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Physiology II > Renal Physiology II > Flashcards

Renal Physiology II Flashcards

Chad Touchberry, PhD UMKC – SOM, Basic Medical Sciences

1
Q

Why is reabsorption & secretion important?

A
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2
Q

What is mainly filtered in the proximal tubule?

A
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3
Q

What is reabsorbed in the proximal tubule into the tubular fluid?

A
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4
Q

What is mainly reabsorbed in the descending limb?

A

Water

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5
Q

What is mainly reabsorbed in the ascending limb?

A
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6
Q

What ions are reabsorbed in the distal tubule?

A
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7
Q

What ions are reabsorbed in the distal tubule?

A
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8
Q

What is reabsorbed first in the collecting duct?

A
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9
Q

Lastly, what is secreted in the collecting duct?

A
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10
Q

What is Glomerulotubular balance?

A
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11
Q

What does Glomerulotubular balance accomplish?

A
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12
Q

How does high GFR stimulate more reabsorption?

A
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13
Q

Early Proximal Tubule (67%): Na+ Co-Transport

What are the main transporters?

A
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14
Q

What percentage of Na+/Cl-/K+ and H2O are reabsorbed in the proximal tubule?

A

67%

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15
Q

What percentage of Na+ coupled HCO3- /H+ transport occurs in the proximal tubule?

A

80%

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16
Q

What percentage of Na+ coupled Glu, AA, Pi transport occurs in the proximal tubule?

A

98%

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17
Q

Where can drugs/toxins (pancuronium/morphine) build up in patients with AKI or CKD?

A

Proximal tubule

Toxins and drugs are secreted here. (Morpine & Pancuronium “build up” in pts w/ AKI or CKD!

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18
Q

What transporter is most important for Na+ & water reabs.?

A
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19
Q

What is the main function of the Na+/H+ antiporter (NHE) / Na+/HC03- co-transporter?

A
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20
Q

Where do carbonic anhydrase inhibitors work?

A

Carbonic anhydrase inhibitors -Na+ and bicarb bind in lumen and some is excreted. Lose K+! (moderately powerful).

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21
Q

What is the function of angiotensin II and where does it work?

A

Stimulates NHE, Na+/HCO3-, & Na+/K+ pump in the proximal tubule to ultimately raise BP

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22
Q

What stimulates and inhibits the Na+/Pi (NaPi) & Na+/Glucose transporters (SGLT)?

A
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23
Q

How does the Tubular fluid/Plasma concentration vary between ions and substances in the proximal tubule if:

=1
>1
<1

A
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24
Q

What limits how fast things can be reabsorbed?

A
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25
Q

Board Review…

A
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26
Q

What is the big picture of the descending LOH…

A
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27
Q

What is the big picture of the Thick Ascending Limb LOH (25%): Na/Cl/K Co-Transport?

A
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28
Q

What is the purpose of the Na+/K+/Cl- (NKCC2) transporter in the ascending LOH?

A
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29
Q

What is the role of ADH in the ascending LOH?

A

ADH – Increases NKCC2 activity.

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30
Q

What are the function of Loop diuretics in the ascending LOH?

A

Loop diuretics - Furosemide (Lasix)

Lose Ca2+ and Lose K+! (very powerful)

31
Q

What is the purpose of the Na+/H+ antiporter (NHE) in the ascending LOH? What effect does carbonic anhydrase inhibitors have here?

A
32
Q

What is the big picture of the Distal Tubule (5%): NaCl Co-Transport?

A
33
Q

What is the purpose of the Na+/Cl- Cotransporter (NCC) in the distal tubule? What diuretics act here?

A
34
Q

How are Ca2+ TRP channels regulated in the distal tubule?

A
35
Q

Whats the big picture of the Distal cortical tubule/Cortical collecting duct?

A
36
Q

What is the function of the principle cells in the distal corticle tubule/cortical collecting duct?

A
37
Q

How does ADH work in the Distal cortical tubule/Cortical collecting duct?

A
38
Q

How does amiloride work in the Distal cortical tubule/Cortical collecting duct?

A
39
Q

What is the function of Type A intercalated cells in the Distal cortical tubule/Cortical collecting duct?

A
40
Q

So how do the [substances] change as they move through the regions of the nephron?

A
41
Q

So how do the [substances] change as they move through the regions of the nephron?

A
42
Q

So how do the [substances] change as they move through the regions of the nephron?

A
43
Q

So how do the [substances] change as they move through the regions of the nephron?

A
44
Q

General review of transport in the nephron. (If you know this you know renal physiology)

A
45
Q

What is the role of ADH in the body?

A
46
Q

How can we obtain such a wide range of urine Vol and Osm?

A
47
Q

The Loop of Henle: Counter current flow acts as a countercurrent multiplier!

Explain the countercurrent multiplier.

A
48
Q

ADH is regulated by Osm & Vol/Pressure

ADH responds greater to changes in _________.

RAAS responds greater to changes in __________.

A

ADH responds greater to changes in mOsmolarity (Na+).

RAAS responds greater to changes in plasma volume.

49
Q

How does ADH controls ECF via urine concentration in the distal nephron?

A
50
Q

How does ADH respond to changes in plasma osmolarity?

A

ADH concentrates the urine and maximizes the medullary osmotic gradient

51
Q

Board Review…

A
52
Q

What mainly controls Na+ reabsorption? How does ANP/BNP affect reabsorption?

A
53
Q

How do AngII and Aldosterone increase Na+ reabsorption?

A
54
Q

How does ANP/BNP regulate Na+ transport?

A
55
Q

What happens during a hemmorhage?

A
56
Q

What factors increase/decrease sodium excretion?

A
57
Q

How does the RAAS system control K+ excretion/reabsorption?

A
58
Q

How does an increase in K+ not result in hyperkalemia, independent of the RAAS system?

A
59
Q

What determines the [K+]ICF -vs- [K+]ECF?

A
60
Q

How does an ↑Plasma K+ lead to ↑K+ secretion/excretion?

A
61
Q

What does an ↑ Flow do to distal nephron principal cells?

A
62
Q

What factors regulate how much K+ is excreted?

A
63
Q

How do early diuretics = ↑K+ & NaCl secretion/excretion?

A
64
Q

Hormonal Regulation:
Practice Problems

A
65
Q

Hormonal Regulation:
Practice Problems

A
66
Q

Hormonal Regulation:
Practice Problems

A
67
Q

Hormonal Regulation:
Practice Problems

A
68
Q

Hormonal Regulation:
Practice Problems

A
69
Q

Hormonal Regulation:
Practice Problems

A
70
Q

What are three factors that stimulate potassium secretion by the principal cells?

A
  1. Increased extracellular fluid potassium concentration
  2. Increased aldosterone
  3. Increased tubular flow rate
71
Q

What is one factor that decreases potassium secretion?

A

Increased hydrogen ion concentration (acidosis)

72
Q

Increased dietary potassium intake and increased extracellular fluid potassium concentration stimulate potassium secretion by what four mechanisms?

A
  1. Na+/K+ ATPase is stimulated increasing potassium uptake across the basolateral membrane which ultimately makes its way across the luminal membrane into the tubule
  2. Increased extracellular K+ increases the potassium gradient from the renal interstitial fluid to the interior of the epithelial cell, which reduces backleakage of K+ from the inside of the cells through the basolateral membrane
  3. Increased K+ intake stimulates more potassium channels from the cytosol to luminal membrane, increasing K+ diffusion
  4. Aldosterone is stimulated by the adrenal cortex, which further stimulates K+ secretion
73
Q

If renal clearance is greater than the GFR, that implies there must be __________ of that substance

A

secretion

Physiology II (10 decks)

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