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KCSU17 Patho/Pharm Submodule 2 > Renal Physiology > Flashcards

Renal Physiology Flashcards

1
Q

Renal Pelvis

A

expanded upper portion of ureter

divided into major calyces

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2
Q

major calyces

A

subdivisions of renal pelvis

divide into minor calyces

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3
Q

minor calyces

A

subdivisions of major calyces into which renal papillae discharge

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4
Q

Urter

A

conveys urine from the kidney into the bladder by peristalsis

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5
Q

bladder

A

stores the urine, discharges it to the urethra

anatomically unlikely to have reflex into ureters

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6
Q

voiding

A

when the bladder discharges urine into urethra

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7
Q

urethra

A

conveys urine from bladder for excretion

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8
Q

Kidneys are from ___ to ___ (vertebrae)

A

retroperitoneal

T12 - L3

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9
Q

how many lobes?

A

8-18 lobes

ea. has nephron capped by pyramids that drain into renal pelvis

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10
Q

kidney major division

A

outer cortex

inner medulla (renal pyramids and columns)

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11
Q

Three basic functions

A
  1. excretes waste products of food metabolism
  2. Regulate mineral and water balance
  3. specialized cells to produce erythropoietin and rennin
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12
Q

Waste products secreted by the kidney

A

CO2, H20 (end products of fat and carb metabolism, also lungs,GI)

urea and other acids (end products of metabolism only kidneys can excrete)

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13
Q

How does the kidney regulate mineral and H20 Balance? (general?)

A

excrete and conserves excess minerals and water ingested when required

internal environment is really determine by what kidneys retain

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14
Q

renin fnx

A

regulates blood pressure

activates RAAS

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15
Q

erythropoietin

A

regulates RBC production in marrow

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16
Q

functional unit of the kidney

A

Nephron

millions in the kidney

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17
Q

contents of the nephron

A

glomerulus

proximal and distal convoluted tubule

loop of henle

collecting duct

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18
Q

glomerulus

A

tuft of blood vessels supplied to nephron by afferent arteriole and drained by efferent arteriole

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19
Q

3 layered system of glomerulus

A

filters material to urine

inner

middle

outer

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20
Q

mesangial cells

A

contractile phagocytic cells that hold the capillary tuft together

regulate caliber of capillaries affecting filtration rate

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21
Q

inner glomerulus is lined by the

A

fenestrated capillary endothelium

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22
Q

middle glomerulus has the

A

glomerular basement membrane

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23
Q

outer glomerulus

A

capillary endothelial cells (foot processes and filtration slits)

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24
Q

afferent or efferent article has larger diameter?

A

afferent

blood flows thru glomerulus under high pressure

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25
Q

path from glomerular capillaries

A

thru fenestrations –> bowman’s space

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26
Q

what makes the glomerular capillaries unique

A

larger fenestrations than other capillaries

everything gets thru to capillary lumen

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27
Q

glomerular basement membrane

A
  • found in the middle glomerulus
  • acellular meshwork of collagen fibers, glycoproteins, and mucopolysaccharides
  • has aquaphorin water channels
  • basis of pathophysiology is alteration of structure or fxn to let protein and RBCs through
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28
Q

size of pores on GBM

A

small

restricts the size of filtered particles

29
Q

aquaphorin water channels

A

found in GBM

provide rapid filtration of water

30
Q

substances that are filtered from the blood are controlled by the

A

glomerular basement membrane

“you are what your kidneys filter”

31
Q

pathophysiology of glomerular disease have a basis in

A

alteration of GBM structure or function

allows proteins and RBCs through

SOME are caused by mesangial cell hyperplasia or increased mesangial matrix

32
Q

After the GBM, trace the path thru the kidney

A

Bowmans capsule –> Proximal convoluted tubule –> descending loop of Henle –> ascending loop of henle –> distal convoluted tubule –> collecting ducts

33
Q

GFR of a healthy kidney

A

125 mL/min

basis for determination of CKD

34
Q

GFR is regulated by the tone of

A

Afferent and Efferent arterioles

35
Q

proximal convoluted tubule anatomy

A

villous structures to increase surface area

rich in mitochondria (supply ATP for pumps to reabsorb molecules)

36
Q

Electrolyte absorption in proximal convoluted tubule

A

water and urea (passive reabsorption)

NA, PO4, Ca, K, Cl (active reabsorbed)

Glucose, amino acids (active reabsorbed)

H and K actively secreted into ultra filtrate

37
Q

descending loop of Henle (electrolyte)

A

reabsorbs water

imp. role in urine concentration

38
Q

ascending loop of henle (electrolyte)

A

impermeable to water

solute absorption Na+, K+, Cl-

39
Q

what class of drugs work on the ascending loop of henle

A

Loop diuretics

prevention of ion reabsorption (esp. K)

therefore, water stays in

40
Q

Distal convoluted tubule (electrolyte)

A

relatively impermeable to water

NaCL is absorbed here

main site for Ca++ absorption (PTH active site)

41
Q

what class of drugs work on the distal convoluted tubule

A

Thiazide diuretics

block Ca and NaCl reabsorption to increase water removal

42
Q

late distal convoluted tubule and collecting ducts (electrolytes)

A

absorb water

reabsorb HCO3, Na, Cl

excretes H+ and most K+ (most common place)

Aldosterone works here

43
Q

What class of drugs work on the late distal convoluted tubule

A

aldosterone agonists

44
Q

how much of the GFR is actually excreted as urine?

A

1 mL

so 60 mL/hr

45
Q

osmoreceptors

A

monitor serum osmolarity

in hypothalamus

stimulate ADH secretion as osmolality rises

46
Q

ADH on the kidney (general)

A

kidney is able to maintain osmotic balance of serum by absorbing more or less water from ultrafiltrate

47
Q

Kidney blood flow

A

20-25% of cardiac output

large amount of blood despite a small amount of tissue

48
Q

sympathetic nervous system on kidney

A

very responsive

catecholamines cause substantial decrease in renal blood flow by constricting afferent and efferent arterials

49
Q

vasodilators that maintain renal blood flow

A

NO, dopamine, prostaglandins (NSAIDS inhibit prostaglandins)

keep the blood supply open to maintain the blood flow

50
Q

autoregulation

A

maintenance of renal perfusion

process that allows kidney to have direct control over afferent and efferent arteriolar tone

51
Q

how does the kidney regulate the blood flow?

A

activation of the RAAS and other

if it feels like it is not getting enough, will increase BP to cause problem everywhere else

52
Q

two things that would stimulate RAAS activation

A
  1. hypotension

2. low Na/onchotic

53
Q

pump failure

A

effective circulation volume

the heart pumps less bc more resistance, heart gets stressed out and there is a loss of perfusion

heart failure causes hypotension bc the pump to move blood around is in failure

kidney will fail bc it is calling for more from the heart and the heart can’t deliver

54
Q

reasons for low onchotic levels

A
  1. losing protein (GBM/capillary don’t keep it)

2. can’t make protein (liver dx)

55
Q

low onchotic levels and kidney failure

A

no chemical pressure to keep it in, goes out into 3rd space causing a drop in pressure (BP and perfusion)

no solute to pull water into kidney, water then 3rd spaces

cure: fix underlying dx processes (liver dx, severe malnutrition, etc.)

56
Q

BP meds that work on kidney

A

ACE inhibitors
Angiotensin receptor blockers
direct renin inhibitors
aldosterone agonists

can be nephroproteictive

57
Q

ACE inhibitors

A

PRILS

prevent cleavage of angiotensin to angiotensin 2

block vasoconstriction and rest of cascade

58
Q

ARBs

A

divan/Valsartan

block angiotensin 2

59
Q

Direct renin inhibitor

A

rare

stops renin release

60
Q

Kidney is responsible for elimination:

A
  1. Sodium
  2. Potassium
  3. Urea
  4. Uric Acid
  5. Drugs
61
Q

sodium removal

A

dependent upon aldosterone

urine can contain as much as 40g/day to as little as none

disfunction here is not as big a deal bc water follows sodium

62
Q

potassium removal

A

kidney is a major site of K exertion

renal failure or lack of aldosterone can lead to toxic levels of potassium in blood

can cause cardiac arrhythmia

63
Q

urea elimination

A

end product of protein metabolism

filtered in glomerulus and reabsorbed in tubule

longer it sits, more is absorbed (increases BUN)

64
Q

BUN increased by

A

urea sitting in the tubule

dehydration

high protein diet: kidney has a cap on how much it can do

GI bleed: digestion of blood causes increase in protein absorption and again kidney is unable to get rid

65
Q

uric acid elimination

A

product of purine metabolism

can cause gout if blood levels are high, renal calculi if filtrate concentrations are high

66
Q

drugs elimination

A

kidney is better at eliminating water soluble forms of medication (this is aided by liver metabolism in some medications)

changing PH of uric can increase elimination

67
Q

urea reabsorption

A

we absorb Urea down its concentration gradient in the proximal convoluted tubule

this means that we will never get rid of it all, it only does this when it needs to

68
Q

urologist

A

physician who cares for the urethra, bladder, and ureters

surgeons of the urinary tract

69
Q

nephrologist

A

doctor for kidneys

expert in acid base disorder, water/sodium and electrolyte disorders and hypertension specialist

supervise dialysis

KCSU17 Patho/Pharm Submodule 2 (14 decks)

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