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Block 2 > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Differences between Juxtramedullar and Cortial Nephron

% of each?

Loop of Henle?

Location of glomerulus?

A

85% / 15%

Short / Extends a lot into medulla

Cortex / Border of cortex and medulla

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2
Q

Which nephron generates osmotic gradient?

A

Juxtamedullar Nephron

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3
Q

What structures are proximal to glomerulus?

A

Afferent arteriole, efferent arteriole, and distal convoluted tubule

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4
Q

What is the general pattern of the resistance to the flow of fluid in nephron?

What regulates the paracellular water flow?

A

The resistance increases

The types of protein in tight junctions

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5
Q

What is the general patter of water permability?

What protein affects permiability of water in collecting duct?

A

Water not permeable in ascending limb and distal convoluted tubule

Antidiuretic hormone (ADH) aka Vasopressin (AVP)

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6
Q

What are the “water holes” called?

Which aquaporin is regulated by ADH?

A

Aquaporins

AQP2 (Gs-PKA pathway)

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7
Q

What blood vessels supply PCT and DCT?

In which nephrone does efferent artery has two routes?

A

Peritubular capillaries

Juxtamedullary (peritubular and vasa recta)

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8
Q

Diagram of the renal Circulation

A
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9
Q

Where is Juxta glomerular apparatus?

What cells sense flow?

Where are they?

What cells are associated with afferent and efferent artery?

What is their function?

A

Distal convoluted tubule

Macula densa

Distal convoluted tubule

Juxtaglomellular cells

Secrete renin

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10
Q

What does the TGF stand for?

What is it?

A

Tubuloglomerular feedback

A mechanism that serves to maintain a relatively **constant GFR ** by sensing NaCl levels in the distal nephron and releasing substances that feed back onto the glomerulus to modify arteriolar resistance.

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11
Q

What is the mechanism that maintains a constant GFR?

What is the mechanism when the flood to glomerulus is too slow?

A

Tubuloglomerular feedback

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12
Q

What is the mechanism when the flow to glomerulus is too high?

A

Mediated by adenosine binding from macula densa to cells surrounding afferent arteriole

Less renin release

Constriction of afferent arteriole

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13
Q

RBF

A

Renal blow flow

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14
Q

How changes in the resistance of afferent and efferent arteriole affect the

renal blood flow

pressure in glomerulus

glomerular filtration rate

A
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15
Q

What is the filtration fraction?

Equation?

What happens if the efferent arteriole contracts?

A

The percentage of renal plasam that gets filtered

FF = GFR / RPF

FF goes up

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16
Q

Purpose of autoregulation of blood flow in kidneys

Two mechanisms for autoregulation

A

To mantain a constant pressure in glomerulus

Myogenic and tubuloglomerular feedback (TGF)

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17
Q

What are other mechanisms for regulation of renal blood flow except autoregulation?

A

Nerves

Hormones (RAAS)

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18
Q

What three mechanisms cause renin release?

A

Less strech in afferent arteriole

Decrease in NaCl in DCT

Sympathetic Activity

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19
Q

What are the effects of Angiotensin II

A

Contract arteriorle (efferent arteriol preference)

Brain enhances thirst and ADH release (water absorption)

Stimulates sympathetic nerves

Adrenal gland release NE, E, and aldosterone (Na+ absorption)

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20
Q

Acute Renal Failure

What is it?

What is importance of prostaglandins and acute renal failure (in cases of percieved or real blood loss)?

A

Retention of waste products (urea and nitrogenous waste) and disregulation of volume and electrolytes

Low volume leads to sympathetic activation that leads to renin (contraction) and prostaglandins (dialation). Sone NASIDs can cause decrease in prostaglandins and lead to further constriction and lowering the filtration rate.

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21
Q

Which blood vessels in kideny are acted preferentially by renin?

A

Efferent

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22
Q

How is the consumption of oxygen releated to flow?

A

GFR = Na+ reabsorption = Renal oxygen consumption

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23
Q

What might be a cause (potentially) of taking ACE inhibitor (in case of stenosis where cells do not feel pressure)?

A

Hypertension

Aggrevated by ACE inhibitor can lead to Acture Renal Failure

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24
Q

Ouabain function

A

Increase Na/K ATPase activity

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25
Q

Three types of peritoneum

A

Visceral

Pericardial

Mesentary (suspending)

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26
Q

Is Gut in peritoneum?

A

No

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27
Q

Retroperitoneal structures

examples?

Intraperitoneal structures?

A

Kidney, ureter, aorta, inferior vena cava, posterior abdominal wall, and bladder

Stomach, liver

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28
Q

Name this muscle

Origin?

Insertion?

A

External oblique

Ribs 5-12

Rectus sheet (aponeurosis)

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29
Q

Name this muscle

Origin?

Insertion?

A

Latissimus dorsi

thoraco-lubar aponeurosis

Floor of intertubercular groove of the humerus

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30
Q

Name this muscle

Origin?

Insertion?

A

Internal oblique

Inguinal ligament, Iliac crest

Linea alba

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31
Q

Name this muscle

Insertion?

Origin?

A

Transversus abdominis

linea alba

thoracolumbar fascia

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32
Q

Name this muscle

Origin?

Insertion

A

Quadratus Lumborum

iliac crest and iliolumbar ligament

Last rib and transverse processes of lumbar vertebrae

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33
Q

Which rib is kidney laying on?

Which kidney is lower? Why?

Do kidneys move during respiration?

A

12th
Right 2-3cm (liver)

Yes 2.5cm

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34
Q

By what fat is kideny surrounded by?

What separates these two fat layers?

What separates kideny and adrenal glands?

A

Peri and para renal fat

Renal facia

Renal facia

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35
Q

Where do the kideny start to develop?

Because of that where the autonomic innverations come from?

A

In pelvis

Pelvic splanchnics / Vagus

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36
Q

Polar arteries

A

Arteries that formed to support kidney

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37
Q

Name the main blood supply to kideny

Which one is longer artery/vein and left/right

Problem with left renal artery?

What do these arteries split into?

Where else the left receives blood?

Where else the left can supply blood?

A

Renal artery / vein

Longer: Right artery, left vein

Superior mesenteric artery syndrome (affect left renal artery due to pressure)

Anterior and posterior segmental branches

Left gonadal vein

Connection to azygous system

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38
Q

List structures in kideny

A

Capsule

Cortex

Medulla (renal pyramid / papilla)

Minor calyx

Major calyx

Pelvis

Ureter

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39
Q

Sympathetic innervations to kideny

Where do these neurons synapse?

A

Lesser and least thoracic nerve

Mesenteric plexus

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40
Q

What is kidney medulla made of?

Where is the base of the pyramid?

Who many glomeruli are present in 1 kideny?

A

lobes (pyramids) 15-20 per kidney

Cortico-medullary border

1mln

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41
Q

Kidney functions

A

filtration – kidney glomeruli

selective resorption and excretion – kidney tubular system

synthesis of renin (regulates blood pressure via renin-angiotensin system)

synthesis of erythropoietin (regulates RBC production via ¯ [O2] produced by interstitial fibroblast of the kidney

activates Vitamin D3

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42
Q

What are the three parts of cortex?

A

renal corpuscles or glomeruli

cortical labyrinth

medullary rays

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43
Q

What are medullar rays?

Where do medullary rays originate?

Where do they end?

How many collecting ducts each renal papilla drains?

A

Collection tubules

Come from medulla and extend into cortex

Rounded renal papillae

20

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44
Q

What is kideny lobe?

What is kidney lobule?

A

A medullary pyramid + the overlying cortex

A group of nephrons that open into branches of the same main collecting duct

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45
Q

What separates cortex and medulla?

A

Arcuate vessels

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46
Q

What is nephron?

What is uriniferous tubule?

A

Glomerulus + kidney tubules

Nephron + collecting duct

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47
Q

Where are they found?

What is it?

Usuall capillary bed

Arterial capillary system

Venous portal system

A

CP = muscle

ACS = kideny

VPS = liver, pituitary

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48
Q

What is the purpose for arterial capillary system?

A

To control blood flow

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49
Q

What connect the arcuate and afferent arteries?

A

Interlobular arteries

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50
Q

What forms a visceral layer of bowman’s capsule?

What forms a parietal layer of bowman’s capsule?

What is between?

A

Podocytes

Simple squamous epithelium

Urinary space

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51
Q

What are two poles of Bowman’s capsule

What is in vascular pole?

A

Urinary pole & Vascular pole

Afferent arterioles, efferent arterioles, extraglomerular mesangeal cells

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52
Q

What is the juxtraglomerular apparatus made of?

A

Macula densa cells (look like teeth in DCT)

Extraglomerular mesangeal cells (between a and e arteriole)

Juxtaglomerular cells JG cells (smooth muscle of a and e arteriole)

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53
Q

Are mesengial cells and endothelial cells separated by basement membrane?

What forms basement membrane?

A

No, they have direct contact. Communication? Diameter?

Produced by endothelial cells

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54
Q

What two components form a basal lamina inside of glomerulus?

A

Basal lamina of podocytes

Basal lamina of endothelium

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55
Q

What are the three layers of basal lamina in glomerulus (electron microscopy)?

A

lamina rara interna (capillary side)

lamina densa (very thick)

lamina rara externa (visceral layer side)

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56
Q

What is the name for secondary processes of podocytes?

Where are they locted on top of?

A

Pedicels

Lamina rara externa

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57
Q

Mesengial cells

Germ layer?

Function?

Can they change size?

What do they synthesize?

What proteins do they secrete?

A

Mesoderm (not bone marrow like other phagocytes)

Phagocytosis

Contractile = alter blood flow

Matrix and collagen

Prostaglandins and Endothelins

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58
Q

What is the protein that makes up the diaphragm between podoytes processes that control the slits?

A

Nephrin

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59
Q

What is the name of the border of PCT?

Staining?

Shape of cells?

What is absorbed?

What is elememinated?

A

Striated border (microvilli)

Eiosinophilic

Simple cuboidal epithelium

Most of Na and all glucose or amino acids

Toxins drugs

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60
Q

Three limbs of loop of henle?

Type of epithelial lining?

A

descending thin limb, Henle’s loop, ascending thin limb

Simple squamous

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61
Q

3 components of Juxtaglomerular apparatus (JGA)

Part of?

Function?

A

Macula densa / DCT /

Juxtaglomerular cells / on afferent and efferent / smooth muscle that produces renin

Extraglomerular mesangial cells / between afferent and efferent / connected to other by gap junctions ; ATII causes contraction of these cells

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62
Q

What type of epithelium is present in collecting duct?

What two types of cells can be distinguished in collecting duct under EM?

A

Cuboidal epithelium

Principal cells are lighter than intercalated cells.

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63
Q

Types of collecting tubules

A

Collecting tubules

Medullary collecting tubules (larger collection of several cortical collecting tubules)

Papillary collecting tubules (Dcuts of Bellini) * lined with tall columnar principal cells only; open in area cribosa of renal papilla

Minor Calyxes

Major Calyxes

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64
Q

Layers of ureter

A

Mucosa (fibroelastic lamin propia; no glands; no muscularis mucosae)

NO SUBMUCUSA

Muscularis

Adventitia (UPPER 2/3 , Inner longitudinal, outer longitudinal LOWER 1/3 Inner longitudinal, middle circular, outer longitudinal)

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65
Q

Urinary bladder layers

A

Mucosa

transitional epithelium

fibroelastic lamina propria

Muscularis

IL MC OL

Adventitia

-fibroelastic adventitia is covered superiorly by peritoneum, forming a serosa

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66
Q

Female urethra lining (from bladder to end)

Male urethra lining (prostatic, membranous, penile)

A

transitional near the bladder, transitions to a pseudostratified and stratified columnar to a stratified squamous, non-keratinized at the distal end

prostatic (transitional) membranous (pseudostratified and stratified columnar) penile (pseudostratified and stratified columnar transition to simple squamous non-keratinized)

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67
Q

Similarities in female and male urethra

A

Vascular fibroelastic lamina propia

urethral glands (glands of Littre in male)

Internal sphincter IL OC

at urogenital diaphragm start voluntary control

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68
Q

What is K constant responsible for?

A

Area and permiability

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69
Q

How does the constriction of efferent artery affects filtration and reabsorption?

A

Increases filtration rate and reabsorption

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70
Q

What is the relationship between filtration and molecular radius/charge?

A
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71
Q

What is clearance?

A

The volume of plasma per minute from which all of a substance is removed

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72
Q

When clearance can be used to estimate glomerular filtration rate?

A

When molecule is:

freely filtered

not reabsorbed

not secreted

e.g. CIn = GFR

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73
Q

What other molecule can be used to measure the GFR except for inulin?

What are the problems associated with this molecule?

A

Creatinine

Ucr Overestimated because of secretion

Pcr Overestimated because of lab chemistry

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74
Q

What is

Filtration?

Reabsorption?

Secretion?

Excretion?

A
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75
Q

Two types of transport between tubules and capillaries

A
76
Q

How sodium is transported in

Proximal tubule?

Thick ascending loop of henle?

Distal convoluted tubule?

Collecting duct?

A
77
Q

How clorine is transported in

Proximal tubule?

Thick ascending loop of henle?

Distal convoluted tubule?

Collecting duct?

A
78
Q

What is the result of the active sodium gradint?

A

Passive Cl- reabsorption

Passive urea reabsorption

79
Q

How do

metabolic acidosis/alkalosis

hypokalemia/hyperkalemia

affect K+/H+ (pH) ions?

A
80
Q

What causes shifts of K+ inside and outside of the cell?

A
81
Q

How potassium is transported in

Proximal tubule?

Thick ascending loop of henle?

Distal convoluted tubule?

Collecting duct?

A

There are two types of cells in collecting duct. The principal cell and interacalated cells.

The principal cells has leak channels for potassium leading to higher

82
Q

What affects potassium secretion?

A

Aldosterone

Intracellular potassium (stimulates adrenal gland to release aldosterone)

83
Q

What is the effect of … on kideny?

Furosemide, Thiazide, Amiloride

A

Potassium losing diuretics: Furosemide, Thiazide (inhibit Na+ absorption)

Potassium sparing diuretics: Amiloride (inhibit K+ leak)

84
Q

What it is? Effects?

Bartter’s syndrome (type 1)

Gitelman’s syndrome

Which one contains: low potassium? Alkalosis? Polydisia (thirst)? Polyuria (excessive pee)? Hypertension /normal BP?

A

Bartter’s syndrome (Type I) Mutation of Na/K/Cl transporter in thick ascending limb.

Gitelman’s syndrome. Mutation of Na/Cl transporter in distal tubule.

Liddle’s syndrome (pseudohyperaldostronemia). Increased number and open time of principal cell sodium channels.

85
Q

Transport Maximum

A

The highest rate at which the renal tubules can transfer a substance either from the tubular luminal fluid to the interstitial fluid or from the interstitial fluid to the tubular luminal fluid.

86
Q

How sodium is abosrbed in proximal tubules?

What transporter is involved?

A

90% of transport via SGLT2

10% of transport via SGLT1

87
Q

Tx (reabsorption rate) =

equation

A

Tx (reabsorption rate) = GFR * Px (filtered load) - V * Ux (excretion rate)

88
Q

What happens when concentration in filtrate exceeds Tm?

A
89
Q

When sodium-glucose linked transporter-2 (SGLT2) inhibitors can be used?

A

Diabities

90
Q

Why is urine flow increased with diabetes mellitus?

A

Enhanced Na reabsorption in the proximal tubule increases tubuloglomerular feedback (TGF)

Glucose in the tubule causes osmotic diuresis

91
Q

Clearance vs. glucose and inulin concentration

A
92
Q

What occurs if the secretion Tx exceeds the Tm?

A
93
Q

Clearance vs. inulin and Para Aminohippurate (PAH) concentration

A
94
Q

What is gout?

Treatment of gout?

A

A painful condition caused by the buildup of uric acid crystals in tissues and joints

95
Q

Graph compare and contrast relative concentration over kideny tubules

A
96
Q

Urea

What type of transport is used for urea transport in kidenys?

How Na+ reasborption affects urea transport?

How does urea excretion changes with urine flow?

What factors affect the urea reabosrbed?

A

Passive (reabsorption)

Increases it (water follows Na+)

Increases (less time for passive transport)

Tubular area, urea permeability, concentration gradient

97
Q

How is the clearance of urea if affected by drinking / thirst?

A

Drinking increases clearance and decreases urea concentration in urine

Thirst decreases clearance and increases urea concentration in urine

98
Q

Which layer does the urinary system originates from?

A

Intermediate mesoderm

99
Q

Describe 3 intrauterine kideny systems

A

Pronephros cervical region; onyl during 4 week; nonfunctional

Mesonephros thoracolumbar region; 4wk-2mo; mesonephric duct (wolffian duct) stay

Metanephros 5wk; definative kideny

100
Q

Mesonephros

Order of differentiation?

What is urogenital ridge? When it is formed?

When does it dissapear?

A

Exeretory tubules TO

Renal corpuscle (bowman’s capsule and glomerulus) TO

Mesonephric (Wolffian) duct

It is future gonads and forms during 2nd month

2nd month except mesonephric ducts in males

101
Q

Metanephros (definitive kideny)

When does it appear?

Where does it originate from?

A

Week 5

Buds off from mesonephric duct

102
Q

What fors ureter, renal pelvis, major and minor calyces, and collecting tubules?

Where is that structure coming from?

A

Ureteric bud

Outgrowth of mesonephric duct

103
Q

Filtration system

What is it made from? What is it induced by?

What is newly collecting tubule covered with?

Development of glomeruli?

A

From metanephric mesoderm included by uteric bud

Metanephric tissue cap

-> renal vesicle -> S-haped tubules -> capillaries grow in -> glomeruli

104
Q

Kideny signalling function:

WT1 gene

Glial-derived neurotrophic factor (GDNF)

RET and MET receptors (for GDNF and HGF)

PAX2 and WNT4

A

WT1 gene

in mesenchyme, mantains competency to the induction by the ureteric bud

Glial-derived neurotrophic factor (GDNF) and hepatocyte growth factor (HGF)

in mesenchyme, stimulate branching and growth of the ueteric buds

RET and MET receptors (for GDNF and HGF)

In epithelium of the ureteric bud

PAX2 and WNT4

Conversion of the mesenchyme into epithelium

105
Q

Congenital Polycystic Kidney

Pathogenesis?

A

Cyst formeation from collecting tubules

Recessive -> renal failure in infancy or childhood

Dominant -> renal failure in adulthood

106
Q

Duplication of ureter

Cause?

A

Early splitting of the ureteric bud (partial or complete)

107
Q

Why kidney ascends?

What happens as kidney ascends?

What happens to gonads as kideny ascends?

A

Decrease in body curvature and growth

Mesonephric system degenerates.

The descend

108
Q

Positioning defects in kidneys

A

Horseshoe kideney

Kideny form in pelvis

109
Q

Cloaca

A

Divides urogenital sinus (anterior) and the anal canal (posterior) by urorectal septum

110
Q

Which strucutre alantois becomes?

A

Median umbilical ligament

111
Q

What will the upper, peliv, and lower phallic part of urogenital sinus becomes?

A

Upper: bladder

Pelvic: prostatic and membranous part of urethra

Phallic part: different for sexes

112
Q

Where do ureter migrate?

What part of ureter forms on the bladder?

Where do mesonephic duct move?

What do they become?

A

They are absorbed into the bladder wall and move cranially

Trigone area

Lower to enter urethra where prostate forms

Ejaculatory duct

113
Q

What germ layer gives a rise to mesonephric ducts and ureters?

What germ layer gives a rise to mucosa of the urinary bladder?

What is mesodermal lining of the trigeon replaced with?

A

Mesoderm

Mesoderm

Endodermal epithelium

114
Q

Bladder defects

Urachal fistula

Exstrophy of the bladder

Epispadias

A

Urachal fistula

Persistence of entire allantois results in urachal fistula

Local area of allantois results in urachal cyst

Upper part peristenace results in sinus

Exstrophy of the bladder

Ventral body wall defect: Mucosa is exposed

115
Q

What is filtered load?

How to calculate filtered load?

A

The amount of substance that kidney filtrates.

Filtered load = GFR * Px

116
Q

What molecule is called a glomerular market?

A

Inulin

117
Q

With reference to the kidney, what PAH stands for?

A

Para-aminohippuric acid (weak acid)

118
Q

Which hydrostatic or osmotic variable changes as the plasma flow through glomerulus?

A

Oncotic pressure in capillary

119
Q

How BUN/creatinine ratio would allow to distinguish between volume contraction (hypovolemia) vs. chronic renal failure.

A

Creatinine = not reabsorbed

BUN = reabsorbed

Volume contraction (hypovolemia)

Normal serum creatinine

Increase serum BUN

>20 High BUN/creatinine ratio

Renal faliure

Increase serum creatinine

Increase serum BUN

Nomrla BUN/creatinine ratio

120
Q

Whole kidney variables

C

[U]

[P]

V

GFR

RBF

RBF

A

C = Clearance

[U] = Concentration in urine

[P] = Concentration in plasma

V = Urine flow rate

GFR = Glomerular filtration rate

RPF = Renal plasma flow

RBF = Renal blood flow

121
Q

Single Nephron variables

[TF]

[TF/P]x

[TF/P]in

[TF/P]x / [TF/P]in

A

[TF] = Concentration in tubular fluid

[TF/P]x = Concentration relative to plasma

[TF/P]x / [TF/P]in = Fraction of the filtered load remaining in tubular fluid or fractional excretion (* this includes correction for water loss)

122
Q

What is the name of the fluid that comes out of the capillary?

A

Ultrafiltrate because it has proteins removed.

123
Q

Simple Plasma flow equation

Renal Plasma flow equation

Effective Plasma flow equation

Does PAH underestimate or overestimate RPF?

A

Q = dP / R

RPF = (V pah*[U]pah)/d[P]pah

Underestimate (there is some left in the veins).

124
Q

Clearance equation

Clearance ratio equation

A

C = Ux * V / Px

C ratio = Cx/Cin

125
Q

Glomerular filtration rate equation

A

GFR = Uin * V / Pin = Cin

126
Q

Filtration fraction equation

A

FF = GFR / RPF

127
Q

What is the name of the spaces between foot processes of the podocytes?

A

Filtration slits

128
Q

Free-water clearance equation

A

CH2O = V - Cosm

129
Q

Renal blood flow equation

A

RBF = RPF / (1-Hct)

130
Q

Reabsorption or secretion rate equation

A

Reabsorpton or secretion = Filtered load - Excretion

131
Q

What does the Tm stands for?

A

Transport Maximum

132
Q

What are examples of kidney vasoconstrictors?

Ware are examples of kidney vasodilators?

A

Vasoconstrictor

Sympathetic

Angiotensin II

Endothelins

Vasodialator

Prostaglandin

Nitric Oxide

Bradykinin

Dopamine

ANP

133
Q

What are two mechanisms for autoregulation?

A

Autoregulation

Mediated by strech opening Ca2+ channels and causing contraction

Affects more afferent arteriole

Tubuloglomerular feedback (TGF)

Macula densa cells signal (ADP) due to higher flow.

ADP binding to JG cells.

Relaxation of afferent arteriole

134
Q

How dopamine can be used to treat hemorrhage?

A

At low levels, dopamine dilates cerebral,

cardiac, splanchnic, and renal arterioles, and it

constricts skeletal muscle and cutaneous arterioles.

135
Q

Effects of Angiotensin II on afferent/efferent arteriole

Low concentration?

High concentration

A

Efferent arteriole is more sensitive to A II

Low A II => Efferent constriction => (+) GFR

High A II => Afferent constriction => (-) GFR

136
Q

How do prostaglandins protect flow in kidneys?

How do RAAS protects flow in kidneys?

How these protection mechanisms can be disturbed?

A

Protect from constriction / ACE inhibitor

Protect from dilation / NSAID

137
Q

What two systems that balance each other in kidney are activated during hemorrhage?

A

RAAS and prostaglandins

138
Q

BNP effect

A

Dilation of afferent arteriole (more significant)

Constriction of efferent arteriole

139
Q

What is the name of the transporter that is responsible for glucose/Na+ coortransport in PCT?

What is the name of the glucose transporter present in basolateral membrane?

A

SGLT (SGLT2 90%; SGLT1 10%)

GLUT I & GLUT II

140
Q

What factors shifts K+ into cells?

What factors shift K+ outside of cells?

A

Insulin (Na+/H+ exchanger +)

b-agonist (Na+/K+ ATPase +)

Aldosterone (Na+/K+ +)

Hyperosmolarity

Exercise

Cell death

141
Q

What are two effects of aldosterone in DCT?

How aldosterone affects principal cells?

A

Activation of Na+ channels and

Activation of Na+/K+ ATPase on basolateral side

Aldosterone stimulates H+ secretion

142
Q

What mechanisms regulate Na+ absorption?

A

Sympathetic

Atriopeptin (ANP)

Starling forces

RAAS

143
Q

What is the function of intercalated and principal cells?

What channels do these cells contain?

A

Principal

Na+ absorption

K+ secretion

Na+ and K+ channel

Na+/K+ ATPase on basolateral

Intercalated

K+ reabsorption

H+ secretion

144
Q

Name the condition where glucose is released to urine.

When can it occur?

A

Glucosuria

Can occur:

DM

Pregnancy (up GFR)

Congenital abnormality (SGLT)

145
Q

How does the probenecid affect penicillin?

A

Penicillin uses the same transporter as PAH in kideny. Probenecid inhibits this transporter.

146
Q

What shifts in K+ would acidemia or alkelemia produce?

A

In alkelemia, H+ leave cells, and K+ enter cells producing hypokalemia

In acedemia, H+ enter cells, and K+ leave cells producing hyperkalemia

147
Q

Where are these ions absorbed?

PCT/DTL/ATL/DCT/CD

Na+

K+

PO4-

Ca2++

Mg2++

Urea

A

Na+ = 67% / 0 / 25% / 5% / 3% = <0.4%

K+ = 67% / 0 / 20% / low K+ diet / secreted

PO4- = 70% / 15% / 0 / 0 / 0 = 15%

Ca2+ = 67% / 0 / 25% / 8% / 0 = 1%

Mg2+ = 30% / 0 / 60% / 5% / 0 = ~5%

Urea = 50% / (thin) -50% / 0 / 0 / 40%* (ADH) = 1%-110%

148
Q

What affects potassium secretion to late distal convoluted tubule?

A

Dietary K+

Aldosterone

Acid-base balance

Flow rate

Luminar anions

149
Q

What is the difference in permeability between thin ascending and descending limb?

A

Descending is permeable to H2O, NaCl, Urea

Ascending is only permeable to NaCl

150
Q

What is an example of K+ sparing diuretic?

A

Inhibit K+ channel

Amiloride

Triamterene

Inhibit aldosterone

Sprionolactone

151
Q

Three types of diuretics

Examples

A

Loop diuretics (e.g. furosemide)

Thiazide diuretics (e.g. thiazide)

K+-sparing diuretics (e.g. amiloride)

152
Q

What are three effects of ADH?

A

Fusion of H2O channels (V2-cAMP mediate) in late DCT and CD (cortical and medulla)

Inhibition of 2Cl-/K+/Na+ channels in thick AL

Increase in UT1 urea channels in CD (medulla)

153
Q

SIADH

Abbreviation?

What is it?

Treatment?

A

Syndrome of inappropriate ADH

Excess of ADH

Demeclocycline (ADH inhibitor)

154
Q

What is the target cell for ADH?

A

Principal cell

155
Q

Central Diabetes Insipidus

Nephrogenic Diabetes Insipidus

A

Lack of ADH, dDAVP analog replacement

Lack of response to ADH, Thiazide diuretics

156
Q

How PTH regulates phosphate?

Sign of high phosphate excretion?

How PTH regulates Calcium?

A

PTH inhibit phosphate reabsorption in PCT (cAMP mediated). High phosphate/cAMP in urine is a sign of PTH action.

PTH increase Ca++ reabsorption in distal convoluted tubule (cAMP mediated).

157
Q

How thiazide diuretics action differs on Na+/Ca++ in distal convoluted tubule?

A

Transport in DCT of Na+ and Ca2+ is not linked

Na+ absorption inhibited

Ca+ absorption increased

158
Q

What is absorbed in early promixal tubule?

How absorption of Na+ differs from early to late proximal convoluted tubule?

Type of absorption in proximal convoluted tubule?

How does angiotensin affect PCT?

A

Glucose, Amino acids, Phosphate, Lactate, Cirtrate

Early: basolateral Na+/K+ driven; Na+/H+ (Na+ enters with HCO3-)

Late: Na+/Cl- driven

Isosmotic

Stimulates Na+/H+ exchange

159
Q

What type of Na+ transport is present in ascending limb of thick ascending limb?

What can leak and what is the importance of it?

A

Na+/K+/2 Cl-

K+ leaks creating lumen-positive potential and driving Ca2+ and Mg2+ into cells

160
Q

What does the reabsorption of urea follow?

Where is urea permable?

What mode of transport is urea using?

A

Water reabsorption

In proximal tubule (50% reabsorbed)

In medullary collecting duct (UT1 – ADH regulated)

Passive transport

161
Q

What type of transport is present in Early Distal Convoluted Tubule?

A

Reabsorption of NaCl without water (dilutio)

162
Q

What determines the flow of water via paracellular route?

What is the pattern of the resistance to flow via a paracellular route?

A

Tight junction proteins (claudins and occludins)

Resistance increases

163
Q

What causes renin release

A

Stretch in afferent arteriole

NaCl delivery

Sympathetic

164
Q

Downstream effect of angiotensin II

A

Constriction of arterioles

Brain thirst and ADH release

NE release

Aldosterone production

165
Q

Ouabain function

A

Inhibit Na+/K+ ATPase

166
Q

Function of allopurinol

Function of probenecid

A

Prevents synthesis (xantinine oxide inhibitor)

Prevents reabsorption (increases secretion)

167
Q

Two mechanisms that are used in formation in hypertonic urine

A

ADH and an intersititial osmotic gradient

168
Q

Psychogenic Polydipsia

A

Drinking too much water

169
Q

What transporters are used for urea transport?

A
170
Q

Where does the osmolarity is sensed?

A

Paraventricular and supraoptic neurons

171
Q

What are the downstream effects of ADH?

A

Bidning to V2 receptor

Kinease cascade

AQP recycling

172
Q

What is?

Diuresis

Osmotic Diuresis

Water Diuresis

Antidiuresis

A

Diuresis (V > 1 ml/min) – low flow

Osmotic Diuresis – flow with too much salt

Water Diuresis – flow with too much water

Antidiuresis (V < 0.5 ml/min) – antiduresis

173
Q

How high or low ADH affects urea, salt, and water reabsorption?

A
174
Q

What is the compositon of urine?

A
175
Q

Types of tracers

A
176
Q

Equations for:

Intracellular fluid Volume

Blood Volume

Interstitial Fluid Volume

A

Intracellular fluid Volume = TBW

Blood Volume = PV/(1-hct)

Interstitial Fluid Volume = EFV - PV

177
Q

How is water distributed?

A
178
Q

Darrow Daigram

Overhydration

A

Careless over administration of saline

179
Q

Darrow Daigram

Hypotonic Overhydration

A

Compulsive water drinking

180
Q

Hypertonic Overhydration

A

Drinking sea water

181
Q

Darrow Daigram

Isotonic Dehydration

A

Hemorrage

182
Q

Hypertonic Dehydration

A

Lost in the desert without access to water

Diabetes insipidus (lack of ADH)

183
Q

What is hypernatremia?

A

Rise in sodium levels

184
Q

How does the hypothalamus responds to changes in osmolarity?

A

ADH and thirst

185
Q

What is Glomerulotubular (GT) Balance

A
186
Q

Hypoaldosteronemia

Hyperaldosteronemia

characteristics?

A

Adrenal insufficiency (Addison’s disease)

Acidosis

Hyperkalemia

Hypotensin (salt wasting)

Alkalosis

Hypokalemia

Hypertension

(usually not overt volume expansion)

187
Q

Where is the action of

Aldosterone?

ANP?

ADH?

Angiotensin?

A

Block 2 (7 decks)

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