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Physiology > Renal Physiology I (Exam V) > Flashcards

Renal Physiology I (Exam V) 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 & symptoms in soft hard tissues

A

90%

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3
Q

_____ & _____ of body fluid compartments are essential for homeostasis

A
  1. Constant volume
  2. Stable composition
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4
Q

In order to maintain body fluid homeostatis ____ & ____ in must equal ____ & ____ out

A

Water & electrolytes; water & electrolytes out

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5
Q

Fluid distribution in the body influences:

A

Electrolyte concentrations

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6
Q

Electrolytes concentrations influence:

A

Fluid distribution in the body

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7
Q

What causes water gain?

A
  1. Food & drink
  2. Metabolism
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8
Q

Where can water be lost?

A
  1. Skin
  2. Lungs
  3. Urine
  4. Feces
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9
Q

Sweat & evaporation leading to water loss occur where:

A

Lungs & skin

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10
Q

What is insensible water loss?

What does this mean?

A

Sweat & evaporation; can’t be controlled

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11
Q

Urine output is typically ____ but varies to create ____

A

1.5L/day; balance

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12
Q

What amount insensible water loss do we have per day?

(70kg man)

A

0.9L/ day

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13
Q

How much water is lost through feces per day?

(70kg man)

A

0.1 L/day but varies

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14
Q

What amount of water gain brought in through food & drink per day?

(70kg man)

A

2.2 L/day

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15
Q

How much water gain does metabolism bring in per day?

(70kg man)

A

0.3L/day

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16
Q

We want the extracellular fluid & intracellular fluid volumes to be:

A

Constant

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17
Q

Imbalances change vascular & total body volumes:

A

Na+

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18
Q

The primary determinant of extracellular fluid osmolarity & 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 & neural functions:

A

K+

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21
Q

Potassium plays a role in our:

A

Excitable tissues

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22
Q

Imbalances alters skeletal muscle, cardiac, neural function & bone structure:

A

Ca++

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23
Q

Necessary for synaptic transmission, skeletal/cardiac/smooth muscle contraction & one of the primary components making up the bone:

A

Ca++

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24
Q

H+ comes mainly from:

A

Metabolism

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25
Q

Imbalances of this ion alters multiple systems

A

H+

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26
Q

Imbalances in pH impacts multiple systems because pH impacts:

A

Protein function

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27
Q

Extracellular fluid makes up _____% of the body weight in kilograms

Intracellular fluid makes up ____% of the body weight in kilograms

A

ECF = 20%
ICF = 40%

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28
Q

Extracellular fluid breaks down into:

A

Plasma & interstitial fluid

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29
Q

ECF found within the blood vessels:

A

Plasma

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30
Q

ECF found outside of blood vessels & outside of 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 & 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 kilograms?

A

Plasma

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34
Q

Our is comprised of:

____L of intracellular fluid

____ L of extracellular fluid

The ECF breaks down into
____L of interstitial fluid
____L of plasma

A

28- ICF

14- ECF
11 IF
3 Plasma

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35
Q

Plasma and interstitial fluid are extremely similar in composition, the only thing that cannot move back & forth between these 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, total body water volume is _____L, making up____% of body weight (kg)

A

42L
60%

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38
Q

What is the barrier between the ECF & ICF?

A

Plasma membrane

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39
Q

What ions are in a higher level in the extracellular fluid?

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

What ions are in a higher level in the intracellular fluid?

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

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

A

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

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42
Q

Hypervolemia:

Hypovolemia:

Normo/eu-volemia

A

High blood volume

Low blood volume

Normal blood volume

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43
Q

Hypernatremia:

Hypo natiremia:

Normo/eu-natremia:

A

High blood sodium

Low blood sodium

Normal blood sodium

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44
Q

Hyperkalemia:

Hypokalemia:

Normo/eukalemia:

A

High blood potassium

Low blood potassium

Normal blood potassium

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45
Q

Hyercalcemia:

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 plasma & interstitial fluids?

A

Hydrostatic & colloid osmotic pressure vai capillary pores & bulk flow

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48
Q

Hydrostatic & colloid osmotic pressure via capillary pores is the main force governing:

A

Bulk flow

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49
Q

Movement of substances between plasma & interstitial fluid occurs via:

A

Bulk flow

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50
Q

Fluid distribution between ICF & ECF is determined by ________ of _____ acting across cell membrane

A

Osmotic effect of small solutes

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51
Q

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

A

Impermeable substances

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52
Q

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

A

Na+ & Cl- (& other anions)

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53
Q

Anytime we have a change in extracellular fluid osmolarity what affect will this have on tonicity? Why?

A

We will also have a change in tonicity because these substances are impermeable (Na+ & Cl-)

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54
Q

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

A

K+ (& other ions)

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55
Q

The cell membrane may also be referred to as:

A

Plasma membrane

56
Q

Describe the cell membranes permeability to water:

A

High dependent on where you are in the body

57
Q

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

A

Relatively impermeable to small solutes such as these

58
Q

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

A

Because the cell membrane is relatively impermeable to these small solutes

59
Q

Cell volume is at the mercy of:

A

ECF tonicity

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

61
Q

Concentration of impermeable substances in the bathing solution is greater than the concentration of impermeable substances inside the cell: How would you describe this bathing solution?

A

Hypertonic solution

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

Isostonic solution

64
Q

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

A

Yes there is movement, but no net movement

65
Q

Concentration of impermeable substances in the bathing solution is less than the concentration of impermeable substances inside the cell: How would you describe this bathing solution?

A

Hypotonic solution

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 & volume of ECF change determines composition & 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 waterloss?

A

Because the skin a major water-proofing organ

70
Q

If a _____ solution is added into a normal individuals, the ECF volume is increased, the ECF osmolarity is unchanged & the ICF osmolarity & volume are both unchanged

A

Isotonic

71
Q

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

A

Hypertonic

72
Q

If a _____ solution is added into a normal individual, this will lower the ECF osmolarity & raise the ECF volume, creating a gradient causing the water to move into the ICF via osmosis increasing the volumes of both ECF & ICF & decreasing the osmolarities of both ECF & ICF

A

Hypotonic solution

73
Q

The kidneys regulate body fluid volume & composition by controlling:

A

ECF volume & ECF composition

74
Q

Too much water in tissues

A

Edema

75
Q

What are the two types of edema?
Which is more common?

A

Extracellular & intracellular; extracellular

76
Q

Describe what extracellular edema is:

A

Too much water in extracellular space

77
Q

Describe what intracellular edema is:

A

Too much water in intracellular space

78
Q

What are the three causes of intracellular edema?

A
  1. Hyponatremia
  2. Decreased metabolism: Na+/K+ pump failure
  3. Inflammation
79
Q

How does hyponatremia lead to intracellular edema?

A

If you don’t have enough Na+ you will lower the osmolarity of the ECF (because Na+ is higher in ECF) & this will cause water to rush into the cell = intracellular edema

80
Q

How does decreased metabolism (blood flow): Na+/K+ pump failure lead to intracellular edema?

A

The Na+/K+atpase typically pumps two K+ into the cell for every three Na+ out of the cell, if this isn’t functioning properly Na+ can build up in cell and water will follow

81
Q

How does inflammation (with a cause of things such as infection & burns) lead to hyponatremia?

A

Inflammation leads to increased membrane permeability & leakage, this would lead to alot of extra ions in the cell and water will follow

82
Q

The most important cation in the body:

A

Sodium

83
Q

Na+ salts make up >90% of _____ solute in the _____

A

osmotically active solute; ECF

84
Q

Na+ is highly ______ therefore ECF ______ is highly ____

A

Regulated; Regulated

85
Q

Too little ECF volume leads to: (3)

A
  1. Volume contraction
  2. Hypotension
  3. Organ hypoperfusion
86
Q

Too much ECF volume leads to: (4)

A
  1. Edema
  2. Ascites
  3. Pleural effusion
  4. Hypertension
87
Q

What ion do we look at to determine water balance?

A

Na+

88
Q

When the concentration of Na+ is below normal in the ECF:

A

Hyponatremia

89
Q

In hyponatremic individuals, what is their sodium level:

A

Less than 142 mOsm/L

90
Q

Na+ input < Na+ output
or
H2O input > H2O output

These would both lead to:

A

Hyponatremia

91
Q

Most common electrolier disorder in clinical practice:

A

Hyponatremia

92
Q

Hyponatremia may account for ______ of hospitalized patients

A

20-25%

93
Q

What are the three types of hyponatremia?

A
  1. Hyponatremia-dehydration
  2. Hyponatremia-overhydration
  3. Hyponatremia-low solute intake
94
Q

A type of hyponatremia characterized by increased NaCl loss:

A

Hyponatremia-dehydration

95
Q

Hyponatremia dehydration may be caused by (5):

A
  1. Vomiting
  2. Diarrhea
  3. Renal disease
  4. Diuretics
  5. Addison’s disease
96
Q

A type of hyponatremia characterized by excessive H2O retention:

A

Hyponatremia-overhydration

97
Q

Hyponatremia-overhydration may be caused by (2):

A
  1. Inappropriate ADH secretion
  2. H2O toxicity
98
Q

How does Addison’s disease lead to hyponatremia-dehydration?

A

Aldosterone stimulates Na+ reabsorption in the kidneys, so if we don’t have enough aldosterone, we won’t have enough sodium brought back into the body

99
Q

Drinking too much water too quickly:

A

H2O toxicity

100
Q

How can inappropriate ADH secretion lead to hyponatremia-overhydration?

A

ADH causes water retention, so too much ADH will cause too much water to be retained which will dilute the ECF too much leading to hyponatremia

101
Q

A type of hyponatremia characterized by decreased NaCl intake:

A

Hyponatremia-low solute intake

102
Q

What may be a cause of hyponatremia-low solute intake?

A

Extreme diets (rare)

103
Q

Characterized by a gradual decrease (can take weeks to months) in Na+ concentration in the ECF:

A

Chronic hyponatremia

104
Q

Chronic hyponatremia stimulates transport of ___, ____ and ____ (in/out) of the cells

This causes water diffusion (in/out) of the cells

A

Na+, K+ and organic solutes; out

out

105
Q

With chronic hypotanremia, the brain swelling is attenuated by:

A

transport of solutes from the cell

106
Q

Why must chronic hyponatremia be fixed slowly?

A

To avoid osmotic demyelination

107
Q

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

A

Acute hyponatremia

108
Q

Acute hyponatremia can be caused by: (2)

A
  1. Loss of Na+
  2. Excess H2O
109
Q

In acute hyponatremia water rushes (into/out) of the cells

A

into

110
Q

In acute hyponatremia, what does the water rushing into the cells cause?

A

Swelling of the brain tissue

111
Q

Not properly hydrating for a marathon leading can cause what type of hyponatremia?

A

Acute hyponatremia

112
Q

Increased interstitial fluid volume causes:

A

Extracellular edema

113
Q

What are the common causes of extracellular edema?

A
  1. Increased capillary filtration
  2. Lymphedema
  3. Increased capillary permeability
  4. Increased capillary hydrostatic pressure
  5. Decreased capillary colloid osmotic pressure
114
Q

Failure of lymphatics to return interstitial fluid to circulation:

A

Lymphedema

115
Q

What is the most common reason for extracellular edema?

A

Increased capillary filtration

116
Q

What is an example of a condition that may cause increased capillary filtration leading to extracellular edema?

A

Congestive heart failure

117
Q

Determine whether each of the following pressures is a filtration or absorption force:

  • Capillary pressure (Pc)
  • Interstitial fluid pressure (Pisf)
  • Plasma Colloid Osmotic pressure (Pi-c)
  • Interstitial colloid osmotic pressure (Pi-isf)
A

(Pc)- filtration
(Pisf)- absorptive
(Pi-c)- absorptive
(Pi-isf)- filtration

118
Q

K(f) is a constant for:

A

Membrane permeability

119
Q

K(f) is a function of:

A

The surface ares & membrane permeability

120
Q

Equation for filtration rate:

A

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

121
Q

What does it mean if the filtration rate is a positive value?

What does it mean if the filtration rate is a negative value?

A

Positive value: overall net filtration out of capillaries

Negative value: overall net absorption into capillaries

122
Q

How does increased capillary permeability lead to extracellular edema?

A

This allows more water and proteins to escape and if the proteins escape to the interstitial fluid that causes colloid osmotic pressure of the interstitial fluid, this will draw more water out and lead to extracellular edema

123
Q

What are some examples of conditions that make the capillaries more permeable? (3)

A
  1. Inflammation (infection, immune reactions)
  2. Burns
  3. Ischemia
124
Q

What are some conditions that can cause increased capillary hydrostatic pressure which ultimately leads to extracellular edema? (2)

A
  1. Heart failure
  2. Renal disease
125
Q

_____ leads to extracellular edema all over the body, while _____ leads to extracellular edema in pulmonary circulation

A

Generalized heart failure; left heart failure

126
Q

What can cause decreased capillary colloid osmotic pressure which can ultimately lead to extracellular edema: (2)

A
  1. Renal loss (nephrotic syndrome)
  2. Liver disease
127
Q

How can liver disease liver disease cause decreased capillary colloid osmotic pressure?

A

Bc the liver produces the plasma proteins so if the liver is not functioning we aren’t getting enough plasma proteins

128
Q

Describe what happens when someone has nephrotic syndrome:

A

You start losing proteins in the urine and this decreases colloid osmotic pressure leading to edema

129
Q

The buildup of fluid in other potential spaces like the pleural, pericardial, peritoneal and synovial cavities:

A

Effusions

130
Q

What are the potential spaces that an effusion may occur in? (4)

A
  1. pleural cavity
  2. pericardial cavity
  3. peritoneal cavity
  4. synovial cavity
131
Q

Effusions can happen, because lining membranes are highly:

A

Permeable

132
Q

Important for clearing fluids and proteins

A

Lymphatic drainage

133
Q

A buildup of fluid in the peritoneal space:

A

Ascites

134
Q

What are the changes in the following variable after giving 2.0L of water I.V.?

  • ECF volume
  • ECF osmolarity
  • ICF volume
  • ICF osmolarity
A
  • increase
  • decrease
  • increase
  • decrease
135
Q

The kidneys regulate body fluid volume & composition by controlling: (2)

A
  1. ECF volume
  2. ECF composition

Physiology (11 decks)

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