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Tim's Cards > Renal Q2 > Flashcards

Renal Q2 Flashcards

1
Q

What is the principal mechanism for modifying the composition of the filtered fluid?

A

Tubular reabsorption

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2
Q

Movement from the lumen into the Peritubular capillary is…

Movement from the Peritubular capillary into the lumen is…

A

Tubular reabsorption

Tubular secretion

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3
Q

Amount excreted =

A

Amount filtered (+ secreted) - amount reabsorbed

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4
Q

If amount X excreted

A

A % of X was reabsorbed

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5
Q

What are 2 examples of substances that are fully reabsorbed?

amount excreted = 0

A

Glucose

Bicarb

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6
Q

T/F
A homeostatic mechanism is altering the amount of reabsorption of the filtered load

**Are there exceptions to this????

A

True

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7
Q

What are the 2 membranes of Renal Epithelial cells?

A

Luminal

Basolateral

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8
Q

What type of transport occurs across both membranes (luminal and basolateral) of renal epithelial cells?

What type of transport occurs between renal epithelial cells across tight junctions by simple diffusion?

What type of transport is most common?

A

Transcellular

Paracellular

Transcellular

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9
Q

What does the Transcellular route require on both membranes?

A

Transport proteins

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10
Q

What does Passive Transport require?

A

favorable electrochemical gradient

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11
Q

Name 4 types of Transport.

A

Simple diffusion
Ion channels
Facilitated (uniporter, symporter, antiporter)
Energy Dependent (ATPases)

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12
Q

What is the rate limiting step in the reabsorption of sodium (and many other solutes)?

A

Na/K pump

ATP ase

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13
Q

What is the Glucose transporter of the kidney?

A

GLUT 2

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14
Q

How does the Collecting tubule transports Sodium out through the Luminal membrane?

A

Na+ selective channels through luminal side

exits cell via Na/K pumps (ATP powered)

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15
Q

How does the Proximal tubule transport Sodium out through the Luminal membrane?

A

Na+ crosses lumen via Na+/Glc symporter

exits cell via Na/K pump (ATP powered)

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16
Q

What fraction of glomerular filtrate is reabsorbed by the Proximal Tubule?

A

2/3

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17
Q

How much water is filtered per day?

How much is reabsorbed at the Proximal Tubule?

A

180L

120L

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18
Q

How is Glucose reabsorbed in the Proximal Tubule?

A

Na+ symporter on Luminal side
(Downhill Na+ carries Glc Uphill)

*SGLT-1/SGLT-2 are Na+/Glc cotransporters

GLUT2 (uniporter) on basolateral membrane

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19
Q

What is one of the principal techniques used to assess tubule function?

A

In vivo micropuncture

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20
Q

What are 2 of the anatomical limitations of In Vivo Micropuncture?
(what can’t the pipette reach)

A

Collecting tubule

Juxtamedullary nephron

*these aren’t accessible from the surface of the kidney

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21
Q

What 3 solutes are absorbed early in the Proximal Tubule?

A

Glucose

Amino Acids

Bicarb

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22
Q

What solute is absorbed late in the Proximal Tubule?

A

Cl-

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23
Q

What is absorbed throughout the entire length of the Proximal Tubule?

A

Water

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24
Q

The filtration of water and solute at the Lumen of the Proximal Tubule is what type of fluid reabsorption?

A

Isosmotic

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25
Q

If there is an isotonic relationship between the tubular fluid and interstitial fluid in the Proximal Tubule, what accounts for the Isosmotic fluid reabsorption?

A

Small transepithelial osmotic gradient

tubular fluid osmolality slightly lower than EC fluid

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26
Q

What are the 2 phases of Proximal Tubule reabsorption?

A

Water/Solutes from Lumen > Interstitium

Interstitium > Peritubular Capillaries

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27
Q

What are 2 Starling forces within Peritubular capillaries that promote fluid uptake?

A

Low hydrostatic pressure

High Oncotic pressure

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28
Q

What happens to the fluid if it’s not taken up into the capillaries?

A

Excreted in the Urine

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29
Q

T/F

The Proximal tubule reabsorbs a constant percentage of the filtered load (67%)

A

True

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30
Q

The constant percentage of filtered load reabsorbed by the Proximal Tubule is know as…

A

Glomerulotubular Balance

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31
Q

Why is Glomerulotubular Balance important?

A

Delivers fluid to distal nephron continuously

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32
Q

Name 2 ways Efferent Arteriole resistance increases Proximal Tubule reabsorption (export)

A

Peritubular pressure goes down

Increased filtration fraction causes increases Oncotic pressure within Peritubular capillaries

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33
Q

Where are pipette A and B sampled in In Vivo Micropuncture?

A

Pipette A - Proximal convoluted tubule

Pipette B - Distal convoluted tubule

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34
Q

What are the samples from In Vivo Micropuncture compared to?

A

A (Proximal tubule) compared with Plasma

A and B (Proximal and Distal) compared to ascertain late Proximal tubule and Loop of Henle

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35
Q

What is the advantage to In Vitro Microperfusion?

A

Any segment of nephron can be analyzed

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36
Q

What is the Primary site of secretion of organic anions and cations?

A

Proximal Tubule

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37
Q

What are 3 reasons a substance must be secreted?

can’t be filtered by Glomerulus

A

Molecular size
Charge
Plasma binding protein

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38
Q

Name 2 anionic Organic Ion Transporters on the basolateral membrane.
(used in Secretion)

A

OAT-(1,3)
NaDC

*(Na-dicarboxylate co-transporter)

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39
Q

Name 2 anionic Organic Ion Transporters on the Luminal membrane
(used in secretion)

A

OAT4

MRP2

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40
Q

Name a cationic Organic Ion Transporter on the Basolateral side.

Name 2 cationic Organic Ion Transporter on the Luminal side.

A

OCT

OCTN
MDR1

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41
Q

What is the rate limiting step in Tubular Secretion?

A

Na/K ATPase

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42
Q

T/F

Organic anion and cation transporters are non-selective

A

True

*relatively non-selective

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43
Q

How might the secretory system in the kidney be manipulated to enhance the effect of drugs?

A

Block transporters with inert substances increases uptake

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44
Q

What are 2 drugs that are completely dependent on tubular secretion to be effective?

A

Furosemide

Bemetanide

*Diuretics

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45
Q

T/F

The Proximal Tubule is the only site of secretion in the nephron.

A

False

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46
Q

Equations for the following:

Amount filtered

Amount excreted

Amount reabsorbed

A

Filtered: GFR x Plasma conc.

Excreted: Volume x Urine conc.

Reabsorbed: Amount filtered - Amount excreted

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47
Q

How do we experimentally illustrate the transport maximum concept?

A

Renal handling of Glucose

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48
Q

The plasma concentration at which Tm is exceeded is called?

A

Threshold

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49
Q

The variance in Tm between individual nephrons is called?

A

Splay

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50
Q

The maximal transport capacity when all carriers/channels are maxed is called…

A

Tm

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51
Q

What is the relationship between GFR and Threshold?

A

Generally GFR is proportional, but Glucose Threshold is exceeded/excreted until 2mg/ml, then curves toward proportionality

*normal plasma glc conc. well below threshold

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52
Q

T/F

Diabetes mellitus is a compensatory response of the kidneys to lower Plasma Glucose

A

False

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53
Q

Why is there Glc in urine (glcosuria) in Diabetes Mellitus?

A

Filtered load of Glc (GFR x Pglc)&raquo_space;> Tm

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54
Q

Why can Inulin and Creatinine be used to measure GFR?

2 reasons

A

Not reabsorbed or secreted

Not metabolized or produced by Kidney

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55
Q

T/F

The clearance of Inulin or Creatinine is equal to the GFR

A

True

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56
Q

What is the Clearance Forumula?

A

Cx = V x Ux / Px

Clearance of X = Volume plasma cleared / time

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57
Q

For inulin and creatinine, all of the plasma filtered by the glomeruli is effectively “cleared”

A

True

*not reabsorbed

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58
Q

T/F
Using inulin or creatinine when testing GFR will yield slightly different results. The same inert substance should be used with each test to ensure consistent results.

A

True

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59
Q

Using Inulin or Creatinine in addition to another solute will tell us what?

A

How much solute is cleared

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60
Q

Why does the amount of PAH into the kidney = Renal Plasma Flow?

A

All PAH excreted

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61
Q

T/F
The amount of PAH in the renal artery will equal the amount in the urine

PAH will not be present in the renal vein

A

True

True

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62
Q

T/F

The same fundamental formula is used to measure Renal Plasma Flow and GFR

A

True

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63
Q

How do we calculate renal blood flow from renal plasma flow?

A

Add the Hematocrit back in

*about .45
45%

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64
Q

What progressively increases from the cortex/medulla border to the papilla tip?

A

Interstitial osmolarity

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65
Q

What establishes the increasing hypertonicity as you travel deeper into the nephron?

A

Interstitial NaCl and Urea

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66
Q

T/F

The absolute values for the osmolarity changes to the interstitium are universal

A

False

Rats have 2x concentration

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67
Q

Why is the unique environment of the Interstitium so important?

A

Essential for urine concentration

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68
Q

Are there examples of the same kind of Interstitial environment found in the nephron elsewhere in the body?

A

No

69
Q

T/F

Nephron only interstitium in body that can stand a Hypertonic environment

A

True

70
Q

How do the transport characteristics of the thin descending and ascending limbs of the Loop of Henle differ?

A

Thin descending: reabsorbs Water (no NaCl)

This ascending: reabsorbs NaCl (no Water)

71
Q

How much water does the thin descending limb reabsorb per day?

A

30-40 Liters

72
Q

How much (%) NaCl does the thin/thick ascending loop of Henle reabsorb per day?

A

20-25% of Filtered load

73
Q

The thin descending limb concentrates fluid from 300 to _____ mOsm/L
(long looped nephrons)

A

1200

74
Q

The thick ascending limb dilutes fluid from 1200 mOsm/L to _______

A

100

75
Q

At the tip (of the Loop of Henle), what is the osmolarity of short nephrons?
long looped nephrons?

A

800 (short looped)

1200 (long looped)

76
Q

What immediately transports water away from the interstituim, thereby preventing the neutralization of the osmotic gradient?

A

Vasa Recta

specialized capillaries

77
Q

What is the common term for the ascending limb of the loop of Henle?

**Why?

A

Diluting Segment

**resorption results in dilution

78
Q

What is the unique transporter found on the Luminal membrane of the Thick Ascending Limb?

What is on the Basolateral side?

A

Na/K/2Cl co-transporter

Na/K ATPase

79
Q

What are 2 reasons the tubular lumen must have a high concentration of K+

A

Na/K/2Cl cotransporter

Generates Lumen positive potential to drive Paracellular transport of other cations

80
Q

How are Na, K, Ca, Mg reabsorbed Paracellularly?

A

K gradient in Lumen

81
Q

Which class of drugs affect transport in the Thick Ascending Limb?

Name 2

A

Loop Diuretics

Furosemide
Bumetanide

82
Q

What do Loop Diuretic inhibit?

A

Na/K/2Cl Cotransporter

83
Q

The Distal Nephron is made up of what two structures/segments?

A

Distal Convoluted Tubule

Collecting Tubule

84
Q

What fraction of the filtered load of Water and NaCl remain by the time the Distal Nephron is reached?

A

10% Water

10% NaCl

85
Q

What 2 hormones regulate Water and Na reabsorption in the Distal Nephron?

A

ADH - water

Aldosterone - Na

86
Q

What happens to the distal collecting tubule in the presence of ADH?

A

Antidiuresis

Distal Collecting Tubule more permeable to water

87
Q

T/F

In Diuresis, the distal collecting tubule is impermeable to water due to lack of ADH

A

True

88
Q

Why does tubular fluid become even more dilute from beginning to end of Distal nephron?

A

NaCl further reabsorbed

89
Q

How does ADH make the collecting tubule cell permeable to water?

What side is affected?

A

Aquaporin II inserted on Luminal side

90
Q

What second messenger does ADH use to stimulate AQP-2 on the Luminal membrane?

What is the pathway?

A

cAMP

Basolateral ADH > cAMP > PKA > AQP-2

91
Q

AQP-2 is in what membrane?

AQP-3 is in what membrane?

A

Luminal

Basolateral

92
Q

Where are Aquaporins in the low ADH state?

A

Intracellular vescicles

*storage

93
Q

T/F

Both AQP-2 and AQP-3 are under the influence of ADH

A

False

*AQP-3 on basolateral side constitutively expressed

94
Q

What are the 2 effects of Aldosterone and where does it act?

A

Reabsorbs Na+

Secretes Potassium

Cortical collecting tubule

95
Q

What is the intracellular mechanism of Aldosterone?

A

Steroid hormone, so stimulates Transcription factors for Na/K pumps

96
Q

ADH is _____, while Aldosterone ______

A

Fast acting

Takes hours

97
Q

Circulating Glucocorticoid (cortisol) is prevented from affecting Na reabsorption by what enzyme?

A

11 B-hydroxysteroid dehydrogenase type 2

*mutations of which cause hypertension (also licorice)

98
Q

What is countercurrent multiplication?

A

Deposition of NaCl

99
Q

T/F
Without countercurrent multiplication, isotonic fluid of 100 mM NaCl would flow through the ascending limb into the distal tubule

A

True

100
Q

3 Step model of Countercurrent Multiplication

A

Step 1: NaCl from ascending tubule flows into interstitium via Active Transport

Step 2: Water from descending tubule follows Na via Passive Diffusion

Step 3: Multiple cycles sets up Vertical Gradient

101
Q

The Vertical Gradient goes from 590 to 315, but the Horizontal Gradient is always within…

A

100-200 mOsm

102
Q

What section of tubule cannot reabsorb urea?

What sections can?

In what section is Urea passively diffused into the interstiitum?

A

Cortical/outer medullary collecting tubule

Outer Medullary and Inner Medullary

Inner Medulla

103
Q

Why is ADH important for Urea reabsorption?

A

Increases permeability of Inner Medullary section of the collecting tubule

104
Q

What is the term for Urea diffusing from Inner Medullary Collecting tubule to the Interstitium, then re-concentrated and reabsorbed?

A

Urea recycling

105
Q

T/F

Decrease in ADH will decrease Urea excretion

A

True

106
Q

A decrease in ADH will decrease Urea reabsorption, which decreases general osmolarity. What else, then, is affected by a decrease in ADH?

A

Decrease in interstitial NaCl

107
Q

What ensures the hypertonic gradient in the medullary interstitium remains Hypertonic

A

Countercurrent Exchange in the Vasa Recta

108
Q

The osmolality of the Vasa Recta will be higher flowing out than in. Why?

A

Reabsorbs all water by descending limb

Reabsorbs Most NaCl by ascending limb

109
Q

How is the hypertonicity of the Medulla maintained by the Vasa Recta?

A

As it flows out, NaCl and Urea flow from Plasma to Interstituim

110
Q

Why is the flow rate of the Vasa Recta higher flowing out than in?

A

Picks up all water from descending limb

111
Q

What happens to Medullary cells in a hypertonic environment?

In this environment, what diffuses into cells to disrupt proteins?

A

Shrinkage

Urea

112
Q

What protects Medullary cells from their hypertonic environment full of urea?

What is the Transcription factor?

A

Organic Osmolytes

TonEB

113
Q

What increases intracellular osmolarity and disrupts Urea effects in the cell?

A

Osmolytes

*by TonEB

114
Q

What is the Balance Concept?

A

Water Input = Water Output

115
Q

What are the major sources of Water Input and Output?

A

Input: Food, Fluid, Metabolism

Output: Insensible losses (feces, sweat, urine)

116
Q

Maximum Diuresis Urine Volume:

Maximum Antidiuresis Urine Volume:

A

20-25L/day

.5L/day

117
Q

Why can’t we shut down water excretion completely in extreme circumstances?

A

500mL is lowest volume to dissolve solutes that MUST be excreted in solution

118
Q

What class of hormone is ADH?

A

Peptide hormone

119
Q

Where is ADH synthesized?

Stored and Secreted?

A

Supraoptic and Paraventricular nucleii of hypothalamus

Posterior Pituitary

120
Q

ADH secretion is regulated by what 2 receptors?

A

Hypothalamic osmoreceptors

Volume receptors (baroreceptors)

121
Q

What regulatory mechanism of ADH secretion is more sensitive, the osmoreceptors of the hypothalamus or the volume receptors?

A

Osmoreceptors

122
Q

Do the Barorecptors and Osmoreceptors regulating ADH interact?

A

Yes. Volume status influences osmolality and ADH secretion

123
Q

What is the plasma osmolality at which ADH secretion = 0

A

Set point

124
Q

T/F

Small changes in ADH can elicit large changes in urine osmolality

A

True

125
Q

In a state of water deficit, an increase in ADH will do what?

A

Minimize further loss of water

*not replace

126
Q

What controls thirst?

A

Extracellular Osmolarity

127
Q

What can be caused by Trauma, Tumors, or Drugs that affects ADH?

A

SIADH

Syndrome of Inappropriate ADH secretion

128
Q

In SIADH, there is an overproduction of ADH, leading to Hyponatremia, and can lead to coma

A

True

129
Q

What are the 2 causes of Diabetes Insipidus?

A

Hypothalamic

Nephrogenic

130
Q

T/F

In diabetes insipidus, you have no ability to reabsorb water, so urine output is very high. Leads to Hypernatremia.

A

True

131
Q

2 treatments for Diabetes Insipidus:

A

synthetic ADH nasal spray

make sure Water output = Water input

132
Q

What is the assessment of the diluting efficiency of the thick ascending limb?

A

Free Water Clearance

133
Q

The amount of distilled water that must be added to or removed from urine to create an Isotonic fluid is Free Water Clearance, and tells us…

A

Diluting efficiency of Thick Ascending Limb

134
Q

Is the standard Clearance formula used for Free Water Clearance?

A

No

Ch2o = V - Cosm

135
Q

When would Free Water Clearance = 0

A

When excreting Isotonic Urine

136
Q

When Hypertonic urine is excreted, what is the term used?

A

Free Water Absorption

137
Q

What are 3 reasons ECF volume is directly related to total body NaCl?

A

ECF to ICF shifts

ADH secretion/distal nephron reabsorption

Thirst

138
Q

How do kidneys maintain constant ECF?

A

Adjust NaCl excretion to match NaCl intake

139
Q

Na+ excretion is primarily regulated by _____ on the ________.

(latter is only place Aldosterone affects Na reabsorption )

A

Aldosterone

Cortical Collecting Tubule

140
Q

In what 3 ways does Aldosterone control reabsorption of Na+?

A

Na+ channels on Luminal side

Na/K ATPase synth

Increases Krebs enzyme synth
(more ATP for ATPase)

141
Q

The action of Aldosterone takes _______.

The action of ADH takes _______.

A

Hours

Minutes

142
Q

Why is the measurement of extracellular fluid sodium concentration not a reliable index of total body sodium content?

What is a better measurement for sodium content?

A

Volume from ICF compensates and returns osmolarity to normal.

ECF Volume

143
Q

What is ECV?

How is it monitored?

A

Effective Circulating Volume

Baroreceptors

*this is an effective measurement of Sodium

144
Q

What is the rate limiting step in the Renin-Angiotensin-Aldosterone System?

A

Renin release from Kidney

145
Q

T/F

Renin is a hormone

A

False

*it’s an enzyme

146
Q

Where is Antiotensinogen synthesized?

A

Liver

*in circulation

147
Q

Where is Angiotensin I converted to Angiotensin II?

A

Lungs

148
Q

Where is Aldosterone synthesized?

A

Zona glomerulosa of Adrenal Cortex

149
Q

What is the apparatus that regulates renal blood flow and glomerular filtration rate found by the glomerulus?

A

Juxtaglomerular apparatus

150
Q

Where is Renin synthesized?

A

Granular Cells of the Juxtaglomerular Apparatus

151
Q

What are the 3 mechanisms regulating Renin release?

A

Baroreceptors

Sympathetic nerves

Macula Densa

152
Q

Why doesn’t the autoregulatory control of the Macula Densa increase pressure? Why the Renin?

A

Blood Pressure (macro) has to increase

153
Q

What increases Cardiac Output to help restore “normal” blood pressure despite low ECV>

A

Angiotensin II’s Rapid Onset effects

154
Q

What are the 2 longer onset effects of Angiotensin II?

A

Decrease NaCl and water excretion

Increase NaCl and water intake

155
Q

T/F

Sustained increases in aldosterone secretion results in relatively transient Na+ retention

A

True

156
Q

What is the cessation of Sodium retention of Aldosterone due to pressure natriuresis and pressure diuresis?

A

Aldosterone Escape

157
Q

ECF volume after escape…

A

Continues to rise?

158
Q

Positive sodium balance:

Negative sodium balance:

A

Intake > excretion

Excretion > intake

159
Q

What is the most direct indication of a Positive and Negative sodium balance?

A

Water Retention or Water Excretion

160
Q

Why do the Kidneys have a difficult time with sudden and sustained changes in sodium intake?

A

Because it operates on Aldosterone and is transcription/channel dependent, Kidney takes days to adjust.

161
Q

Where is Atrial Naturetic Peptide synthesized?

What stimulates its release?

A

Atrial Monocytes

ECV increase

162
Q

In what 4 ways does ANP excrete salt?

A

Vasodilation afferent arteriole

Aldosterone inhibition

NaCl reabsorption inhibition

Inhibits ADH release/action on collecting tubule

163
Q

T/F

Under normal circumstances, ANP doesn’t do much

A

True

  • things must be whack
  • *AngII is primary means of regulation
164
Q

What condition is a result of mutations in one or more ascending limb transport proteins?

A

Bartters Syndrome

165
Q

5 physiological abnormalities of Bartter’s Syndrome:

A 
Salt wasting
Volume depletion
Hyperreninemic hyperaldosteronism 
Hypercalciuria
Hypokalemic metabolic alkalosis
166
Q

What disease is marked by fluid filled sacs that develop from renal tubular epithelial cells
(and is autosomal dominant 85%)

A

Polycystic Kidney Disease

167
Q

Name 4 classes of Diuretics

A

Proximal tubule carbonic anhydrase inhibitors

Thick ascending limb “loop diuretics”

Distal tubule luminal NaCl cotransport inhibitors

Collecting tubule K+ sparing diuretics (inhibit Na channels)

168
Q

What is the accumulation of excess fluid in the interstitial space?

*caused by?

A

Edema

*Starling forces out of whack

169
Q

How does normal kidney function exacerbate edema?

A

Reabsorbs Na and Water, which decreases Oncotic Pressure

Tim's Cards (140 decks)

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