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Physiology > Renal Physiology > Flashcards

Renal Physiology Flashcards

1
Q

This is an ultrafiltrate of blood

A

Urine

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2
Q

Urea is a waste product from:

A

Proteins

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3
Q

Uric acid is a waste product from:

A

Purines

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4
Q

Creatinine is a waste product from:

A

Muscles

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5
Q

Bilirubin is a waste product from:

A

RBCs

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6
Q

Life is only compatible with a plasma pH range of:

A

6.8 - 8.0 (beyond this, denature proteins)

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7
Q

2 hormones produced by the kidney:

A

Calcitriol, renin

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8
Q

Water excretion ranges between:

A

0.5 - 1.5 L/day

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9
Q

Urine pH range:

A

5.0 - 7.0

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10
Q

Osmolality of urine:

A

500 - 800 mOsm/kg H2O

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11
Q

Location and weight of the kidney:

A

T12 - L3, 150g

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12
Q

Trace the renal circulation.

A

Renal artery –> segmental artery –> interlobar artery –> arcuate artery –> interlobular artery (cortical radiate/radial artery) –> [afferent arteriole –> glomerular capillaries –> efferent arteriole –> peritubular capillaries/vasa recta] –> interlobular vein –> arcuate vein –> interlobar vein –> segmental vein –> renal vein

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13
Q

Highly fenestrated, responsible for GFR, only capillaries that lead to arterioles and not venules

A

Glomerular capillaries

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14
Q

Supplies O2 and glucose to tubular cells

A

Peritubular capillaries

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15
Q

Cells found in the peritubular capillaries that secrete EPO

A

Interstitial cells

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16
Q

Hairpin-looped shaped peritubular capillaries of the juxtamedullary nephrons that participate in countercurrent exchange

A

Vasa recta

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17
Q

Urinary bladder: capacity

A

600 mL

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18
Q

Urinary bladder: urge to urinate

A

150 mL

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19
Q

Urinary bladder: reflex contraction

A

300 mL

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20
Q

Urinary bladder: bladder muscle

A

Detrusor muscle

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21
Q

Urinary bladder: internal urethral sphincter

A

Involuntary

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22
Q

Urinary bladder: external urethral sphincter

A

Voluntary

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23
Q

Condition in which the full capacity of the urinary bladder is reached without reflex contraction

A

Neurogenic bladder

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24
Q

Functional and structural unit of the kidney

A

Nephron

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25
Q

Number of nephrons per kidney

A

1 million

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26
Q

Kidneys undergo compensatory hypertrophy when there is ___ percent damage to the nephrons

A

75%

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27
Q

Cortical nephrons vs Juxtamedullary nephrons:

75% of nephrons

A

Cortical

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28
Q

Cortical nephrons vs Juxtamedullary nephrons:

Long loops of Henle

A

Juxtamedullary

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29
Q

Cortical nephrons vs Juxtamedullary nephrons:

25% of nephrons

A

Juxtamedullary

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30
Q

Cortical nephrons vs Juxtamedullary nephrons:

Short loops of Henle

A

Cortical

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31
Q

Cortical nephrons vs Juxtamedullary nephrons:

Capillary network: peritubular capillaries

A

Cortical

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32
Q

Cortical nephrons vs Juxtamedullary nephrons:

Capillary network: vasa recta

A

Juxtamedullary

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33
Q

Other name for the renal corpuscle

A

Malfegian corpuscle

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34
Q

Components of the renal tubular system

A

Proximal convoluted tubule
Loop of Henle
Distal tubule
Collecting duct

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35
Q

Renal corpuscle: First filtration-charge barrier; 50x more permeable than skeletal muscle capillaries; secrete nitric oxide and endothelin-1

A

Capillary endothelium

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36
Q

Renal corpuscle: Main charge barrier; with Type IV collagen, laminin, agrin, perlecan, fibronectin

A

Basement membrane

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37
Q

Renal corpuscle: cells of the capillary endothelium; contains foot processes, filtration slits

A

Podocytes

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38
Q

Modified smoth muscle intimately attached to the glomerular capillaries; contractile, mediates filtration, take up immune complexes and involved in glomerular diseases

A

Mesangial cells

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39
Q

Glomerular cells of the afferent arterioles; found at the walls of the afferent arterioles; secrete renin

A

Juxtaglomerular cells

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40
Q

Found in the walls of the distal convoluted tubules; monitor Na+ concentration in the distal tubule (consequently, blood pressure)

A

Macula Densa

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41
Q

Workhorse of the nephron, most prone to ischemia and acute tubular necrosis

A

Proximal convoluted tubule

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42
Q

Site of 66% Na, K, H2O reabsorption and 100% Glucose, amino acid reabsorption

A

Proximal convoluted tubule

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43
Q

Part of the loop of Henle which is permeable to H2O but impermeable to solutes

A

Descending limb

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44
Q

Part of the loop of Henle which is permeable to solutes but impermeable to H2O

A

Thin ascending limb

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45
Q

Part of the loop of Henle which contains the Na-K-2Cl pump

A

Thick ascending limb

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46
Q

Diluting segment of the renal tubular system

A

Thick ascending limb of the loop of Henle

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47
Q

What is inhibited by loop diuretics?

A

Na-K-2Cl pump found at the TAL

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48
Q

Contains the Macula Densa

A

Early distal tubule

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49
Q

Contains the principal cells and intercalated cells

A

Late distal tubule

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50
Q

Cells responsible for Na reabsorption and K secretion

A

Principal cells

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51
Q

Cells responsible for H+ secretion and K absorption

A

Intercalated cells

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52
Q

What stimulates the principal and intercalated cells?

A

Aldosterone

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53
Q

What is the action of ADH at the collecting duct?

A

Insert aquaporins to increase water reabsorption (decrease urine volume, increase urine concentration)

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54
Q

Movement from glomerular capillaries to Bowman’s space

A

Glomerular filtration

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55
Q

Movement from tubules to interstitium to peritubular capillaries

A

Tubular reabsorption

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56
Q

Movement from peritubular capillaries to interstitium to tubules

A

Tubular secretion

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57
Q

Formula for excretion

A

Excretion = (amount filtered + secreted) - amount reabsorbed

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58
Q

Substances which are 100% filtered

A

Inulin, creatinine

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59
Q

Substances which undergo filtration and complete reabsorption

A

Glucose, amino acids

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60
Q

Substances which undergo filtration and partial reabsorption

A

Many electrolytes

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61
Q

Substances which undergo filtration and secretion but never reabsorbed

A

Paraaminohippuric acid (PAH), organic acids and bases

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62
Q

Substance which has the highest clearance

A

PAH

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63
Q

Substances which have zero clearance

A

Glucose, amino acids

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64
Q

Substances which can be used to estimate GFR

A

Inulin, creatinine

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65
Q

Amount filtered in the glomerular capillaries per unit time

A

GFR (Normal: 125mL/min or 180L/day)

Filtration fraction: GFR/RPF

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66
Q

What is the size of subtances which can be filtered freely?

A

20 angstrom or less

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67
Q

What is the size of substances which cannot be filtered at all?

A

> 42 angstrom

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68
Q

What is the filterability of solutes according to size?

A

Water, Na, Glucose, Inulin > Myoglobin > Albumin

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69
Q

What is the filterability of solutes according to charge?

A

Positive substances > neutral > negative

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70
Q

What is the normal net filtration?

A

2mL/min

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71
Q

Effect on GFR:

Afferent arteriole dilate

A

Increase

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72
Q

Effect on GFR:

Afferent arteriole constrict

A

Decrease

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73
Q

Effect on GFR:

Efferent arteriole dilate

A

Decrease

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74
Q

Effect on GFR:

Efferent arteriole constrict moderately

A

Increase

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75
Q

Efferent arteriole contrict severely

A

Decrease

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76
Q

What are the reasons for the decrease in GFR in a severely contricted efferent arteriole?

A
  1. Gibbs Donnan effect
    (albumin which is a negative charged solute will attract positively charged Na ions, attracting H2O inside the capillaries)
  2. Albumin, because of its size cannot pass through, will be trapped inside the capillary, and will increase the capillary oncotic pressure
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77
Q

Effect on GFR:

GC hydrostatic pressure increased

A

Increase

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78
Q

Effect on GFR:

GC oncotic pressure increased

A

Decrease

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79
Q

Effect on GFR:

BS hydrostatic pressure increased

A

Decrease

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80
Q

Effect on GFR:

Kf increased

A

Increase (Kf refers to capillary permeability)

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81
Q

Number one cause of increase in Bowman’s space hydrostatic pressure

A

Urinary tract obstruction secondary to renal stone

82
Q

What are the causes of decreased Kf?

A

Renal diseases, DM, HTN

83
Q

What is the mechanism for decreased GC hydrostatic pressure in hypotension?

A

Decreased arterial pressure

84
Q

What is the mechanism for decreased GC hydrostatic pressure of ACEI?

A

Decreased efferent arteriole constriction

85
Q

What is the mechanism for decreased GC hydrostatic pressure in sympathetic stimulation?

A

Increased afferent arteriole constriction

86
Q

What are the hormones that will increase GFR?

A

EDRF, PGE2, PGI2, Bradykinin, glucocorticoids, ANP, BNP

87
Q

Which hormone will preserve GFR?

A

Angiotensin II (preferentially constricts efferent arteriole)

88
Q

Local autoregulation of renal blood flow occurs at a BP of:

A

between 75 - 160 mmHg

89
Q

What do you call massive sympathetic stimulation that results in massive vasoconstriction of the kidneys?

A

CNS ischemic response

90
Q

The CNS ischemic response is activated at what BP? optimal at what BP?

A

Activated at BP

91
Q

This maintains the GFR at a constant 125 mL/min

A

Tubuloglomerular feedback/ Macula Densa feedback

92
Q

What substance that is part of the TGF that vasoconstricts the afferent arteriole?

A

Adenosine

93
Q

What substance that is part of the TGF that vasodilates the afferent arteriole?

A

Nitric oxide

94
Q

What substances are secreted by the macula densa in response to low blood pressure (low GFR)?

A 
Angiotensin II (vasoconstricts efferent arteriole)
Nitric oxide (vasodilates afferent arteriole)
95
Q

What substance is secreted by the macula densa in response to high blood pressure (high GFR)?

A

Adenosine (vasoconstricts afferent arteriole)

96
Q

Percentage of solute reabsorbed is held constant. Buffers effect of drastic GFR changes on urine output

A

Glomerulotubular balance

97
Q

State when substance start to appear in the urine; some nephrons exhibit saturation

A

Renal threshold

98
Q

State when all excess substance appear in the urine; all nephrons exhibit saturation

A

Renal transport maximum

99
Q

What is the renal threshold for glucose?

A

200 mg/dL

100
Q

What is the transport maximum for glucose?

A

375 mg/dL

101
Q

Rate of transport is dependent upon electrochemical gradient, membrane permeability and time; does not have a transport maximum and threshold

A

Gradient-time transport (all passively transported solutes; ex: Cl, Urea)

102
Q

Which is more hypertonic relative to the other, fluid entering the PCT or fluid leaving the PCT?

A

None. There is isoosmotic reabsorption.

103
Q

What is the epithelium of the PCT?

A

Low columnar with extensive brush border

104
Q

What is the epithelium of the loop of Henle?

A

Thin segments: simple squamous with no brush border

Thick segments: simple cuboidal

105
Q

The thin segments of the loop of Henle is responsible for what?

A

slow flow of fluid in the loop of Henle

106
Q 
In the loop of Henle:
\_\_% of filtered H2O is reabsorbed
\_\_% of filtered Na,K,Cl is reabsorbed
Mg2+ and Ca2+ also reabsorbed
Hydrogen is secreted via \_\_\_\_
A

20%, 25%, Na-H countertransport

107
Q

What is the epithelium of the distal tubule?

A

Simple cuboidal without brush border

108
Q

3 components of the juxtaglomerular apparatus

A

Macula densa, juxtaglomerular cells, lacis cells

109
Q

Mechanisms used by intercalated cells for secretion of H+

A

H+-ATPase pump, Na-H+ countertransport

110
Q

The distal tubule reabsorbs ___% of filtered H2O, and is impermeable to ____.

A

5%, urea

111
Q

Site for regulation of final urine volume and concentration

A

Collecting duct

112
Q

What happens to tubular reabsorption when peritubular capillary hydrostatic pressure increases?

A

Decreases

113
Q

What happens to tubular secretion when peritubular capillary hydrostatic pressure increases?

A

Increases

114
Q

What happens to tubular reabsorption when peritubular capillary oncotic pressure increases?

A

Increases

115
Q

What happens to tubular secretion when peritubular capillary oncotic pressure increases?

A

Decreases

116
Q

Aldosterone acts on the distal tubule to:

A

Increase Na and H2O reabsorption; Increase K+ and H+ secretion

117
Q

Angiotensin II acts on the PCT, TAL LH, distal tubule to:

A

Increase Na and H2O reabsorption

118
Q

Catecholamines act on the PCT, TAL LH, distal tubule and collecting duct to:

A

Increase Na and H2O reabsorption

119
Q

Vasopressin acts on the distal tubule and collecting duct to:

A

Increase H2O reabsorption

120
Q

ANP and BNP act on the distal tubule and collecting duct to:

A

Decrease Na reabsorption

121
Q

Uroguanylin and guanylin act on the PCT and collecting duct to:

A

Decrease Na and H2O reabsorption

122
Q

Dopamine acts on the PCT to:

A

Decrease Na and H2O reabsorption

123
Q

PTH acts on the PCT and TAL LH to:

A

Increase Ca2+ reabsorption, stimulate 1 alpha hydroxylase, decrease PO4 reabsorption

124
Q

What are the triggers for ADH secretion?

A

Increased plasma osmolarity, decreased blood pressure, decreased blood volume

125
Q

What is the number one trigger for ADH secretion?

A

Increased plasma osmolarity (Normal: 300 mOsm/L)

126
Q

What is the effect of alcohol on ADH secretion?

A

Decreases ADH secretion

127
Q

Which hormone secreted by DT and CD acts similar to ANP?

A

Urodilatin

128
Q

Rate at which substances are removed from blood in the kidneys

A

Renal clearance

129
Q

Urine clearance is directly proportional to ______ and _____ and inversely proportional to _____.

A

direct: urine concentration of substance x and urine flow rate per minute
indirect: plasma concentration of substance x

130
Q

If a substance has high clearance, what are the blood and urine level of this substance?

A

Urine: high
Blood: low

131
Q

If a substance has low clearance, what are the blood and urine level of this substance?

A

Urine: low
Blood: high

132
Q

Renal clearance:

Substance with highest clearance

A

PAH

133
Q

Renal clearance:

Substance with zero clearance

A

Glucose, amino acids

134
Q

Renal clearance:

Substance whose clearance is used to estimate GFR

A

Inulin, creatinine

135
Q

Renal clearance:

Substance whose clerance is used to estimate renal blood flow and renal plasma flow

A

PAH

136
Q

Substances that do not appear in the urine have a clearance of:

A

zero

137
Q

Substances filtered and partially reabsorbed have a clearance ____ than the GFR

A

less

138
Q

Substance filtered and with net secretion have a clearance ____ than the GFR

A

more

139
Q

Clearance of inulin is ____ to that of the GFR

A

equal

140
Q

How many percent of filtered water is reabsorbed?

A

87 - 98.7%

141
Q

What is responsible for the regulation of glucose?

A

Na+-Glucose cotransport in the proximal tubule

142
Q

Glucose transport from the lumen to the PCT?

A

SGLT-2 (secondary active transport)

143
Q

Glucose transport from the PCT to the peritubular capillaries?

A

GLUT-1 and GLUT-2 (facilitated diffusion)

144
Q

Sodium is actively tranported in all parts of the renal tubules except:

A

descending limb of the loop of Henle

145
Q 
Sodium reabsorption:
\_\_\_% in the PCT
\_\_\_% in the TAL LH
\_\_\_% in the DCT
\_\_\_% in the Descending limb
\_\_\_% Excreted
A

67% in the PCT
25% in the TAL LH
5% in the DCT
3% in the Descending limb

146
Q

Mechanism of ANP in decreased Na and H2O reabsorption

A

Constriction of efferent arterioles –> increase GFR

147
Q

What is the normal plasma K+?

A

4.2 mEq/L

148
Q

Potassium shift into the cell vs out of the cell:

Hyperinsulinemia

A

Into the cell

149
Q

Potassium shift into the cell vs out of the cell:

Hyperaldosteronism

A

Into the cell

150
Q

Potassium shift into the cell vs out of the cell:

Alkalosis

A

Into the cell

151
Q

Potassium shift into the cell vs out of the cell:

Low K+ diet

A

Out of the cell

152
Q

Potassium shift into the cell vs out of the cell:

High K+ diet

A

Into the cell

153
Q

Potassium shift into the cell vs out of the cell:

Acidosis

A

Out of the cell

154
Q

Potassium shift into the cell vs out of the cell:

B-adrenergic stimulation

A

Into the cell

155
Q

Potassium shift into the cell vs out of the cell:

Cell lysis, strenuous exercise, increase ECF osmolarity

A

Out of the cell

156
Q

Potassium shift into the cell vs out of the cell:

Potassium-sparing diuretics

A

Out of the cell

157
Q

Potassium shift into the cell vs out of the cell:

Thiazide, loop diuretics

A

Into the cell

158
Q

Normal plasma Calcium

A

2.4 mEq/L

159
Q

Calcium reabsorption in the kidneys is controlled by:

A

Vitamin D and PTH

160
Q

Acidosis causes ___; Alkalosis causes ____

A

Acidosis: hypercalcemia; Alkalosis: hypocalcemia

161
Q

Increased or decreased Calcium excretion:

Increased PTH

A

Decreased

162
Q

Increased or decreased Calcium excretion:

Increased exctracellular fluid volume

A

Increased

163
Q

Increased or decreased Calcium excretion:

Decreased blood pressure

A

Decreased

164
Q

Increased or decreased Calcium excretion:

Decreased plasma phosphate

A

Increased

165
Q

Increased or decreased Calcium excretion:

Metabolic alkalosis

A

Increased

166
Q

What is the transport maximum of phosphate?

A

0.1 mM/min

167
Q

What is the normal plasma magnesium

A

1.8 mEq/L

168
Q 
Mg reabsorption:
\_\_\_% TAL LH
\_\_\_% PCT
\_\_\_% excreted
\_\_\_% stored in bones
A

65% TAL LH
25% PCT
10% excreted
50% stored in bones

169
Q

This hormone’s effect on the collecting duct dictates final urine output and urine concentration

A

ADH level

170
Q

If ADH levels are high, what happens to water reabsorption at the collecting duct, urine volume and urine concentration?

A

Water reabsorption: High (more aquaporins inserted)
Urine volume: Low (Min: 500mL/day)
Urine concentration: High (Max: 1200 mOsm/L)

171
Q

If ADH levels are low, what happens to water reabsorption at the collecting duct, urine volume and urine concentration?

A

Water reabsorption: Low (less aquaporins inserted)
Urine volume: High (Max: 20L/day)
Urine concentration: Low (Min: 50mOsm/L)

172
Q

What provides the stimulus for water reabsorption?

A

Countercurrent mechanism

173
Q

What provides the opportunity for water reabsorption?

A

ADH

174
Q

What creates the corticopapillary osmotic gradient?

A

Countercurrent multipliers: Loop of Henle

175
Q

What maintains the corticopapillary osmotic gradient?

A

Countercurrent exchangers: Vasa recta

176
Q

Whys is the loop of Henle able to act as a countercurrent multiplier?

A
  1. Countercurrent flow (hairpin-loop shape)
  2. Difference in permeability to H2O and electrolytes in the ascending and descending wall
  3. Na-K-2Cl pump in the TAL LH
  4. Slow flow in the LH
177
Q

What is the end-result due to the countercurrent mechanism?

A

Corticopapillary osmotic gradient: 300 mOsm as you enter the PCT, 1200 mOsm at the tip of the LH

178
Q

Why do you need a countercurrent exchanger?

A

Gradient would dissipate quickly if Na+ and urea+ are removed quickly

179
Q

How does the vasa recta preserve the osmotic gradient?

A

Na and urea moves around in circles

180
Q

This contributes up to 50% of renal medullary osmolarity; determines osmolarity at the tip of LH (from 600 - 1200 mOsm)

A

Urea recycling

181
Q

Where is the thirst center found?

A

Anterolateral wall of 3rd ventricle and preoptic nuclei

182
Q

How long does it take for absorption and distribution in the body to take place upon stimulation of the thirst center?

A

30 - 60 minutes

183
Q

Where is the micturition center found?

A

Pons

184
Q

Micturition can be inhibited by the:

A

cerebral cortex

185
Q

What is the pH of Gastric HCl

A

0.8

186
Q

What is the formula for plasma anion gap?

A

Plasma anion gap = [Na+] - ([HCO3-] + [Cl-])

187
Q

Metabolic acidosis caused by increase in organic anions

A

HAGMA

188
Q

Metabolic acidosis caused by increase in chloride

A

NAGMA

189
Q

HAGMA or NAGMA?

DKA

A

HAGMA

190
Q

HAGMA or NAGMA?

Diarrhea

A

NAGMA

191
Q

HAGMA or NAGMA?

Acetazolamide

A

NAGMA

192
Q

HAGMA or NAGMA?

Uremia

A

HAGMA

193
Q

HAGMA or NAGMA?

Methanol

A

HAGMA

194
Q

HAGMA or NAGMA?

Ureteroenteric fistula

A

NAGMA

195
Q

HAGMA or NAGMA?

Lactic Acidosis

A

HAGMA

196
Q

HAGMA or NAGMA?

Ethanol

A

HAGMA

197
Q

HAGMA or NAGMA?

Salicylic acid

A

HAGMA

198
Q

HAGMA or NAGMA?

Pancreaticoduodenal fistula

A

NAGMA

199
Q

HAGMA or NAGMA?

Renal tubular acidosis

A

NAGMA

200
Q

HAGMA or NAGMA?

Isoniazid

A

HAGMA

201
Q

HAGMA or NAGMA?

Propylene glycol

A

HAGMA

Physiology (13 decks)

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