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Analytical and Clinical > Week 8 - Renal Function - Optional > Flashcards

Week 8 - Renal Function - Optional Flashcards

1
Q

hilum

A

entry/exit of blood vessels, veins and ureter

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2
Q

cortex

A

outer pale layer

contains nephrons

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3
Q

medulla

A

pinky central area

contains nephrons

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4
Q

nephrons

A

are a complex tubular structure that enables the refinement of the filtrate which will eventually be excreted based on what components the blood needs

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5
Q

What’s the nephron responsible for?

A

processing the blood

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6
Q

What are the three main areas of the nephron?

A

renal corpuscle

renal tubule

collecting ducts

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7
Q

What are the two different kinds of nephrons?

A

juxtamedullary and cortical

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8
Q

What is the functional unit of the kidney?

A

nephron

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9
Q

What allows the nephron to perform its function?

A

changes in the types of cells along the length of the nephron

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10
Q

What is the process of refining the filtrate?

A

1.
isosmotic fluid leaving the proximal convoluted tubule becomes progressively more concentrated in the descending limb

  1. removal of solutes in the thick ascending limb creates hyposmotic fluid

3.
permeability to water and solutes in the distal tubule and collecting ducts is regulated by hormones

4.
final urine osmolarity depends on reabsorption in the collecting ducts

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11
Q

Where does glomerular filtration occur?

A

renal corpuscle
where plasma moves from blood vessels of the glomerulus into the lumen of Bowmans capsule

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12
Q

What percent of the plasma moves into the Bowmans capsule?

A

20%
- most of this is reabsorbed further

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13
Q

What happens to the 80% in GF?

A

proceeds to the peritubular capillary (or vasa recta) where decoration of desired solutes into the nephron lumen occurs, ready for excretion.

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14
Q

What is the rate of filtration called?

A

glomerular filtration rate (GFR)

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15
Q

What percentage of volume is excreted in GF?

A

<1%

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16
Q

What is glomerular filtration rate?

A

it is the volume of plasma from which a given substance is removed by glomerular filtration

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17
Q

What are the factors effecting GFR?

A

hydrostatic pressure

colloid osmotic pressure

hydrostatic pressure

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18
Q

What is the GFR like?

A

relavtiely constant

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19
Q

What is GFR control by?

A

net filtration
- changes in renal blood flow and blood pressure

filtration coefficient
- changes in diameter of the afferent and efferent arterioles to alter the GFR

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20
Q

What are the three ways GFR can be controlled?

A

hormonal
- angiotensin ii
- prostaglandins

nervous
- sympathetic nerves release noradrenaline
-> arteriole constriction

Autoregulation
- myogenic réponse - response to pressure changes
- tubuloglomular feedback - release of hormones due to physical changes in afferent and efferent arterioles and ascending limb of loop of henle

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21
Q

Tubuloglomerular Feedback

A
  1. GFR increases
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22
Q

Clinical uses of GFR

A

evaluate kidney function
- assessment of filtering capabilities but not diagnose

23
Q

What does GFR tell us?

A

estimates efficiency with which substrate are cleared from the blood by glomerular filtration

measure of nephron function

24
Q

One method of GFR estimation

A
  • can be performed using exogenous or endogenous substances
  • clearance of substance by kidney can be measured if substance fits the following criteria
    -> present at stable conc.
    -> physiologically inert
    -> freely filtered at the glomerulus
    -> is not secreted, reabsorbed, synthesised or metabolised in the kidney

therefore
filtered s = excreted s in urine

GFR x [S]plasma = [s]urine x urinary flow rate (V excreted/unit time)

25
Q

Method 2 of GFR estimation

A
  • exogenous substances
  • most accurate estimation
  • can be radio isotopes or not
  • example = inulin
26
Q

Inulin

A
  • plant product that is filtered but not reabsorbed
  • if 100% goes in 100% must come out
27
Q

What does creatine phosphate break down into?

A

creatinine

28
Q

What is the production of creatinine like?

A

relatively constant depending on amount of muscle mass

29
Q

Where does creatinine pass through?

A

the glomerulus into the filtrate during glomerular filtration

30
Q

How much creatinine is excreted into the proximal convoluted tubule?

A

a small amount

31
Q

How much creatinine is reabsorbed?

A

virtually nothing

32
Q

GFR estimation - methods 2 - urinary clearance

A
  • Timed urine collection throughout 24-h
  • Large intra-individual day-to-day coefficient of variation for repeated measures of creatinine clearance
33
Q

basic function of kidney

A
  1. Control of blood composition (fluid and electrolyte balance)
    - regulation of osmolarity
    - Maintenance of ion balance
    - Homeostatic regulation of pH
  2. Control of blood volume
  3. Control of blood pressure

4.Production of hormones: erythropoietin and calcitriol

  1. Excretion of waste: urea, urate, creatinine in urine
34
Q

Changes in Blood Composition

A
  • Osmolarity and volume can change independently
  • Dehydration decreases blood volume/pressure, and increases
    osmolarity
    -> Compensation involves cardiovascular responses, Angiotensin II (ANG II), vasopressin, and thirst
  • pH changes:
    -> H+ concentration is closely regulated
    -> changes can alter three-dimensional structure of proteins
    abnormal pH affects the nervous system

pH changes:
- Acidosis: neurons become less excitable; CNS depression
- Alkalosis: hyperexcitable
- pH disturbances (often associated with K+ disturbances

35
Q

Controlling Fluid and Electrolyte Balance - ascending limb events

A

ascending limb pumps out Sodium, potassium and chloride ions and filtrate becomes hyposmatic

36
Q

Controlling Fluid and Electrolyte Balance - What happens to blood in vasa recta?

A

vasa recta removed water leaving the loop of henle

37
Q

Controlling Fluid and Electrolyte Balance - What happens to the filtrate entering the descending limb?

A

becomes progressively more concentrated as it loses water

38
Q

Controlling Fluid and Electrolyte Balance - How is it achieved?

A

by countercurrent exchanger mechanism

39
Q

Controlling Fluid and Electrolyte Balance - What controls the permeability to water of the ducts?

A

ADH

40
Q

Controlling Fluid and Electrolyte Balance - What controls the permeability of descending limb of henle?

A

aldosterone

41
Q

Products that change the acid-base balance - Acid

A
  • organic acids
  • ketoacids, metabolic organic acid production can increase
  • production of CO2 -> H2 production
42
Q

Products that change the acid-base balance - Base

A

few dietary or metabolic sources of bases

43
Q

How is acid-base balance achieved?

A
  1. NHE secretes H+
  2. H+ in filtrate combines with filtered HCO3- to form CO2-
  3. CO2 diffuses into cell
  4. CO2 combines with water to form H+ and HCO3-
  5. H+ is secreted again
  6. HCO3- is reabsorbed with Na+
  7. Glutamine is metabolised to ammonium ion and HCO3-
  8. NH4+ is secreted and excreted
44
Q

Principle of Blood Volume Control

A

if volume falls too low, GFR stops

volume loss can be replaced only by volume input from outside the body

volume gain - cab be offset by volume loss in urine

GFR can be adjusted and kidney recycles fluid

Regulated H2O reabsorption

= kidney conserves volume

45
Q

When is erythropoietin produced?

A

production stimulated by decrease in PO2

46
Q

What happens when is erythropoietin produced?

A

stimulates erythrocyte production through differentiation of CFU-E proerythroblast

47
Q

Where is erythropoietin produced?

A

production in interstitial cells in kidney

48
Q

What is calcitriol?

A

active form of vitamin D

49
Q

Where is calcitriol produced?

A

produced by the enzyme C1-alpha-hydroxylase from stored calcifediol

50
Q

What is the half life of calcitriol?

A

approx 14 days

51
Q

Why is calcitriol important?

A

essential in maintenance of calcium uptake from the GI tract

52
Q

What duration can kidney disease be?

A

can be acute or chronic

53
Q

Acute Kidney disease

A

rapid metabolic disbalance

high mortality but commonly reversible with treatment

54
Q

Chronic Kidney Disease

A

associated with a number of disorders such as
- diabetes
- hypertension
- glomerulonephritis
- polycystic kidney disease

Analytical and Clinical (11 decks)

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