glomerular filtrate

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34
Q

T/F

the glomerular filtrate is nearly identical to plasma

A

TRUE

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35
Q

the rate the kidney is perfused with blood

A

renal plasma flow

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36
Q

three components of the filtration barrier

A
  1. fenestrated capillary endothelial cells
  2. glomerular basement membrane
  3. visceral epithelium (podocytes)
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37
Q

The layers of the glomerular basement membrane

A
  1. lamina rara interna
  2. lamina densa
  3. lamina rare externa
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38
Q

T/F

the glomerular filtrate contains many proteins

A

FALSE –

basically IMPERMEABLE to proteins and is relatively protein free

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39
Q

T/F

albumin is freely filterable

A

FALSE – filterability is almost 0

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40
Q

List 3 freely filterable substances

A

water
sodium
glucose

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41
Q

Which charge of ions are filtered more easily through the barrier

A

cations filtered more than anions

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42
Q

What is the main driving force for filtration?

A

the glomerular capillary hydrostatic pressure

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43
Q

What percent of the GFR returns to the extracellular compartment via tubular reabsorption

A

99%

1% excreted as urine

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44
Q

2 substances that can be used to measure renal clearance (GFR)

A

creatinine and inulin

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45
Q

byproduct of muscle metabolism

A

creatinine

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46
Q

regulatory mechanism for changes in systemic blood pressure

A

RAAS

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47
Q

Autoregulatory mechanism for changes in glomerular perfusion

A

Myogenic reflex/ bayliss effect

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48
Q

Autoregulatory mechanism for changes in tubule fluid delivery

A

tubuloglomerular feedback

**inhibits renin release

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49
Q

Where is Renin produced

A

in the wall of cells located in the afferent arterioles (juxtaglomerular cells)

**released by kidney when there is a decrease in arterial pressure

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50
Q

T/F

endothelin is a vasodilatory agent

A

FALSE –

it is a constricting factor

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51
Q

the ultrafiltrate that accumulates in the capsular space between the glomerulus and bowmans capsule and contains the same concentration salt and glucose as plasma

A

primary urin

**made in the glomerulus after blood is filtered

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52
Q

an indicator of functional integrity in the renal tubules

A

fractional excretion rate

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53
Q

The net rate of reabsorption and secretion of a filtered substance

A

fractional excretion rate

54
Q

reabsorbs most of the filtered solutes

A

Proximal tubule

55
Q

maintain medullary hypertonicity

A

thin limbs of loop of henle

56
Q

T/F

proximal tubule cells are polarized

A

TRUE

**apical and basolateral ends – also have brush borders and tight junctions

57
Q

transport in PT fueled directly by ATP consumption

A

Primary Active Transport

*basolateral Na/K ATPase

58
Q

movement in PT mainly by carrier-mediated transport across the apical membrane – through the cytoplasm – into the interstitial fluid then peritubular capillary

A

Transcellular pathway

59
Q

tubule fluids pass through the epithelium across the tight junctions. The substances enter the lateral intercellular space and then the interstitial fluid and peritubular capillaries

A

Paracellular pathway (PT)

**solvent drag / passive diffusion

60
Q

driven by the electrochemical gradient produced by the primary active transporter

A

secondary active transport

**tertiary driven by secondary’s gradient then (H+ grad)

61
Q

Substances that the secondary active transport system transports in the PT for reabsorption

A 
glucose 
amino acids
phosphate
sulfate 
citrate
62
Q

process in the PT for low-molecular-weight proteins reabsorption

A

receptor mediated endocytosis

**receptors are in the plasma membrane of the PT cells (megalin and cubilin)

63
Q

T/F

receptor-mediated endocytosis is saturable

A

TRUE

can lead to an elevated plasma concentration of filterable proteins or increased filtration of proteins / glomerular filter damage

64
Q

pathological presence of protein in the urine

A

proteinuria

65
Q

pre-renal proteinuria

A

if the concentration of free filterable proteins is increased

**hyperproteinemia

66
Q

intrarenal proteinuria

A

if the glomerular filter is damaged

**glomerular damage

67
Q

post-renal proteinuria

A

tubular loss of proteins (inflammatory processes)

**tubular cell death or UTI

68
Q

K+ uptake in the PT is mainly by ______

A

transcellular

69
Q

Ca++ uptake in the PT is by _____ and _____

A

paracellular and solvent drag

70
Q

Cl- ion uptake in the PT occurs by ____ and _____

A

paracellular and transcellular

71
Q

examples of organic anions secreted by the PT

A 
PAH
Oxalate 
Drugs like penicilin, diuretics
herbicides 
glucuronic acid

**done by using OATS and MRP-2

72
Q

examples of organic cations secreted by the PT

A

epinephrine
choline
histamine, serotonin
drugs like atropin and morphine

**done by using OCT and MDR-1

73
Q

presence of glucose in the urine

A

glucosuria

74
Q

“concentrates” the tubule fluid segment of the loop of henle

A

Thin descending limb

**water is reabsorbed because it is highly permeable here due to AQUAPORINS but NaCl does not flow

75
Q

“diluting” segment of the loop of henle

A

mTAL – thick ascending limb

**reabsorbs NaCl but water cannot flow because it is impermeable to water

76
Q

transport system used in the mTAL

A

NKCC (for Na, K, Cl)

**can be inhibited by furosemide, a common diuretic

77
Q

where is angiotensin produced

A

the liver

78
Q

T/F

cortical nephrons have thin ascending loops

A

FALSE

79
Q

Three things that glomerular filterability depends on

A
  1. size
  2. electrical charge
  3. plasma protein binding
80
Q

2 forces that oppose filtration

A
  1. bowmans space hydrostatic pressure

2. blood plasma oncotic pressure

81
Q

T/F

hemaglobin is freely filterable

A

FALSE

82
Q

GFR units

A

mL/min/Kg

83
Q

4 properties indicator substances must have

A
  1. must not alter renal funciton
  2. must be freely filterable
  3. must not be metabolized in the kidney
  4. amount filtered must not be changed due to secretion or reabsorption
84
Q

renal clearance

A

Volume of plasma from which a substance is completely removed by the kidney in a given amount of time.

85
Q

vasodilatory agents

A

NO and PGE2

86
Q

steps of myogenic reflex

A
  1. Arteriolar wall tension increases
  2. Smooth muscle cells depolarize and calcium enters into the cell
  3. Contraction of smooth muscle occurs in the afferent arteriole
  4. Results in decreased blood flow to nephron
87
Q

steps of tubuloglomerular feedback

A
  1. GFR and tubular fluid increase
  2. Macula Densa suppresses renin release and afferent arteriole is constricted by mesangial cells
  3. GFR decreases
88
Q

result of the RAA system

A

Upregulation of Aldosterone secretion via Angiotensin II acting on the Adrenal Gland

89
Q

functions of the Distal Tubule

A

Reabsorbs sodium, chloride, calcium, and magnesium. Regulates pH. Excretion of ammonia, water, and some electrolytes

90
Q

functions of the Collecting Duct

A

Regulates ammonia, urea, and water excretion/reabsorbtion. Regulates pH

91
Q

two cell types of the CD

A
  1. principal

2. intercalated

92
Q

cells of the CD that absorb NaCl through apical epithelial Na channels (ENaC)

A

Principal cells

**few mitochondria and small apical projections

93
Q

cells of the CD that have many membrane folds (microplicae) on the apical surface and also many mitochondria

A

intercalated cells

**types A and B – important for acid base homeostasis

94
Q

T/F

ENaC can be induced by aldosterone

A

TRUE

95
Q

CD cells that control the net renal K+ excretion through ROMK

A

principal cells

**intracellular K+ leaves through the apical end (down the gradient)

96
Q

intercalated cell type A and B transporters

A

secretes H+ and reabsorbs HCO3- on type A

type B is opposite functions and opposite side of the membrane

**acid base homeostasis

97
Q

inhibits the apical NaPi transporters in the proximal tubule

A

parathyroid hormone (PTH)

98
Q

functions of the hormone angiotensin II

A

increases Na+ reabsorption in the PT, TAL, and DCT

99
Q

functions of the hormone aldosteron

A

increases Na+ reabsorption in the CD

**hyperkalemia also stimulates aldosterone release

100
Q

hormone that stimulates NKCC in the TAL

A

ADH

101
Q

increases Na+ excretion through inhibition of

NHE3, Na,K ATPase, NKCC, and ENaC

A

NO

**regulation of systemic extracellular fluid and blood pressure

102
Q

endothelin-1 hormone inhibitory effects

A

increases Na+ excretion through inhibition of

NHE3, Na,K ATPase, NKCC, ENaC

103
Q

Atrial Natriuretic Peptide (ANP) hormonal effects

A

inhibits aldosterone and renin release and increases Na+

excretion

104
Q

effects of hypercalcemia

A

triggers PTH to stimulate the apical uptake of Ca++ through channels in the TAL and DCT

105
Q

Vitamin D effects?

A

PTH also stimulates Vit D synthesis in the kidney

Vitamine D hormone stimulates
calcium reabsorption from the
intestine and kidney stimulating
calcium channels

106
Q

increase RBF =

A

increases GFR

107
Q

increase systemic pressure =

A

increases GFR

108
Q

increase afferent arteriole tone =

A

decreases GFR

109
Q

increase efferent arteriole tone (slight) =

A

increases GFR

110
Q

increase efferent arteriole tone (strong) =

A

decreases GFR

111
Q

increase hydrostatic pressure =

A

decreases GFR

112
Q

the main way some drugs and toxins are excreted from the body

A

active transport in the PT

113
Q

if water is being removed from the fluid, but the NaCl stays, what is happening to the tubular fluid

A

concentrates

114
Q

if NaCl is being reabsorbed but water cannot flow, what is happening to the tubular fluid?

A

it is being diluted

115
Q

T/F

within the autoregulatory window, the GFR increases proportionally with the blood pressure

A

FALSE

116
Q

what is the autoregulatory window?

A

80-180mmHg

117
Q

where is aldosterone produced?

A

the cells of the adrenal cortex

118
Q

What is PAH used to measure and why?

A

it measures RPF because it is filtered and additionally secreted

119
Q

what is creatinine used to measure and why?

A

it measures GFR because it is only filtered and never secreted!

120
Q

changes in arteriole resistance will alter the pressures where?

A

glomerular and peritubular capillaries

121
Q

mechanism that prevents a flow rate that would exceed transport capacity

A

tubuloglomerular feedback

122
Q

increase in aldosterone leads to what

A

increased renal reabsorption of Na+

**high angiotensin II in plasma leads to increase in aldosterone

123
Q

T/F

saturation of carriers leads to more reabsorption

A

FALSE

less reabsorption –> excreted in urine

124
Q

Where does receptor-mediated endocytosis occur and what does it transport

A

proximal tubules ..low molecular weight proteins like insulin, PTH, and glucagon

125
Q

Thiazide diuretics acts on NCC channels in which tubule

A

Distal tubules

126
Q

What is the effect of ADH and which tubules does it act on?

A

increases water reabsorption in the Distal tubule and CD

127
Q

How does ADH control the amount of water in the collecting ducts?

A

increases the amount of aquaporins in the CD

128
Q

where is urea reabsorbed?

A

collecting duct

129
Q

where is urea excreted?

A

thin descending limb

130
Q

T/F

if organic ions are protein bound, they will be poorly filtered by the glomerulus

A

TRUE

131
Q

are the ENaC located apically or basolaterally?

A

apically on principal cells for NaCl reabsorption

physio 2 (4 decks)

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