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3RD YEAR > WEEK 3 > Flashcards

WEEK 3 Flashcards

1
Q

what is the functional unit of kidney?

A

nephrons

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2
Q

approximately, how many functional units are needed for the nephrons of each kidney?

A

1 to 1.5 million

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3
Q

what are the main functions of the kidney

A

maintaining homeostasis, excretion of waste products, and maintenance of blood pressure and erythropoiesis

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4
Q

the blood supplier of the kidney

A

renal artery

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5
Q

the large blood flow percentage

A

25%

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6
Q

what is the average body size?

A

1.73 mm2

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7
Q

Process of renal blood flow

A

renal artery - afferent arteriole - glomerulus - efferent arteriole - peritubular capillaries - vasa recta - renal vein

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8
Q

glomerulus is responsible for?

A

filtration

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9
Q

vasa recta is responsible for?

A

water and salt exchange

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10
Q

peritubular capillaries is responsible for?

A

immediate reabsorption

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11
Q

makes up 85% of nephrons, primarily in the cortex of the kidney and is responsible for the removal of waste products and reabsorption of nutrients

A

cortical nephrons

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12
Q

they have longer loops of henle, extending to deep part of medulla and responsible for concentration of urine

A

juxtamedullary nephrons

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13
Q

what are the renal functions?

A

renal blood flow, glomerular filtration, tubular reabsorption, and tubular
secretion

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14
Q

what part of the kidney is responsible for glomerular filtration?

A

glomerulus

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15
Q

glomerulus consists of _____ of approximately ______ referred to as ______

A

coil, 8 capillary lobes, capillary tuft

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16
Q

where is glomerulus located?

A

bowman’s capsule

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17
Q

what is the molecular weight as a non-selective filter of plasma substances?

A

less than 700, 000

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18
Q

factors that influence the actual filtration process

A

cellular structure of capillary walls and structure
hydrostatic and oncotic pressures
feedback of the renin-angiotensin-aldosterone system

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19
Q

what are the cellular layers that plasma filtrate must pass through?

A

capillary wall membrane
basement membrane or basal lamina
visceral epithelium of bowman’s capsule

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20
Q

capillary wall membrane contains ____ referred to as ____

A

pores, fenestrated

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21
Q

the pores increase ____ but do not allow the passage of _______

A

capillary permeability, large molecules and blood cells

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22
Q

in the basal lamina what process occurs as the filtrate passes through?

A

restriction of large molecules

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23
Q

the thin membranes covering the ________ formed by the intertwining foot processes of the _______ of the ______

A

filtration slits, podocytes, inner layer of bowman’s capsule

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24
Q

what pressure happens in the glomerular pressure

A

hydrostatic pressure

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25
Q

overcome the opposition of pressure from the fluid from the _____ and the ______ of unfiltered plasma protein

A

bowman’s capsule, oncotic pressure

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26
Q

what mechanism maintains the glomerular blood pressure at constant rate regardless the fluctuations in systemic blood pressure?

A

autoregulatory mechanism

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27
Q

what part of the kidney does the autoregulatory mechanism happen?

A

juxtaglomerular apparatus

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28
Q

______ of the afferent arterioles and ______ of the efferent arterioles when blood pressure drops prevent a marked ________ in blood flowing through the kidney

A

dilation, constriction, decrease

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29
Q

when the blood pressure drops, what increase in the blood does this process prevents?

A

prevent an increase in blood level of toxic waste products

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30
Q

it controls the regulation of blood flow and within the glomerulus

A

raas - renin-angiotensin-aldosterone system

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31
Q

what changes does the system respond to?

A

changes in blood pressure and plasma sodium content

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32
Q

the system is monitored by which part?

A

juxtaglomerular apparatus

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33
Q

the juxtaglomerular consists of what?

A

juxtaglomerular cells in afferent arteriole
macula densa of distal convoluted tubule

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34
Q

low plasma sodium contents decreases ______ within circulatory system, resulting in _____

A

water retention, decreased overall blood volume and subsequent decrease in blood pressure

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35
Q

what is the enzyme produces by the juxtaglomerular cells

A

renin

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36
Q

renin is secreted with the blood-borne substrate ____ to produce the inert hormone ______

A

angiotensinogen, angiotensin I

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37
Q

what enzyme changes it to the active form of angiotensin II

A

ACE: Angiotensin-converting enzyme

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38
Q

which way does the angiotensin I passes through?

A

lungs

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39
Q

it corrects the renal blood flow

A

angiotensin II

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40
Q

what are the ways does angiotensin II corrects its renal blood flow?

A
  • vasolidation of afferent
  • vasoconstriction of efferent
  • Sodium reabsorption in Proximal Convoluted Tubule
  • Aldosterone release from the adrenal cortex
  • Antidiuretic release from hypothalamus
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41
Q

when the systemic blood pressure and plasma sodium content ______, the secretion of renin ______

A

increase, decreases

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42
Q

Approximately _____ million glomeruli filter approximately _____ mL of water-containing low-molecular-weight substances every minute.

A

2-3, 120

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43
Q

Because this filtration is nonselective, the only difference between the compositions of the filtrate and the plasma is the ___________

A

absence of plasma protein

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44
Q

Analysis of the fluid as it leaves the glomerulus shows the filtrate to have a specific gravity of

A

1.010

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45
Q

The body cannot lose ____ mL of water-containing essential substances every minute

A

120

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46
Q

what are the 2 transports of the reabsorption mechanism?

A

active and passive

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47
Q

it is the plasma concentration at which active transport stops

A

renal threshold

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48
Q

the substance to be reabsorbed must combine to a ______ contained in the membranes of the

A

carrier protein, renal tubular cells

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49
Q

Active transport is responsible for the reabsorption of

A
  • glucose, amino acids, and salts in the proximal convoluted tubule
  • chloride in the ascending loop of Henle
  • sodium in the distal convoluted tubule
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50
Q

the substances, glucose, amino acids, and salts are located in?

A

proximal convoluted tubule (PCT)

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51
Q

sodium is located in?

A

proximal and distal convoluted tubule

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52
Q

it is the movement of molecules across a membrane result of differences in their concentration or electrical potential on opposite sides of the membrane

A

passive transport

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53
Q

what are the physical differences?

A

gradients

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54
Q

what happens when the renal threshold of substances exceeds?

A

maximal reabsorptive capacity of tubules is affected

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55
Q

what appears when the renal threshold exceeds?

A

appearance of the substance in the urine

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56
Q

Passive reabsorption of water takes place in all parts of the nephron except

A

ascending loop of Henle

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57
Q

why does the reabsorption of eater does not take place in the ascending loop of Henle?

A

the walls of which are impermeable
to water

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58
Q

the substance, water is located in?

A

Proximal Convoluted Tubule
Descending loop of Henle
Collecting Duct

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59
Q

the substance, urea is located in?

A

Proximal Convoluted Tubule
Ascending loop of Henle

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60
Q

the substance, Sodium is located in?

A

Ascending loop of Henle

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61
Q

where does the tubular concentration begin?

A

descending and ascending loop of henle

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62
Q

water is removed by ______ in the descending loop of Henle, and _______ and_____ are reabsorbed in the ascending loop

A

osmosis, sodium and chloride

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63
Q

what is the selective reabsorption process?

A

countercurrent mechanism

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64
Q

what does the mechanism (countercurrent) maintain

A

osmotic gradient of the medulla

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65
Q

Maintenance of the osmotic gradient is essential for the _____ concentration of the filtrate when it reaches the _______

A

final, collecting duct

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66
Q

The final concentration of the filtrate through the _______ of water begins in the _____________ and continues in the __________

A

reabsorption, late distal convoluted tubule, collecting duct

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67
Q

reabsorption depends on what hormone?

A

vasopressin (ADH)

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68
Q

what part of the kidney does reabsorption depend?

A

osmotic gradient in medulla

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69
Q

production of vasopressin is determined by what state?

A

state of body hydration

70
Q

A high level of ADH _____ permeability, resulting in _____ reabsorption of water, and a ____ -concentrated urine

A

increases , increased, low

71
Q

___ Body Hydration - ↓ADH - ___ Urine Volume

A

↑↑

72
Q

↓Body Hydration - __ ADH - ↓Urine Volume

A

↑

73
Q

what are the 2 main functions of tubular secretion?

A
  • elimination of waste products not filtered by the glomerulus
  • regulation of acid-base balance
74
Q

Tubular secretion involves the passage of substances from the _____ in the _______ to the ________

A

blood, peritubular capillaries, tubular filtrate

75
Q

what are examples of foreign substances that cannot be filtered by the glomerulus?

A

urea and medications

76
Q

why can’t they be filtered by the glomerulus

A

because they are bound to plasma proteins

77
Q

what is the normal blood pH?

A

7.4

78
Q

the buffering capacity of the blood depends on what ions?

A

bicarbonate ions

79
Q

what does the bicarbonate ions do?

A

they act as buffer to maintain the proper pH of the blood

80
Q

the blood must buffer and eliminate the ______ formed by dietary intake and body metabolism

A

excess acid

81
Q

secretion of hydrogen ions by the ________ into the filtrate prevents the
_________ from being excreted in the urine and causes the return of a bicarbonate ion to the _____.

A

renal tubular cells, filtered bicarbonate, plasma

82
Q

In the proximal convoluted tubule, ______ is produced from the breakdown of the amino acid glutamine.

A

ammonia

83
Q

a disruption in these secretory functions can result in ___ and its inability to produce an acid urine

A

metabolic acidosis or renal tubular acidosis

84
Q

it is the standard tests used to measure the filtering capacity of the glomeruli

A

clearance test

85
Q

it measures the rate at which the kidneys are able to _____ (to clear) a ______ from the blood

A

remove, filterable substance

86
Q

what filtration rate does the clearance test measures?

A

glomerular filtration rate

87
Q

The substance analyzed must be one that is neither ____________ by the tubules.

A

reabsorbed nor secreted

88
Q

Factors to consider in the selection of a clearance test substance

A
  • stability of the substance in urine during 24-hour urine collection
  • consistency of the plasma level
  • substances availability to the body
  • availability of tests for analysis of substance
  • reported in mL / min
89
Q

it is the standard method for GFR

A

urea clearance test

90
Q

what percentage of the filtered urea is reabsorbed?

A

40%

91
Q

patients were hydrated to produce a urine flow of ___ mL/min

A

2

92
Q

use of urea as a test substance for glomerular filtration has been replaced by the measurement of other substances including _____

A

creatinine, inulin, beta2 microglobulin, cystatin C, or radioisotopes

93
Q

about ___ of creatinine clearance

A

50%

94
Q

it is a polymer of fructose and is an extremely stable substance that is not reabsorbed or secreted by the tubules

A

inulin

95
Q

was the original reference method
for clearance tests, it is currently not used for glomerular filtration testing.

A

inulin clearance test

96
Q

not routinely done because of the necessity for continuous _____

A

IV infusion

97
Q

Why are values higher in males?

A

Larger renal mass

98
Q

what is the priming dose?

A

25 mL of 10% inulin solution

99
Q

what is the continuous infusion?

A

500 mL of 1.5% inulin solution

100
Q

What is the reference values for male?

A

127 mL / min

101
Q

What is the reference values for female?

A

118 mL / min

102
Q

this test requires an infused substance that is termed ____

A

exogenous procedure

103
Q

is seldom the method of choice if a suitable test substance is already present in the body

A

endogenous procedure

104
Q

a waste product of muscle metabolism which is normally found at a relatively constant level in the blood and provides the laboratory with an endogenous procedure for evaluating glomerular function

A

creatinine

105
Q

it is the most commonly used screening method for GFR

A

creatinine clearance test

106
Q

Measurement of creatinine clearance is not a reliable indicator in patients suffering from ________ diseases

A

muscle-wasting

107
Q

creatinine is freely filtered by the _____ but not _____

A

glomerulus, reabsorbed

108
Q

reference value for males?

A

85 - 125 mL / min

109
Q

reference value for females?

A

75 -112 mL / min

110
Q

what is the standard body surface?

A

1.73

111
Q

UC stands for?

A

urine crea

112
Q

UV stands for?

A

urine volume

113
Q

PC stands for?

A

plasma crea

114
Q

how many minutes?

A

1140 mins

115
Q

What is the significance of GFR?

A

determines the functional capacity of nephrons

116
Q

significance of Creatinine clearance

A
  • extent of nephron damage in known cases of renal disease
  • feasibility of administering medications
117
Q

disadvantages of CCT

A
  • Some creatinine is secreted by tubule
  • chromogens - human plasma
  • medications - false decreased value
  • creatinine breakdown by bacteria
    heavy diet
118
Q

Average body surface?

A

1.73 mm2

119
Q

approximate amount of plasma filtrate

A

120 mL

120
Q

normal creatinine clearance values

A

120 mL / min

121
Q

men creatinine values

A

107 - 139 mL / min

122
Q

women creatinine values

A

87 - 107 mL / min

123
Q

normal reference range of plasma creatinine

A

0.5 - 1.5 mg / L

124
Q

it is indirect estimate of GFR and a low molecular weight protease inhibitor

A

Cystatin C

125
Q

Cystatin is good procedure for?

A

Screening and monitoring GFR

126
Q

What specimen is being used in Cystatin C

A

Serum or plasma

127
Q

TRUE OR FALSE: Fasting is required in Cystatin C

A

False, it is not required

128
Q

What diseases are associated when there are increased levels of Cystatin C?

A

Acute and Chronic Renal Failure
Diabetic nephropathy

129
Q

It dissociates from human leukocyte antigens at constant rate

A

Beta 2 Microglobulin

130
Q

What type of filtration happens in Beta 2 Microglobulin?

A

Glomerular filtration by plasma

131
Q

TRUE OR FALSE: Beta 2 Microglobulin is reliable for patients who have immunologic disorders

A

False

132
Q

What method is being used in Beta 2 Microglobulin?

A

EIA

133
Q

It is used for routinely screening patients as part of a metabolic profile

A

Estimated Glomerular Filtration Rates

134
Q

What type of patients are being monitored in eEGFR test?

A

patients diagnosed with renal disease or at risk

135
Q

It utilizes additional variables
and does not include body weight.

A

Modification of Diet in Renal Disease (MDRD)

136
Q

MDRD-ISMS stands for?

A

MDRD- Isotope dilution mass spectrometry

137
Q

NKDEP?

A

National Kidney Disease Education Program

138
Q

What description is at stage 3 of Chronic Kidney Disease

A

Moderate ↓ GFR

139
Q

What GFR is at stage 3 of Chronic Kidney Disease

A

30-59

140
Q

What description is at stage 5 of Chronic Kidney Disease

A

Kidney Failure

141
Q

What GFR is at stage 5 of Chronic Kidney Disease

A

less than 15 or Dialysis

142
Q

What description is at stage 1 of Chronic Kidney Disease

A

Kidney Damage with normal or ↑GFR

143
Q

What GFR is at stage 1 of Chronic Kidney Disease

A

≥ 90

144
Q

What description is at stage 4 of Chronic Kidney Disease

A

Severe ↓ GFR

145
Q

What GFR is at stage 4 of Chronic Kidney Disease

A

15-29

146
Q

What description is at stage 2 of Chronic Kidney Disease

A

Kidney Damage with Mild or ↓ GFR

147
Q

What GFR is at stage 2 of Chronic Kidney Disease

A

60-89

148
Q

Ability of the tubules to reabsorb the essential salts and water

A

Concentration test

149
Q

What are the tests used for the Specific Gravity?

A

Fishberg and Mosenthal Test

150
Q

It compares the volume and specific gravity of day and night urine samples

A

Mosenthal Test

151
Q

Patients were deprived of fluids for 24 hours prior to the specific measures needed

A

Fishberg Test

152
Q

It is affected only by the number of particles present.

A

Osmolarity

153
Q

Renal concentration is concerned with small particles, s_________ and c_______ molecules

A

sodium, chloride

154
Q

Large molecular weight molecules such as _____ and ________

A

glucose and urea

155
Q
A
156
Q

specific gravity is influenced by ____ and _____ (molecular weight) of particles

A

number, density

157
Q

What is the principle of Freezing Point Osmometers

A

Measurement of freezing point depression

158
Q

What is the principle of Vapor Pressure Osmometer?

A

Measures the drew point

159
Q

What is drew point?

A

Temperature at which water vapor condenses to a liquid

160
Q

Temperature at which water and ice are in equilibrium and related to solute concentration

A

Freezing point

161
Q

What is the standard reference for Freezing point and Vapor pressure osmometers

A

NaCL (Sodium)

162
Q

Tests to measure tubular secretion of nonfiltered substance and renal blood flow

A

P-aminohippuric acid (PAH) test

163
Q

what can cause an abnormal result?

A
  • Impared tubular secretory
  • inadequate presentation of substance to capillaries
164
Q

The ability of the kidney to produce an acid urine depends on the tubular secretion of hydrogen ions and production and secretion of ammonia by the cells of the distal convoluted
tubule.

A

Titratable acidity and Urinary ammonia

165
Q

FILL IN THE BLANKS: A normal person excretes approximately ____ mEq/day
of acid in the form of either _______ (H+), _______ (H2PO4-), or ______ (NH4+)

A

70, titratable acid, hydrogen phosphate ions, ammonium ions

166
Q

What time range does alkaline tides appear?

A

2 - 8 pm

167
Q

What time of the day is the lowest pH?

A

Night

168
Q

the inability to produce an acid urine in the presence of metabolic acidosis

A

Renal Tubular Acidosis

169
Q

This condition may result from impaired tubular secretion of _______ associated with the __________

A

hydrogen ions, proximal convoluted tubule

170
Q

This condition may also defect in _________ secretion associated with the ________

A

ammonia, distal convoluted tubule

3RD YEAR (1 decks)

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