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mic cabatu Physiology > Renal Physiology > Flashcards

Renal Physiology Flashcards

1
Q

Ammonium phosphate magnesium stone

Proteus mirabilis

A

Staghorn calculi

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2
Q

Renal circulation

A

Renal artery -> segmental artery -> interlobar artery -> arcuate artery -> interLOBULAR artery (otherwise known as Cortical Radiate/Radial Artery) -> afferent arteriole -> glomerular capillaries -> Efferent arteriole -> Peritubular Capillaries / Vasa Recta -> interLOBULAR vein -> arcuate vein -> RENAL VEIN

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3
Q

Only capillaries in the human body that leads to arteriole stand not venules

A

Glomerular Capillaries

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4
Q

Countercurrent exchange

A

Vasa Recta

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5
Q

Capacity of the urinary bladder

A

600 ml

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6
Q

Urge to urinate

A

150 ml (25%)

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7
Q

Reflex contraction

A

300 ml (50%)

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8
Q

Bladder muscle

Smooth muscle responsible for stretch activating Ca channel

A

Detrussor muscle

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9
Q

Internal urethral sphincter

A

Involuntary

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10
Q

External Urethral sphincter

A

Voluntary

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11
Q

Functional & Structural unit of Kidney

A

Nephron

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12
Q

Basic parts of the kidney from lateral to medial

A 
Capsule
Cortex
Medulla
Renal Papilla
Renal Calyces (Minor & Major)
Renal Pelvis
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13
Q

RBC size

A

6 - 8 macro meters

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14
Q

Visceral epithelium

A

Podocytes

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15
Q

Parietal epithelium

A

Bowman’s capsule

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16
Q

Albumin cannot be filtered
protein urea 3.5 g/day
Damage basement membrane

A

Nephrotic syndrome

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17
Q

75% of nephrons
Located at renal cortex (more vascular)
Short LH
Peritubular Capillaries

A

Cortical Nephrons

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18
Q

25% of nephrons
Located at corticomedullary junction
Long LH
Vasa Recta

A

Juxtamedullary Nephrons

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19
Q

Secretes Renin

Found at the walls of the Afferent Arterioles

A

JG cells / Glomerular cells of the Afferent Arterioles

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20
Q

Found in the walls of the Distal convoluted tubule

Monitor Na conc. In the DT

A

Macula Densa

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21
Q

Contains foot processes
Filtration slit
cells of Capillary endothelium

A

Podocytes

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22
Q

(+) micro villi
Workhorse of Nephron
Require ATP - requires O2

A

PCT

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23
Q

66% reabsorbed - Na, K, H2O
100% reabsorbed - glucose, AA
Secrete H
Prone to ischemia

A

PCT

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24
Q

Carbonic Anhydrase Inhibitor

A

PCT

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25
Q

S/E of Carbonic Anhydrase Inhibitor

A

Metabolic Acidosis

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26
Q

Permeable: H20
Impermeable: solute so

A

Descending Limb of Loop of Henle

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27
Q

Permeable: solute so
Impermeable: H20

A

Ascending Limb of Loop of Henle

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28
Q

Loop diuretic S/E

A

Hypokalemia
Alkalosis
Hypokalemia

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29
Q

Na K Cl cno transport
Absorb NaCl
Contributes to counter current of LH
Diluting Segment of Nephron

A

TAL

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30
Q

Permeable: Solutes
Impermeable: H20

Cortical Diluting Segment
Found in macula Densa

A

Early Distal Tubule (1st part)

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31
Q

Principal cells & Intercalated cells - stimulated by Aldosterone Hormone

A

Late Distal Tubule (2nd part)

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32
Q

Thiazides

A

Distal Tubule

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33
Q

S/E of Thiazides

A 
Hypokalemia
Alkalosis
Hypercalcemia
Hyperglycemia
Hyperuricemia
Hyperlinked is
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34
Q

ADH - Aquaporin type 2
Greater water reabsorption
Urine volume low
Urine conc. High

A

Collecting duct

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35
Q

Dec ADH - Dec Aquaporin

A

Urine volume - increase

Urine conc - decrease

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36
Q

Potassium sparing diuretics

A

Collecting duct

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37
Q

Aldosterone antagonist

A

Collecting duct

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38
Q

S/E of Potassium Sparing diuretics

A

Hypercalcemia

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39
Q

S/E of Aldosterone Antagonist

Ex. Spiranolactone

A

Gynecomastia

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40
Q

Movement from Glomerular Capillaries to Bowman’s Capsule

A

Glomerular Filtration

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41
Q

Movement from tubules to interstitium to Peritubular capillaries

A

Tubular Reabsorption

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42
Q

Movement from Peritubular Capillaries to Interstitium to Tubules

A

Tubular Secretion

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43
Q

Excretion = (amount filtered) - (amount reabsorbed) + (amount secreted)

A

Excretion

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44
Q

Cardiac function marker

A

Ejection Fraction

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45
Q

Renal blood flow

A

25% of cardiac output

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46
Q

Preferential constriction of efferent Arterioles

A

Angiotensin II

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47
Q

Estimated by PAH clearance

A

Renal Plasma Flow (RPF)

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48
Q

Fraction of renal plasma flow that is filtered

A

Filtration fraction

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49
Q

Afferent Arteriole: Dilate

A

Increase effect on GFR

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50
Q

Afferent Arteriole: Constrict

A

Decrease effect on GFR

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51
Q

Efferent Arteriole: Dilate

A

Decrease

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52
Q

Efferent Arteriole: Constrict moderately

A

Increase

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53
Q

Efferent Arteriole: Constrict Severely

A

Decrease

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54
Q

GC Hydrostatic pressure: increased

A

Increase

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55
Q

GC Oncotic Pressure: increased

A

decreased

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56
Q

BS Hydrostatic Pressure: Increased

A

Decrease

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57
Q

If: increased

A

Increase

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58
Q

Which of the following are actions of the hormone renin?

A

Converts angiotensin open to angiotensin I

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59
Q

Increased Renin due to sympathetic action from a gunshot wound to the abdomen will eventually lead to which of the following. Effects in the kidney?

A

Decreased renal plasma flow

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60
Q

Which of the following would cause an increase in both glomerular filtration rate and renal plasma flow?

A

Dilation of the Afferent arteriole

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61
Q

All of the following. Would cause a decrease in the GFR except

B. Constriction o the efferent arteriole (inc GFR)

A

Constriction of the Afferent arteriole
increased plasma protein content
Urethral obstruction with a stone

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62
Q

Vasodilator in all except in Renal

A

Adenosine

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63
Q

What are the causes of decreased Kf (filtration coefficient of GC)?

A

Renal disease
DM
HPN

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64
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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65
Q

What are the hormones that will increase GFR?

A 
EDRF
PGE2
PGI2
Bradykinin
Glucocorticoids
ANP
BNP
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66
Q

What hormone preserve GFR?

A

Angiotensin II (preferentially constricts efferent arteriole)

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67
Q

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

A

CNS ischemic response

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68
Q

Percentage of solute reabsorbed is held constant

Buffers effects of drastic GFR changes on urine output

A

Glomerulotubular Balance

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69
Q

Macula Densa feedback

For autoregulation of GFR

A

Tubuloglomerular Feedback

70
Q

Percentage of solute reabsorbed is held constant

Buffers effect of drastic GFR changes on urine output

A

Glomerulotubular balance

71
Q

Workhorse of the nephrons

A

Proximal convoluted tubule

72
Q

Where is the site where PAH is secreted in the kidneys?

A

PCT

73
Q

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

A

None. (Isotonic reabsorption takes place)

74
Q

Principal cells

A

Secrete K+

75
Q

Intercalated cells

A

Secrete H

76
Q

Impermeable to urea

A

Distal tubule

77
Q

Site for regulation of final urine volume and concentration

A

Collecting Duct

78
Q

secreted at atrium

A

ANP

79
Q

Increased angiotensin II levels in the blood in response to blood loss from a motor vehicular accident will lead to which of the following physiology effects?

A

Increased Na-H exchange and HCO3 reabsorption in the kidneys (effect of Angiotensin II)

80
Q

All of the following are actions of aldosterone on the principal cells of the late distal tubule and collecting duct except?

C. Renal H+ secretion - intercalated cells

A

Renal Na reabsorption

Renal K secretion

81
Q

A 60 year old bussiness man is evaluated by his physician, who determines that his blood pressure is significantly elevated at 185/130 mmHg. Lab test reveal an increase in plasma renin activity, plasma aldosterone level, and left renal vein renin level. His right renal vein renin level is decreased. What is the most likely cause of the patient’s hypertension?

A

Left renal artery stenosis

82
Q

What are the triggers for ADH secretion?

A

Increased plasma osmolarity - Normal 300 mOsm/L
Decreased BP
decreased blood volume

83
Q

What are the effects of alcohol on ADH secretion?

A

Alcohol decreases ADH secretion

84
Q

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

A

Urodilatin

85
Q

Substance with the highest clearance

A

PAH

86
Q

Substance with zero clearance

A

Glucose

AA

87
Q

Substances whose clearance is used to estimate GFR

A

BUN

Crea

88
Q

Substance whose clearance is used to estimate Renal Blood Flow and Renal Plasma Flow

A

PAH

89
Q

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

A

0 / zero

90
Q

Substances filtered and partially reabsorbed have a clearance ___ than the GFR

A
91
Q

Substances filtered and with net secretion have a clearance ___ than the GFR

A

>

92
Q

Clearance of insulin is ___ to that of the GFR

A

=

93
Q

Plays a crucial role in water reabsorption and thus, urine volume and concentration

A

Vasopressin or ADH

94
Q

Increased angiotensin II levels in the blood in response to blood loss from a motor vehicular accident will lead to which of the following physiology effects?

A

Increased Na-H exchange and HCO3 reabsorption in the kidneys (effect of Angiotensin II)

95
Q

All of the following are actions of aldosterone on the principal cells of the late distal tubule and collecting duct except?

C. Renal H+ secretion - intercalated cells

A

Renal Na reabsorption

Renal K secretion

96
Q

A 60 year old bussiness man is evaluated by his physician, who determines that his blood pressure is significantly elevated at 185/130 mmHg. Lab test reveal an increase in plasma renin activity, plasma aldosterone level, and left renal vein renin level. His right renal vein renin level is decreased. What is the most likely cause of the patient’s hypertension?

A

Left renal artery stenosis

97
Q

What are the triggers for ADH secretion?

A

Increased plasma osmolarity - Normal 300 mOsm/L
Decreased BP
decreased blood volume

98
Q

What are the effects of alcohol on ADH secretion?

A

Alcohol decreases ADH secretion

99
Q

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

A

Urodilatin

100
Q

Substance with the highest clearance

A

PAH

101
Q

Substance with zero clearance

A

Glucose

AA

102
Q

Substances whose clearance is used to estimate GFR

A

BUN

Crea

103
Q

Substance whose clearance is used to estimate Renal Blood Flow and Renal Plasma Flow

A

PAH

104
Q

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

A

0 / zero

105
Q

Substances filtered and partially reabsorbed have a clearance ___ than the GFR

A
106
Q

Substances filtered and with net secretion have a clearance ___ than the GFR

A

>

107
Q

Clearance of insulin is ___ to that of the GFR

A

=

108
Q

Plays a crucial role in water reabsorption and thus, urine volume and concentration

A

Vasopressin or ADH

109
Q

Increased angiotensin II levels in the blood in response to blood loss from a motor vehicular accident will lead to which of the following physiology effects?

A

Increased Na-H exchange and HCO3 reabsorption in the kidneys (effect of Angiotensin II)

110
Q

All of the following are actions of aldosterone on the principal cells of the late distal tubule and collecting duct except?

C. Renal H+ secretion - intercalated cells

A

Renal Na reabsorption

Renal K secretion

111
Q

A 60 year old bussiness man is evaluated by his physician, who determines that his blood pressure is significantly elevated at 185/130 mmHg. Lab test reveal an increase in plasma renin activity, plasma aldosterone level, and left renal vein renin level. His right renal vein renin level is decreased. What is the most likely cause of the patient’s hypertension?

A

Left renal artery stenosis

112
Q

What are the triggers for ADH secretion?

A

Increased plasma osmolarity - Normal 300 mOsm/L
Decreased BP
decreased blood volume

113
Q

What are the effects of alcohol on ADH secretion?

A

Alcohol decreases ADH secretion

114
Q

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

A

Urodilatin

115
Q

Substance with the highest clearance

A

PAH

116
Q

Substance with zero clearance

A

Glucose

AA

117
Q

Substances whose clearance is used to estimate GFR

A

BUN

Crea

118
Q

Substance whose clearance is used to estimate Renal Blood Flow and Renal Plasma Flow

A

PAH

119
Q

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

A

0 / zero

120
Q

Substances filtered and partially reabsorbed have a clearance ___ than the GFR

A
121
Q

Substances filtered and with net secretion have a clearance ___ than the GFR

A

>

122
Q

Clearance of insulin is ___ to that of the GFR

A

=

123
Q

Plays a crucial role in water reabsorption and thus, urine volume and concentration

A

Vasopressin or ADH

124
Q

Increased angiotensin II levels in the blood in response to blood loss from a motor vehicular accident will lead to which of the following physiology effects?

A

Increased Na-H exchange and HCO3 reabsorption in the kidneys (effect of Angiotensin II)

125
Q

All of the following are actions of aldosterone on the principal cells of the late distal tubule and collecting duct except?

C. Renal H+ secretion - intercalated cells

A

Renal Na reabsorption

Renal K secretion

126
Q

A 60 year old bussiness man is evaluated by his physician, who determines that his blood pressure is significantly elevated at 185/130 mmHg. Lab test reveal an increase in plasma renin activity, plasma aldosterone level, and left renal vein renin level. His right renal vein renin level is decreased. What is the most likely cause of the patient’s hypertension?

A

Left renal artery stenosis

127
Q

What are the triggers for ADH secretion?

A

Increased plasma osmolarity - Normal 300 mOsm/L
Decreased BP
decreased blood volume

128
Q

What are the effects of alcohol on ADH secretion?

A

Alcohol decreases ADH secretion

129
Q

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

A

Urodilatin

130
Q

Substance with the highest clearance

A

PAH

131
Q

Substance with zero clearance

A

Glucose

AA

132
Q

Substances whose clearance is used to estimate GFR

A

BUN

Crea

133
Q

Substance whose clearance is used to estimate Renal Blood Flow and Renal Plasma Flow

A

PAH

134
Q

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

A

0 / zero

135
Q

Substances filtered and partially reabsorbed have a clearance ___ than the GFR

A
136
Q

Substances filtered and with net secretion have a clearance ___ than the GFR

A

>

137
Q

Clearance of insulin is ___ to that of the GFR

A

=

138
Q

Plays a crucial role in water reabsorption and thus, urine volume and concentration

A

Vasopressin or ADH

139
Q

Which of the following conditions can produce hypo olefin hyponatremia?

A

Diuretic therapy

140
Q

All of the following are causes of euvolemic hyponatremia except?

A. SIADH
B. Hypothyroidism
C.Nephrotic syndrome
d. Adrenal insufficiency

A

C. Nephrotic syndrome

141
Q

Causes of increased K secretion

A 
High K diet
Hyperaldosteronism
Alkalosis
Thiazide diuretics
Loop diuretics
Luminal anions
142
Q

Causes of Decreased K Secretion

A

Low K diet
Hypoaldosteronism
Acidosis
K sparing diuretics

143
Q

Regulation of calcium

A

Calcium reabsorption in the kidneys controlled by VITAMIN D and PTH and parallels that of sodium and water

144
Q

Trio of Electrolytes

H, Ca, K

A

High H levels -> hyperCalcemia hyperKalemia

145
Q

Regulation of phosphate

A

Reabsorption inhibited by PTH (adenylate cyclase & cAMP inhibition of the Na-PO4 cno transport)

146
Q

Serve as urinary buffer for H+

A

Un absorbed PO4

147
Q

Magnesium

A

HyperCalcemia causes hypomagnesemia

Hypocalcemia causes Hypermagnesemia

148
Q

Final urine output and urine concentration is determined by

A

Collecting ducts

149
Q

If ADH levels are high, what happens to water reabsorption at the collecting duct, urine volume & urine concentration

A

Water reabsorption: High (more aquaporins inserted)
Urine volume: Low (min:500 mL/day)
Urine concentration: High (max: 1200 mOsm/L)

150
Q

If ADH levels are low, what happens to water reabsorption at the collecting duct, urine volume, urine concentration

A

Water reabsorption: Low ( less aquaporins inserted)
Urine volume: High (max: 20L/day)
Urine concentration: Low (Min 50 mOsm/L)

151
Q

How do we concentrate urine?

A

Aside from ADH levels, the countercurrent current mechanism is also needed to concentrate urine.
Countercurrent mechanism provides the stimulus for water reabsorption (ADH provides the opportunity)

152
Q

Countercurrent Multipliers

A

Loops of Henle

Creates the corticopapillary Osmotic Gradient in the renal interstitium

153
Q

Countercurrent Exchangers

A

Vasa Recta

Maintains the corticopapillary osmotic gradient in the renal interstitium (prevents dissipation of gradient)

154
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 & electrolytes in the ascending & descending wall
  • Na-K-2Cl pump in the TAL LH
  • Slow flow in the LH
155
Q

What is the end result due to the countercurrent mechanism?

A

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

156
Q

Thirst center

A

Found in the anteroom trial wall of the 3rd ventricle & preoptic nuclei

157
Q

Increase thirst

A 
Inc osmolarity
Dec blood volume
Dec blood pressure
Inc angiotensin
Dryness of mouth
158
Q

Decrease thirst

A 
Dec osmolarity
Inc blood volume
Inc blood pressure
Dec angiotensin II
Gastric distinction
159
Q

Micturation center

A

Pons

160
Q

Due to conditions resulting in Decreased Ventilation (RR)

A

Respiratory Acidosis

161
Q

Due to conditions resulting in Increased Ventilation (RR)

A

Respiratory Alkalosis

162
Q

Respiratory Acidosis

A

Opiates, sedatives, a esthetics, GBS, Poliomyelitis, ALS, Multiple sclerosis, Airway obstruction, ARDS, COPD

163
Q

Respiratory Alkalosis

A

Pneumonia, pulmonary embolus, high altitude, psychogenic, salicylate intoxication

164
Q

Due to conditions resulting in excess acid or loss of base

A

Metabolic Acidosis

165
Q

Metabolic Acidosis

A

Ketoacidosis, lactic acidosis, salicylate intoxication, methanol/ formaldehyde intoxication, ethylene glycol intoxication, diarrhea

166
Q

HAGMA

A

Dec HCO3

Increased Organic Anions to maintain electroneutrality

167
Q

HAGMA

-MUDPILES

A 
Methanol
Uremia
DKA
Par aldehyde, Propylene glycols
Iron, isoniazid, idiopathic acidosis
Lactic acidosis
Ethylene glycol, ethanol
Salicylate acid
168
Q

NAGMA

  • HARD-UP
A 
Hyperalimentation
Acetazolamide
RTA
Diarrhea
Ureteroenteric fistula
pacreaticoduodenal fistula
169
Q

Due to conditions resulting in loss of acid or gain of base

A

Metabolic Alkalosis

170
Q

Metabolic Alkalosis

A

Loop diuretics
Thiazides diuretics
Vomiting’hyperaldosteronis,
Ingestion of alkaline drugs (sodium bicarbonate)

171
Q 
All of the following causes of anion gap metabolic acidosis except?
A. Renal tube acidosis
B. Lactic acidosis
C. DKA
D. Methanol poisoning
A

RTA

mic cabatu Physiology (12 decks)

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