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renal - pcc

first exam - renal

The excretory function of the kidney is central to their ability to regulate what? (2) 1. Composition 2. Volume of body fluids
The kidney controls both ___ and _____ of the body fluids 1. Osmolality 2. Volume
Why do we need to control body fluid osmolality? 1. Maintain cell volume 2. Maintain CV functions
The kideneys regulate the excretion of what? Water and NaCl
What 2 systems integrate the kidney's function? CV and CNS
The kidney regulates ___ balance Electrolyte
The kidneys are the _____ route for excretion in the body Primary or sole
Functions of the kidney : 5 1. Regulation of body fluid volume and osmolality 2. Electrolyte 3. Acid-base balance 4. Metabolic products and foreign substances 5. Hormones
How do we maintain an acid-base balance? 2 1. Buffers 2. Coordination of the lungs with the kidneys
What is metabolic waste? Waste that is produced BY the body
What are the hormones produced by the kidneys? Renin, calcitrol and Epo
What does renin do? How? regulates BP : Na-K balance
Function of calcitrol? Normal reabsorption: calcium by GI tract and for deposition in bone
Why could calcitrol production be impaired? Renal disease
You have ______ in chronic renal disease Abnormalities in bone formation
What is the function of erythropoietin? Stim RBC formation by the bone marrow and control oxygen carrying capacity if blood
Because epo production and secretion is reduced in chronic renal failure, you get ___ Anemia
Urinary volume may vary from 0,5 to 18L per day
Diluted urine = 50 mOsm/L
Concentrated urine = 120mOsm/L
Useless to the body: excess in the body Waste
A waste substance produce by the body Metabolic waste : Nitrogen or CO2 for example
All metabolic waste is nitrogenous False!
A by-product of protein catabolism Urea
Renal failure can lead to what? What is this? Azotemia : accumulation of nitrogenous waste in blood
Azotemia leads to what which leads to what? Uremia - convultion - coma - DEATH!!!
Normal urinary output 1-2 L day
Polyuria = more than 2L day
Oliguria = Less that 500 ml day
Anuna can be due to what? Kidney disease, Dehydration, prostate enlargement
Range for anuna. If output drop below ___ you get azotemia 1. 0-100 ml day 2. 400 ml day
Molarity The amount of a substance, relative to its molecular weight, dissolved in a solution
Equivalence If a solution dissociates into more than one particle when dissolved in a solution
Equivalence refers to what? The interaction between cations and anions, determined by the valence of these ions
For univalent ions (NaCl), the concentrations expressed in terms of ___ and ___ are identical 1. Molarity 2. Equivalence
Is this true for ions that have a valence greater than 1? Nope
Osmosis: The passage of water from a region of ______ through a _____ to a region of _____ when a barrier ____ the movement of solutes 1. High water density 2. semi-permeable membrane 3. low water concentration 4. Restricts
What is the driving force for movement of water across cell membranes? Osmotic pressure diffrence
If you have 2 chambers seperated by a semi-permeable membrane, B is filled with distilled water, A is filled with a solute. Water will move from B to A. At equilibrium, what will stop mvt from B to A? Hydrostatic pressure
Hydrostatic pressure will equal and opose what? Osmotic pressure
How do you determine osmotic pressure? By the number of solute particles in a solution
Law that calulates osmotic pressure? equation 1. van't Hoff's law 2. pi = nCRT
n = ? C = ? R = ? T = ? n = # of dissociable particles per molecule C = total solutes concentration R = Gas constant T = Absolute temp (K)
Osmotic pressure may also be expressed in terms of ___ Osmolarity
T or F: Solutions containing 1 mmol/L solute particles exerts an osmotic pressure of l mosm/L. Substances that can dissociate in a solution will have a value other than 1. true
Osmolarity = Concentration x # dissociable particle
mOsm/L = mmol/L x # particles/molecule
Definition of osmolarity # of solution particles per 1 L of solvent
Expressed in? milliosmoles/L (mOsm/L)
Role of temperature Proportionate to temp
Osmolality: definition, based on what?, temp dependant? 1. # of solution particles per 1kg of solvent 2. based on mass of solvent 3. nope
Expressed in? Osm/Kg H2O
What is tonicity? The effect of a solution on cell colume
3 types of tonicity Hypo, Hyper, Isotonic
Hypotonic: Solution that causes a cell to swell
Hypertonic: Solution that causes a cell to shrink
Isotonic: No effect on cell volume
What factors affect tonicity? 1. Permiability 2. Osmolality
To exert ____ across a membrane, a solute must ___ ____ that membrane 1. Osmotic pressure 2. Must not permeate
What is an effective osmole? An osmole that generate pressure equal and opposite to the osmotic pressure generated by the contents of RBCs
What is an ineffective osmole? An osmole that can cross the RBC membrane easily and therefore can not exert osmotic pressure to balance that generated by the solutes of ICF
A solution that has an osmotic coefficient or reflection coefficient of 1 means what? Osmotic pressure is exerted and the substance is an effective osmole
What is oncotic pressure? It is the osmotic pressure generated by macromolecules (proteins)
What is the oncotic pressure exerted by proteins in human plasma? 28-26 mmHg or 1.4 mOsm/Kg H2O osmotic pressure
The oncotic pressure is important for what? Important force involved in fluid movement across caps
Oncotic pressure is smaller or bigger than osmotic? smaller
What is specific gravity? The weight of a volume of a solution divided by the weight of an equal volume of distilled water
The specific gravity of biologic fluids is? Greater than 1
What is the cilical use for specific gravity? used to assess the concentration ability of the kidneys
Specific gravity varies in proportion to its osmolarity
Specific gravity depends on what? The number and weight of solute particles
% of total body water? 60%
% of ECF? ICF? 1. 20% BW 2. 40% BW
% of ISF? Plasma? 1. 75% of ECF 2. 25% of ECF
The ionic composition of the ISF and plasma is similar with 1 diffrence Plasma has a crap load more protein
Which ion is the major determinant of ECF osmolality? Na+
A rough estimate of ECF osmolality = ? Double the Na+ concentration
Why measure plasma osmolality? Provides a measure of osmolality of ECF and ICF
___ is in osmotic equilibrium across cap endothelium and cell membrane H2O
Equilibrium between ICF and ECF occurs how? By movement of water
Which ion is the major catin of ICF? K+
How is the asymetric distribution of Na an K maintained across the cell membrane? Na/K pump
What are the 2 forces that determine the free movement of water between the various body compartements? 1. Hydrostatic pressure 2. Osmotic pressure
Hydrostatic pressure is exerted by the ___ and osmotic pressure is exerted by ___ 1. Pumping of the heart 2. Plamsa proteins
Fluid exchange between body compartements: this process is called what? Oncotic pressure
Hydrostaic and osmotic pressure determine what? Fluid movement across the cap wall
Is hydrostatic pressure present across the cell membrane? no
What pressure between ICF and ECF cause fluid movement into and out of cells? Osmotic pressure diffrence
Fluid movement across cap wall is measured by what? Starling forces Kf{(Pc-Pi) - theta(PIc - PIi)}
Kf= Filtration coefficient of cap wall
Pc = hydrostatic pressure within cap lumen (a force for the movement of fluid from the lumen into interstitium)
PIc = Oncotic pressure of plasma
What retards the movement of fluid out of the cap lumen? Oncotic pressure of plasma (PIc)
PIi = Hydrostatic pressure of interstitium
The force that will cause fluid to move out of the cap PIi - hydrostatic pressure of intertitium
PIi = also Oncotic pressure of the ISF
The proteins that leack across the cap wall into the intersitium exert ___ pressure and promote what? 1. Oncotic 2. Promotes the movement of fluid out of the cap lumen
Theta = Reflection coefficient... relative availability for a solute to cross a cell membrane
Do starling forces for cap fluid exchange vary between tissues and organs? Sure do
What causes fluid to leave the lumen along its entire lenght? 1. Balance of starling force across muscle cap 2. the filtered fluid is then returned to circulation via lymphatics
Is the freaken cell membrane highly permeable to water yes!!!!!!!
The ICF and ECF are in ____ equilibrium osmotic
What does movement of ions across the plasma membrane dependant on? 1. specific membrane transporters 2. Cell membrane permiability
If increase in vascular volume is needed: 5% albumin: the oncotic pressure retains fluid in vascular compartement
If expansion of ECF is needed: 0.9% NaCl
If body fluid is hyperosmotic: need hypotonic solution: 0.45% NaCl
Hypotonic solution of 0.45% NaCl increases what? Both ICF and ECF
Kidneys are ___ organs retroperitoneal
What percent of the blood flows to the kidneys? 25% cardiac output
Kidneys make up what percent of body wieght? less than 0.5 percent
Describe the blood flow pathway Renal artery -- arcuate artery -- interlobular artery -- afferent arterioles -- glomerular caps -- efferent arterioles -- cap network
What brings the blood into the nephron? Afferent arterioles
What carried the blood out of the kidneys? Efferent arterioles
What supplies blood to the nephron? peritubular caps
What gives rise to the vasa recta? Juxtamedullary nephron's peritubular caps
What is the vasa recta? long hairpin shaped vessel that follows the course of the loop of henle
Function of vasa recta Omsotic exchanges for producing concetrated urine
What is the functional unit of the kidey? Nephron
Nephrons consist of: 1. Gloreulus 2. Renal tubual
Glormerulus consist of: 1. Glomerular caps 2. Bowman's membrane
Where to glomerular caps extend from and where are they located? Come from afferent arterioles inside bowman's membrane
What is ultrafiltration? Passive movement of protein free fluid from glomerular caps
Blood is ultrafiltered across the gloermular caps to where? Bowman's membrane
Ultrastructure of the nephron corpuscle: 1. Podocytes 2. Filtration barrier
What are podocytes? Glomerular caps covered by epithelial cells
Can do phagocytosis and are protective in nature...are endocytic Podocytes
Where can you find the filtration barrier? 1. The cap endothelium 2. The basement membrane 3. Mesangium
What does the cap endothelium allow through? water, sodium, urea, glucose and small proteins
The basement membrane is composed of ___ charged proteins Negetively
How do particles pass through the basement membrane and cap endothelium? Filtration slits
Function of filtration slits To retard the filtration of some proteins and macromolecules
What is nephrin? Transmembrane protein of slip diaphragm
What happens if there is mutation of the nephrin gene? Massive proteinuria and renal failure
Mesangial cells are ___ Phagocytic
Function of mesangium 1. Secrete prostaglandins and cytokines (defense proteins and inflammation) 2. Contract and influence GFR
Mesangium is involved in _____ immune complex mediated glomerular disease
The remainder of the nephron is a ____ lined with a single layer of ____ 1. Tubular structure 2. Epithelial cells
Function of the epithelial cells of the nephron Reabsorption from tubular lumen into peritubular cap blood stream
The renal tubual is composed of: 1. Proximal convoluted tubule (brush border) 2. Proximal straight tubule
The proximal straight tubule is composed of: 1. Loops of Henle 2. Distal convoluted tubule 3. Collecting ducts
The loop of Henle is composed of: 1. Thin ascending limb 2. This descending limb 3. Thick ascending limb (TAL)
Function of the brush border (proximal convoluted tubule) Has microvilli that provide an area for absorption
2 types of nephrons 1. Superficial cortical nephrons 2. Justamedullary nephrons
Superficial cortical nephrons: Location and structure 1. Glomeruli located in outer cortex 2. Short loop of henle
Justamedullary nephrons: location ond structure 1. Glomeruli located near the corticomedullary border 2. Longer loop of Henly (allows more time for water conservation)
Where do you find vasa recta? in the juxtamedullary nephron
What percent of the RBF enters the vasa recta? less than 0.7%
Function of vasa recta 1. Osmotic exchnager 2. Concentration and dilution of urine 3. Convey oxygen and nutrients to nephron 4. Return reabsorbed water and solutes to blood
The ultrastructure of the juxtaglomerular apparatus has the following 1. Macula densa 2. Extraglomerular mesangial cells 3. Renin producing granular cells
What are granular cells of the afferent arterioles? modified smooth muscle cells that produce renin
The macula densa is part of the: TAL
Function of renin Regulated BP INDIRECTLY through renin-angiotensin-aldosterone pathway
What is the function of the tubuloglomerular feedback mechanism? Autoregulation of RBF and GFR
Function of renal nerves help regulate RBF, GFR and water reabsorption by the nephron
Sympathetic originate from the ___. Parasympathetics originate from the ___. 1. Celiac plexus 2. No parasympathetics!
Adrenergic fibers relase: 1. NE 2. Dopamine
3 effects of dopamine 1. Affects smoooth muscle cells 2. secretion of renin 3. enhances Na+ reabsorption
What is nephrotic syndrome? Increased protein permiabilty in the glomerular caps
Patients may dev what other condition>? Albuminemia
Uncontrolled diabetes can lead to what? Nephrotic symdrome
What else can lead to nephrotic syndrome? Foot process disease and amyloidosis
What does Alport's syndrome lead to? 1. Hematuria 2. Glomerulonephritis
Defect which leads to Alport's syndrome? Defect in collagen 4 of basement membrane
2 parts of the bladder 1. Fundus 2. Neck
Connects with the urethra Neck
Diffrence between female and male urinary tract Males has a post-urethra
Region of posterior bladder wall Trigone
Detrusor muscle is under ___ control Autonomic
Function of detrusor muscle, found where? Stop urine flow for storage...neck
External sphincter: muscle type, function 1. Skeletal 2. prevent or interupt urination
Where do you find ruggae? Walls of the ureters, bladder and urethra
What is there little or no change in intravesicular pressure when the bladder fills? The ruggae flatten out
3 types of cells that make up thge calyces, pelvis, ureter and bladder 1. Columnar cells (basilar layer) 2. Cuboidal (intermediate layer) 3. Squamous (superficial layer)
Fibers in the detrusor muscle are arranged ___ Randomly
Innervation of the bladder 1. Sympathetics via hypogastric nerves 2. Parasympathetics via pelvic nerves 3. Sacral pudendal nerves
Function of sympathetics Contract neck and urethra for urine storage
Function of para innervate fundus...muscarinic receptors cause sustained bladder contration
Function of pudendal Innervate the skeletal muscle fibers of the external sphincter...cause contraction
Created by: LrB