Renal Pt 2 Flashcards
Transport Maximums:
if you reach your reabsorption max, you have no choice but to __________ the rest.
Just memorize these numbers:
______ mg/min is max reabsorbable load for glucose
DOES NOT APPLY TO _________, which are just time dependent, aka _________ transport.
Exception: ____________
if you reach your reabsorption max, you have no choice but to excrete the rest.
Just memorize these numbers:
375 mg/min is max reabsorbable load for glucose
DOES NOT APPLY TO PASSIVELY ABSORBED, which are just time dependent, aka gradient-time transport.
Exception: Sodium reabsorption
If you have infinite glucose, you can ______ infinite glucose. However, you can only _________ so much. The leftover is __________
In passively absorbed substances, you just need time to _________.
If you have infinite glucose, you can filter infinite glucose. However, you can only reabsorb so much. The leftover is excreted
In passively absorbed substances, you just need time to reabsorb.
______% of Sodium and Water is reabsorbed in the ___________
Bicarb and glucose reabsorption also
66% of Sodium and Water is reabsorbed in the Proximal Convoluted Tubule (PCT)
Bicarb and glucose reabsorption also
this is where those SGLT2 (90%) are located
Glucose + AAs are reabsorbed in the ___________.
Urea and Creatinine ___________ in concentration here (aka ____________)
Glucose + AAs are reabsorbed in the Proximal Convoluted Tubule .
Urea and Creatinine INCREASE in concentration here (aka not reabsorbed at all)
Part of the nephron that is HIGHLY PERMEABLE TO WATER, the water is _________.
Water permeability is important for that ___________ later on, which is seen in the ___________.
Descending Loop Reabsorption
HIGHLY PERMEABLE TO WATER, the water is leaving.
Water permeability is important for that countercurrent multiplier later on, which is seen in the ascending limbs.
The Nephron:
Section with 0% PERMEABILITY TO WATER is?
Ascending Loop Reabsorption has 0% PERMEABILITY TO WATER
Part of the nephron in which the _____% of sodium leaves since water can’t. which _________ urine. A lot of reabsorption happens here!
What meds work here?
Using what transported?
Ascending loop reabsorption:
Since water can’t leave, 20% of sodium leaves instead, which concentrates urine. A lot of reabsorption happens here!
This is where loop diuretics work, on the 1Na-2Cl-1K transporter.
Distal Tubule Reabsorption
First Part = _________
Macula Densa
Distal (tubule) = _______ urine, aka reabsorbing the rest of the ions like ___________________
Completely impermeable to _______ and ________ also.
This is where ________drugs work.
Distal = Dilutes urine, aka reabsorbing the rest of the ions like Sodium-Chloride, Bicarb, and Calcium
Completely impermeable to water and urea also.
This is where thiazide drugs work.
Distal Tubule Reabsorption:
Thiazides are ________ than loops because the transporter they work on is later and affects less electrolytes.
Thiazides are weaker than loops because the transporter they work on is later and affects less electrolytes. They primarily only can cause hyponatremia or hypokalemia as side effects. They do not affect calcium or magnesium as greatly as a loop, but they are also less efficacious as a result. Big takeaway maybe for future reference is the lack of hypocalcemia as a side effect!
Where are Principal cells and Intercalated cells located and what do they do?
Cortical Collecting Tubule/Late distal tubule.
Principal cells = REABSORB Na + water into blood, Excrete K out.
Also reabsorbs a little Cl-
Intercalated cells = REABSORB K in, Excrete H+ out
Also reabsorbs bicarbonate
Principal cells are where both ______ and _______ drugs work.
Principal cells are where both Aldosterone antagonists and sodium channel blockers work.
Cortical Collecting tubule reabsorption:
Aldosterone antagonists are a lot more relevant to know about. You might know them as ________________. Since they work on the transporter that moves potassium _____, inhibiting it _________ potassium concentration in your blood. They work on the _________- pump.
Aldosterone is also known as a __________, hence it works on a mineral like _________.
Cortical Collecting tubule reabsorption:
Aldosterone antagonists are a lot more relevant to know about. You might know them as POTASSIUM SPARING diuretics. Since they work on the transporter that moves potassium OUT, inhibiting it increases potassium concentration in your blood. They work on the Sodium-Potassium ATPase pump.
Aldosterone is also known as a mineralcorticoid, hence it works on a mineral like sodium.
what is the final determinant of urine concentration?
what is the final determinant of urine concentration?
Medullary Collecting Duct Reabsorption
This is where hydrogen ion concentrations can be adjusted in case you’re too acidic/basic.
Medullary Collecting Duct Reabsorption
ADH works here
High ADH = ______ water reabsorption.
Medullary Collecting Duct Reabsorption
A little in distal and cortical?
High ADH = more water reabsorption.
Only place where urea is permeable
Medullary Collecting Duct Reabsorption
High ADH + Hyperosmotic renal medulla =
High ADH + Hyperosmotic renal medulla = concentrated urine
how we concentrate urine
Countercurrent Mechanism
There is only one place in the loop of Henle that is permeable to water:
There is only one place in the loop of Henle that is permeable to water: descending loop.
Essentially, in the ascending loop, you just keep pumping solutes into the __________
When new filtrate flows into the descending loop, it pushes water out to dilute the _______
Essentially, in the ascending loop, you just keep pumping solutes into the medulla (out of loop)
When new filtrate flows into the descending loop, it pushes water out to dilute the medulla (out of loop)
As the process of pumping solutes and filtrate into the medulla repeats, you are left with a ________ medulla, since water can only flow into the medulla at the ____________.
The entire time, the medulla cannot send _______ back into the loop. It is a one way street.
The main solute that makes the medulla hyperosmotic is _______. (requires _____)
As the process of pumping solutes and filtrate into the medulla repeats, you are left with a hyperosmotic medulla, since water can only flow into the medulla at the descending loop.
The entire time, the medulla cannot send solutes back into the loop. It is a one way street.
The main solute that makes the medulla hyperosmotic is urea. (requires ADH)
Vasa Recta Role in Countercurrent Multiplier:
Medullary blood flow is very______, so the solutes don’t flow ______ via_______.
Medullary blood flow is very slow, so the solutes don’t flow away via blood.
Vasa Recta Role in Countercurrent Multiplier:
Because the medulla is so concentrated with ______, some it flows into the Vasa Recta.
However, this makes it __________ as it continues to gain ______ but lose ________.
As it goes up the loop, the Vasa Recta is permeable to ________ unlike the loop of Henle, so it reabsorbs _________ and gets rid of ________ (aka undoing what happened in the beginning).
This ensures that all the hard work of concentrating the medulla via the _________ is not lost.
Blood gets __________ as it descends, but it is reversed as it ascends, so pretty much nothing changed and no solute is lost.
Vasa Recta Role in Countercurrent Multiplier
Because the medulla is so concentrated with solutes, some it flows into the Vasa Recta.
However, this makes it hyperosmotic as it continues to gain solute but lose water.
As it goes up the loop, the Vasa Recta is permeable to water unlike the loop of Henle, so it reabsorbs water and gets rid of solute (aka undoing what happened in the beginning).
This ensures that all the hard work of concentrating the medulla via the loop of Henle is not lost.
Blood gets hyperosmotic as it descends, but it is reversed as it ascends, so pretty much nothing changed and no solute is lost.
The Vasa Recta mirrors ________,
The Vasa Recta mirrors the loop of henle, hence why it is also U-shaped.
what can lead to hyperkalemia and metabolic acidosis.
Acute Renal Failure
Acute Renal Failure
Prerenal (AKA before the kidneys.)
________ is the MCC.
Intrarenal (Within the kidneys)
_______ is MCC
Postrenal (ureter)
___________ MCC
Prerenal
Hypoperfusion is the MCC.
Intrarenal
Abnormalities of vessels or glomeruli
Postrenal (ureter)
Kidney stones are MC
Hyperkalemia can occur because the kidneys are the primary way we _________ potassium.
Acidosis can occur because _________ is also excreted primarily via kidneys.
Hyperkalemia can occur because the kidneys are the primary way we EXCRETE potassium.
Acidosis can occur because H+ is also excreted primarily via kidneys.
3 ways acute renal failure happens:
Prerenal Acute Renal Failure
Volume depletion
Cardiac Failure
Peripheral vasodilation/shock
AKA not enough blood to flow to kidney or not enough pressure to get blood to the kidney.
Reversible unless renal blood flow is < 25%
Kidneys adjust by slowing GFR temporarily.
Glomerular capillary/vessel damage caused by:
Vasculitis, cholesterol, acute glomerulonephritis (GN)
can cause what type of renal failure?
Intrarenal Acute Renal Failure
Renal tubular epithelium damage caused by: _______
Rental interstitium damageccaused by:
_________ (UTI going up to the kidneys themselves)
_______________ (drugs or immune)
can cause what type of renal failure?
Renal tubular epithelium damage
ATN (acute tubular necrosis)
Rental interstitium damage
Acute pyelonephritis (UTI going up to the kidneys themselves)
Acute interstitial nephritis (drugs or immune)
Intrarenal Acute Renal Failure
AKA the kidneys themselves are damaged in some way, affecting their ability to filter/absorb casued what type of renal failure?
Intrarenal Acute Renal Failure
______________ is usually caused by getting a group A beta-hemolytic Streptococcus (GABHS infection), and AFTERWARDS, the infection can develop an immune complex type 3 HSR. Possible exam Q.
The GABHS bacteria is not the actual cause of acute GN.
ATN is acute tubular necrosis, pretty much damage of the tubules themselves causes them to ________. It can happen due to drugs, or ischemia.
Acute Glomerular Nephritis is usually caused by getting a group A beta-hemolytic Streptococcus (GABHS infection), and AFTERWARDS, the infection can develop an immune complex type 3 HSR (from MOD). Possible exam Q.
The GABHS bacteria is not the actual cause of acute GN.
ATN is acute tubular necrosis, pretty much damage of the tubules themselves causes them to kinda dry out and shed. It can happen due to drugs, or ischemia.
3 ways to cause postrenal acute renal failure
Bilateral obstruction of ureters/renal pelvis due to clots or stones
Bladder obstruction
Obstruction of Urethra
AKA theres a backup at the end of the kidneys.
Can be stones, but in males, it can also be your prostate!
Chronic Renal Failure leads to end stage renal disease. What are the biggest causes?
DM
HTN
Infections
Vascular diseases
(Obesity plays a role in both DM and HTN)
Even if your nephrons are dying, it’s not really visible until you’ve lost over _____% of them.
As you lose more nephrons, your kidney gets ________.
This is why kidney disease can suddenly appear, because your kidneys have been dying all along but you were asymptomatic.
The main kidney-protective drugs are __________
Even if your nephrons are dying, it’s not really visible until you’ve lost over 25% of them.
As you lose more nephrons, your kidney gets scarred.
This is why kidney disease can suddenly appear, because your kidneys have been dying all along but you were asymptomatic.
The main kidney-protective drugs are ACEs and ARBs.
What is benign but irreversible, also MC form of kidney disease
Nephrosclerosis (benign but irreversible, also MC form of kidney disease) leading to chronic renal failure
Nephrotic syndrome
__________ is MCC of nephrotic syndrome in children
It is just excretion of________ in urine.
Adult causes: __________ or amyloidosis
Nephrotic syndrome
Minimal change dz is MCC of nephrotic syndrome in children
It is just excretion of protein in urine.
Adult causes: chronic Glomerulonephritis or amyloidosis
These all cause what?
They all lead to what?
Atherosclerosis
Fibromuscular hyperplasia
Nephrosclerosis (benign but irreversible, also MC form of kidney disease)
Glomerulosclerosis
Glomerulonephritis (usually immune-complex mediated)
Pyelonephritis
Nephrotic syndrome
AMPLIFIED BY DIABETES AND HTN
Injury to the renal vessels:
Chronic Renal Failure => ESRD
Atherosclerosis
Fibromuscular hyperplasia
Nephrosclerosis (benign but irreversible, also MC form of kidney disease)
Glomerulosclerosis
Glomerulonephritis (usually immune-complex mediated)
Pyelonephritis
Nephrotic syndrome
AMPLIFIED BY DIABETES AND HTN
Plasma glucose and filtered load at what levels is the “threshold” for glucose.
Glucose above Threshold levels means ____________
Plasma glucose 200 mg/dl
Filtered load 250 mg/min
Glucose above Threshold levels means glucose starts appearing in urine
To excrete urine you must have what 2 things
High ADH level
Hyperosmotic Renal Medulla
