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Physiology > Renal System > Flashcards

Renal System Flashcards

1
Q

What does the word Renal mean

A

Kidney

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2
Q

Function of Kidneys (broad)

A

handle the stuff found in plasma

maintain plasma volume*

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3
Q

What is plasma composed of

A 
Water
Ions
Organic molecules
Trace elements and vitamins
Waste material
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4
Q

Functions of the kidneys (5)

A
  1. regulate blood volume and pressure
    - water conc and fluid volume
    - inorganic ion concentration
  2. acid/base balance
  3. excretion
  4. synthesis of glucose
  5. secretion of hormones
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5
Q

Gluconeogenesis

A

synthesis of glucose via the kidneys (when fasting)

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6
Q

Hormones the kidney secretes

A

Erythropoietin (EPO)
Renin
1,25-dihydroxy Vitamin D

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7
Q

Causes of fluid volume changes

A 
health disorders (dehydration)
rapid movement of water (osmosis)
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8
Q

ICF

A

Intracellular fluid - fluid inside the cell

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9
Q

Ions predominant in ECF

A

Na+, HCO3-, Cl-

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10
Q

Ions predominate in ICF

A

K+

Mg2+, Pi, Protein

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11
Q

ECF

A

extracellular fluid - fluid found outside the cell; plasma, interstitial fluid, CSF

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12
Q

Plasma

A

non-cellular part of blood, fluid inside blood vessels

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13
Q

Body Fluid Components

A

ICF
ECF
Plasma

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14
Q

What does the kidney excrete

A 
Urea
Uric acid
Creatinine (muscle metabolism)
Bilirubin (Hb breakdown)
Foreign chemicals (drugs, food additives, pesticides)
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15
Q

How does water diffuse across membrane?

A

Aquaporins - water channels

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16
Q

Water concentration

A

Osmoles - 1 osm is equal to 1 mole of solute particles

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17
Q

Osmolarity

A

number of solutes per unit volume of solution expressed in mol/L

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18
Q

T/F: Pure water has low osmolarity

A

TRUE

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19
Q

Diffusion

A

movement of molecules from one location to another as a result of random thermal motion

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20
Q

Diffusional Equilibrium

A

movement of water and solutes has equalized; water and solute concentration are equal on both sides of the petition

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21
Q

Osmosis

A

diffusion of water across a selectively permeable membrane from region of high water concentration to one with lower water concentration

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22
Q

Semi-permeable membrane

A

permeable to water, not solutes

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23
Q

Osmotic pressure

A

increases when water moves to create osmotic EQb
Pressure applied to stop movement of water
Required to stop cells from bursting

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24
Q

Tonicity

A

determined by the concentration of non-penetrating solutes of an extracellular solution relative to the intracellular environment of the cell.
The solute concentrations may influence changes in cell volume

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25
Q

Three conditions of tonicity

A
  1. Isotonic (isosmotic) - same osmolarity outside and inside the cell - shape stays constant shape
  2. Hypertonic (hyperosmotic) - outside envrionment has higher osmolarity than inside the cell - cell would shrink
  3. Hypotonic (hypoosmotic) - lower osmolarity than inside the cell - cell would swell/bulge
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26
Q

Changes in cell volume

A
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27
Q

fate of the RBC:
Hypotonic solution
Isotonic solution
Hypertonic solution

A

Hypo - cell bulge/swell
Iso - no change
Hyper - cell shrinkage

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28
Q

Penetrating solute

A

urea

can cross cell membranes

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29
Q

What is given in an emergency

A

Isotonic saline

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30
Q

Absorption

A

movement of solute/water INTO blood (plasma)

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31
Q

Filtration

A

Movement of solute/water OUT of blood (plasma)

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32
Q

Net filtration pressure

A

Startling Forces

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33
Q

Capillary hydrostatic pressure (Pc)

A

pushes fluid OUT OF capillary into interstitial fluid

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34
Q

Interstitial fluid hydrostatic pressure (Pif)

A

fluid push INTO capillary from interstitial fluid

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35
Q

Pic

A

Osmotic force INTO capillary

due to plasma protein concentration

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36
Q

Pi IF

A

Osmotic force OUT OF capillary

due to interstitial fluid protein concentration

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37
Q

Arterial end of capillary

A

Favours FILTRATION - fluid pushed out of capillary

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38
Q

Venous end of capillary

A

Favours ABSORPTION - fluid flows INTO capillary

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39
Q

Homeostasis

A

Total body balance of any substance
Fixed volume of water in body
Gain- ingestion, metabolism product
Loss- excretion, metabolized

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40
Q
A

Kidneys - retroperitoneal
Ureter - drain urine from kidneys
Bladder
Urethra

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41
Q

micturition

A

release of urine outside body (urination)

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42
Q

Anatomy of the Kidney

A 
Outer cortex
Inner cortex
Nephron
--> renal corpuscle
--> renal tubule
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43
Q

Structure of a Nephron

A

Bulb like renal corpuscle

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44
Q

Components of Renal Corpuscle

A

Glomerulus

Bowman’s Capsule

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45
Q

Components of Renal Tubule

A 
convoluted - twisted
Proximal convoluted tubule (PCT)
Loop of Henle
Distal convoluted tubule (DCT)
Collecting duct
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46
Q

Loop of Henle segments

A

descending limb - downward

Ascending limb - upwards

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47
Q

Renal Corpuscles

A

Initial blood filtering component

First making of urine

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48
Q

Glomerulus

A

Interconnected capillaries in the renal corpuscle

First filtration of blood

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49
Q

Development of Renal Corpuscle

A

Parietal and Visceral layers important**

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50
Q

Glomerular capillary

A
  • fenestrated endothelial layers
  • basement membrane
  • podocyte (foot) with filtration slits
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51
Q

Two types of nephrons:

A

Cortical (85%) - closer to cortex

Juxtamedullary (15%) - closer to medulla, corpuscle is in cortex

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52
Q

T/F: blood flow to kidney is LOW

A

FALSE: very high blood flow to kidney via renal artery

53
Q

Three types of capillaries (around nephron)

A
  1. glomerular
  2. peritubular
  3. vasa recta - capillaries associated with juxtamedullary nephron)

highly vascularized organ

54
Q

Three basic renal processes

A
  1. Glomerular filtration
  2. Tubular secretion
  3. Tubular reabsorption
55
Q

Urine formation

A

water is brought in via drinking and metabolism
Blood is brought to kidney via renal artery
enters glomeruli via afferent arteriole

56
Q

Substances that a re reabsorbed

57
Q

Amount excreted

A

amount filtered + amount secreted - amount reabsorbed

58
Q

Filtration layers

A
  1. fenestrated endothelial layer
  2. Basement membrane
  3. Podocytes with filtration slits
59
Q

Why are PROTEIN or ALBUMIN held back

A
  • pores are not large enough to allow passsage
  • pores and BM have negative charged proteins
  • podocyte slits are covered with semipros membranes
60
Q

What is filtered through the glomerulus

A

everything except large proteins (held back in blood)

61
Q

What is ultrafiltrate

A

same concentration as plasma

cell-free fluid in bowman’s space.

62
Q

What is proteinuria

A

condition where proteins are able to pass through the barrier (show up in urine)
NOT SUPPOSED TO OCCUR
infection, inflammation in golmerular site
Protein escape into pores and pass into ultrafiltrate

63
Q

T/F: Net glomerular filtration pressure is always POSITIVE

64
Q

What does Glomerular Filtration pressure initiate? how?

A

Urine formation

forcing protein-free filtrate from plasma, out of glomerulus, into Bowman’s space

65
Q

5 steps of Filtration Fraction

66
Q

T/F: Increased blood pressure increases GF

67
Q

Decreased plasma volume decreased filtration rate

68
Q

Glomerular Filtration Rate

A

Volume of fluid filtered from the glomerulus into the Bowman’s capsule

125 ml/min; 180 L/day

69
Q

Kidneys:

A

Clean up and clear stuff from plasma

–> plasma passes through 60 times a day

70
Q

Factors influences GFR

A

Blood pressure –> net GFR
Neural and endocrine control
Permeability of corpuscular membrane
Surface area for filtration

71
Q

Autoregulation

A
  1. GFR remains constant (despite large changes in arterial or renal blood flow)
  2. Regulated by changes in the myogenic reflex
  3. Occurs by changing renal blood vessel resistance to compensate fro changes in pressure
72
Q

Mean Arterial Blood pressure

A

pressure driving blood into the tissues

equal to diastolic pressure + 1/3 systolic pressure

73
Q

Arteriolar Resistance and GFR

A

Resistance to changes in renal arterioles alter renal blood flow and GFR

74
Q

what causes decreased GFR

A

Vasoconstricton - decreased amount of renal blood flow

75
Q

Control of GFR

76
Q

GFR Regulation

A

Myogenic response - similar to autoregulation (arteriole smooth muscle)
Hormones and autonomic neuron - change resistance in arterioles
Tubuloglomerular feedback - role for juxtaglomerular apparatus (JGA) - paracrine control of afferent arteriole resistance

77
Q

Juxtaglomerular Apparatus (JGA)

A

located ext to the glomerulus

78
Q

Macula dense

A

cells on wall of distal tube
cense increased fluid flow through distal tubule
secretes vasoactive compounds
by paracrine effect, changes afferent arteriolar resistance
signals to JG cells

79
Q

Juxtaglomerular cells

A

granular cells
on wall of the afferent arteriole
SECRETE RENIN

80
Q

Renin

A

control afferent arteriole resistance

81
Q

Mesangial cells

A

not a part of JGA
contraction of these cells reduce surface area of glomerular capillaries
GFR is decreased

82
Q

Tubuloglomerular Feedback: Role of Macula Densa

83
Q

Filtered Load

A

Total amount of non-protein or non-protein bound substance filtered into Bowman’s space

GFR x [substance in plasma]

84
Q

Glucose Filtered Load

A

[glucose] = 1 g/L
GFR = 180 l/day
Glucose filtered load = 180 g/day

85
Q

Substance excreted in urine < filtered load

A

REABSORPTION has occurred

86
Q

Substance excreted in urine > filtered load

A

SECRETION has occurred

87
Q

Filtration of 3 substances

A

filtration + secretion
filtration + partial reabsorption
filtration + complete reabsorption

88
Q

Renal handling of Four Substances

A

Filtration only - waste products (urea)
Filtration + partial reabsorption - electrolytes
Filtration + complete reabsorption - glucose, amino acids
filtration + secretion - organic acids

89
Q

inulin

A

polysaccharide found in vegetable/plants, handled by kidneys

90
Q

creatinine **

A

behaves like inulin

91
Q

Values of Filtration and Reabsorption

92
Q

Tubular epithelium and reabsorption

A

mediated by:

  • diffusion across tight junction (paracellular) MINOR
  • mediated transport (transepithelial) MAJOR
93
Q

sodium transport is mediated (uses a protein to assist)

94
Q

Reabsorption of Na+ by Mediated Transport

95
Q

Reabsorption of Na+

A

Occurs in the proximal tube
Filtrate —> Interstitial Fluid (mediated transport)
—> Blood Plasma (diffusion and bulk flow)

96
Q

Reabsorption of Glucose

A

glucose clearance is ZERO
all filtered glucose is reabsorbed
Active transport on luminal sides via SGLT protein
–> mediated transport
Facitiliated diffusion (basolateral side) carrier protein GLUT

97
Q

Glucosuria

A

Above renal threshold, glucose appears in urine

Diabetes

98
Q

Sodium-linked glucose reabsorption

A

Na+/K+-ATPase

[Na+] is high outside the cell, low inside the cell

99
Q

Transport Maximum

A

Limit of a substance that can be transported per unit time
BINDING SITES of TRANSPORT PROTEINS become SATURATED
Filtered load exceeds the limit of reabsorption

100
Q
A

A - Glucose filtration and plasma glucose is linear

B - linear until Tm is reached, plateu (no more reabs)
SGLT are saturated

C - Excretion rate vs plasma glucose

D - composite of all

101
Q

Diabetes mellitus

A

Capacity to reabs glu is normal - filtered load is greatly increased & beyond the threshold level to reabs glucose by tubules

102
Q

Renal Glucosuria

A

Benign glucosuria or familial renal glucosuria

Genetic mutation of the Na+/glucose cotransporter, normally meditates active reabs of glucose in proximal tubes

103
Q

Reabsorption of UREA

A

waste product
freely filtered at glomerulus
REABS of urea is DEPENDENT ON WATER REABSORPTION

104
Q

Mechanism of ADH/Vasopressin

A

Collecting ducts
Binds to cell receptor to activate adenylate cyclase
cAMP activates phosphokinaseA
Protein phosphorylation
AQP2 protein is upregulated (by ADH)
H2O moves outside of cell (into interstitial fluid)

105
Q

Diuresis

A

large volume of urine is produced

106
Q

Diabetes Insipidus

A

Large amounts of urine

107
Q

Diabetes Insipidus

A

Large amounts of urine

Water Diuresis - collecting duct is impermeable to water, cause large amount of urine

108
Q

Absence of ADH

A

Not enpough Aquaporin2 channels

cells are impermeable to wear

109
Q

Central diabetes Insipidus

A

Failure of ADH release from posterior pituitary

110
Q

Nephrogenic diabetes inspidius

A

body does not respond to ADH

111
Q

When is ADH increased

A

shock, pain, warm/hot weather, water deprivation
lots of water is reabsorbed
low urine quantity

112
Q

ADH is decreased

A

cold, humid environment
alcohol
Pee lots

113
Q

Water deprivation

A

High plasma osmolarity (increased concentration)

Increase plasma ADH –> thirst/water intake and anitdiuresis (renal water retention)

114
Q

High water intake

A

Low plasma osmolarity
AHD block, decreased plasma ADH
increased urination

115
Q

Water Diuresis

A

water volume is large
only water is excreted (no solute)
D. Insipidus

116
Q

Osmotic diuresis

A

excess solute in urine with high levels of water excretion

Uncontrolled diabetes mellitus (glucose in the urine)

117
Q

Na+ level regulation

A

closely associated with water levels

NEVER SECRETED INTO RENAL TUBULES

118
Q

Mechanism of Na+ level regulation

A

Low [Na+] in plasma
- short term (Baroreceptors regulate GFR)
- aldosterone (Na+ reabsorption)
—-> renin, angiotensin 2 for aldosterone secretion
High [Na+] in plasma
- Atiral Natriuretic peptide (ANP)
—-> regulated GFR, inhibiting Na reabsorption
—-> inhibit aldosterone actions

119
Q

NaCl intake

A

0.05 - 25 g /day

120
Q

Baroreceptors (short term [Na+] regulation)

A

Respond to pressure changed in cardiovascular system - plasma volume
Low plasma volume = low Na+ levels
Nerve endings sensitive to stretch
INTRARENAL (juxtaglomerular cells of JGA)
Processed in medulla oblongata
Decrease GFR

121
Q

Longe term regulation of Low Na Levels

A

Aldosterone (steroid hormone) secreted from adrenal cortex
regulated Na+ reabsorption

Distal tubule and cortical collecting duct

Na+ transport proteins
Na+ reabsorption

K+ is given out in the process

122
Q

regulation of Aldosterone

A

Sodium content in diet
High NA - low aldosterone
Low NA - high aldosterone

Angiotensin 2 acts on adrenal cortex

123
Q

Renin is secreted from:

124
Q

ACE inhibitor

A

used to lower blood pressure

125
Q

Macula densa

A

chemoreceptors that sense low sodium passing through distal convoluted tubule

126
Q

What determines [Renin] in plasma

A

JG cells receive 3 inputs:

  1. sympathetic input from external baroreceptors
  2. intrarenal baroreceptors
  3. signals from macula densa
127
Q

Atrial netriuretic peptide

A

synthesized and secreted by cardiac atria
works on tubular segments
Inhibit Na+ abs
Increases GFR and Na+ excretion

ATRIAL DISTENSION - true sensor - increases secretion of ANP - Aldosterone levels decrease - decrease Na+ reabs -

128
Q

Regulation of K+ levels

A

important for intracellular fluid
small, constant range
regulated in last part of cortical collecting duct

129
Q

HYPERKALEMIA

A

excess K+ in blood

Physiology (3 decks)

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