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PhysQ2_Test1

RenalFcn

QuestionAnswer
What do the kidneys regulate Inorganic Ion Balance Osmolarity Volume Water
What do the kidneys excrete Metabolic waste(urea,uric acid, creatinine) Foreign Chemicals (drugs)
What do the kidneys secrete Hormones: Renin & Epo -1,25-dihydrocholecalcificol
Juxtaglomerular(granular cells) secrete what? Renin
Interstitial cells secrete what? Epo
How much water is inputted per day? 2300mL
How much water is outputted per day? 1200mL
How much water is UNACCOUNTED for each day? 1100mL (steady state)
Pt has urinary flow of >1100ml/day. Dx? Negative Water Balance
Pt has urinary flow of 1100ml/day. Dx? Steady State
Pt has urinary flow of <1100ml/day. Dx? Positive Water Balance
Pt has diarrhea, what do you suspect of their sodium/water balance? Negative Balance
Pt on diuretic, what do you suspect of their sodium/water balance? Negative Balance
Pt has adrenal dysfunction(NOT enough aldosterone), what do you suspect of their sodium/water balance? Negative Balance
Pt on excess steroids, what do you suspect of their sodium/water balance? Positive Balance
Pt has congestive heart failure, what do you suspect of their sodium/water balance? Positive Balance
Pt has salt-retaining renal disease, what do you suspect of their sodium/water balance? Positive Balance
This part of the kidney is striated Medulla
This part of the kidney is granular cortex
Ureter pressure is typically high or low? Very low
This structure has 3 components: tubular, vascular & combined (JGA) Nephron
This contains the glomerulus & Bowman's Capsule Renal Corpuscle
This DRAINS the Bowman's Caspule where 60-80% of filtered solute & water is reabsorbed (isosmotic) Proximal Tubule
These descending and ascending loops generate osmotic gradients in the medulla that allow the kidney to concentrate the urine Loop of Henle
This is where thick ascending limb passes btwn afferent/efferent arteriole Juxtaglomerula Appartaus (JGA)
This has some reabsorption of water/ions. Fluid here is iso OR hyposomtic Distal Convuluted Tubule
This is where the final concentration of urine is adjusted Collecting Duct
In the collecting duct water permeability is controlled by what Vasopressin
These glomeruli in outer cortex have short loops of Henle that do NOT extend into the inner medulla Cortical Nephrons
These glomeruli near corticomedullary border have long loops of Henle and extend deep into the inner medulla. Juxtamedullary Nephrons
The number of juxtamedullary neprhons will control what? The ability to produce a certain amt of concentration in the urine
All nephrons function in what way? In parallel (collecting ducts shared by many nephrons)
Capillary endothelium, basement membrane & capsular epithelial cells all comprise this Filtration barrier
Podocytes separated by slits are present in the capsular epithelial cells. What do they constitute? The path of filtrate flow from capillary lumen into urinary space
This is composed of macula densa, granular cells & extraglomerula mesangial cells JGA (Juxtaglomerula Apparatus)
This helps control glomerula filtration rate & renin secretion (BP & volume) JGA (Juxtaglomerula Apparatus)
These cells found inbetween and within capillary loops of the JGA contract in response to angiotensin 2 Mesangial cells
This part of the peritubular capillary bed follows the loops of Henle of JGA nephrons. Found in medulla Vasa Recta
Cortical aa give off afferent arterioles. How many per glomerulus? One afferent arteriole per glomerulus
Fluid NOT filtered by kidney goes where Efferent arterioles-->peritubular capillaries
There are 2 arterioles (afferent & efferent) and 2 capillary beds (glomerula & peritubular) which do what Go in series
These specialized tubular capillaries of juxtamedullary nephrons are long, hairpin shaped that follow the loops of henle. They supply nutrients to medullary tissue & are impt for water recovery Vasa Recta
Renal nerves are SNS(Adrenergic: dopamine/NE) and use which receptors Alpha1 on arterioles
Are the kidneys PNS or SNS or both? SNS only (Adrenergic: NE/Dopamine)
Only adrenergic stimulation (SNS) will do what to renal blood flow & glomerula filtration rate Will decrease renal blood flow & glomerula filtration rate
Adrenergic stimulation (SNS) with the simultaneous release of PGE2 and PGI2 will do what to renal blood flow & glomerula filtration rate Will reduce the reduction of renal blood flow and glomerula filtration rate -PGE/PGI will oppose the effect of SNS
SNS (adrenergic) stimulation of granular cells(JGA) will lead to what when beta receptors are stimulated? Renin release
What is the rate of glomerula filtration? 120-125ml/min
After glomerula filtration, what is produced? A protein-free filtrate
What occurs from tubular lumen to PTC Tubular Reabsorption
What occurs from PTC to tubuluar lumen Tubular secretion
Kidneys receive how much of cardiac output? 1/4 -180L Filtrate/day -Plasma filtered 65x/day
Dividing the glomerula filtration rate/renal plasma flow gives you what? Filtration Fraction
Vasoconstriction in the renal area is mediated by which receptors Alpha1
Vasoconstriction by SNS (alpha1) effects RBF & GFR how? Decreases renal blood flow Decreases glomerula filtration rate
AngII, ADH, ATP & Endothelun all do what? Vasoconstrict-->DEC RBF & GFR
AngII constricts both afferent & efferent arterioles. Which are more sensitive to its effects? Efferent arterioles
ANP, Glucocorticoids, NO, Prostaglandins all do what? Vasodilate--> INC RBF & GFR
Constant blood flow and GFR @difft arterial pressures determined by? Autoregulation: Range 80-180mmHg
This can be OVERridden by LARGE increases in sympathetic tone(vasoconstriction by SNS or other constrictors) Autoregulation
When would you expect to see decreased RBF & GFR? Hypotension during severe blood loss
Intrinsic to vascular smooth m cells it contracts in response to stretch of vessels. Myogenic Mechanism for Autoregulation of RBF & GFR
Increasing GFR will INC NaCl delivery to LOH which is sensed by the macula densa. This will cause resistance of the afferent arteriole(Ra) to INC-->DEC RBF&GFR Tubuloglomerula Feedback("Flow Dependent") Autoregulation of GFR & RBF
Signaling that affects RBF & GFR mainly by changing resistance in this arteriole AFFerent arteriole
This maintains constancy of salt load delivered to distal tubule Tubuloglomerula Feedback
What is the suspected tubuloglomerula feedback signal Adenosine
All small-MW solutes NOT protein-bound appear in the filtrate comparitively how w/blood plasma concentrations? In SAME concentrations
The fluid in Bowman's Capsule: Protein-FREE filtrate of blood plasma
Fenestrae-->basal lamina-->slits btwn pedicels of podocytes(bridged by diaphragms) Route of Filtrate
What are the MAIN barriers to proteins during filtration Basal Lamina & Filtration Slits
Why are proteins unable to filter into glomerula BC slits are coated w/negative charge and cannot pass thru since proteins also negative
What is more permeable to filtration: polycation or polyanion? Polycation (+)charge
Mesangial cells (produce AngII) alter filtration rate Kf how? By decreasing
What is the driving force for GFR? Blood pressure in glomerula capillary (Pgc)
What slows down GFR? Back pressure in Bowman's Capsule (Pbc)
What oncotic pressure is caused by proteins unable to cross the barrier, slowing GFR. Will increase as plasma is diverted into BC. Oncotic pressure of glomerular capillary blood (pi-gc)
Glomerula Capillary Pressure Hydrostatic Pressure 45mmHG
Oncotic Pressure of glomerula capillary? 26mmHg (MEAN VALUE)
Pressure of Bowman's Capsule? 10mmHg
Kf for filtration 14ml/min/mmHg
When afferent (Ra) and efferent (Re) BOTH INC what happens to glomerula capillary hydrostatic pressure? There is NO EFFECT on glomerula capillary pressure if BOTH resistances INC
When afferent (Ra) and efferent (Re) BOTH INC what happens to renal blood flow? There is a DRAMATIC decrease in renal blood flow
When afferent (Ra) INC and efferent (Re) stays constant what happens to glomerula capillary hydrostatic pressure? Glomerula capillary pressure will DEC
When afferent (Ra) INC and efferent (Re) stays constant what happens to renal blood flow? Renal Blood Flow will DEC
When afferent (Ra) stays constant and efferent (Re) INC what happens to glomerula capillary hydrostatic pressure? Glomerula capillary pressure will INC
When afferent (Ra) stays constant and efferent (Re) INC what happens to renal blood flow? Renal blood flow will DEC
INC glomerula surface area does what to GFR Increase GFR
INC renal a pressure does what to GFR Increase GFR
DEC afferent-arteriole resistance via afferent dilation does what to GFR Increase GFR
INC efferent-arteriole resistance via efferent constriction does what to GFR Increase GFR
INC intratubuluar pressure bc of an obstruction of tubule or extrarenal urinary system does what to GFR Decrease GFR
INC systemic plasma oncotic pressure does what to GFR Decrease GFR
DEC renal plasma flow causing an INC in osmotic pressure in glomerula capillaries will do what to GFR Decrease GFR
Amount of material in glomerula filtrate Filtered Load=GFR*Px
Amt of material lost in urine Excretion Rate=Ux * V
Amt of material added to (secreted) or removed (reabsorbed) from glomerula filtrate Transport rate=Tx=FL-ER
Positive transport rate Reabsorption: material was removed from filtrate
Negative transport rate Secretion: material was added to filtrate
Fraction of filtered mass represented by excreted mass Fractional Excretion: FE=ER/FL
Fractional excretion <1 Reabsorption: material was removed from filtrate
Fractional excretion >1 Secretion: material was added to filtrate
What is 100% reabsorbed Glucose
Transcellular & paracellular(leaky epithelium) are what Routes of reabsorption
What 2 barriers must you cross for transcellular reabsoption Apical & basolateral membrane _Diffusion thru IF & capillary wall is fast
Perfect GFR marker is freely filtered, not reabsorbed or secreted. What is gold standard but not commonly used? Inulin
What is commonly used to indicate GFR Creatinine clearance & plasma creatinine
Produced by skeletal m @relatively constant rate from breakdown of creatinine phosphate. Freely filtered, not reabsorbed, only slightly secreted. At a steady-state conc in blood. Creatinine
Which levels can provide an estimate of GFR over the preceding hrs Creatinine
a.a. catabolism in liver makes urea which varies w/protein intake & liver function. About 1/2 of filtered urea is reabsorbed. This is NOT a good GFR marker Blood Urea Nitrogen (BUN) Normal: 9-18
What happens to reabsorption of urea when GFR is low Reabsorption will increase
High BUN:Cr ratio: >15 Dehydration (DEC GFR) Upper GI Bleeding
Normal BUN:Cr ratio: 10-15 Acute tubular necrosis Loss of nephrons
Low BUN:Cr ratio: <10 Severe skeletal m injury(INC Cr) Liver Dz(DEC BUN) Malnutrition(DEC BUN)
What is more sensitive to decreased GFR, BUN or plasma Cr BUN
Volume of plasma that is cleared of solute x per minute Clearance
Injected diuretic that inhibits osmotic water flow from lumen-->basolateral spaces. Causes Na+ back-diffusion into lumen of tubule w/INC Na+ and H20 loss. Mannitol (in Proximal Tubule) _INC loss of water & electrolytes in urine
Cr clearance of 85-125 for females Normal
Cr clearance of 97-140 for males Normal
Clearance of secreted substance, lesser or greater than CCr Clearance of secreted substance GREATER than clearance of creatine(and thus >GFR)
Clearance of reabsorbed substance, lesser or greater than CCr Clearance of secreted substance lESSER than clearance of creatine(and thus >GFR) _Glucose, complete reasorption, clearance is zero
Clearance of substance:Clearance of Inulin=1 substance being filtered must also be a GFR marker
Clearance of substance:Clearance of Inulin<1 Substance Not Filtered OR Filtered & Reabsorbed
Clearance of substance:Clearance of Inulin >1 Substance Filtered & secreted
This can estimate RPF(renal plasma flow) because ALL the blood is cleared of this Para-aminohippurate(PAH)
Glucose uses this process to move during reabsorption Secondary active transport w/Na+ INFLUX
How much Na+ is reabsorbed in the proximal tubule 67% (2/3)
How much water is reabsorbed in the proximal tubule 65% (2/3) _Solute Linked
How is Na transported across basolateral membrane By Na/K ATPase _H20 will follow passively
How does Na enter proximal tubule cells Organic cotransport & Na/H antiport
How does Cl enter proximal tubule cells Paracellular Routes
How does Na leave proximal tubule cells Na/K ATPase or via cotransport w/bicarbonate
Stimulates Na/H exchange across apical membrane(NHE family of transporters) & INC Na reabsorption & H secretion. Angiotensin II
Stimulates Na reabsorption SNS Activity
Inhibits Na/PO4 cotransport. INC urinary excretion of PO4. Parathyroid Hormone
What can the loop of Henle NOT transport more than? 200
Tubular Fluid/Plasma (TF/P) ratio in Bowman's space for freely filtered solutes 1
What happens to osmolarity across the proximal tubule? Osmolarity DOES NOT change
Tubular Fluid/Plasma Conc. (TF/P) ratio=1 Reabsorption of substance has been EXACTLY proportional to reabsorption of water
Tubular Fluid/Plasma Conc. (TF/P) ratio <1 Reabsorption of substance has been GREATER than reabsorption of water _more water in plasma, than tubules _more solute in tubules
Tubular Fluid/Plasma Conc. (TF/P) ratio >1 Reabsorption of substance has been LESS than reabsorption of water OR There's net secretion of the substance _more water in tubules, than plasma _more solute in the filtrate
Tubular Fluid/Plasma Inulin (TF/P) used why? Since ONLY filtered, it's conc in the tube is solely determined by water movement
Max rate which renal can transport a certain solute Tubular Maximum (Tm) _caused by saturation of membrane transport proteins
Fluid leaving LOH more or less dilute than other fluids? MORE dilute.
Below Tm All filtered load is reabsorbed into tubules
Above Tm Extra filtered load is excreted
Where are Tm's usually found? Proximal Tubule
Where glucose first appears in the urine. Depends on the GFR Threshold of plasma
What happens to the threshold when you decrease GFR? Decreasing filtration rate will increase the threshold(not all receptors are full therefore takes longer to saturate)
What happens to the threshold when you increase GFR? Increasing filtration rate will decrease the threshold(easier to saturate all the receptors)
Causes back-diffusion into lumen of tubule w/INC Na+ and water loss (diuresis). INC water loss & electrolytes in urine. Mannitol _Osmotic Diuresis
Where is the Na/K pump always present? Basolateral membrane twds ISF of tubule
Furosemide(lasix) a loop diuretic blocks this Na/K/2Cl- transporter (in Thick Ascending Limb)
What stimulates the Na/K/2Cl transporter ADH _Stimulation can be blocked by Loop diuretic(lasix)
Can result in a rapid loss of Na & H20 (polyuria) Osmotic Diuresis
Occurs w/high filtered urea load Osmotic Diuresis _rapid loss of Na/H20(polyuria)
Occurs when gluose load exceeds Tm in DM patients Osmotic Diuresis _rapid loss of Na/H20(polyuria)
Non-reabsorbed carbohydrate that's given IV to induce osmotic diuresis Mannitol _rapid loss of Na/H20(polyuria)
Is tubuluar secretion specific or non-specific? VERY non-specific
Typical cmpds SECRETED Metabolites, waste products, foreign chemicals tagged by liver
Liver will tag things w/glucoronic acid or sulfate. What does this do? Promotes secretion into filtrate
How are organic anions (PAH) secreted? Via tertiary active transport
PAH is taken into filtrate(secreted) in exchange for what? alpha-KG will go back to blood
How does PAH leave on the apical side twds the filtrate for secretion? PAH-anion transporter
The apical side faces which substance: plasma or filtrate Filtrate
If you have INC plasma levels of an ion, how will it effect other anions? Secretion of anions will be inhibited since compete for same transporter.
Infusion of PAH with penicillin is used why? Extends penicillin's half-life by inhibiting it's secretion into filtrate
Stimulates Na+ reabsorption in late distal tubule & collecting duct(principal cells) Aldosterone
Stimulates K+ secretion so that Na+ can be reabsorbed Aldosterone
Angiotensin II stimulates the release of this Aldosterone
K+ plasma stimulates the release of this Aldosterone
Vasoconstrictor which stimulates aldosterone release & Na/H exchange in the proximal tubule Angiotensin II
Functions favor salt retention & elevation of arterial BP Angiotensin II
Levels of this hormone which favors salt retention & elevation of arterial BP is controlled by renin Angiotensin II
Renin release by JGA has 3 components 1)Intrarenal baroreceptors 2)Macula Densa 3)Renal SNS
Granular cells of JGA respond to pressure(stretch) in AFFerent arterioles. Release of renin INVERSELY related to pressure in AFFerent arterioles Intrarenal baroreceptors
Pressure in afferent arterioles rises, what happens to renin release? Renin release decreases which decreases blood volume to decrease blood pressure
Pressure in afferent arterioles drops, what happens to renin release? Renin release increases which increases blood volume to increase blood pressure
Senses flow to distal tubule(GFR) and renin release is INVERSELY related to GFR Macula Densa
GFR increases, what happens to renin release Renin release decreases which decreases blood volume to decrease blood pressure
GFR decreases, what happens to renin release Renin release increases which increases blood volume to increase blood pressure
Stimulation of these increases renin release via b-receptor stimulation Renal Sympathetic nn
A hemorrhage would do what to renin? Increase renin secretion which increases blood volume to increase blood pressure
A hemorrhage would do what to angiotensin 2? Increase angiotensin 2 which increases blood volume to increase blood pressure
A hemorrhage would do what to aldosterone? Increase aldosterone which increases blood volume to increase blood pressure
What is the effect of lowering blood volume? Lowers blood pressure
Released from atria when pressures are high, increases NaCl excretion by INC GFR. Atrial Natriuretic Peptide(ANP)
Dilates the afferent arteriole & INC GFR & the filtered load of NaCl Atrial Natriuretic Peptide(ANP)
Decreases NaCl reabsorption by the collecting duct by directly inhibiting renin/aldosterone secretion AND Na+ uptake by the medullary collecting duct Atrial Natriuretic Peptide(ANP)
MOST important hormone regulating water balance that's released from pituitary when plasma osmolality INC ADH(Antidiuretic Hormone)
MOST important hormone regulating water balance that's released from pituitary when plasma volume DEC ADH(Antidiuretic Hormone)
Causes the movement of aquaporins to control water balance ADH(Antidiuretic Hormone)
Though an impt hormone to regulate water, has little effect on NaCl excretion ADH(Antidiuretic Hormone)
Hypovolemia senses SMALL changes in plasma osmolarity via OSMORECEPTORS. Stimulate this: ADH(Antidiuretic Hormone)
Hypovolemia senses LARGE changes in plasma osmolarity via ARTERIAL & L ATRIAL BARORECEPTORS. Stimulate this: ADH(Antidiuretic Hormone)
INC Na/K/2Cl cotransporters in the LOH increasing the medullary gradient ADH(Antidiuretic Hormone)
INC permeability of the collecting duct to water ADH(Antidiuretic Hormone)
INC permeability of inner medullary collecting duct to urea ADH(Antidiuretic Hormone)
Avg Osmolarity level 290mOsm/L
During a hemorrhage what happens to ADH secretion? ADH secretion increases in order to raise plasma volumes & thus raise blood pressure. Will lower water excretion & increase its reabsorption
During a hemorrhage what happens to too much water that's ingested? ADH secretion decreases, and water reabsorption decreases and excess water is excreted
ml/min of plasma cleared of a given substance Clearance
ml/min of plasma cleared of osmotically active particles Osmolar Clearance= (Uosm*V)/Posm
Positive osmolar balance is a sign of gaining osmoles & water in plasma. Progressing to edema. What's ur Osmolar clearance? DEC Osmolar Clearance(water gain)
Decreased GFR causes edema by causing this DEC Osmolar Clearance(water gain)
Increased aldosterone causes edema by causing this DEC Osmolar Clearance(water gain)
"Dumping" osmolytes leads to a loss of ECF. How does this effect osmolar clearance? INC Osmolar Clearance(water loss)
Diuretic reduce the ability of the kidney to reabsorb normally. How does this effect osmolar clearance? INC Osmolar Clearance(water loss)
Reduced aldosterone reduce the ability of the kidney to reabsorb normally. How does this effect osmolar clearance? INC Osmolar Clearance(water loss)
What would it mean if the osmotic clearance=urine flow Urine is isotonic
Volume is greater than osmotic clearance Additional solute-free water is being LOST from the body (urine is HYPOtonic)
Volume is less than osmotic clearance Additional solute-free water is being RETURNED to the body (urine is HYPERtonic)
If you take the urine flow-osmotic clearance, the difference gives you what? Amt of solute-free water lost/saved
ml/min of solute-free water excreted by the kidneys Water clearance=Volume-Osmotic Clearance
Water Clearance is negative Solute-free water being conserved by the body
Water Clearance is positive Solute-free water being excreted by the body _Dilute urine
Created by: glittershined