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ANAP 520 > TEST 4 - RENAL SYSTEM > Flashcards

TEST 4 - RENAL SYSTEM Flashcards

1
Q

The kidneys excrete end products of metabolism from the blood such as what 3 things, and others.

A

Urea
Creatinine
Metabolic acids

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2
Q

In coordination with ______, kidneys regulate vascular interstitial, and intracellular osmolality and volume by regulating _______ volume and osmolality.

A

ADH

Urine

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3
Q

The kidneys regulate electrolyte and other solute balance of body fluids. TRUE/FALSE

A

TRUE

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4
Q

The kidneys regulate this in conjunction with body buffers and the lungs; by far the most powerful at this.

A

Acid-base balance

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5
Q

Kidneys are the most powerful acid base buffers, and also the quickest to react. TRUE/FALSE

A

FALSE

Takes them longer to kick in and regulate acid-base balance, but can maintain for days, weeks, years.

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6
Q

How do kidneys regulate blood pressure?

A

Controlling vascular volume

Secreting renin

Synthesis of angiotensin II

Aldosterone secretion

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7
Q

How do kidneys regulate bone marrow production of RBCs?

A

Secreting erythropoietin

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8
Q

Stimulates secretion of EPO

A

Hypoxia of epithelial cells of peritubular capillaries

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9
Q

Kidneys Synthesize ______ to the active form, 1, 25-DHCC, which helps regulate calcium and phosphate balance and ______ formation.

A

Vitamin D

Bone formation

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10
Q

Kidneys Synthesize various hormones that help regulate renal blood flow, such as what 3 things?

A

PGs (vasodilator)

Enothelin (vasoconstrictor)

Nitric oxide (vasodilator)

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11
Q

Kidneys perform ________, the production of glucose from noncarbohydrate substances; also done by the liver.

A

Gluconeogenisis

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12
Q

Kidneys help excrete ______ and _______ from the body fluids.

A

Drugs

Toxins

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13
Q

Kidneys attached at the souther poles, can have normal fxn, but also can lead to dysfxn.

A

“Horse shoe kidney”

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14
Q

Kidney should be ~_____cm longitudinally, nor more than _____cm difference between the two kidneys.

A

~11-13 cm

> 1.5cm difference

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15
Q

Where is the kidney located?

A

Retroperitoneal space under ribcage

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16
Q

_______ kidney sits slightly lower than the ______ kidney

A

Right sits lower than left

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17
Q

Separate organ, sits on tops of kidney; has its own SNS innervation and BF etc.

A

Adrenal glands

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18
Q

Kidneys recieve about ______% of CO, they are very vascular.

A

~20-25%

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19
Q

Kidney fxn is dependent on renal _______.

A

Bloodflow

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20
Q

Amount of blood delivered to the kidneys

A

Renal fraction

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21
Q

Lined with smooth muscle, undergoes peristaltic contraction to propel urine to bladder

A

Ureters

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22
Q

Other factor other than ureters that moves urine to bladder

A

Gravity

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23
Q

If pt is flat for a long period of time, what are they at risk for?

A

Kidney infection

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24
Q

What happens when the bladder fills and pressure increases, up to a certain point.

A

Reflexively relaxes

Increase in volume does not directly result in increase in pressure at first

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25
Q

_________ impulses sent to brain to let you know you need to pee.

A

Afferent

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26
Q

________ outflow contracts the bladder and relaxes the internal sphincter

A

Parasympathetic outflow

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27
Q

With average CO: renal blood flow is ~ ______ ml/min

A

100-1200 ml/min

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28
Q

Altered RBF = altered __________

A

Renal function

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29
Q

Fibrous capsule that protects kidney, but can injure if trauma, etc occurs.

A

Renal capsule

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30
Q

Kidney is separated into a renal _______ (outer part) and a renal ______ (inner part)

A

Renal cortex

Renal medulla

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31
Q

Pyramids are located here

A

Renal medulla

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32
Q

Urine is formed in the _______

A

Pyramids

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33
Q

After urine is formed it moves through renal _______ into ______ calyx, and then empties into ______ calyx.

A

Papilla

Minor
Major

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34
Q

Renal vein empties into _____

A

IVC

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35
Q

Just as important to have unobstructed outflow of blood as well as inflow. TRUE/FALSE

A

TRUE

Increased pressure and decreased inflow of blood

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36
Q

Renal artery divides into ________ arteries (superior, middle, and inferior)

A

Segmental

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37
Q

Segmental arteries branch into _______ arteries, which run along the sides of the pyramids.

A

Interlobar

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38
Q

When interlobar arteries reach the base of pyramids (outer part), they make a hairpin turn and become ______ arteries, then become _______ arteries, which is at the microscopic level.

A

Arcuate

Interlobular

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39
Q

Interlobular arteries divide into MULTIPLE ______ arterioles, which are delivering blood towards the glomerulus, 12-24 capillaries.

A

Afferent

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40
Q

Capillaries of the glomerulus join back to form _______ arteriole which divides into _______ capillaries that transport blood away form the glomerulus.

A

Efferent

Peritubular

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41
Q

Peritubular capillaries join back together to form _________ veins – _______ veins— _____ veins, which then join to form the renal vein and empty into IVC.

A

Interlobular

Arcuate

Interlobar

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42
Q

Vascular and tubular component of the kidney

A

Nephron

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43
Q

Each kidney has how many nephrons?

A

1-1.25 million nephrons

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44
Q

Blood is filtered from the glomerular capillaries and enters __________; which completely surrounds the capillaries.

A

Bowman’s capsule

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45
Q

Bowman’s capsule empties into the ________ tubule.

A

Proximal

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46
Q

Proximal tubule starts out as _________prox tubule and straightens out to become __________ prox tubule.

A

Convoluted

Straight

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47
Q

The straight proximal tubule thins out and becomes ___________; also called the _________ segment.

A

Thin descending limb of loop of Henle

Concentrating

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48
Q

Loops of henle makes a hairpin turn and becomes ________, or __________ segment

A

Thin ascending loop of henle

Passive diluting segment

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49
Q

Thin, ascending loop of henle becomes ___________ loop of henle or __________ segment

A

Thick ascending limb

Active diluting segment

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50
Q

Thick ascending loop of henle turns into _______ tubule; can be divided how?

A

Distal

Early and late distal tubule

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51
Q

This part of the distal tubule is very similar in form/fxn of thick ascending limb of LOH.

A

Early distal tubule

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52
Q

Late distal tubule is very similar in form/fxn to what? (Next part of the tubule

A

Cortical collecting duct

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53
Q

When tubule gets down to medulla it becomes ________

A

Medullary collecting duct

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54
Q

When does fluid officially become urine? (Cannot be altered at this point)

A

When moves from medullary collecting duct (renal papilla) into minor calyx

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55
Q

Two types of nephrons

A

Cortical

Juxtomedullary

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56
Q

Cortical nephrons compose ~__% of nephrons and most components are located in ____ of the kidney.

A

~85% (most abundant)

Cortex

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57
Q

Juxtomedullary nephrons make up ~___% of nephrons; what is different about their LOH?

A

~15%

Very long thin LOH that dive way down into medulla of kidney

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58
Q

The long, thin LOH of the juxtomedullary nephrons are very important because they are responsible for determining the final _______ and _______ of the urine.

A

Volume and osmolality

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59
Q

Vascular structures that lie adjacent to long, thin LOH in JM nephrons; also play role in final volume/osm of urine.

A

Vasa recta

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60
Q

This lies between afferent and efferent arterioles; plays a role in tubuloglomerular feedback.

A

Distal tubule

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61
Q

Cells associated with distal tubule

A

Macula densa cells

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62
Q

Group of cells affiliated with afferent arteriole; secrete_________.

A

Juxtaglomerular cells

Secrete renin

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63
Q

Collectively JG cells and macula densa are referred to as what? (Play major role in JG feedback)

A

Juxtoglomerular apparatus

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64
Q

3 layers water/solutes must traverse to get form glomerular capillaries into bowman’s capsule

A

Capillary endothelium

Basement membrane

Podocyte cells

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65
Q

First layer water/solutes traverse when moving into bowmans capsule

A

Capillary endothelium

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66
Q

Capillary endothelium has openings, larger than normal, in the capillaries; called ________; allow some substances to pass through and prevents others.

A

Fenestrae

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67
Q

RBC, WBC, plts, and albumin should move through the capillary endothelium. TRUE/FALSE

A

FALSE.

ONLY ALBUMIN should move through

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68
Q

Basement membrane has openings as well, strongly lined with __________; allows/prevents substances from moving into capsule

A

Negative charges

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69
Q

RBC, WBC, plts should not move through the basement membrane. TRUE/FALSE

A

TRUE

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70
Q

Why should albumin not be able to move through basement membrane?

A

Bc it is negatively charges and so is the membrane

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71
Q

Podocyte cells have these that should NOT filter RBC, WBC, or plts through to the capsule

A

Filtration slits

72
Q

What should primarily move to bowman’s capsule?

A

Water and whatever is dissolved in it

73
Q

All 3 layers have negative charges, just the basement membrane has the strongest. TRUE/FALSE

A

TRUE

74
Q

Blood pressure in the glomerular capillary, moves fluid from the blood to bowman’s capsule

A

Glomerular (hydrostatic) capillary pressure

75
Q

GCP FAVORS/OPPOSES filtration.

A

Favors

76
Q

Pressure in bowman’s capsule that moves fluid from bowman’s capsule into the glomerular capillary; opposes filtration

A

Capsule pressure

77
Q

The blood protein concentration that moves fluid from bowman’s capsule into the glomerular capillary by osmosis; opposes filtration.

A

Blood colloid osmotic pressure

78
Q

Filtration pressure equation

A

GCP - CP - COP = FP

79
Q

Average GFR in adults

A

100-125 ml/min

180 L/24hrs

80
Q

_______% of filtrate reabsorbed from tubules into peritubular capillaries and back to systemic circulation; why we don’t pee that much.

A

98-99%

81
Q

Average 24 hr urine output is ______ L.

A

1-2L per 24 hrs

82
Q

GFR remains fairly constant, despite MAP ~70-180mmHg bc of _________

A

Autoregulation

83
Q

Innervates both afferent/efferent arterioles; constriction via alpha-1 receptors and decreases glom BF and GFR

A

SNS

84
Q

What 2 things does tubuloglomerular feedback monitor?

A

Tubular filtrate flow rate

Tubular filtrate sodium concentration

85
Q

If either flow rate/sodium content decrease, activates what cells>

A

Macula densa

JG cells

86
Q

Macula densa of distal activation causes what?

A

Afferent arteriole dilation

87
Q

Activated JG cells of afferent arterioles causes what?

A

Secrete renin, produces renin-angiotensin II, abundant receptors on efferent arteriole = constriction

88
Q

TGF increases _______, which increases GFR and helps maintain kidney fxn

A

GHCP

89
Q

Indirect stimuli for renin secretion from SNS

A

Nor epi and epi– alpha1 receptors on smooth muscle of AA– AA constriction– decreased blood flow into AA

90
Q

Direct stimuli for renin secretion via SNS

A

Norepi and epi – beta1 receptors on JG cells in wall of AA – increase in cAMP– increase renin secretion

91
Q

Indirect stimuli for renin secretion via JG cells

A

Decreased sodium and/or decreased tubular filtrate flow rate at macula densa of distal tubule– JG cells– renin

92
Q

Decreased RBF, SNS stimulation (epi/NE), and other stimuli cause JG cells to secrete _______.

A

Renin

93
Q

Renin converts ________ (protein synthesized in the liver) into ________.

A

Angiotensinogen

Antiotensin I

94
Q

Antiotensin I is converted to antiotensin II by _______.

A

ACE

Angiotensin converting enzyme

95
Q

Where does ACE come from?

A

Endothelial cells of small arterioles

96
Q

Largest conglomeration of small arterioles where ACE is synthesized?

A

In the lungs

97
Q

Other than converting angiotensin I to II, ACE decreases _________, which causes blood vessels to dilate normally.

A

Bradykinin

98
Q

Angiotensin II is a potent _________ of arteries and veins; this results in increased ______, ______, _____, and _____.

A

Vasoconstrictor

Increased MAP,
Venous return
Preload
SV and CO

99
Q

Angiotensin II, also has a direct effect on _______ and _______ which favors renal reabsorption of ____ and ____; this results in increased vascular volume, etc.

A

Renal tubules
Peritubular capillaries

Na+ and H2O

100
Q

Antiotensin II is also a very potent stimulus for ______ secretion from the adrenal cortex.

A

Aldosterone

101
Q

Aldosterone favors this, which results in increased vascular volume.

A

Renal reabsorption of Na+ and H2O

102
Q

All of the effects of angiotensin II result in increased _______.

A

RBF

103
Q

When RBF is increased, it sends _______ message back to the JGA to decrease renin secretion.

A

Negative feedback

104
Q

Glomerular and tubular process where movement of water/solutes from lumen of tubules back into peritubular capillaries.

A

Tubular reabsorption

105
Q

Glomerular and tubular process; movement of water/solutes from the peritubular capillaries back into the lumen of the tubule.

A

Tubular secretion

106
Q

3 components for glomerular and tubular processes

A

Glomerular filtration
Tubular reabsorption
Tubular secretion

107
Q

Secretion and reabsorption can occur anywhere throughout the tubule. TRUE/FALSE

A

TRUE

108
Q

Amount of solute filtered from glomerulus into tubular lumen (MINUS) total amount _________ form filtrate of tubular lumen into blood of peritubular capillaries (PLUS) total amount _______ from blood of peritubular capillaries into filtrate of tubular lumen = amount excreted into the urine or _________.

A

Reabsorbed

Secreted

Clearance

109
Q

Clearance is how much of a solute is cleared by the kidneys each _________.

A

Minute

110
Q

We can use _______ clearance as a clinical estimate of GFR.

A

Creatinine

111
Q

GFR is a good indicator of kidney fxn. True/false

A

TRUE

112
Q

The reason we use creatinine is bc why?

A

No problem getting into tubular lumen, readily filtered from glomerular capillaries into tubular lumen.

113
Q

___% additional creatinine is secreted into _______ tubule; slightly overestimates GFR.

A

~10% or less

Proximal tubule

114
Q

There is _____ reabsorption of creatinine from the tubular lumen

A

ZERO

115
Q

This test requires one blood sample and lab measures volume of urine, UrCr, and Scr.

A

Cr. Clearance; 24 hr urine collection

116
Q

UrVol (ml/min) x UrCr (mg/dl) / Scr (mg/dl)

A

Creatinine clearance; 24 hour urine sample

117
Q

End result of CrCl equation is in ___/___, which indicated GFR; normal value is _______.

A

ml/min

100-125ml/min

118
Q

(140-age in yrs) x (body wt. in kg) / 72 x Scr (mg/dl)

A

CrCl; Cockcroft-Gault method

119
Q

With the Cockcroft-Gault method, you must multiple females results by ___%

A

85%

120
Q

Cockcroft-Gault method overestimates GFR and renal fxn in _____ and ______ pts.

A

Obese

Fluid overloaded

121
Q

This type of cell makes up which part of the tubule?

Large, cuboidal epithelial cells/endothelial cells (line the inside of the tubule)

A

Proximal tubule

122
Q

This type of cell makes up which part of the tubule?

Tons of mitochondria; lots of ATP and lots of active Tx.

A

Distal tubule

123
Q

This type of cell makes up which part of the tubule?

Cells can change permeability to water dramatically; can be completely permeable/very impermeable

A

Medullary collecting duct

124
Q

This type of cell makes up which part of the tubule?

Rudimentary border, small nucleus, few mitochondria and no transport proteins

A

Descending loop of LOH

125
Q

This type of cell makes up which part of the tubule?

Luminal border faces inside of tubule; increases surface area and rapid reabsorption of solutes

A

Proximal tubule

126
Q

This type of cell makes up which part of the tubule?

Active diluting segment; pumping out sodium, potassium, and chloride = diluting tubular filtrate

A

Distal tubule

127
Q

This type of cell makes up which part of the tubule?

Permeability determined by presence of ADH, when present very permeable, when absent, impermeable.

A

Collecting duct

128
Q

This type of cell makes up which part of the tubule?

Large nucleus, lots of DNA synthesis; lots of mitochondria = ATP for active tx of solutes from lumen to peritubular capillary

A

Proximal tubule

129
Q

This type of cell makes up which part of the tubule?

Allow concentration of tubular filtrate; water is moving out into interstitium and sodium is staying in.

A

Descending LOH

130
Q

This type of cell makes up which part of the tubule?

Basal border cells face interstitium which would face peritubular capillary

A

Proximal tubule

131
Q

Overall, the _______ favors rapid reabsorption of filtrate

A

Proximal tubule

132
Q

Present on basal border of tubular cell; necessary for secondary-active co-transport.

A

Primary active Na-K pump

133
Q

Na-K pump pumps _______ out and _______ in everytinme it cycles; creates and maintains gradient for )________ to move from tubular lumen into the proximal tubule cell and eventually to peritubular capillary

A

3 Na out
2 K in

Sodium

134
Q

There is a transport proteins on the brush border; AA and Na bind to binding site on tx protein at the same time; ____ goes with its gradient and ____ travels across with it, but against its conc gradient.

A

Na

AA

135
Q

Under normal conditions, 100% of AA should be reabsorbed from the proximal tubule by secondary active co-tx along with Na, should never have AA in your urine. TRUE/FALSE

A

TRUE

136
Q

This is also transported via secondary active cotransport; transport maximum is present

A

Glucose

137
Q

100% of filtered glucose should be reabsorbed from the proximal tubule by secondary active cotransport along with Na. TRUE/FALSE

A

TRUE

138
Q

K is also transported via secondary active cotransport, but what is different from it and AA/glucose?

A

Not all K is reabsorbed from the proximal tubule

139
Q

This allowed buffering of H+ by excretion into the urine; maintains acid/base balance

A

Secondary active counter-transport of sodium-H+

140
Q

Normal tubular load of glucose filtered from glomeruli into tubular lumen each minute

A

~125mg/min

141
Q

If you have normal absorption/tubular load, you should have only small amount of glucose in the urine. TRUE/FALSE

A

FALSE

Should be NO spillage of glucose into urine

142
Q

Tubular threshold is _______mg/min, where tx proteins are becoming saturated and cannot take on any more glucose.

A

~220 mg/min

143
Q

At this point, glucose tx’s are completely saturated and no more glucose can be reabsorbed. There is a direct linear relationship b/w increase in glucose and urine spillage

A

Tubular tx maximum

~320 mg/min

144
Q

Tubular load equation

A

Blood glucose x GFR

145
Q

Tubular load of glucose is a good indicator/representation of blood glucose. TRUE/FALSE

Why?

A

FALSE

NOT a good indicator; dependent on GFR

146
Q

65-70% of ____ is actively reabsorbed

A

Sodium

147
Q

65-70% of_______ reabsorbed via secondary active co-tx with sodium

A

K

148
Q

65-70% of _____ passively reabsorbed

A

Calcium

149
Q

~100% of _______ reabsorbed; regulated by PTH

A

Phosphate

150
Q

25% ______ actively reabsorbed

A

Magnesium

151
Q

________ is passively reabsorbed with cations; negatively charged

A

Chloride

152
Q

100% of these two things are reabsorbed via secondary active co-tx

A

AA

Glucose

153
Q

100% of ______ reabsorbed by pinocytosis; very damaging to kidneys

A

Proteins

154
Q

10% additional _______ secreted into tubule; overestimates GFR/kidney fxn

A

Creatinine

155
Q

65-70% of ________ reabsorbed by osmotic gradient created by sodium reabsorption

A

Water

156
Q

Acid-base balance begins where?

A

Secondary active countertransport

157
Q

Volume of filtrate decreases by 65-70%, but osmolality DOES NOT CHNAGE and remains ~300 mosm throughout the proximal tubule; TRUE/FALSE

A

TRUE

158
Q

Proximal tubule invaginates and absorbs ________, broken down to ______, then eventually reabsorbed back into peritubular capillary and into body fluids

A

Proteins

AA

159
Q

At the end of the LOH and additional ______% of Na, K, and water is reabsorbed; so ~______% of these are reabsorbed totally.

A

25-27%

95-97%

160
Q

3 layers of the adrenal cortex

A

Zona glomerulosa
Zona fasciculata
Zona reticularis

161
Q

Outer layer of adrenal cortex secretes aldosterone

A

Zona glomerulosa

162
Q

Middle layer of adrenal cortex that secretes cortisol

A

Zona fasciculata

163
Q

Innermost layer of adrenal cortex, secretes androgens

A

Zona reticularis

164
Q

2 major stimuli for aldosterone secretion

A

Hyperkalemia

Angiotensin II

165
Q

Other stimuli for aldosterone secretion; not the two main ones

A

Hyponatremia

ACTH from ant pit

166
Q

Steroid based hormone; can directly cross cell membrane and bind to preceptors

A

Aldosterone

167
Q

After aldosterone binds with receptors, there is increased activation of ________.

A

Ribosomal transport proteins

168
Q

3 layers of the adrenal cortex

A

Zona glomerulosa
Zona fasciculata
Zona reticularis

169
Q

Outer layer of adrenal cortex secretes aldosterone

A

Zona glomerulosa

170
Q

Middle layer of adrenal cortex that secretes cortisol

A

Zona fasciculata

171
Q

Innermost layer of adrenal cortex, secretes androgens

A

Zona reticularis

172
Q

2 major stimuli for aldosterone secretion

A

Hyperkalemia

Angiotensin II

173
Q

Other stimuli for aldosterone secretion; not the two main ones

A

Hyponatremia

ACTH from ant pit

174
Q

Steroid based hormone; can directly cross cell membrane and bind to preceptors

A

Aldosterone

175
Q

After aldosterone binds with receptors, there is increased activation of ________.

A

Ribosomal transport proteins

ANAP 520 (6 decks)

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