Toxic Responses of the Kidney Flashcards
Principal Role of Kidney
Excretion of metabolic wastes
Metabolic wastes came from the ________ (mainly the
byproducts) are processed by the kidneys
liver
Other functions of kidneys
Synthesize Hormones
Regulation of Extracellular fluid volume
Electrolyte composition
Acid-base balance
The Kidneys transform Vit D to _______
Vit D3 (Active form)
THREE DEMARCATED ANATOMICAL AREAS
Cortex
Medulla
Papilla
90% of the kidney
Cortex
~6-10% of the kidney
Medulla
1-2% of the kidney
Papilla
Functional unit of the kidney
Nephron, Vascular element,
glomerulus, tubular element
Interlobar, arcuate, interlobular arteries
and afferent arterioles that supply the glomerulus
RENAL ARTERY
T/F: Both afferent and efferent arterioles control glomerular
capillary pressure and glomerular plasma flow rate
True
a complex, specialized capillary bed
composed primarily of endothelial cells
glomerulus
Characterized by an attenuated and fenestrated
cytoplasm & visceral epithelial cells
glomerulus
Cell body (podocyte), trabeculae and pedicles (foot
processes), glomerular basement membrane (GBM)
glomerulus
These are sandwiched in the endothelial cells between
the glomerulus
Cell body (podocyte), trabeculae and pedicles (foot
processes), glomerular basement membrane (GBM)
The blood flow from the heart that travels from the
___________ goes to the glomerular site of the kidney.
Once the wastes are delivered, it goes back to the
heart as _____________ blood
renal artery; deoxygenated
S1
Pars convolute
S2
Transition between pars
convolute and pars recta
S3
Pars Recta
___________ is the workhorse of the nephron, as it
reabsorbs 60-80% of solute and water filtered at the
glomerulus
proximal tubule
mainly filters the solute and water
Glomerulus
___________ reabsorbs virtually all the filtered low MW proteins
by specific endocytotic protein reabsorption processes
proximal tubule
Approximately 25% of the filtered Na and K and 20% of
the filtered water are reabsorbed by the segments of the ___________
Loop Henle
Iso-osmotic to the renal
interstitium
Tubular fluid
entering the thin
descending limb
Water is freely permeable, and
solutes (electrolytes and urea)
Tubular fluid
entering the thin
descending limb
Impermeable to water, and
electrolytes are reabsorbed by the
active Na+/K+/2Cl- cotransport
mechanism (Na+,K+, -ATPase)
Thin ascending limb
Reabsorbs most of the remaining
impermeable to water
Early distal tubule
Perform the final regulation and
finetuning of urinary volume and
composition
Late distal tubule,
cortical collecting
tubule, and medullary
collecting duct
is characterized by an abrupt decline in GFR with
resulting azotemia
AKI
buildup of nitrogen in the blood
azotemia
describes the entire spectrum of the disease and is defined
as a complex disorder that comprises multiple causative
factors with clinical manifestations ranging from minimal
elevation in serum creatinine to anuric renal failure
AKI
Any decline in GFR is complex and may result from:
Prerenal, Postrenal and Intrarenal factors
Renal vasoconstriction
Prerenal factors
Intravascular volume depletion
Prerenal factors
Insufficient cardiac output
Prerenal factors
Ureteral or bladder obstruction
Postrenal factors
Glomerulonephritis
Intrarenal factors
Tubular cell injury
Intrarenal factors
Death and loss resulting in back leak
Intrarenal factors
Causes reduction of blood flow that results to
diminished capillary pressure
In Afferent arteriolar constriction; ↓ capillary presure in the glomerulus=___________glomerular
function
↓ glomerular function
Possible causes of constriction
high blood pressure
In Obstruction of the tubular lumen, ↑ tubular pressure = _____ glomerular capillary pressure
and filtration
↓ glomerular capillary pressure
and filtration
Paracellular space between cells decreases
Back-leak
Glomerular filtrate leaks into the extracellular space
and bloodstream
Back-leak
Poisoning of the circulation
Back-leak
Wastes are reabsorbed, since highly vascularized ang
kidney
Back-leak
T/F: NSAIDs cause many types of chemically-induced AKI
True
Tx for Permanent kidney damage
kidney replacement,
dialysis
in-vitro system of kidneys
Dialysis
Machine that filters all the metabolic
wastes of the body
Dialysis
Common patients of Dialysis
eriatric, diabetic
patients since they have reduced GFR
Tx For adults who have reduced GFR
reduce drug doses
If you have different insults to the nephrons and
kidney, it may lead to the following:
○ Compensatory hypertrophy
○ Cellular adaptation
○ Cellular proliferation
○ Cellular repair
Progressive deterioration of renal function may occur with
long term exposure to various chemicals (analgesics, lithium,
cyclosporine)
CKD
Used by patients with depression
Lithium
alterations in CKD are maladaptive, and ________________ eventually develops, which may lead to
________________ and ________________
focal
glomerulosclerosis; tubular atrophy ; interstitial fibrosis
T/F: If you have a kidney problem it is possible that you
also have a cardiac problem and vice versa
true
Although the kidneys constitute only 0.5% of total body
mass, they receive about __________ of the resting
cardiac output
20% to 25%
T/F: A nontoxic concentration of a chemical in the plasma may
reach toxic concentrations in the kidney and its tubules
True
NSAIDs: _________________ → ↓ renal
blood flow → __________
prostaglandin synthesis suppressor; AKI
ACEIs: block ____________ → precipitous decline in
filtration pressure and _________
vasoconstriction; AKI
the initial site of chemical exposure within
the nephron
glomerulus
the most common site of
toxicant-induced renal injury
proximal tubule
has a leaky epithelium, favoring the flux
of compounds into proximal tubular cells
proximal tubule
Functional abnormalities at distal nephron sites manifest
primarily as impaired concentrating ability and/or
acidification defects
LOOP OF HENLE/DISTAL TUBULE/
COLLECTING DUCT INJURY
susceptible to the chronic injurious
effects of abusive consumption of analgesics
renal papilla
T/F: Xenobiotics in the systemic circulation will be delivered to
the kidney in relatively high amounts.
True
T/F: The process that concentrates urine does not
concentrate potential toxicants in the tubular fluid
False
contribute to the susceptibility of the kidney to
toxic injury
Renal transport, accumulation, and biotransformation of
xenobiotics
Numerous nephrotoxicants cause____________
via compromised respiration and ATP production, or some
other cellular process, leading to either apoptosis or necrosis
mitochondrial dysfunction
