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os renal > Renal Physiology I - Wall > Flashcards

Renal Physiology I - Wall Flashcards

1
Q

Which ion determines size of the extracellular fluid volume?

A

Na

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2
Q

Which ion has the greatest effect on blood pressure?

A

Na

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3
Q

What is the major body anion?

A

Cl

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4
Q

What are the major waste products that the kidney is in charge of clearing?

A

Urea (from protein), creatinine (from muscle metabolism), and uric acid (from nucleic acid metabolism)

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5
Q

What is 1-alpha hydroxylase?

A

Enzyme in kidney in charge of final synthesis step for active vitamin D

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6
Q

What is bradykinin?

A

A vasodilator important for regulating vasofiltration rates

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7
Q

What are the three ways through which the kidney as an organ maintains blood pressure?

A

1) Homeostasis of Na and H20
2) Controling renin-angiotensin system
3) Producing vasodilatory substances

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8
Q

Does the kidney have an important role in regulating insulin levels?

A

Yes because it excretes insulin. In instances of kidney atrophy, less cleared insulin means hyperglycemia

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9
Q

What is neutral balance?

A

Diet intake + endogenous production = excretion rate

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10
Q

What is positive balance?

A

Intake + endogenous production > excretion, leading to increased total body content

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11
Q

What is negative balance?

A

Intake + endogenous production < excretion, leading to decreased total body content

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12
Q

About how much of the glomerular filtrate is reabsorbed?

A

~99%

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13
Q

How does filtrate differ from blood?

A

Filtrate doesn’t have cells or large proteins

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14
Q

What is always the best measure of overall kidney function?

A

GFR

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15
Q

Is water ever secreted into the tubule downstream from the glomerulus?

A

NO

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16
Q

Where are the kidneys located anatomically?

A

Retroperitoneal from T12-L3

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17
Q

Which part of the kidney is most perfused?

A

Cortex, with about 98% of total kidney flow

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18
Q

What is the area called where the ureters, vessels, lymphatics, and nerves enter the kidney?

A

Renal hilus

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19
Q

What type of anemia would you expect to see in someone with a reduced-function kidney?

A

Less EPO leads to low reticulocytes and thus a normocytic normochromic anemia

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20
Q

What is the function of prostaglandins secreted by the kidney?

A

Autoregulation of CFR, particularly via PGI2 and PGE2

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21
Q

What is endothelin?

A

Made during endothelial injury; very powerful vasoconstrictor

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22
Q

How is potassium eliminated by the kidney?

A

Secretion (as opposed to filtered out at the glomerulus)

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23
Q

Where do the glomeruli reside in the kidney?

A

Cortex

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24
Q

Describe the flow of urine from the collecting duct

A

Duct –> papilla –> minor calyx –> major calyx –> renal pelvis

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25
Q

Where is the most common site of urine blockage in males and what is this called?

A

Prostatic uretha; obstructive uropathy

26
Q

Where is the ureter most vulnerable to obstruction?

A

Pelvic-ureteral junction
Crossing pelvic brim
Urinary trigone (bladder)

27
Q

Trace the flow of blood starting in the renal artery

A

Renal artery, segmental artery, lobar artery, interlobar artery at the corticomedullary junction, arcuate arteries, interlobular artery, afferent arteriole, glomerulus, efferent arteriole,

28
Q

Compare the pressure of juxtamedullary and cortical nephrons?

A

Cortical nephrons have slightly lower perfusion pressure, being further from aorta

29
Q

Which type of nephron has the longer loop of Henle?

A

Juxtamedullary

30
Q

What are juxtamedullary nephrons particularly important for?

A

Maximal water conservation and urine concentration

Medullary thick ascending limb esp important for Na transport

31
Q

Why do you not want much perfusion to the medulla?

A

Want to maintain the hypertonic medulla in order to concentrate urine through secretions

32
Q

What do the efferent arterioles turn into?

A

Peritubular capillary network of cortical nephrons

33
Q

Where does the capillary network in the medulla come from?

A

Vasa recta

34
Q

Which types of nephrons are always operating at full capacity?

A

Juxtamedullary, thus they are at greatest risk for hemodynamic stress

35
Q

Which proteins lead to congenital nephrotic syndrome when defective?

A

Podocin or nephrin

36
Q

What are the key cells in the proteinuric condition?

A

Podocytes

37
Q

Which Starling forces promote filtration out of the capillary?

A

Hydrostatic pressure within capillary

Oncotic pressure within interstitium

38
Q

Which Starling forces oppose filtration out of the capillary?

A

Oncotic pressure within capillary

Hydrostatic pressure within interstitium

39
Q

What is the GFR formula?

A

LP*S(delP-delTau)

Lp - capillary wall permeability
S - glomerular capillary SA
delP - hydrostatic pressure gradient between capillary and Bowman’s space
delTau - Oncotic pressure gradient between capillary and Bowman’s space

40
Q

What is the main thing that determines GFR?

A

High glomerular capillary pressure

41
Q

Why is oncotic pressure low in Bowman’s space?

A

Because albumin was prevented from entering

42
Q

What are some features of mesangial cells?

A

Contractile to adjust filtration rate
Macrophage activity
Ground material for stabilization of glomerulus structure

43
Q

When you think proteinuria, you think what?

A

Dysfunctional podocytes

44
Q

What process does the macula densa govern?

A

Tubular-glomerular feedback

45
Q

What changes to the arterioles occur during hypovolemia?

A

Afferent relaxes, efferent constricts

46
Q

What is pressure natriuresis?

A

Increased urinary flow due to increased perfusion pressure, which results in more Na+ excretion and therefore also water; however this does NOT mean that GFR has changed

47
Q

What is filtered load?

A

[Plasma] x GFR of a solute; represents amount of substance in plasma filtered per unit time

48
Q

What is excretion rate?

A

[urine] x UFR; represents amount of substance excreted into the urine per unit of time

UFR is not autoregulated like GFR is

49
Q

What is an exogenous example of something used to measure GFR?

A

inulin

50
Q

What is an endogenous example of GFR measurement?

A

Creatinine

51
Q

Is creatinine exactly the same as GFR?

A

No, it is ~10 secreted in tubule so measuring creatinine overestimates GFR by 10%

52
Q

Pinulin x GFR =

A

Uinulin x UFR

53
Q

For inulin, filtered load is equal to….

A

excretion rate

54
Q

What is the simplified formula for GFR?

A

([U] x UFR ) / [P]

55
Q

What is the clearance ratio?

A

(clearance rate of substance) / GFR

56
Q

What substances would you expect to have a clearance ratio of ~1?

A

Inulin, creatinine

57
Q

What does it mean if clearance ratio is <1 and what is an example?

A

Solute is filtered but reabsorbed

Na

58
Q

What does it mean if clearance ratio is >1 and what is an example?

A

Solute is filtered and actively secreted as well

K+, H+

59
Q

What are some reasons a substance could have a clearance ratio of 0?

A

Too large to be filtered (proteins)
Highly protein bound (e.g., meds)
Filtered but 100% reabsorbed (glucose/AAs)

60
Q

How do you measure renal plasma flow?

A

Using para-aminohippurate (PAH), an exogenous substance that is filtered and also actively secreted to the point of complete extraction in one pass

61
Q

What is GFR (not formula)?

A

How much blood passes through glomeruli per minute

62
Q

What is the clearance of PAH equal to?

A

Renal plasma flow

os renal (25 decks)

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