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