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CSF3 Exam 3 > Renal Structure and Function- Lee > Flashcards

Renal Structure and Function- Lee Flashcards

1
Q

What is the primary regulator of ECF volume?

A

the kidneys

The primary regulator of extraceulluar lfuid volume

Typically 14L
Composed of plasma ,capilary membrane, and largest part is the interstiial fluid

Outputs ???
Kindeys are the primary for eliminating the most of the extracellular fluid

pH ????

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2
Q

What are examples of metabolic wastes that the kidney is responsible for excreting?

A
  • urea (from protein metabolism)
  • uric acid (from nucleic acid metabolism)
  • creatinine (from muscle metabolism)
  • bilirubin (from hemoglobin metabolism)
  • hydrogen
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3
Q

Azotemia and uremia are conditions of renal failure. Characterize them both.

A

azotemia: nitrogenous wastes in blood
uremia: toxic effects as wastes accumulates

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4
Q

What is the difference between unconjugated and conjugated bilirubin? What are their normal levels in urine?

A

unconjugated (indirect): created from RBC breakdown and travels in blood to liver

Conjugated (direct): undergoes a chemical change once it reaches liver and moves to stool before being removed through the stool

Normal level in urine: <1 mg/dL

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5
Q

What are some laboratory test that can indicate abnormality in kidney function?

A
  • elevated serum creatinine concentration
  • elevated blood urea nitrogen (BUN) concentration
  • decreased creatinine clearance
  • BUN: creatinine ratio (elevated in prerenal AKI)
  • hyperkalemia
  • metabolic acidosis
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6
Q

What are examples of pre-renal acute kidney injury?

A
  • dehydration
  • stenosis of the renal artery leading to hypoperfusion
  • increase in BUN:creatinine ratio above 20:1 emphasizing decrease in perfusion and blood flow to kidney as there is accumulation of waste products BUN and creatinine
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7
Q

What is the difference between pre-renal, renal, and post-renal acute kidney injury?

A

pre-renal: inadequate perfusion

renal: cellular damage/ intrinsic; damage to the cells that make filtering mechanism possible

post-renal: obstruction thus urine unable to drain adequately; system “backed up”

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8
Q

What are the hormones produced in the kidney?

A
  • renal erythropoietic factor
  • 1,25 dihydroxycholecalciferol (vitamin D)
  • renin
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9
Q

What are hormones metabolized and excreted by the kidney?

A

most peptide hormones such as:

  • insulin
  • angiotensin II
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10
Q

How is erythrocyte production regulated?

A
  • low O2 delivery to kidney
  • increase in erythropoietin
  • causing increased erythrocyte production in bone marrow
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11
Q

The kidney produces what form of vitamin D that is important in what kind of metabolism?

A

ACTIVE form:
1,25 dihydroxycholecalciferol (vitamin D3)

-important in calcium and phosphate metabolism

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12
Q

What is unique in the kidney regarding acid excretion?

A

Kidneys are the ONLY means of excreting non-volatile acids

examples are sulfur and phosphorus containing amino acids

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13
Q

Which buffer system in the body does kidney regulate?

A

bicarbonate buffer system

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14
Q

Why is the kidney’s role in gluconeogenesis important?

A

kidneys are responsible for the synthesis of 1/5 of glucose in the body during prolonged fasting

gluconeogenesis: synthesis of glucose from precursors such as amino acids

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15
Q

How do the kidneys regulate arterial pressure?

A

through endocrine:

  • renin-angiotensin system
  • prostaglandins
  • kallikrein-kinin system

control of ECF volume

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16
Q

How does the kidney regulate water and electrolyte balances?

A
  • sodium is the key electrolyte as it dictates water reabsorption and the start of a gradient for the other electrolytes
  • potassium in terms of hyperkalemia
  • hydrogen ions as it relates to acid base balance
  • Calcium, Phosphate, Magnesium as it relates to calcitriol
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17
Q

What is the effect of increased sodium intake 10-fold on urinary sodium excretion and ECF volume?

A

Sodium intake causes fluid retention with excretion lagging behind the sodium retention.

kidneys are not fast acting organs.

As the sodium levels decrease, ECF will return to normal after 2-3 days.

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18
Q

What is the normal glomerular filtration rate? Approximately how many times is your entire blood volume filtered through the kidneys each day?

A
  • 180 L/day
  • 125 mL/min

Roughly 36 times per day

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19
Q

T/F. GFR changes under normal conditions.

A

FALSE

GFR does not change under NORMAL conditions.

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20
Q

Creatinine clearance and inulin is indicative of???

A

GFR ????

21
Q

Which part of the kidney contains 80% of the kidneys’ vasculature?

A

renal cortex

22
Q

The nephron is located in which part of the kidney?

A

renal medulla

23
Q

Accumulation of the filtrate occurs here immediately before entering the ureter?

A

renal pelvis

24
Q

T/F. Nephrons in the kidney do not regenerate.

A

TRUE

We are born with approximately 1,000,000 nephrons.

HTN, DM will deteriorate the number of functioning nephrons contributing to kidney damage.

25
Q

The entire blood volume is approximately how many liters?

A

5L

26
Q

Where does the majority of reabsorption occur in the kidney?

A

proximal convoluted tubule

27
Q

What is considered the concentrating segment of the nephron and why?

A

descending limb of the loop of Henle

28
Q

What is considered the diluting segment of the nephron and why?

A

thick ascending limb of the loop of Henle

has the ability to dilute the fluid in the loop from 1200 mOsm/L to 100 mOsm/L

actions of loop diuretics occur here

29
Q

What is the tubuloglomerular feedback and where does it occur?

A
  • occurs in the macula densa
  • is a feedback mechanism in the kidney to maintain GFR at a normal rate
  • it is autoregulatory

Within each nephron, information from the renal tubules (a downstream area of the tubular fluid) is signaled to the glomerulus (an upstream area). ???

30
Q

What is the effect of ADH and aldosterone on sodium reabsorption in PCT?

A

it promotes sodium reabsorption ???

31
Q

Where is ADH reabsorbed in the nephron?

A

in the collecting duct

32
Q

Where in the nephon is water reabsorbed ONLY?

A

loop of Henle

33
Q

In the collecting duct you need to insertion of aquaporins to do what?

A

water reabsorption????

34
Q

How does lithium interfere with sodium?

A

????

35
Q

What are the two types of nephrons within in the kidney? What is the difference between the two?

A

cortical: within the renal cortex
juxtamedullary: in between the border of the cortex and the medulla

36
Q

Where in the kidney does filtration only occur?

A

glomeruli

37
Q

What is the filtration fraction of renal plasma flow at the glomeruli?

A

20%

38
Q

What is excretion with respect to filtration, reabsorption and secretion?

A

Excretion= filtration - Reabsorption (plus) Secretion

39
Q

What is the difference in selectivity and variability in filtration, reabsorption, and secretion?

A

filtration: somewhat variable; not selective (except of proteins), averages 20% of renal plasma flow; depends on the size and charge of the particle
reabsorption: highly variable; selective of most electrolytes (Na, K, Cl) and nutritional substances (glucose) are almost completely reabsorbed; most waste products (urea) are poorly reabsorbed
secretion: highly variable; important for rapidly excreting some waste products (protons), foreign substances (including drugs) and toxins

40
Q

What type of substances are ideal for determining GFR?

A

substances that are filtered but not reabsorbed or secreted and thus go straight to the urine

-inulin
-creatinine
-Para-aminohippurate (PAH)
????

41
Q

Plasma glucose under normal conditions will undergo what type of renal handling?

A

filtration and complete reabsorption back into the blood

42
Q

Compare and contrast the renal handling of water, sodium, glucose, and creatinine.

A

Water: 180 filtered, 179 reabsorbed, with 1 excreted

Sodium: 25,560 filtered; 25,410 reabsorbed, and 150 excreted

Glucose: 180 filtered, 180 reabsorbed

Urea: 1.8 Filtered, 1.8 excreted

43
Q

Excretion represents what will be present in what?

A

urine

44
Q

How does GFR change with age?

A
  • overtime GFR DECREASES with age (there is a natural regression)
  • At 80 years, GFR will be approximately half than when 20 years.
45
Q

GFR is an index of what?

A

kidney function

46
Q

What is normal GFR? GFR below 60 and GFR below 15 is considered what?

A

normal GFR: more than 60; 85-90

Kidney disease GFR: below 60

Kidney failure GFR: below 15 (need renal replacement therapy)

47
Q

Describe the autoregulation mechanism in the kidney during dehydration.

A

In the setting of decreased effective circulating volume, you run the risk of hypoperfusion (inadequate perfusion to the kidney). Vasodilatory signals will be sent from the macula densa cells to the afferent arteriole. The afferent arterioles vasodilate via prostaglandins while the efferent arterioles will vasoconstrict via the renin-angiotensin-aldosterone system.

48
Q

What is the effect of NSAIDS on the autoregulatory mechanism during dehydration?

A

-it blocks the protective effect of prostaglandins and thus the afferent arteriole will not dilate to increase blood flow

CSF3 Exam 3 (8 decks)

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