Test 2 - Renal Physiology Flashcards
What is the most common cause of elevated plasma creatinine?
Dehydration
What does it mean to say that the kidney (like the heart and lungs) have reserve capacity?
This means that the kidney can do more work than it does at basal levels, Which means that filtering, reabsorptive and secretory function is not at its maximimal in the basal resting state; all can be increased.
This masks nephron loss to an extent.
What is meant by transport maximum?
There is a maximum rate at which nephron epithelium can remove substances from plasma and secrete them into filtrate. Similarly, there is a maximum rate at which nephron epithelium can reabsorb substances from filtrate.
What is the cause of transport maximum?
Transport is dependent on number/density of membrane transporters that allow for secretion or reabsorption.
Exceeding the transport maximum may occur in disease states and accumulation of substances in plasma may occur OR substances that should be reabsorbed are lost in urine.
What will happen if the rate of glucose getting filtered is greater than the rate of glucose getting reabsorbed?
You will see glucose in the urine.
TRUE/FALSE.
Rate of filtration is not variable.
FALSE.
The rate of filtration is variable and is dependent on GFR (flow) and concentration.
Amount/Time = Concentration x Flow
If concentration increases, more gets filtered.
Once Tmax is reached, the rate of excretion is ___ ( >, <, = ) the rate of filtration.
Equal to
Where does glucose get reabsorbed?
Proximal tubule ONLY.
This is also true for lactate, amino acids, VFAs, Ketones, glycerol, all organic molecules that cells obtain energy from.
TRUE/FALSE.
Tmax differes from one substance to another.
TRUE.
e.g. Tmax is high for glucose, but low for ketones. You only need to have a slight increase for it to appear in the urine.
TRUE/FALSE.
All cells have the same transport maximum.
FALSE.
Each cell has a different number of transporters. This difference accounts for the “splay” in the quantitative representation.
Once glucose passes the proximal tubule, can it be reabsorbed?
NO. It will not go to another nephron to get reabsorbed. It will be excreted.
Describe bovine glucose Tmax.
Bovine has low glucose Tmax. There is less plasma glucose to begin with because not a lot of glucose reabsorption is done in the GI tract. Virtually all roughage is acted on by microbes in the forestomachs to convert them into VFAs. This then undergoes gluconeogenesis. Therefore, the kidney does not have a lot of glucose transporters. Stress causes increase in glucose production.
THE USUAL SUSPECTS:
Urine Glucose
- Too much plasma glucose - Tmax will be exceeded
- Proximal Tubular Disease - Since this is the only place glucose gets reabsorbed
- Hemorrahge into the urinary tract
- Endocrine Problem:
a. Too much Hormones that increase glucose
b. Not enough insulin
What hormones increase plasma glucose?
What causes their increase?
Growth Hormone
Cortisol
Thyroid
Epinephrine
*Too much is a result of stress
In the graph, what is does it mean when the filtered and reabsorption graphs are superimposed?
During this time, the kidney can keep up. The amount being filtered is equal to the amount being absorbed.
When the reabsorption curve begins to deviate from the filtered curve, what is happening in the kidney?
Some nephrons are beginning to reach their transport maximum, while others are not. At the same time, there is a proportional increase in the amount of glucose excreted.
What do filtration, secretion, reabsorption and excretion measure?
Amount of a given substance per time in units mg/min.
GFR and clearance are expressed in units of ______ and measure _____.
ml/min
volume of plasma per time
The slope of the graph is a reflection of ______.
GFR
If the filtration curve were to increase its slope, what would this indicate? Decrease its slope?
An increase in slope would indicate an increase in GFR (it would lean more to the left). A decrease in slope would indicate a decrease in GFR (it would lean more to the right).
What does the amount of reabsorbtion depend on?
- The number of cells in the PCT that can reabsorb
- The number of transporters in each cell.
*Each of these is variable.
TRUE/FALSE.
When filtration = reabsorption of a particular substance, none is seen in the urine.
TRUE.
Only when filtration > reabsorption, is a substance excreted.
How does specific gravity relate to water balance as a whole?
It is a measure of how well the kidney is reabsorbing.
It is a measure of the density of urine in regards to all of the solutes present.
If an animal is dehydrated, you expect the kidney to _____ (increase, decrease, not change) water reabsorption at the PCT.
Increase
During dehydration, does the amount of waste molecule excreted in the urine change?
NO. The same amount of waste moleucles is filtered. The change is the concentration of waste that is excreted since the nephron is sent the message to increase it’s reabsorption.
If the osmolarity of plasma is 300 mOsm, what will the osmolarity be in Bowman’s Space?
300 mOsm
If the osmolarity of plasma is 300 mOsm, what will the osmolarity be in the renal vein?
290 mOsm
If the osmolarity of plasma is 300 mOsm, what will the osmolarity be of waste leaving?
310 mOsm
TRUE/FALSE
During dehydration, the animal is filtering the same volume and solute as prehydration status.
TRUE.
The animal is maintaining GFR (or at least trying to), and so the amount of plasma getting filtered remains the same, with the same amount of waste.
The osmolarity of plasma entering the lungs is _____ ( >, <, = ) the osmolarity of plasma leaving the lungs.
Less than.
This is due to the fact that water is lost during exhalation, concentrating the plasma.
What causes a greater release of ADH, a 10% drop in blood pressure or a 10% increase in osmolarity?
Increase in osmolarity. This will elicit a stronger signal to the kidney to reabsorb water.
What is the osmolarity that you don’t usually see animals exceed? What animals are the exception?
330 mOsm
Camels
TRUE/FALSE.
All osmolytes are freely filterable.
FALSE.
All except the 1mmol of protein are filterable.
What are the main non-protein nitrogen substances found in plasma?
Creatinine and Urea
What does specific gravity test?
Water reabsorption of the kidney.
What is the main route of nitrogen removal?
Urine
Who is putting urea into the blood stream?
LIVER ONLY
Who is putting creatinine into the blood stream?
Cardiac and skeletal muscle
What is the GI tract’s contribution to concentration of solutes and water?
It is putting water into (and taking it out of) plasma.
It puts solutes into the plasma (including amino acids to synthesize creatine).
If you’re going to use amino acids for reasons other than making protein, does nitrogen need to be removed?
Yes, it is done so as urea thanks to the liver.
If liver cells are being lost, then urea levels are _____.
Decreasing
During liver disease, what is happening to unwanted amino groups?
They are being turned into ammonia, giving the animal the smell of ammonia.
What causes the variability in creatinine concentration in plasma?
%body mass that is skeletal muscle.
African americans have more
Geriatrics have less because muscle decreases with age.
Do creatinine and urea exist in the same concentration in plasma?
NO. They are filtered at the same time and in the same volume of water.
How long does it take for all plasma to get filtered?
20-25 minutes
What are the two factors contributing to urine concentration? Which is the most significant contributor?
Water reabsorption and secretion of solute
Water reabsorption is the most significant.
By reabsorbing 99% of water, a substance is being concentrated _____ times.
100
If Substance X is secreted in the same amount that it was filtered, then 99% of water is reabsorbed. How concentrated is Substance X?
200 times more than its original concentration
What substances control urea reabsorption?
ADH and Cortisol
TRUE/FALSE.
There are ports available for creatinine reabsorption.
FALSE.
There are only unidirectional ports for its secretion from plasma to filtrate.
If urine osmolarity is ______ ( >, <, = ) plasma osmolarity, then the kidney is trying to decrease plasma osmolarity. When should this be seen?
Greater than
Most of the time because the animal is mostly in a state of dehydration (and therefore high plasma osmolarity).
When will USG =1?
NEVER. There is always waste in urine.
What is the USG range in bowman’s space?
What is this dependent on?
1.008-1.012
This depends on the animal’s hydration status.
Define isosthenuria.
When an animal excretes a urine with an osmolality/SG that is essentially identical to that of Bowman’s space - the kidney did nothing to the urine.
Is isosthenuria an acceptable finding?
NO. This means that the kidney is not concentrating the urine/doing anything. The only time this is OK is when we have given the animal a lot of fluids.
What would we think if an animal’s USG was 1.013?
It is slightly higher than what is found in Bowman’s space but this could be due to protein secretion. The jury is still out.
What would we think if an animal’s USG was 1.048?
That animal’s got damn good kidneys.
Is USG an accurate measurement of urine osmolarity?
NO. It is a good estimate though. A precise measurement of osmolarity found that one value of USG amongst 3 different dogs had 3 different osmolarities varying about 100 mOSm.
What is the range of mOsm urine for USG 1.008-1.012?
286-290 mOsm
Why does plasma osmolality increase in a dehydrated animal?
Solutes are continuously being deposited into plasma while plasma volume is decreasing.
What would also be seen in addition to isosthenuria?
Since the kidney is not concentrating the urine, the blood volume would be decreasing. USG would also be decreasing. However, plasma urea and creatinine begin to increase. You may think that the animal is dehydrated due to increased urea and creatinine, but it could be due to the fact that the kidney is not concentrating the urine.
Define what is meant by azotemia.
Accumulation of non-protein nitrogen molecules. An animal is azotemic if plasma urea and/or creatinine are greater than normal.
Azotemia is not considered a disease state.
When waste products accumulate such that toxic effects manifest, this is known as _____.
Uremia
What is the main cause of azotemia?
Dehydration
Define prerenal azotemia and some examples of causes.
This is azotemia caused by derangements “in front of” the kindey.
First though = dehydration. Same amount of NPNs just decreased volume. (Diarrhea, excess salivation due to choking)
Failing heart - unable to pump blood effectively and urea/creatinine are still being deposited into the bloood without efficient delivery to the kidneys.
Animal is hemorrhaging into the GI tract = high protein diet due to hemoglobin.
Define renal azotemia and some causes.
Azotemia that results from lack of filters at the kidney.
Edema/interstitial nephritis would decrease the lumen diameter and increase hydrostatic pressure in bowman’s space, leading to decreased GFR.
Kidney disease
Tumor in the renal pelvis
Define post-renal azotemia and some causes.
Azotemia caused by dysfunction downstream from the kidney.
Post-renal obstruction
D. renale
bladder bursts into the peritoneum (animal becomes azotemic when urea and creatinine diffuse across the peritoneal membrane, which they can).
Tumor - transitional epithelial carcinoma
Congenital issues - angles of ureters entering the bladder is wrong and the flow is altered.
TRUE/FALSE.
It is possible to have more than one azotemic condition.
TRUE.
If something is neither secreted nor reabsorbed, this means that ______.
There are no transporters present across the length of the membrane.