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Renal > Tubules- Physiology > Flashcards

Tubules- Physiology Flashcards

1
Q

This is the pathways of water and solutes when they are transported through both the apical and basolateral membranes of a cell.

A

Transcellular pathway

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2
Q

This is the pathway of water solutes when it is transported through the junctional spaces between the cells.

A

Paracellular pathway

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3
Q

This is the term for when once the water and solutes are in the interstitial fluid, they are transported all the way through the peritubular capillary walls into the blood by ultrafiltration.

A

Bulk flow

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4
Q

This is the use of specific ATPase transporters to move substances against an electrochemical gradient.

A

Primary active transport

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5
Q

In secondary active transport, what must be established by a secondary ATPase to cause movement of a substance against an electrochemical gradient?

A

A gradient

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6
Q

This is the movement of solutes down their gradient,

A

Passive transport

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7
Q

When a substance is moved down its gradient with the helping hand of a carrier protein, what is it called?

A

Facilitated diffusion

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8
Q

This is the saturation of the specific transport systems involved when the amt of solute delivered to the tubule exceeds the capacity of the carrier proteins.

A

Transport maximum

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9
Q

If a substance exceeds the transport maximum, which is normally reabsorbed completely in the tubules, what do u see in the pee?

A

The substance, which u normally wouldnt see

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10
Q

Is the transport of water passive or active across cells?

A

Passive

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11
Q

When water is reabsorbed in the PCT, there is a high gradient established for which ion?

A

Cl-

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12
Q

Cl- is also reabsorved through the tubular epithelial cells because of the electrical drive from which ion that’s absorbed?

A

Na+

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13
Q

Urea is pretty big, which causes a ↓ reabsorption rate, resulting in how much % urea reabsorbed?

A

50%

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14
Q

How much Water and NaCl are reabsorbed at the PCT?

A

65%

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15
Q

What is reabsorbed in the descending LH?

A

Water (20%)

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16
Q

How much NaCl is reabsorbed in the descending LH?

A

NOTHING. ONLY WATER. HAHHAHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHA!

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17
Q

When in the LH does water reabsorption stop?

A

at the thin ascending LH

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18
Q

What % of NaCl and K is reabsorbed in the thick ascending LH?

A

25%

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19
Q

How much NaCl is reabsorbed in the early DCT?

A

5%

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20
Q

The pricipal and intercalated cells of the late DCT reabsorb which substances?

A

NaCl, K, HCO3- and water

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21
Q

Which hormone controls the level of H2O reabsorption in the collecting duct (CD)?

A

Antidiuretic Hormone (ADH)

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22
Q

What is reabsorbed in the CD to raise the osmolality of this region to concentrate the urine more?

A

Urea

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23
Q

Glucose, proteins, and AA’s are completely reabsorbed in which segment of the nephron?

A

PCT

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24
Q

The NKCC channels in the thick ascending LH absorb which ions?

A

Na+
K+
2 Cl-

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25
Q

After the NKCC channels reabsorb K, it leaks out again through which channels to cause the reabsorption of Ca and Mg?

A

ROMK

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26
Q

Which drug is almost completely removed in the plasma and excreted, so it can be used to estimate RPF?

A

PAH

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27
Q

Loop diruetics (furosemide, ethacrynic acid, and bumetanide) target which carrier?

A

NKCC on the thick ascending LH

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28
Q

Thiazide diuretics target whcih carrier protein?

A

NaCl in the early DCT

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29
Q

What is the target for spironolactone and eplerenone for K+ sparing?

A

Aldosterone R

they’re competitive antagonists

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30
Q

What is the target for Amiloride and Triamterene for the K+ sparing?

A

ENaC channel (Na+) on luminal membranes

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31
Q

What are the 2 influences on the peritubular capillary hydrostatic pressures?

A

Arterial pressure

Arterial resistance

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32
Q

SANS increases the reabsorption of which ion from the PCT, thick ascending LH, and DCT?

A

Na+

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33
Q

The sans also constricts the renal arterioles, which cause which change in GFR?

A

↓ GFR

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34
Q

Aldosterone stimulates the reabsorption of which ion from the principal cells?

A

Na+

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35
Q

Aldosterone stimulates the secretion of which ion from the principal cells?

A

K+

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36
Q

Aldosterone stimulates the secretion of which ion from the intercalated cells?

A

H+

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37
Q

ADH causes the recruitment and insterion of which proteins int he luminal membrane of the CD to cause ↑ water reabsorption?

A

Aquaporins

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38
Q

What does ANP do to Na reabsorption?

A

Blocks it

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39
Q

PTH increases the reabsorption of which ion from the DCT and LH?

A

Ca++

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40
Q

PTH activates the Gs pathway to decrease the reabsorption of which substance?

A

Phosphate

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41
Q

This is the volume of plasma that is completely cleared of the substance by the kidneys per unit time.

A

Renal Clearance

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42
Q

What is the equation for clearance rate?

A

Cs = (Us x V)/Ps

Us- urine concentration of substance
V- urine flow rate
Ps- plasma concentration

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43
Q

What is the equation for GFR using inulin?

A

GFR = (Uinulin x V)/Pinulin

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44
Q

What is the equation for clearance ratio, using inulin?

A

CR = Cs/Cinsulin

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45
Q

What is the equation for ERPF, using PAH?

A

ERPF = C(PAH) = [U(PAH) x V]/P(PAH)

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46
Q

What is the eqn for RPF?

A

RPF = C(PAH)/E(PAH) = [U(PAH) x V/P(PAH)]/{[P(PAH) - V(PAH)]/P(PAH)}

E(PAH) = urine PAH extration ratio

lol do u like that?

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47
Q

What is the eqn for RBF?

A

RBF = RPF/(1-Hct)

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48
Q

What is the eqn for excretion rate?

A

ER = Us x V

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49
Q

What is the eqn for reabsorption rate?

A

RR = filtered load - excretion rate = (GFR x Ps) - (Us x V)

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50
Q

What is the eqn for secretion rate?

A

SR = ER - FL

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51
Q

How much water is taken in each day through liquids or food?

A

2100 mL/day

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52
Q

How much water is synthesized in the body each day as a result of oxidation of carbs?

A

200 mL/day

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53
Q

SOOOOOOOOOOOOOOOOOOOOOO the total intake of water each day is what?

A

2300 ml/day

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54
Q

How much water do we lose each day to respiration and the skin (insensible)?

A

700 mL/day

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55
Q

How much water is lsot in sweat?

A

100mL normally but i can increase if ur a sweaty bitch

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56
Q

How much water is lost in poop?

A

100 mL/day normally.

10000 ml/day for me.

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57
Q

How much water is lost in pee per day?

A

from 0.5-20L/day

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58
Q

Diarrhea causes the loss of Na, leading to which condition of low Na?

A

Hyponatremia

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59
Q

Which drugs can cause excess Na loss, leading to hyponatremia?

A

Diuretics (typically thiazides)

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60
Q

This is the condition where there is undersecretion of aldosterone, leading to Na loss.

A

Addisons disease

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61
Q

True or False: in SIADH there is too much water retention leading to dilution of Na leading to Hypernatremia.

A

True

ok yeah i didnt know how to make a flashcard for this lol.

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62
Q

So if you can’t secrete ADH, the excessive loss of water will lead to what Na condition?

A

HYPERnatremia

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63
Q

What condition is when there is damage to the posterior pituitary, causing the inability to secrete ADH?

A

central diabetes insipidus

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64
Q

What is it called when there is appropriate ADH release but the kidneys cannot respond to it?

A

nephrogenic diabetes insipidus

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65
Q

How will sweating cause hypernatremia?

A

Lose water –> ↑ [Na]

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66
Q

This is the syndrome where there is hyperaldosteronism causing ↑ Na reabsorption and thus hypernatremia.

A

Conn’s syndrome

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67
Q

What is the osmolarity of the filtrate in the PCT?

A

300

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68
Q

What is the osmolarity of the filtrate in the descending LH?

A

increases from 300 –> 600

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69
Q

Why does the osmolarity of the filtrate increase in the descending LH?

A

water leaves and salt stays in the pee

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70
Q

What is the osmolarity of the filtrate in the ascending LH?

A

decreases from 600 –> 100

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71
Q

Why does the osmolarity of the filtrate decrease so much from themedullary LH to the DCT?

A

cuz salt leaves and water stays

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72
Q

What is the osmolarity of the filtrate in the DCT?

A

100

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73
Q

What is the maximum concentrating ability of the kidneys in osmolarity?

A

1200 mOsm/L

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74
Q

In the countecurrent mechanism, the tubule pumps out ions and urea into the interstitum, creating a large gradient for what?

A

Water

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75
Q

Where does water flow to equalibrize the high somolarity from the coutnercurrent mechanism?

A

From the CD –> interstitum

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76
Q

A loop diruetic will inhibit the NKCC transporter, causing what change in water drive?

A

less driving force to leave –> ↑ urine volume

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77
Q

Where is urea reabsorbed in the nephron?

A

PCT and medullary CD

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78
Q

Reabsorption of urea will increase the drive for what other substance to be reabsorbed?

A

Water

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79
Q

An increased protein diet will cause what change in the urine concentration?

A

↑ protein –> ↑ urea –> ↑ reabsorption of urea –> ↑ concentration of urine

80
Q

Once reabsorbed from the CD, urea can then re-enter the nephron at which points to keep a little cycle action going?

A

medullary portions of the LH

81
Q

Is medullary blood flow from the vasa recta high or low?

A

Low (keeps solutes there)

82
Q

True or False: the vasa recta has a single osmolarity, unlike the LH which varies from cortex –> medulla.

A

FALSE. The vasa recta is the same shape as the LH and has the same weird osmolarities

83
Q

Receptors in what location shrink when osmolarity increases?

A

Anterior pituitary

84
Q

The anterior pitutary then tells the suproptic nuclei what’s up, which then signals which location?

A

Posterior pituitary

85
Q

What does the posterior pituitary release?

A

ADH

86
Q

What will cause baroreceptor firing to increase ADH secretion?

A

decreased arterial pressure (hemorrhage)

87
Q

Will vomiting increase or decrease ADH release?

A

increase a ton

88
Q

Does nicotine and morphine increase or decrease ADH release?

A

Increase

89
Q

Does alcohol increase or decrease ADH release?

A

inhibit

u pee a lot while drinking

90
Q

Which form of diabetes insipidus will respond to Desmopressin, central or nephrogenic?

A

Central

91
Q

Which nuclei in the hypothalamus are responsible for thirst?

A

Lateral nuclei

92
Q

What are the 2 locations that sense osmolarity to tell the lateral hypothalamic nuclei that you’re thirsty?

A

Tractus solitarii nuclei

Area postrema

93
Q

True or False: there is a massive change in plasma Na concentration when the aldosterone systme is blocked, as you can no longer take in Na+.

A

False. it barely changes cuz whenever Na is reabsorbed, water follows. its a balance.

94
Q

True or False: there is a massive change in plasma Na concentration when ADH and thirst systems are blocked.

A

True

95
Q

You take in 50-200mEq/day of what ion?

A

K+

96
Q

What is normal K concentration in the extracellular fluid?

A

4.2 mEq/L

97
Q

This is the condition where there is failure to rapidly ride the ECF of ingested K.

A

Hyperkalemia

98
Q

Too much loss of K will cause what?

A

Hypokalemia

99
Q

Case: pt presents with massive myoglobinuria and increased urine CK. He also has malaise, hyperventilation, metabolic acidosis, and most importantly, cardiac arrhythmia that’s msot likely leading to sudden death. What is his problem?

A

Hyperkalemia

↑ Mb and CK from muscle cells popping, which release a ton of K into the ECF –> hyperkalemia

100
Q

In addition to HTN and arrhythmias, what skeletal muscle abnromalities can be a result from hypOkalemia?

A

Muscle cramps
Flaccid paralysis
Rhabdomyolisis

101
Q

Does insulin increase or decrease K uptake into cells?

A

Increase

102
Q

So are diabetics typically hyperkalemic or hypokalemic?

A

Hyperkalemic (no insulin to get rid of the ECF K)

103
Q

Does aldosterone increase or decrease K uptake into cells?

A

Increase

104
Q

Does beta-adrenergic stimualtion increase or decrease K uptake into cells?

A

Increase

105
Q

Does acid (H+) increase or decrease [K] in the ECF?

A

increase

106
Q

Case: pt presents with cardiac arrhythmias post-marathon. What is happening to his K levels in the ECF?

A

↑ K from SkM lysis –> hyperkalemia

107
Q

If there’s an increased intracellular osmolarity, will there be an increase or decrease of K within the cell?

A

increase

108
Q

What are the 2 places K is reabsorbed along the nephron?

A

PCT and thick ascending LH

109
Q

Where is K SECRETED in the nephron?

A

DCT/CD

110
Q

Does an increase or decrease in Na/K ATPase in the principal cells increase K secretion?

A

Increase Na/K ATPase –> ↑ K secretion

111
Q

What are the 3 ways that stimulate K secretion?

A
  1. ↑ [K] in ECF.
  2. ↑ aldosterone
  3. ↑ tubular flow
112
Q

Which receptor does aldosterone stimualate to cause K secretion and Na reabsorption?

A

Na/K ATPase

113
Q

Why does an increased Na intake not change K excretion?

A

cuz it both ↓ aldosterone (↓ K secretion) but ↑ tubular flow rate (↑ K secretion)

114
Q

What does acid inhibit cause an increase in [K] in the ECF?

A

Na/K ATPase

115
Q

What are 2 drugs that inhibit the aldosterone R to spare K secretion?

A

Eplerenone and Spironolactone

116
Q

What are 2 drugs that inhibit the ENaC channel on the luminal membrane to spare K+ secretion?

A

Amiloride

Triamterene

117
Q

Thiazide and loop diuretics inhibit receptors, leading to what severe K imbalance?

A

Hypokalemia

118
Q

What is a normal Ca++ levels in the plasma?

A

2.4 mEq/L

119
Q

What mg/dL determines hypocalcemia?

A

< 8.5 mg/dL

120
Q

What mg/dL determines hypercalcemia?

A

> 10.3 mg/dL

121
Q

This is the condition of hypocalcemia where there are spastic muscle contractions from ↑ excitability of nerve and muscle cells.

A

Hypocalcemic tetany

from ↑ permeability of neuronal membranes to Na+

122
Q

What is the main issue with hypercalcemia?

A

Cardiac arrhythmias

123
Q

What are the 3 ways PTH stimulates ↑ [Ca++] in the blood?

A

1, Stimulating bone resorption

  1. Activation of vitamin D (↑ GI absorption)
  2. Directly ↑ renal tubular Ca++ reabsorption
124
Q

Whenever you reabsorb what ion in the nephron do u reabsorb Ca++?

A

Na+

125
Q

What % of Ca++ is excreted?

A

1%

126
Q

What mechanism does Ca++ reabsorption in the thick ascending?

A

Passive mechanisms secondary to Na+ reabsorption

127
Q

So a loop diuretic will do what to Ca++ reabsorption?

A

↓

128
Q

How is Ca++ reabsorbed in the DCT?

A

active transport independent of Na+ reabsorption

129
Q

What will thiazide diuretics do to Ca++ reabsorption?

A

increase Ca++ reabsorption

130
Q

So which type of diuretics (loop or thiazide) do u use with osteoporotic pts with HTN?

A

Thiazide diuretics

131
Q

Does metabolic acidosis or alkalosis increase Ca++ reabsorption?

A

Acidosis

132
Q

What is the cap (in mM/min) of Ca++ reaborption of Phosphate in the nephron?

A

1 mM/min

133
Q

Does PTH increase or decrease phosphate excretion?

A

Increase

134
Q

Although PTH causes bone resorption and thus ↑ phosphate dumping, what does it do to the transport maximum on the renal tubules to ↑ phosphate excretion?

A

↓ the transport max

135
Q

This is the term for increased Na excretion from elevated blood pressure.

A

Pressure natriuresis

136
Q

This is the term for the effect of increased blood pressure causes a raise in urinary volume excretion.

A

Pressure diuresis

137
Q

Which form of HTN (acute or chronic) causes a 2-3 fold increase in urinary Na output?

A

Chronic

138
Q

Increased capilalry hydrostatic pressure, ↓ plasma colloid osmotic pressure, ↑ permeability of the capillaries, and obstruction of the lymph vessels can lead to what abnormality?

A

edema

139
Q

What does the SANS do to GFR?

A

↓ GFR by constricting the afferent arteriole

140
Q

What does the SANS do to tubular reabsorption of Na and Water?

A

↑

141
Q

What does the SANS trigger the release of to increase tubular reabsorption?

A

RAAS system

142
Q

After eating your Thanksgiving meal, what happens to the SANS?

A

Reflex inhibition leading to rapid elimination of excess fluid

143
Q

When the control of ATII of naturesis is fully functional, how much change in blood pressure is needed to increase the sodium excretion drastically?

A

A little change

144
Q

If ATII levels cannot eb decreased in response to increased Na intake (like in HTN), how much change in BP is needed to change the Na excretion?

A

A good amount

145
Q

Does ADH have an effect on Na+ excretion?

A

No

146
Q

Cardiac atrial muscle fibers make this protein when the atria are stretched to act on the kidneys to cause small increases in GFR and ↓ of Na reabsorption by the CD.

A

ANP

147
Q

What happens to the kidneys in heart failure?

A

They retain volume in an attempt to return the arterial pressure and CO toward normal

148
Q

If you increase circulation capacity (varicose veins), what do the kidneys retain until blood volumes increase to fill the extra capacity?

A

Na and water

149
Q

Nephrotic syndrome resulting in edema causes what compensation of the kidney?

A

Retains Na and water until plasma volume is restored to normal

150
Q

These are molecules containing hydrogen atoms that can release hydrogen ions in solutions.

A

acids

151
Q

These is an ion or molecule that can accept a H+.

A

base

152
Q

This is the excess removal of H+ from the body fluids (↑ in pH).

A

Alkalosis

153
Q

This is the excess addition of H+ from the body fluids (↓ in pH).

A

Acidosis

154
Q

What is the normal pH for the blood?

A

7.4

155
Q

What are the 3 ways the body can buffer changes in pH?

A

Chemical acid-base buffer systems
Respiratory center
Kidneys

156
Q

Which enzyme convers CO2 + H2O –> H2CO3?

A

Carbonic Anhydrase

157
Q

How is acid buffered by the bicarbonate buffer solution (give the eqn)?

A

↑H + HCO3- –> H2CO3 –> CO2 + H2O

158
Q

How is base buffered by the bicarbonate buffer solution (give the eqn)?

A

NaOH + H2CO3 –> NaHCO3 + H2O

159
Q

What is the Henderson-Hasselbalch eqn to calculate the pH of a sln?

A

pH = 6.1 + log[(HCO3-)/(0.03 x PCO2)]

160
Q

What does an ↑ in respiration rate do to pH?

A

↑ by ↑ CO2 blow-off

161
Q

These are acids that can be excreted from the lungs, like H2CO3.

A

Volatile acids

162
Q

These are acids that cannot be excreted by the lungs, like ketoacids or lactic acid.

A

Nonvolatile acids

163
Q

How does the body get rid of nonvolatile acids?

A

The kidneys excrete them

164
Q

What is the transporter on the luminal membrane of the PCT, thick ALH, and DCT to secrete H+?

A

Na/H antiporter

165
Q

What form of energy transport does H+ use on the PCT, thick ALH, and DCT to secrete H+?

A

Secondary active transport from Na+ gradient set up by Na/K ATPase

166
Q

What always gets reabsorbed whenever H+ is made inside the tubule cell to be secreted?

A

HCO3-

167
Q

From the DCT onwards, how is H+ secreted by the intercalated cells?

A

Primary active transport

H+ ATPase

168
Q

When all the H+ in the pee buffers with the free HCO3-, what 2 systems kick into place to buffer the excess H+ ions?

A

Phosphate and ammonia buffer systems

169
Q

The phosphate and ammonia buffer systems buffer the free H+ but also give rise to the net GAIN of what ion to be reabsorbed?

A

HCO3-

170
Q

In the phosphate buffer system, the NaHPO4- in the pee can buffer acid and be excreted as what salt?

A

NaH2PO4

171
Q

In the PCT, thick ALH, and DCT, which AA is delivered form the liver to the kidneys to buffer H+?

A

Glutamine

172
Q

In the CD, the H+ is secreted by primary active transport into the pee, whcih combines with what from the intercalated cell?

A

NH3

173
Q

So in both forms of the ammonia buffer system, what is excreted as a salt to buffer H+?

A

NH4+ + Cl-

174
Q

An increase in PCO2 causes what change to H+ secretion?

A

↑ H+ secretion

more CO2 to be broken down and secreted

175
Q

Does an increase or decrease in the RAAS system ↑ H+ secretion?

A

↑ RAAS –> ↑ H+ secretion

176
Q

A patient with Conns syndrome will cause what change, acidosis or alkalosis?

A

Alkalosis

↑ aldosterone –> ↑ H+ secretion

177
Q

What is the compensatory response to respiratory acidosis?

A

an increase in plasma HCO3-from the addition of new bicarbonate to the extracellular fluid by the kidneys

178
Q

What is the compensatory response to metabolic acidosis?

A

the lungs compensate by increasing ventilation rate. This decreases PCO2. The kidneys also add new bicarbonate to the extracellular fluid

179
Q

What is the compensatory response to respiratory alkalosis?

A

the kidney compensates by increasing excretion of HCO3-

180
Q

What is the compensatory response to metabolic alkalosis?

A

the lungs compensate by decreasing respiratory rate (↑ PCO2) and the kidneys increase renal HCO3- excretion

181
Q

What happens to the H+, HCO3-, and CO2 levels in respiratory acidosis?

A

H+: ↑
HCO3-: ↑
CO2: ↑

182
Q

What happens to the H+, HCO3-, and CO2 levels in Metabolic acidosis?

A

H+: ↑
HCO3-: ↓
CO2: ↓

183
Q

What happens to the H+, HCO3-, and CO2 levels in respiratory alkalosis?

A

H+: ↓
HCO3-: ↓
CO2: ↓

184
Q

What happens to the H+, HCO3-, and CO2 levels in metabolic alkalosis?

A

H+: ↓
HCO3-: ↑
CO2: ↑

185
Q

What causes respiratory acidosis?

A

↓ ventilation

186
Q

What causes metabolic acidosis?

A

Diarrhea, diabetes, ingesting acids, renal failure

187
Q

What causes respiratory alkalosis?

A

↑ ventilation

188
Q

What causes metabolic alkalosis?

A

Vomiting, diuretics, excess aldosterone, ingestion of alkaline drugs

189
Q

What is the Tx for acidosis?

A

Tums

190
Q

What is the Tx for alkalosis?

A

give ammonium chloride by mouth

191
Q

This is when there are 2 or more underlying causes for acid-base disturbance and disorders are not accompanied by appropriate compensatory responses.

A

Mixed acid-base disorder

192
Q

This is the difference between the unmeasured anions and unmeasured cations in the plasma.

A

Anion gap

193
Q

What is the eqn for the plasma anion gap?

A

Anion gap = [Na+] - [HCO3-] - [Cl-]

194
Q

In metabolic acidosis, plasma HCO3 is reduced, so what much increase to maintain electrostability?

A

Cl-

195
Q

In hyperchloremic metabolic acidosis, is the anion gap increased, decreased, or normal?

A

Normal

196
Q

Matabolic acidosis from increased nonvolatile acids does what to the anion gap, increase, decrease, or keep it normal?

A

Increase

197
Q

Diarrhea, renal tubular acidosis, carbonic anhydrase inhibitors, and Addisons cause what?

A

hyperchloremic metabolic acidosis

Renal (7 decks)

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