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115 Cards in this Set

  • Front
  • Back
aldosterone
hormone synthesized and released by the adrenal cortex; causes the kidneys to reabsorb sodium
ADH - antidiuretic hormone
hormone secreted by the posterior pituitary gland; causes the kidneys to reabsorb more water; aka vasopressin
anuria
O < 50 mL / 24 hours
bacteriuria
bacterial count higher than 100,000 colonies/mL
creatinine
endogenous waste product of muscle energy metabolism
dysuria
painful or difficult urination
frequency
voiding more frequently than every 3hours
glomerulus
tuft of capillaries forming part of the nephron through which filtration occurs
GFR - glomerular filtration rate
volume of plasma filtered at the glomerulus into the kidney tubules each minute; normal rate is approximately 120mL/min
hematuria
RBC in the urine
micturition
urination or voiding
nephron
structural and functional unit of the kidney responsible for urine formation
nocturia
awakening at night to urinate
oliguria
O < 400 mL/24h
proteinuria
protein in the urine
pyuria
WBC in the urine
renal clearance
volume of plasma that the kidneys can clear of a specific solute (eg creatinine); expressed in mL/min
renal glycosuria
recurring or persistent excretion of glucose in the urine
specific gravity
reflects the weight of particles dissolved in the urine; expression of the degree of concentration of the urine
tubular reabsorption
movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta
tubular secretion
movement of a substance from the blood in the peritubular capillaries or vasa recta into the kidney tubule
urea nitrogen
nitrogenous end product of protein metabolism
urinary incontinence
involuntary loss of urine
The primary function of the renal and urinary systems is to...
maintain the body's state of homeostasis by carefully a. regulating fluid and electrolytes, b. removing wastes, and c. providing hormones that are involed in RBC production, bone metabolism, and hypertension.
Location of the kidneys
retroperitoneally on the posterior wall of the abndomen from the T12 to L3.
Which kidney is higher? Why?
the left kidney is higher. because the liver is on the right
How much of total CO do the kidneys receive each minute?
20-25%
How many times per hour does all of the body's blood circulate through the kidneys?
approximately 12 times per hour
When does renal replacement therapy need to be considered? When the total number of functioning nephrons is less than....?
when the total number of functioning nephrons is 20% less than normal
general info about the cortical nephrons...
-80-85% of nephrons
-located in the outermost part of the cortex
general info about the juxtamedullary nephrons
-15-20% of nephrons
-located deeper in the cortex
-have longer loops of Henle that are surrounded by long capillary loops (the vasa recta) that dip into the medulla of the kidney
the length of the tubular component of the nephron is directly r/t?
its ability to concentrate urine
2 basic components of nephrons
-the glomerulus (the capillary network)
-the attached tubule
each kidney has about how many nephrons?
about 1 million
2 forms of nephrons?
cortical and juxtamedullary
3 filtering layers of the glomerular membrane
1. the capillary endothelium
2. the baement membrane
3. the epithelium
what cells is the macula densa made of and what is it's location?
the distal tubular cels located in the area where the afferent and efferent arteriole respectively enter and leave the glomerulus.
composition of the juxtaglomerular apparatus
the macula densa plus the adjacent afferent arteriole
function of the juxtaglomerular apparatus
renin production
what is the site of the renin production?
the juxtaglomeruar apparatus JGA
the urothelium of the ureters prevent?
reabsorbtion of urine
capacity of the adult bladder
300-500 mL
the healthy human body is composed of approximately what % of water?
60%
3 step process of urine formation
1. glomerular filtration
2. tubular reabsorption
3. tubular secretion
what 2 things are normally filtered and then reabsorbed so that neither is excreted?
1. amino acids
2. glucose
when does renal glycosuria occur?
if the amout of glucose in the blood and glomerular filtrate exceedds the amount that the ubules are able to reabsorb
what is the most common clinical expression of a blood glucose level exceeding the kidney's reaborption capacity?
-diabetes
-also common in pregnancy
what are 2 examples of low-molecular-weigh proteins that are usually not found in the urine but may periodically be excreted in small amounts?
1. globulins
2. albumin
normal blood flow through the kidneys per minute
1200 mL/ min
normal percent of filtrate produced from blood passing through the glomeruli AND
how much a day does this amount to?
20%, amounting to 180 L/ day
how much of the filtrate is reabsorbed?
99%
how much of the filtrate is actually excreted as urine?
1%, or 1000-1500 mL
although reabsorption occurs along the entire tubule, where does is mostly occur
the proximal tubule
where does filtrate become concentrated?
in the distal tubule and collecting ducts, under hormonal influence
where is ADH secreted?
the posterior pituitary gland
ADH is secreted why?
in response to change in blood osmolality. ie if blood osmolality increases (more solutes in blood than in surrounding tissues)
as water intake increases, ADH secretion...
is suppressed
decreased ADH secretion leads to...
diuresis
increased ADH secretion leads to...
increased blood volume or HTN
what does a fixed specific gravity (about 1.010) or a fixed osmolality (about 300 mOsm/L) indicate?
-early sign of kidney disease
-indicates an inability to concentrate and dilute the urine
osmolaRity refers to...
the ratio of solute to water
osmolaLity refers to...
the number os osmoles dissoloved per kilogram of solution.
what is the normal osmolality of the filtrate in the glomerular capillary and the blood?
275-300 mOsm / kg
what is the normal intake and output of fluids?
intake of oral liquids - 1300 mL
intake through food - 1000 mL
output through skin and lungs (insensible loss) - 900 mL
output through sweat - 50 mL
output through feces - 200 mL
what is a reliable means of determining overall fluid status?
daily weight measurements
w regards to fluid status, a weight change of as little as 1 lb could suggest an overall fluid gain or loss of ....
500 mL
normally, the volume of electrolytes excreted per day is equal to....
the amount ingested
what is the most plentiful extracellular ion?
sodium
what is the only cation to exert significant osmotic pressure?
sodium
if more sodium is excreted than ingested, what results?
dehydration
if more sodium is ingested than secreted, what results?
fluid retention
what hormone regulated sodium volume excretion?
aldosterone
where is aldosterone synthesized and released?
the adrenal cortex
as aldosterone in the blood is increased, what happens to sodium
less sodium is excreted in the urine / aka the body hold on to more sodium
when is the RAA syste actived?
when pressure in the renal arterioles fall below normal levels, as occurs with
-shock
-dehydration
-or decreased sodium choride deliery to the tubules
activation of the RAA system increases...
water retention and expanision of the intravascular fluid volume, thereby maintaining enough pressure within the glomerulus to ensure adequate filtration
what is the most abundant intracellular ion?
potassium
what percent of daily ingested potassium (K) is excreted by the kidneys
90% of the total daily potassium intake
what factors influence potassium loss
-aldosterone release
-acid-base balance
-amount of dietary potassium intake
-flow rate of the filtrate in the distal tubule
aldosterone release does what pertaining to sodium and potassium
-increases blood Na level
-decreases blood K level
what is the most threatening effect of renal failure
retention of potassium
in what 2 ways do the kidneys help maintain acid-base balance?
1. reabsorption and return to the body's circulation any bicarbonate from the urinary filtrate
2. excretion of acid in the urine
to replace any lost bicarb not reabsorbed, new bicarbonate is generated by the
renal tubular cells
the body's acid production is the result of ...
catabolism of proteins, which produces acid compounds, in particular phosphoric and sulfuric acids, which cannot be eliminated by the lungs. so, they must be excreted in the urine
how does the kidney get rid of acid other than directly as free acid?
excess acids are bound to chemical uffers (phosphate ions and ammonia) so that they can be excreted in the urine
what are 2 important chemical buffers that bind to excess acid in the tubular filtrate?
-phosphate ions
-ammonia (NH3) ions
phosphate is present in the
glomerular filtrate
phosphate is produced by
the renal tubules and secretes into the tubular fluid
when ammonia is buffered with acid, it becomes
NH4, ammonium
through the buffering process, the kidney is able to ...
excrete large quantities of acid in a bound form, without further lowering the pH of the urine
what specialized cells in the kidney constantly monitor BP?
the vasa recta
What happens when the vasa recta detects a decrease in BP?
specialized juxtaglomeruluar cells near the afferent arteriole, distal tube, and efferent arteriole secrete RENIN
what is the most potent vasocontrictor?
antiotensin II
renin, and therefore angiotensin II, production, causes BP to...
increase
when the pituitary glands detects poor perfusion or increase serum osmolality, what happens
stimulation of the adrenal cortex to secrete aldosterone, leading to an increase in BP
when the vasa recta recognizes an increase in BP,
renin production stops
what is one of the primary causes of HTN
failure of the feedback system of the vasa recta
what is the primary test of renal clearance used to evaluate how well the kidney performs it's excretory function
a 24-hour collection of urine to wh
what can effect renal clearance?
-how quickly the substance is filtered across the glomerulus
-how much of the substance is secreted into the tubules
what renal clearance measure is particularly important?
creatinine clearance
what is creatinine
an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine
what is a good measure of GFR?
creatinine clearance
what is creatinine clearance a good measure of?
1. renal clearance
2. GFR
as renal function declines, what happens to creatinine clearance?
as renal function declines, creatinine clearance decreases
why would the kidneys excrete EPO?
when they sense a decrease in the oxygen tension in the renal blood flow
what is the effect of EPO release from the kidneys?
stimulation of the bone marrow to produce RBCs, therby increasin the amount of hemoglobin available to carry oxygen
what is the kidney responsible for r/t vitamin D?
the final conversion of inactive vitamin D to its active form, calciferol
vitamin D is necessary for
maintaining normal calcium balance in the body
what do the kidneys do r/t prostaglandins?
the kidney produce prostaglandin E and prostacyclin
what are the effects of the PGs produced by the kidneys
-vasodilation
-important in maintaining renal blood flow
what is the waste products of metabolism that must be excreted by the kidneys?
urea, creatinine, phoshates, sulfates, and uric acids
what is the major waste product of protein metabolism?
urea
how much urea must be excreted?
all of the urea produced daily, about 25-30 g
uric acid is a waste produce of
purine metabolism
what is the primary mechanism in the body of excreting drug metabolites?
the kidneys