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Anatomy & Physiology: Renal

Where is renin released from? Granular (JG) cells of the macula densa
Where is the juxtaglomerular apparatus located in the nephron? afferent arteriole
What are the 3 causes of renin release? 1. stimulation of B receptors by sympathetic nerves 2. reduction in kidney perfusion 3. reduction in Na+ delivery in macula densa
Where is the macula densa located? distal tubule
What are the autoregulator methods of renal blood flow? 1. myogenic response 2. tubuloglomerular feedback
What is the myogenic response? increased RBF is sensed by vascular smooth muscle and causes them to constrict
What is the tubuloglomerular feedback response? increased NaCl to macula densa leads to constriction of afferent arteriole and decreased renin release
What is the main effect of administering an isotonic saline solution? increased extracellular volume
What changes in starling forces cause edema? What are some specific causes of each? 1. ↑ glomerular capilary pressure; hypertension 2. ↑ interstitial oncotic pressure; trauma, burns or infection 3. ↓ capillary oncotic pressure; liver failure, nephrotic syndrome
What is the purpose of the lymphatic system? to return interstitial fluid and proteins to the vascular compartment
1. How does the charge of the glomerular barrier affect filtration? 2. What contributes these charges? 1. negatively charges barrier repels large negatively charged solutes 2. neg. charged glycoproteins
How do starling forces change along the glomerular capillaries? only capillary oncotic pressure increases
What substance is used to clinically measure GFR? creatinine
How does ADH affect BUN? ADH causes increased BUN reabsorption
If the GFR quickly decreases by 1/2, how does the nephron maintain the same excretion rate of a solute? the solutes plasma concentration increases by 2x
What happens to GFR immediately upon dehydration and why? GFR decreases because of afferent arteriole constriction mediated by sympathetic response (baroreceptors)
1. If arterial pressure increases, how does the nephron maintain constant GFR and RBF? 2. What are these mechanisms called? 1. autoregulatory mechanisms -- mainly constriciton of afferent arteriole 2. Myogenic response and tubuloglomerular feedback
1. What receptors do vascular smooth muscle cells have that lead to vasoconstriction? 2. What do binding of these receptors cause in coronary vasculature? 1. A1 receptors for adenosine 2. vasodilation
How does GFR affect reabsorption? a decrease in GFR allows more time for reabsorption to occur
How does angiotensin II affect renal vasculature at low levels? At high levels? 1. constricts efferent at low levels 2. constricts both afferent and efferent at high levels
Where in the nephron is water permeable? 1. proximal tubule 2. descending limb of Henle's loop 3. collecting duct
Where does AVP act on in the nephron and how does it affect water reabsorption? acts on the collecting duct to increase water reabsorption
When is ADH (AVP) released? 1. ↑ plasma osmolality 2. ↓ plasma volume 3. stress, pain 4. ↓ ethanol
1. What is the greatest stimulus for ADH release? 2. Is ADH released at normal osmolality 1. decreased plasma volume as in hemorrhage 2. Yes
How does glomerulonephritis cause hypertension? 1. decreased GFR causes NaCl and water retention leading to expansion of the vascular volume 2. protein blocks NaCl from filtering at glomerulus
Which has a higher permeability per unit area for salts and water: muscle capillaries or glomerular capillaries glomerular capillaries
How do the kidney's respond to increased mean arterial pressure? autoregulatory responses to constrict afferent arteriole
How do the kidney's respond to decreased mean arterial pressure? 1. renin and AVP release 2. sympathetic response
1. What fraction of water is reabsorbed in the proximal tubule? 2. for solutes in the filtrate that are freely filtered into the tubule, what is their concentration after water reabsorption? 1. 2/3 2. 3x plasma concentration
What is the filtration fraction? FF = GFR/RBF
Which segment of the nephron is the diluting segment? Why? 1. thick ascending limb and distal tubule 2. Na is reabsorbed but not water
What is the osmolality of the proximal tubule? Of the plasma? both are ~300 mOsm
What is TF/P? ratio of the osmolality of tubular fluid to plasma
What is the TF/P in: 1. proximal tubule 2. descending tubule 3. ascending tubule 1. 1 2. increases b/c water is reabsorbed with solute 3. decreases back to 1 b/c solute reabsorbed without water
Lowest tubular osmolarity in a well hydrated subject: Deep medullary collecting duct
1. Where in the nephron is the Na/K/2Cl symporter? 2. Where in the nephron is the Na/K ATPase in the basolateral membrane? 3. Where in the nephron is the Na/H antiporter? 4. Na/organic solute symporter? 5. electrogenic Na+ channels 1. ascending limb 2. entire nephron 3. proximal tubule and ascending limb 4. proximal tubule 5. principal cells of collectig duct
Where in the nephron can tubular fluid be either hypotonic, isotonic or hypertonic to plasma? deep medullary collecting duct depending on the levels of ADH
Where does Angiotensin II stimulate H+ secretion? acts on Na+/H+ transporters in the proximal tubule and thick ascending limp of Henle's loop
1. Where in the nephron does aldosterone act to increase H+ secretion? 2. Where does it act upon the Na/K ATPase? 3. What does this lead to? 1. H+ ATPase in alpha intercalated cells of the collecting duct 2. increases synthesis of Na/K pump in principal cells of collecting duct and late distal tubule 3. increased Na reabsorption and K secretion
Which cells of the collecting duct does ADH act upon? principal cells
90% of HCO3 is reabsorbed where? proximal tubule
What is the most important regulator of aldosterone release? plasma potassium concentration
Tranfusion of 1 liter of whole blood into a normal person will stimulate secretion of ... atrial natriuretic peptide
The substance which makes the greatest contribution to the osmolarity of the deep medullary interstitium is? urea
Changes in the rate of K excretion depend predominantly on changes in the activity of.... transport through principal cell K+ channels
To measure the rate at which the kidney synthesizes new bicarbonate to replace that used in the buffering process, you need to determine... urinary titratable acid + urinary NH4+
What is the tonicity of ___ compared to plasma: 1. proximal tubule 2. end of the descending tubule 3. early distal tubule 4. collecting duct 1. isotonic 2. hypertonic 3. hypotonic 4. variable depending on ADH secretion
1. Transport of glucose against its concentration gradient in kidney cells occurs by which mechanism? 2. Which solute does it travel with? 1. secondary active cotransport (symport) sodium dependent glucose transporter (SGLT-1) 2. sodium
Urea is reabsorbed ____ and secreted ____ in the nephron. 1. inner medullary collecting duct 2. thin ascending limb
1. What is the normal BUN/creatinine ratio? 2. What is BUN/creatinine ratio during renal failure 1. 15 2. still 15 but both values are high
1. BUN/creatinine ratio during dehydration? 2. How does this differ from renal failure + dehydration? 1. 30 2. still has ratio of 30 but values are both very high
Prerenal failure originates because of... hypoperfusion of kidney (ie, from plaque buildup)
What is the formula for net transport rate? = Filtered Load - Excretion Rate = (GFR x Px) - (Ux x V)
1. If net transport rate is positive, what can be said about the solute excreted? 2. If net transport rate is negative, what can be said about the solute excreted? 1. net reabsorption 2. net secretion
1. Total Body Water is approximately? 2. Extracellular Fluid volume is? 3. Intracellular Fluid volume is? 1. 42L 2. 17L 3. 25L
What affect does ANP have on the renal system and circulation? 1. dilation of afferent arterioles 2. inhibition of aldosterone 3. inhibition of renin
Identify how each diuretic acts on the nephron: 1. CA inhibitors 2. Osmotic Agents 3. Loop agents 4. Thiazides 5. aldosterone antagonits 6. ADH antagonist 1. inhibits Na+ reabsorption 2. inhibits reabsorption of solute 3. inhibits Na/2Cl/K symporter 4. inhibits NaCl cotransporter 5. inhibits action of aldosterone 6. inhibits ADH
Identify where each diuretic acts on the nephron: 1. CA inhibitors 2. Osmotic Agents 3. Loop agents 4. Thiazides 5. aldosterone antagonits 6. ADH antagonist 1. proximal tubule 2. proximal tubule and descending limp 3. ascending limp 4. distal tubule 5. distal tubule/cortical collecting 6. deep medullary collecting
Where is K+ reabsorbed? 1. proximal tubule 2. ascending limp 3. a intercalated cells (H+/K+ antiporter)
What effect do AT II and ANP have on peripheral vasculature? AT II causes vasoconstriciton ANP causes vasodilation
If a hyperosmotic NaCl solution was administered, what would happen to urine flow? ADH would increase and urine flow would then decrease
How does NaCl transport differ in the thin and thick ascending limb? 1. thin is passive 2. thick is active by the Na/K ATPase
How do Diabetes Insipidus and SIADH both cause hyponatremia? DI causes polydipsia and dilution of Na+ while SIADH causes water retention and thus dilution
What transporter does Na+ use to cross the lumen in: 1. proximal tubule 2. thin ascending limb 3. thick ascending limb 4. distal convoluted tubule 5. collecting duct 1. Na/H antiporter, Na/solute symporter 2. passive channel 3. Na/K/2Cl symporter, Na/H antiporter 4. Na/Cl symporter 5. passive channel
How would increased aldosterone affect NH4 output? increase NH4 excretion by activating the H ATPase on a intercalated cells
What effect do loop and thiazide diuretics have on K concentration? 1. drugs ↓ Na reabsorption in loop or distal tubule 2. ↑ Na to collecting tubules →↑Na/K activity in collecting duct 3. hypokalemia can result
Vasopressin binds __ receptor on principal cells and activates __ subunit of the GPCR. 1. V2 2. Gas
What are the causes of increased anion gap metabolic acidosis? Methanol Uremia Diabetic ketoacidosis Paraldehyde Iron tablets Lactic acidosis Ethylene glycol Salicylates
Which renal tubule acidosis is proximal and which is distal? Which influences H+ and which influences HCO3-? 1. type 1: distal, prevents H+ secretion on alpha intercalated cells 2. type 2: proximal, prevents bicarbonate reabsorption
Which adrenoreceptor causes renin release? β₁
What is the method of acid base analysis? (BRW AIM) -look at pH -look at HCO3 -look at pCO2 -see if appropriate compensation has occurred
What percentage of total body weight is water? 60%
What gives the glomerular basement membrane a negative charge? heparan sulfate
1. What is a normal adult GFR? 2. Clearance of which substance can be used to calculate GFR? 1. ~100 mL/min 2. inulin (creatinine is a close estimate)
Which substance is the best estimate of: 1. Glomerular filtration rate 2. Renal plasma flow 1. creatinine 2. PAH
How is PAH handled in the kidney? all PAH entering the kidney is excreted because is is both filtered and actively secreted in the proximal tubule
1. What is the calculation for filtration fraction (FF)? 2. What is the normal FF? 1. FF = GFR/RPF 2. Normal FF = 20%
1. Which substance controls the blood flow into the afferent arteriole? 2. Which substance controls the blood flow into the efferent arteriole? 1. prostaglandins dilate 2. Angiotensin II constricts
How do the following effect filtration fraction: 1. afferent arteriole constriction 2. efferent arteriole constriction FF = GFR/RPF 1. FF doesn't change because both RPF and GFR ↓ 2. FF ↓ because GFR ↑ and RPF ↓
How does an increase in plasma protein concentration effect GFR? decreases GFR
What is the greatest stimulus for ADH secretion? low blood volume
How does digitalis effect potassium concentration? shift K out of cells causing hyperkalemia
What effect does acidosis have on K+ concentrations? ↑K+/H+ exchanger → ↑ plasma K (hyperkalemia)
What effect does alkalosis have on calcium concentration? alkalosis → stronger binding of free Ca2+ to albumin → ↓ free calcium
How are the following handled within the renal tubule: 1. creatinine 2. BUN 1. filtered and neither secreted or reabsorbed 2. filtered and partly reabsorbed in proximal tubule
1. What is azotemia? 2. Cause of prerenal azotemia 1. increase in BUN and creatinine 2. hypoperfusion of kidney → ↓ GFR (usually from a ↓ in cardiac output)
What BUN:creatinine ratio is seen in: 1. prerenal azotemia 2. renal azotemia 3. postrenal azotemia 1. ratio > 15 2. ratio < 15 3. ratio > 15
Why does renal azotema present with a BUN:creatinine ratio of < 15. extrarenal loss of urea (GI, skin)
What controls blood flow in: 1. afferent arteriole 2. efferent arteriole 1. PGE2 2. angiotensin II
Created by: amichael87



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