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renal - pcc
first exam - renal
| Question | Answer |
|---|---|
| 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
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