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42 Cards in this Set

  • Front
  • Back
what is the course that ureters go?
ureters pass UNDER uterine artery and ductus deferens (retroperitoneal)

what is the rule of fluid compartments?

60% total body water

40% ICF

20% ECF
what is the ECF made out of?
ECF is made out of plasma volume + interstitial volume

plasma volume - 1/4

interstitial volume - 3/4
how do you measure ECF
how do you measure plasma volume
radiolabeled albumin
1) how do you calculate renal clearance?

2) how do you know if there is net reabsorption or secretion of x?
1)Cx = ([U]x * urine flow rate) / [P]x

2) Cx > GFR = net secretion

Cx < GFR = net absorption
1) what makes up the glomerular filtration barrier?

2) what is the purpose of the glomerular filtration barrier?
1) fenestrated capillary endothelium (size barrier)
fused basement membrane + heparan sulfate (negative charge barrier)
epith layer of podocyte

2) purpose: size/charge plasma filtration
what happens in nephrotic syndrome and what symptoms do you see?
loss of heparan sulfate

albuminuria, hypoproteinemia,
generalized edema, hyperlipidemia
what do you use to measure effective renal plasma flow (ERPF)?
para amino hippuric acid (PAH)

filtered/actively secreted in prox tubule
how do you det filtration fraction (FF)?
1) what dilates afferent arteriole?

2) how does this change Filtration Fraction (FF)?

3) what inhibits this?
1) prostaglandin

2) FF constant b/c both RPF and GFR increase together

1) what constricts efferent arteriole?

2) how does this change Filtration fraction (FF)?

3) what inhibits this?
1) angiotensin II

2) FF increases b/c decreases RPF and increases GFR

3) ACE inhibitor
what changes in renal fxn occur?

1) constrict afferent arteriole

2) constrict efferent arteriole

3) ↑ plasma protein []

4) ↓ plasma protein []

5) constricted ureter
1)↓GFR / ↓RPF = normal FF

2)↑GFR / ↓RPF = ↑FF

3) ↓GFR / normal RPF = ↓FF

4) ↑GFR / RPF = ↑FF

5) ↓GFR / RPF = ↓FF
calculate free water clearance
C H20 = urine flow rate - [( Uosm * urine flow rate) / Posm]
where is glucose reabsorbed?
proximal tubule
what is the threshold for glucosuria?
200 mg/dL
when is the glucose transport mechanism saturated?

what signs/symptoms do you see?
350 mg/dL

s/s - restless and increased irritability
where / how is amino acid clearance acheived?
competitive inhibition reabsorption by 3 carrier systems

secondary active transport occurs in proximal tubule and is saturable
what happens in the early proximal convoluted tubule?
"workhorse" ab gh na

reabsorbs - glucose, aa, bicarb, Na, H20

secretes - ammonia
what happens in the early distal convoluted tubule?
actively reabsorbs Na, Cl

Ca under control of PTH
what happens in the thin descending loop of Henle?
passive reabsorption of H20 via medullary hypertonicity

impermeable to Na
what happens in the thick ascending loop of henle?
active reabsorption of Na, K, Cl

indirect reabsorption of Mg, Ca

impermeable to H20
what happens in the collecting tubules?
aldosterone - reabsorbs Na, secretes K+ and H+

ADH - regulates reabsorption of H20
Mechanism for Renin-Angiotensin-Aldosterone system
decreased bp stim kidney to release renin

renin cleaves angiotensinogen to angiotensin I

ACE cleaves ATI (decapeptide) to AT II (octapeptide)

AT II vasoconstricts, aldosterone released from adrenal cortex

ADH released from posterior pituitary, stimulates hypothal to increase thirst

% increases intravascular volume and bp
what does the atria release to check the RAA system in heart failure?
atrial naturetic peptide
what does AT II do overall?
↑ intravascular volume and bp
1) what is JGA made up of?

2) what does JGA do?
1) JG cells (modified sm of afferent arteriole) + macula densa (Na sensor, DCT)

2) maintain GFR by secreting renin in response to
↓renal bp,
↓Na delivery to distal tubule,
↑ sympathetic tone
endocrine fxns of kidney during

1) hypoxia

2) Vit D conversion

3) ↓renal arterial pressure, ↑renal sympathetic discharge (beta 1 effect)

4) the process of increasing GFR
1) hypoxia - endothelial cells of peritubular capillaries secrete EPO

2) PTH activates 1 alpha hydroxylase to convert 25-OH vit D -> 1,25(OH)2 vit D

3) JG secrete renin

4) secretes prostaglandins to vasodilate afferent arterioles to ↑GFR
what causes acute renal failure in high vasoconstrictive states by inhibiting the renal production of prostaglandins?
when is aldosterone secreted?
↓blood volume

↑ plasma K
what does aldosterone cause
↑Na reabsorption

↑K secretion

↑H secretion
what does ATII cause?
efferent arteriole constriction


↑ Na, HCO3 reabsorption
what does vasopressin/ADH cause
↑plasma osmolarity

↓blood volume

binds to receptors on principal cells, causing ↑# of water channels and ↑H2O reabsorption
when is renin released
when blood volume ↓
what does atrial naturetic factor cause

↑Na excretion

*in response to ↑ atrial pressure)
what does PTH cause?
↑Ca reabsorption (DCT)

↓PO4 reabsorption (PCT)

1,25(OH)3 vit D production to ↑Ca and PO4 reabsorption

*in response to ↓plasma [Ca]
what is the compensatory response for

1) metabolic acidosis

2) metabolic alkalosis

3) respiratory acidosis

4) respiratory alkalosis
1) hyperventilation

2) hypoventilation

3) reabsorb HCO3 in kidney

4) secrete HCO3 in kidney
what causes respiratory acidosis

airway obstruction
acute lung disease
chronic lung disease
opioids, narcotics, sedatives
weakening of respiratory muscles
what causes metabolic acidosis with ↑ anion gap?

Diabetic ketoacidosis
Iron tablets/INH
Lactic acidosis
Ethylene glycol
what causes metabolic acidosis with normal anion gap?
glue sniffing
renal tubular acidosis (type I/II)
what causes respiratory alkalosis
pulmonary embolism


early aspirin ingestion
what causes metabolic alkalosis with compensation




NG suction


11-OH def

mineralocorticoid excess