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176 Cards in this Set

  • Front
  • Back
5 kidney functions
1. Waste removal via urine
2. LTR of arterial pressure
3. Reg of acid-base balance
4. LTR of RBC production
5. Reg of minerals
1. Kidneys remove _______ products in urine.
waste
2. Kidneys perform long term regulation of _______ pressure.
arterial
3. Kidneys regulate the ___________ balance.
acid-base
4. Kidneys perform long term regulation of _______ production.
Red Blood Cell
5. Kidneys regulate __________.
minerals
Name all the parts of kidney anatomy you can think of (at least 10):
kidney, ureter, bladder, urethra, renal A/V/N, ureter, Minor calyx, Major calyx, Nephron, Papilla, renal cortex, renal medulla, renal pelvis, renal pyramid, capsule
what kind of bilirubin in urine? in feces?
conjugated in urine, unconjugated in feces
What can be used as a unit to compare one person's urine to another person's urine?
creatine levels
all things not absorbed (filtered) by kidneys are called
metabolic waste products and foreign chemicals
name at least 5 things excreted by kidneys
urea, uric acid, creatinine, bilirubin, pesticides, food additives, toxins, drugs
made in liver only

*from PROTEIN metabolism
urea
gout

*from Nucleic Acid metabolism
uric acid
from muscle metabolism
creatinine
from HEMOglobin metabolism (RBC)
bilirubin
Basic mechanisms of Urine formation
1. FILTRATION
2. RE-ABSORPTION
3. SECRETION
4. EXCRETION
Where does FILTRATION take place?
Bowman's capsule (filtrate from afferent)
Where does REABSORBED material go?
into peritubular capillaries
What kind of things get SECRETED?
H+ ions, drugs, toxins
Final stage of basic mechanisms of urine formation?
EXCRETION
2 arterioles attached to Glomerulus
Afferent (in) arteriole
&
Efferent (out) arteriole
Glomerular capillaries go to the
Bowman's space and capsule
Efferent arteriole goes to the
efferent arteriole filter
Bowman's capsule surrounding glomerulus goes to
Nephron : where filtration, reabsorption, secretion and excretion all happen
efferent arteriole filter goes to
Peritubular capillaries

then to Vasa Recta,

then to the Renal vein
the back-up plan as well as the gate for reabsorption mechanism of urine formation
peritubular capillaries
All the glomeruli are in the
Cortex!

**because that's where the afferent and efferent arterioles are
Vein portion right after Peritubular capillaries
VASA RECTA
Every afferent arteriole is in the
Cortex!
Some nephrons drop Loops of Henle into the ___________, so the longer the nephron, the more is ________.
medulla

absorbed
Functional unit of the kidney
Nephron
camels and desert rats have crazy long ___________
nephrons (so more will be reabsorbed)
blood supply of nephron
interlobar artery and veins
*going to corticolobar and juxtamedullary nephrons
brings blood to the glomerulus
AFFERENT arteriole -
large size, unfiltered blood
blood leaving glomerulus travels through the
Efferent arteriole -
provides back pressure
How do you tell the difference between the afferent and efferent arterioles physically?
Afferent is very large, muscular due to high volume of unfiltered blood

efferent is opposite
What percentage of water is reabsorbed of the 100L that goes through the Bowman's space?
99%
Step 1: Glomerular filtration takes place where?
Glomerulus and Bowman's Capsule
Step 1: Glomerular filtration is based on __________ of molecule.
size of molecule (not type)
surrounds glomerulus
Bowman's CAPSULE
space around glomerulus
Bowman's space (it's in the description)
Percentage of renal plasma flow averaged by glomerular filtration
20% of all of your blood is in your kidney right now
the glomerulus is made of capillaries with specialized epithelium - describe?
Fenestrations (pores)
Podocytes (reinforcement)
Basement membrane (leak prevent)
What holds podocytes (reinforcement around glomerulus epithelium) together?
glucosamine
(makes sticky ie hyaluronic acid in urine)
Podocytes have nuclei & finger-like projections that cover the fenestrated epithelium of the glomerulus. What are these openings called?
Slit pores
another term for the epithelial cells of the glomerulus
podocytes
restriction site for proteins on glomerulus
basement membrane
The pressure gradient of glomerulus uses _______- flow equation.
capillary flow equation
How can I increase hydrostatic pressure in glomerulus?
make Afferent WIDE or Efferent TINY
How can I decrease hydrostatic pressure in the glomerulus?
to decrease hydrostatic pressure, make Afferent narrow and Efferent large
Net Filtration pressure of +10 is got by subtracting what 3 things?
glomerular Hydrostatic p.
Bowman's capsule p.
glomerular oncotic/Colloidal osmotic p.
GFR
Glomerular Filtration Rate :

125 ml/min = 180 liters/day
Plama volume is filtered ___x a day.
60
Glom filtrate and plasma filtrate are about same composition, except what?
large proteins should never be in filtrate
You have 90 mg/decaliter glucose in plasma. How much is in your filtrate?
90 (same - because it has the same composition of every thing that is small)
Why does Bowman's capsule have NO interstitial colloidal osmotic/oncotic pressure?
because it has NO proteins to attract water - better not be!!!
Blood plasma (125 mg/decL NaCl) =
Filtrate (125 mg/decL NaCl)
Step 1 was Glomerular FILTRATION.
What is step 2?
Tubular RE-ABSORPTION
Location of step 2/tubular RE-ABSORPTION
Proximal Convoluted Tubule of nephron
How much does the PCT of nephron reabsorb?
65% of water
- 100% of glucose and aminos

Electrolytes Na+, K+, and Cl-
Where is 65% of the 99% of REabsorption taking place?
Proximal Convoluted Tubule!
In the PCT, there are 2 paths of REabsorption via the microvilli:
1. Paracellular path (between/next to)

2. Transcellular path (through)
How does water go through PCT lumen to Peritubular capillary?
OSMOSIS - can go paracellularly or transcellularly
How do solutes go through PCT lumen to peritubular capillary?
Active (ATP)
or
Passive (diffusion)
- can go paracellularly or
transcellularly
How do very small solutes go from the PCT lumen through tubular cells to the peritubular capillary/blood?
PASSIVE DIFFUSION for small molecules and ions in PCT
can only be reabsorbed in the PCT
K+
can go in on lumenal surface of PCT passively, but can only be pumped out by Na/K-ATPase pump actively to peritubular capillary/blood?
Na+
(goes in passive diffusion, needs pumping out active)
Na+ comes into the PCT lumenal surface via passive diffusion. Why?
Because filtrate that it is in has a Total Osmotic Pressure = to the Capillary Osmotic Pressure.
Na+ comes into PCT from filtrate via passive diffusion due to equal osmotic pressures inside and outside of the capillary? Why, then, does it require the Na/K-ATPase pump to get it out?
Because that would be against the concentration gradient since the pressures are the same and passive diffusion was pulling it in just fine. It wants to stay but needs to be asked to leave.
bulk flow
water + solutes
some K+ is going both ways
results in the reabsorption of sodium and urinary excretion of potassium
active transport of sodium via the Na/K-ATPase pump to move Na+ against conc. gradient back into the Peritubular capillary/blood/body
How is Na+ RE-absorbed back into the body so it isn't excreted with filtrate?
Na/H+ ANTIPORTER protein in lumenal surface of PCT excretes H+ and absorbs/collects Na+
Glucose has a TRANSPORT MAXIMUM, whether it's facilitated diffusion or secondary active transport. What is this Transport Maximum?
max rate of tubular transport due to SATURATION of carriers, limited ATP, etc.
How do both glucose & amino acids travel through the tubular epithelial cells of the PCT (interstitial fluid)?
CO-TRANSPORT: attached to Na+

1. Na+ assisted Facilitated Diffusion
2. Na/K-ATPase pump as Secondary Active Transport
NORMAL glucose transport maximum
80-120 mg/min (on T.M.curve)
Excretion (the amt of glucose in urine) is found by ?
EX glucose = Filtered load - Transport Maximum
the tubular load at which transport maximum is EXCEEDED in some nephrons
Threshold
Is threshold the same as the transport maximum in all parts of the kidney?
no, some nephrons have lower transport max's than others
GFR: 150 ml/min
FL: 300 mg/ml
What is EX rate of glucose?
EX glucose= Filtered Load - Trans Max
300mg/100ml x 150ml/min =
450 ml/min so...
450 mg/min - 300 mg/min =
150 mg/min so abnormal (80-120)
What goes into the PCT (5)
water
Na+
Cl-
bicarbonate
K+
What goes out of the PCT (You 3 out!)
H+
organic acids
organic bases
Why is pH lower in PCT?
Na/H+ antiporter in PCT
Plasma Colloidal Osmotic pressure is always
32
Why is hydrostatic pressure of PCT lower?
because of so much water left in glomerulus
When figuring the Peritubular Capillary REABSORPTION, add things going ___, and subtract things going ____.
add in (+) to interstitial fluid
subtract out (-) to peritubular cap
function of Loop of Henle
Concentration of Urine
How does Loop of Henle concentrate urine (mechanism)?
Counter-current concentration
Loop of Henle DESCENDING water permeable?
yes
water reabsorbed into the interstitium
Is the Ascending Loop of Henle permeable to water?
no
NaCl is reabsorbed here, increasing osmolarity of interstitium to suck water from descending loop (counter current or trade agreement!)
Water permeability in what parts of nephron?
Descending loop
(skip ass)
Collecting duct
...this is counter current concentration
Describe counter current concentration short version?
Loop of Henle:

Descending - Water
Ascending - Salt
collecting duct - Water
Total osmotic pressure in glomerulus
300
By the end of PCT, 65% of the total 99% has be reabsorbed, but osmotic pressure has?
remained the SAME on both sides so the cells don't shrink or swell
Osmolarity of Filtrate =
Osmolartity of Plasma
How do we concentrate the urine?
Counter current CONCENTRATION in the Loop of Henle

(Descending - Water, Ascending - Salt) collecting duct - Water
lowest osmolarity of Loop of Henle
Distal Convoluted Tubule

(because of NaCl being reabsorbed instead of water)
Where is osmolarity MOST (1200) concentrated in the Loop of Henle?
at bottom where descending meets ascending (1200)
What begins the final squeeze of water (last bit of 99%) in the collecting ducts?
urea passive diffuse into medulla so water will follow it
At top of collecting duct, what promotes water reabsorption?
ADH-dependent with aquaporins
adrenal medulla vs. renal medulla
adrenal: post ganglionic sympathetic 2nd order neuron
renal: loop of Henle & collecting duct + most interstitial osmotic pressure + most concentrated urine
which is more permeable to water:

the thin loop of Henle or the thick loop of Henle?
thin!
very permeable to water
thick loop of Henle
- Not water permeable
- kicks out H+
- absorbs Na, Cl, K, Ca, HCO3, Mg

(think thin, think water)
Tubular SECRETION site:
DCT
Substances that get quickly dumped (secreted) in the DCT?
H+
foreign substances (including drugs)
The Distal Convoluted Tubule is the site of the 99% of solutes are reabsorbed - how is permeability to water determined at this point?
HORMONES!

Aldosterone (reabsorbs Na + Water and secretes K)
Anti-diuretic hormone reabsorbs water
Tell me about Big Al Dosterone
Lives in Zona Glomerulosa of adrenal cortex. Reabsorbs Na + Water, kicks out Potassium bums.
Early DCT is not permeable to
water or urea
Late DCT is not permeable to ______ but permeability to water depends on __________.
not to urea but permeability of water depends on ADH
kind of cells that use big Al Dosterone
Principal cells (columnar epithelium) in LATE DCT to drive Na/K pump to pull water out into blood
The LATE DCT is completely dependent on ADH so it inserts ___________ and water will follow sodium out to the tissues.
aquaporin
What special cells are in the
LATE DCT?
a. Principal cells (Al Dosterone, aquaporins, ADH)

b. Intercalated cells (K + HCO3)
big Al Dosterone actions in late DCT
Up Na+ reabsorb - principal cells

Up K+ (bums)secretion - principal cells

Up H+ secretion - Intercalated cells
3 actions of Aldosterone
1. Increase Na reabsorption (principals)
2. Increase K secretion (principals)

3. Increase H & Bicarbonate secretion (intercalated)
How does ADH (antidiuretic hormone) get in the blood to start with?
responding to Na+ conc. in blood via the SUPRAOPTIC NUCLEI of the hypothalamus detects - talks to posterior pituitary that actually secretes the ADH
Where is Big Al?
distal tubule
Where is ADH?
collecting tubule
increases water permeability and reabsorption in the distal (Big Al) and collecting tubules (_____).
ADH
allows differential control, solute excretion via AQUAPORINS insertion into cell membrane of principal cells
ADH secreted by posterior pituitary -

*important controller of extracell. fluid osmolarity
Why does big Aldosterone show up?
there is not enough Na to attract water for re-absorption, so he pulls Na to attract water
Anti-diuresis
increases blood volume so increases blood pressure (ADH to increase water perm and re-sorb)
Water ONLY comes out in late DCT and Collecting tubule if?
ADH
No ADH, no
no permeable/no water reabsorbed
what's the only thing that goes back into the medullary collecting tubule? (fig 27-13 Guyton)
H+
If water is reabsorbed to a greater extent than the solute, the solute will become?
more concentrated in the tubule

*creatinine, inulin are NOT absorbed
If solutes are reabsorbed more than water, then the solutes become?
less concentrated in the tubule

***amino acids & glucose ARE absorbed
The appearance of glucose in the urine (above 125 mg/min) at threshold occurs before _____________ is reached.
Transport Maximum
Kind of transport of Na+ through tubular epithelium
ACTIVE
Long term blood pressure control by the kidney:
via renin-angiotensin system
Kidney uses ? to control renal blood flow?
Renin-Angiotensin system
How does the GFR and renal blood flow remain constant?
Blood pressures within physiological range:
Feedback mechanisms of Juxtaglomerular Complex &
Renal-Arteriole Resistance
Location of Macula Densa
DCT between afferent and efferent tubules
Structure of Juxtaglomerular apparatus
Macula Densa
&
Juxtaglomerular cells
Sensa-tive to NaCl
Macul-a Dens-a
The Mac-u-la Dens-A is very sens-A to
NaCl
controls long term blood pressure regulation
JUXTAglomerular Apparatus
sensitive to Renin
Juxtaglomerular cells
sensitive to NaCl concentration, Beta-receptor stimulation (epinephrine) and Drop in BP due to mechanical stretch
Macula Densa
JG cells are in the walls of the
afferent and efferent arterioles
JG complex stores and releases
RENIN (an enzyme)
cells in the distal tubule ADJACENT to the afferent and efferent arterioles
Macula Densa
sensa to NaCl, B-receptor stim and Drop in BP
Renin-Angiotensin-____________ Pathway
(RAAP)
Aldosterone
Step 1 RAAP:
Release of ________ due to _____ concentration
Renin

NaCl (low in macula densa)
RAAP step 1 is release of Renin due to LOW ______ in macula densa
NaCl

Renin dilates the afferent arterioles
Salt is low in Macula Densa, so _______ arterioles dilate to increase blood flow to the glomerulus. This increases G. hydrostatic pressure and increases GFR!
afferent

(NaCl down-afferent dilate-up hydrostatic p. in glomerulus-raises GFR!) Then...Renin is released
Renin is released in response to
low salt levels in macula densa. Afferent arteriole dilates, pressures rise in glomerulus and RENIN gets released
Low salt - dilate afferent arteriole - RENIN released in order to?
Angiotensin I is made and shot out of the liver when the liver detects renin
Angiotensin I from liver keeps afferent arterioles __________.
dilated
Angiotensin I from liver sparks ______ from lung. This causes what to constrict the efferent arterioles?
Angiotensin II
Angiotensin I =
constriction of afferent arterioles (Renin)
Angiotensin II =
constriction of EFFERENT arterioles (ACE)
2 functions of Angiotensin II (ACE)
1. constricts efferent
2. release Al Dosterone

**RESULT: increase GFR via pressure
which keeps afferent arteriole open
JG complex
which constricts efferent arteriole and causes GFR to rise?
Angiotensin II
Angiotensin II is constricting efferent while Angie I opens Afferent - where does Al Dosterone come in?
Angiotensin II signals Big Al to come from his neiqhborhood (zona glomerulosa) in adrenal cortex. He grabs Na and gets water to follow, meanwhile kicking out K bums in DCT
If there is high Na, high BP, what happens to the RAAP?
Off.
*don't need Big Al to come raise salt even higher so RAAP off.
Increase blood volume, increase blood pressure, increase ______
GFR
If Beta-receptors are stimulated in the afferent arteriole, the Macula Densa causes?
DILATION of afferent arteriole, increasing blood flow to glomerulus and increasing GFR
In response to HYPOtension
the macula densa causes dilation of afferent arteriole, increasing blood flow to glomerulus and increasing GFR
2 situations when Macula Densa DILATES afferent arteriole and results:
1. B-receptors stimulated
2. Hypotension (low bp)

Dilation of afferent a. increases blood flow to glomerulus, then increase GFR
How do the kidneys regulate the Acid-Base balance?
Excrete acids (kidneys are it!)

Regulate BODY BUFFERS (bicarb)
determines peritubular capillary fluid reabsorption
balance of hydrostatic and colloid osmotic forces in the peritubular capillaries
__________ efferent arteriole resistance reduces peritubular capillary hydrostatic pressure.
Increased, therefore increases fluid reabsorption
Mg+ reabsorption area of nephron
ASCENDING loop of Henle
water reabsorption area of nephron
PROXIMAL Convoluted Tubule
lungs combine _____+_____ to release bicarbonate buffer
CO2 + H20
kidneys combine ________+__________ to release bicarbonate
H+ and HCO3
How many bicarbonate ions are absorbed for each H+ released from the kidneys?
1:1 ratio of H to H2CO3
What is passively excreted along with the H+ in exchange for bicarbonate?
Cl- ion
Where does the bicarbonate to H+/Cl- and HCO3 exchange take place in the kidneys?
DCT & collecting duct
buffer system stimulated by an increase in extracellular H+,
GLUTAMINE metabolized
Ammonia Buffer System (GLUTAMINE)

yields 2 ammonia, 1 bicarbonate
buffer system that allows excess H+ to be excreted when bicarbonate buffer system is EXHAUSTED
Phosphate buffer system

regenerates bicarbonate ion when bicarbonate buffer sys is EXHAUSTED
How is RBC production regulated by the kidneys?
hormones!
________delivered to the kidney, ups Erythropoetin production, ups erythropoetin production in bone marrow
O2
the delivery of O2 to the kidneys has what effect?
Ups erthyropoetin then production f erythropoetin in bone marrow
How are minerals regulated in the kidney?
vitamin D
What does the kidney produce to regulate calcium and phosphate metabolism?
vitamin D
(1,25-dihydroxy vitamin D3)