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Physiology > Renal Physiology I (Exam 5) > Flashcards

Renal Physiology I (Exam 5) Flashcards

1
Q

What other organ systems are involved in renal physiology?

A
  • nervous system
  • endocrine system
  • musculoskeletal system
  • cardiovascular system
  • respiratory system
  • digestive system
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2
Q

____% of patients with renal insufficiency show oral signs and symptoms in soft and hard tissues.

A

90%

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3
Q

___ & ____ of body fluid compartments are essential for homeostasis

A

constant volume and stable composition

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4
Q

In order to maintain body fluid homeostasis _____ & _____ in must equal ___ & ____ out

A

water and electrolytes in must = water and electrolytes out

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5
Q

Fluid distribution in the body influences:

A

electrolyte concentrations

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6
Q

Electrolyte concentrations influence:

A

fluid distribution in the body

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7
Q

What causes water gain?

A
  1. food and drink
  2. metabolism
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8
Q

where can water be lossed?

A
  1. skin
  2. lungs
  3. urine
  4. feces
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9
Q

Sweat and evaporation leading to water loss occur:

A

in the skin and lungs

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10
Q

What is insensible water loss?

A

sweat and evaporation (can’t be controlled)

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11
Q

Urine output is typically ____ but varies to create ____.

A

1.5 liters per day; balance

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12
Q

How much insensible water loss occurs each day (70kg man)

A

0.9 liters per day

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13
Q

How much water loss occurs through feces each day (70kg man)

A

0.1 liters/ day but varies

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14
Q

What is the water gain due to food and drinks per day? (70 kg man)

A

2.2 liters per day

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15
Q

How much water gain does metabolism bring in per day? (70kg man)

A

0.3 liters per day

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16
Q

we want the extracellular fluid and intracellular fluid volumes to be:

A

constant

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17
Q

Imbalances changes vascular and total body volumes:

A

Na+

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18
Q

The primary determinant of extracellular fluid osmolarity and tonicity:

A

Na+

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19
Q

Any changes in sodium will change water distribution in the body because:

A

Where the salt goes, water follows

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20
Q

Imbalance alters cardiac and neural functions:

A

K+

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21
Q

Potassium plays a great role in our:

A

excitable tissues

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22
Q

Imbalance alters skeletal muscle, cardiac, neural function, and bone structure:

A

Ca++

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23
Q

Necessary for synaptic transmission for skeletal and cardiac and smooth muscle contractions and one of the primary components making up the bone:

A

Ca++

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24
Q

H+ comes in mainly from:

A

metabolism

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25
Q

Imbalances alter multiple systems:

A

H+

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26
Q

Imbalances in pH will alter multiple systems because pH impacts:

A

protein function

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27
Q

ECF = ___% of the body weight in kg

ICF= ___% of the body weight in kg

A

ECF= 20%

ICF= 40%

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28
Q

ECF breaks down into:

A

Plasma and Interstital fluid

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29
Q

ECF found within the blood vessels:

A

plasma

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30
Q

ECF found outside blood vessels and cells:

A

interstitial fluid

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31
Q

When we consume substances, those substances get added to the:

A

plasma

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32
Q

Once substances are consumed and added to the plasma, the capillaries immediately exchange that substance with the ____ through the capillary wall.

A

interstitial fluid

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33
Q

What fluid makes up 4-5% of our body weight in kg?

A

plasma

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34
Q

Our body is comprised of:

____ L of Intracellular fluid
_____ L of extracellular fluid
which breaks down into
_____ L of interstitial fluid
_____ L of plasma

A

28.0 intracellular fluid
14.0 extracellular fluid
11.0 interstitial fluid
3.0 plasma

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35
Q

Plasma and interstitial fluid are extremely similar in composition, the only thing that cannot move back and forth between these 2 compartments are:

A

proteins

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36
Q

The ____ is impermeable to proteins

A

capillary membrane

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37
Q

In a 70kg adult, the total body water volume is ____ liters making up ~ ____% body weight (kg)

A

42 liters; 60%

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38
Q

What is the barrier between the ECF and ICF?

A

plasma membrane

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39
Q

What ions are in a higher composition in the ECF?

A
  1. Na+
  2. Ca++
  3. Cl-
  4. HCO3-
  5. glucose
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40
Q

What ions are in a higher composition in the ICF?

A
  1. K+
  2. Mg++
  3. H+
  4. Amino acids
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41
Q

Describe the amount of protein on the inside of the cell relative to the amount of protein on the outside of the cell:

A

A lot more protein inside than outside, but almost all protein on the outside is found in the PLASMA

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42
Q

Hypervolemia:
Hypovolemia:
Normovolemia/Euvolemia:

A

Hypervolemia= high blood volume
Hypovolemia= low blood volume
Normovolemia/euvolemia= normal amount of blood volume

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43
Q

Hypernatremia:
Hyponatremia:
Normonatremia/eunatremia:

A

high sodium levels in blood
Low sodium levels in blood
normal amount of sodium in blood

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44
Q

Hyperkalemia:
Hypokalemia:
Normo/eunatremia:

A

high potassium levels in blood
low potassium levels in blood
normal potassium levels in blood

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45
Q

Hypercalcemia:
Hypocalcemia:
Normo/eucalcemia:

A

high blood calcium
low blood calcium
normal blood calcium

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46
Q

because the capillary wall is a very leaky barrier, ____ & ___ mix rapidly excepting for ___.

A

plasma & interstitial fluid; proteins

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47
Q

What causes the mixing of the plasma and interstitial fluids?

A

hydrostatic and colloid osmotic pressure via capillary pores & bulk flow

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48
Q

Hydrostatic and colloid osmotic pressure via capillary pore is the main force governing:

A

bulk flow

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49
Q

movement of substance between plasma and interstitial fluid occurs via:

A

bulk flow

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50
Q

Fluid distribution between ICF & ECF is determined by ____ of ____ acting across the cell membrane

A

osmotic effect of small solutes

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51
Q

Water will move down a free water gradient and this free water gradient is determined by the concentration of:

A

impermeable substances

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52
Q

What adds up to equal ~90% of total ECF osmolarity?

A

Na+ and Cl- (and other anions)

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53
Q

Anytime we have a change in ECF osmolarity, what effect will this have on tonicity? Why?

A

we will also have a change in tonicity; because these substances are impermeable (Na + Cl- and other anions)

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54
Q

What adds up to equal ~90% of total ICF osmolarity?

A

K+ and other ions

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55
Q

The cell membrane may also be referred to as:

A

plasma membrane

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56
Q

Describe the cell membranes permeability to water:

A

high permeability to H20 dependent of location of cell in body

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57
Q

Describe the cell membrane permeability to Na+, Cl- & other electrolytes:

A

relatively impermeably to small solutes such as these

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58
Q

Why would changes in the concentration of Na+, Cl- & other electrolytes change the tonicity and water distribution in the body?

A

because the cell membrane is relatively impermeable to these small solutes

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59
Q

Cell volume is at the mercy of:

A

ECF tonicity

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60
Q

If a cell is placed in a hypertonic bathing solution, what will happen to the volume of the cell?

A

cell will shrink

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61
Q

The concentration of impermeable substances in the bathing solution is greater than the the concentration of impermeable substances inside the cell:

How would you describe this bathing solution?

A

Hypertonic

62
Q

If a cell is placed in an isotonic bathing solution, what will happen to the volume of the cell?

A

No change in cell volume

63
Q

Concentration of impermeable substances in the bathing solution is equal to the concentration of impermeable substances inside the cell:

How would you describe this bathing solution?

A

isotonic

64
Q

Is their movement of water between the bathing solution and cell in an isotonic situation?

A

Yes there is movement but no NET movement

65
Q

The concentration of impermeable substances in the bathing solution is less than the the concentration of impermeable substances inside the cell:

How would you describe this bathing solution?

A

Hypotonic

66
Q

If a cell is placed in a hypotonic bathing solution, what will happen to the volume of the cell?

A

Cell swells

67
Q

Composition and volume of ECF change determine composition and volume of:

A

fluid replacement

68
Q

_____ & ____ are constantly being challenged in the body

A

ECF osmolarity & volume

69
Q

Why can the skin being burned cause such extensive body water loss?

A

because the skin is a major waterproofing organ

70
Q

If a ____ solution is added into a normal individual, the ECF volume is increased, the ECF osmolarity is unchanged, and the ICF osmolarity and volume are both unchanged:

A

Isotonic

71
Q

If a ____ solution is added into a normal individual, the volume and osmolarity will expand creating an osmotic gradient for water to move out of the cells into the ECF further expanding, and reducing the volume in the ICF, raising the ICF osmolarity:

A

Hypertonic

72
Q

If a ____ solution is added into a normal individual, we will lower the ECF osmolarity and raise the ECF volume. As the osmolarity is lowered, this creates a gradient to cause water to move to the ICF via osmosis:

A

hypotonic

73
Q

The kidneys regulate body fluid and composition by controlling:

A

ECF volume and composition

74
Q

Too much water in tissues:

A

edema

75
Q

What are the two types of edema?

A

intracellular and extracellular edema

76
Q

____ edema is much more common

A

extracellular

77
Q

What are the 3 causes of intracellular edema?

A
  1. hyponatremia
  2. Decreased metabolism (blood flow)
  3. Inflammation (infection & burns)
78
Q

____ is the primary determinant of ECF osmolarity and tonicity

A

Na+

79
Q

Explain why hyponatremia can cause intracellular edema:

A

sodium is in a higher concentration in the ECF, if you don’t have enough sodium, you will lower the osmolarity of the ECF causing water to rush into the cells causing intracellular edema

80
Q

Decreased metabolism (blood flow) that causes intracellular edema is due to:

A

Na+/K+ pump failure

81
Q

Explain how Na+/K+ pump failure leading to decreased blood flow will lead to intracellular edema:

A

The Na+/K+ ATPase pumps potassium into the cell and sodium out of the cell. If this pump is inhibited, it will cause more sodium to build up in the cell and water will flow into the cell because of this causing intracellular edema

82
Q

Explain how inflammation (infection & burns) can lead to intracellular edema:

A

inflammation causes increased membrane permeability and leakage which causes lots of extra ions to build up inside the cell, and water would follow them in.

83
Q

What do we look at when determining water balance?

A

sodium

84
Q

____ is the most important cation in the body

A

sodium

85
Q

Na+ salts make up greater than _____ in the ECF

A

90% of osmotically active solute in ECF

86
Q

Na+ (and hence ECF volume) is highly:

A

regulated

87
Q

Too little ECF leads to: (3)

A
  1. volume contraction
  2. hypotension
  3. organ hypoperfusion
88
Q

Too much ECF leads to: (4)

A
  1. edema
  2. ascites
  3. pleural effusions
  4. hypertension
89
Q

In hyponatremia, the concentration of sodium in the ____ is below normal.

Give value:

A

ECF; Less than 142 mOsm/L

90
Q

In hyponatremia:

Na+ input _____ Na+ output

H2O input ____ H2O output

A

Na+ Input < Na+ output

H2O input > H2O output

91
Q

Na+ Input < Na+ output

H2O input > H2O output

This leads to:

A

drop in Na+ concentration (hyponatremia)

92
Q

What are the 3 types (causes) of hyponatremia?

A
  1. Hyponatremia-dehydration
  2. Hyponatremia-overhydration
  3. Hyponatremia-low solute intake
93
Q

What is the cause of hyponatremia dehydration?

  • Caused by _____.
  • Which is caused by:
A
  • Increased NaCl loss
  • committing, diarrhea, renal disease, diuretics, Addison’s deficiency
94
Q

How does Addison’s disease cause increased NaCl loss? What does this ultimately cause?

A

Someone with Addisons disease produces insufficient levels of cortisol, but also aldosterone.

Aldosterone stimulates sodium reabsorption in the kidneys, so not enough aldosterone = not enough sodium brought back into the body

95
Q

What hormone involved in Addison’s disease can cause increased loss of NaCl?

A

Aldosterone

96
Q

What is the function of aldosterone?

A

stimulates sodium reabsorption in the kidneys (brings sodium back into the body)

97
Q

Most common electrolyte disorder in clinical practice:

A

hyponatremia

98
Q

Hyponatremia may account for ____% of hospitalized patients

A

20-25%

99
Q

Hyponatremia-overhydration is caused by _____ which is caused by ____.

A

Excess H2O retention; Inappropriate ADH secretion & H2O toxicity

100
Q

What is the function of ADH?

A

Causes water retention

101
Q

How might too much ADH cause hyponatremia-overhydration?

A

Too much ADH causes too much water to be retained which dilutes the ECF leading to hyponatremia

102
Q

H2O toxicity is caused by:

A

drinking too much water too quickly

103
Q

Hyponatremia-low solute intake is caused by ____ which is caused by ___.

A

Decreased NaCl intake; extreme diets

104
Q

If someone has hyponatremia due to NaCl loss this would be considered:

A

hyponatremia-dehydration

105
Q

If someone has hyponatremia due to excess H2O retention, this would be considered:

A

Hyponatremia-overhydration

106
Q

If someone has hyponatremia due to decreased NaCl coming in this would be considered:

A

Hyponatremia-low solute intake

107
Q

The main consequence of hyponatremia is:

A

cell swelling

108
Q

Gradual decrease in the concentration of Na+ in the ECF over months:

A

chronic hyponatremia

109
Q

A gradual decrease in the concentration of Na+ in the ECF over months stimulates:

A

transport of Na+,K+, and organic solutes out of cells

110
Q

A gradual decrease in the concentration of Na+ in the ECF over months stimulates transport of Na+,K+, and organic solutes out of cells which causes:

A

water diffusion out of the cells

111
Q

With chronic hyponatremia, the brain swelling is attenuated by:

A

transport of solutes from the cells

112
Q

Why must we correct the concentration of Na+ in the ECF slowly when treating chronic hyponatremia?

A

to avoid osmotic demyelination

113
Q

What is osmotic demyelination?

A

Rapid loss of H2O from neurons cause axons in the CNS to become demyelinated

114
Q

Acute hyponatremia may be caused by:

A

water toxicity

115
Q

A rapid decrease in the concentration of Na+ in the ECF:

A

acute hyponatremia

116
Q

What are the causes of acute hyponatremia? (2)

A
  1. loss of Na+
  2. Excessive H2O
117
Q

Where is the movement of water in acute hyponatremia?

A

Into the cells

118
Q

What occurs with the brain in acute hyponatremia?

A

swelling of brain tissue

119
Q

What type of hyponatremia is characteristic with a marathon runner?

A

acute hyponatremia

120
Q

Increased interstitial fluid volume would cause:

A

extracellular edema

121
Q

What are the causes of increased interstitial fluid volume leading to extracellular edema?

A
  1. increased capillary filtration
  2. failure of lymphatics to return interstitial fluid to circulation (lymphedema)
122
Q

Failure of lymphatics to return interstitial fluid to circulation is called ____ and is a common cause of ____.

A

lymphedema; extracellular edema

123
Q

Increased capillary filtration causing extracellular edema is most commonly associated with:

A

congestive heart failure

124
Q

~3 liters of fluid is filtered out of the systemic capillaries everyday and that fluid gets returned by:

A

lymphatics

125
Q

What are the two main determinants of bulk flow?

A

Capillary pressure (Pc) & Plasma colloid osmotic pressure (Pi-c)

126
Q

What are the filtration forces?

A

Capillary pressure (Pc) & Interstitial colloid osmotic pressure (Pi-isf)

127
Q

What re the absorptive forces?

A

Plasma colloid osmotic pressure (Pi-c) & Interstitial hydrostatic fluid pressure (Pisf)

128
Q

What determinant of capillary filtration is due to blood pressure?

A

Capillary pressure (Pc)

129
Q

What determinant of capillary filtration is due to impermeable plasma proteins?

A

Plasma Colloid Osmotic pressure (Pi-c)

130
Q

What are the minor determinants for bulk flow?

A

Interstitial fluid hydrostatic pressure (Pisf) & Interstitial colloid osmotic pressure (Pi-isf)

131
Q

The difference between the filtration pressure and the absorptive pressures:

A

Filtration rate

132
Q

If the filtration rate is positive this means:

A

overall net filtration out of capillaries

133
Q

If the filtration rate is negative this means:

A

overall net absorption into the capillaries

134
Q

Equation for filtration rate:

A

Filtration rate= Kf ((Pc + Pi-if) - (Pif + Pi-c))

135
Q

Kf is a constant for ____. It is a fxn of the ___ & _____

A

membrane permeability; SA & membrane permeability

136
Q

List the 3 common causes for extracellular edema:

A
  1. increased capillary permeability
  2. increased capillary hydrostatic pressure
  3. decreased capillary osmotic pressure
137
Q

What are some reasons the capillary may have increased permeability?

A
  1. inflammation (infection & immune reactions)
  2. Burns
  3. Ischemia
138
Q

Anything that increases capillary permeability will allow more water and maybe even more proteins to escape into the ____.

If proteins except into the ___ this raises the ___ of the ____, drawing more water out and leading to extracellular edema

A

interstitial fluid

interstitial fluid; colloid osmotic pressure of the interstitial fluid

139
Q

Increased capillary hydrostatic pressure may be caused by: (2)

A
  1. heart failure
  2. renal disease
140
Q

Left heart failure would cause edema _____; versus generalized heart failure would cause edema ____.

A

left: edema in pulmonary circulation
generalized: edema all over body

141
Q

Decreased capillary colloid osmotic pressure can be caused by (2):

A
  1. renal loss (nephrotic syndrome)
  2. Live disease
142
Q

Liver disease causes decreased capillary colloid osmotic pressure by:

A

lack of production of plasma proteins

143
Q

Renal loss (nephrotic syndrome) causes deceased capillary colloid osmotic pressure by:

A

more loss of proteins in the urine with decreases the colloid osmotic pressure

144
Q

Edema by another name:

A

effusions

145
Q

build up of fluid in potential spaces:

A

effusions

146
Q

Potential spaces that effusions may occur in: (4)

A
  1. pleural cavity
  2. pericardial cavity
  3. peritoneal cavity
  4. synovial cavities
147
Q

Lining membranes are:

A

highly permeable

148
Q

____ is important for clearing fluid and proteins

A

lymphatic drainage

149
Q

Build up of fluid in the peritoneal space:

A

ascites

150
Q

What are the changes in the following variables after giving 2.0 liters of water i.v.?

  1. ECF Volume:
  2. ECF Osmolarity:
  3. ICF Volume:
  4. ICF Osmolarity:
A
  1. increase
  2. decrease
  3. increase
  4. decrease
151
Q
A
152
Q
A

through the skin, lungs, urine, and feces

Physiology (10 decks)

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