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82 Cards in this Set
- Front
- Back
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8 functions of kidney
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1. excretion of metabolic wastes
2. excretion of exogenous products 3. regulation of h20 and electrolytes 4. acid base balance 5.arterial blood pressure 6. erythrocyte production 7. vitamin d activity 8. gluconeogenic capacity |
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How does kidneys regulate arterial blood pressure?
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regulation of Na balance and the renin-angiotensin-aldosterone system
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How does kidneys regulate erythrocyte production?
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decrease in o2 delivery = increase in renal erythropoietin synthesis =increase in erythrocyte synthesis
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how does kidneys regulate vitamin d activity?
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vit d (inert) --> 25-OH vit d (liver) --> 1,25 oh vit d (kidney
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T/F can kidneys make glucose
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T
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Main Consequences for impaired renal function
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1. metabolic acidosis pH<7.4
2. hyperkalemia K>4 meq/L (other -- uremia toxicity, na/h20 imbalance, Ca/K imbalance, plasma protein imbalance, anemia, depressed immune system) |
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What part of kidney can make glucose?
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renal proximal tubule
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8 functions of kidney
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1. excretion of metabolic wastes
2. excretion of exogenous products 3. regulation of h20 and electrolytes 4. acid base balance 5.arterial blood pressure 6. erythrocyte production 7. vitamin d activity 8. gluconeogenic capacity |
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What percentage of kidney function is required for body fluid homeostatis?
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20% of normal kidney function can still maintain body fluid homeostasis
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How does kidneys regulate arterial blood pressure?
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regulation of Na balance and the renin-angiotensin-aldosterone system
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pre-renal ARF
intra renal ARF post renal ARF |
1. decreae renal blood supply =decrease in GFR
2. acute tubular necrosis -ischemia. toxin induced -something wrogn with nephron 3. urinary tract obstruction All typically reversible |
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How does kidneys regulate erythrocyte production?
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decrease in o2 delivery = increase in renal erythropoietin synthesis =increase in erythrocyte synthesis
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how does kidneys regulate vitamin d activity?
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vit d (inert) --> 25-OH vit d (liver) --> 1,25 oh vit d (kidney
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Chronic renal failure (CFR)
define and causes |
irreversible and usually progressive renal injury
causes- diabetes mellitus and hypertension |
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T/F can kidneys make glucose
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T
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Main Consequences for impaired renal function
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1. metabolic acidosis pH<7.4
2. hyperkalemia K>4 meq/L (other -- uremia toxicity, na/h20 imbalance, Ca/K imbalance, plasma protein imbalance, anemia, depressed immune system) |
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What part of kidney can make glucose?
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renal proximal tubule
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What percentage of kidney function is required for body fluid homeostatis?
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20% of normal kidney function can still maintain body fluid homeostasis
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pre-renal ARF
intra renal ARF post renal ARF |
1. decreae renal blood supply =decrease in GFR
2. acute tubular necrosis -ischemia. toxin induced -something wrogn with nephron 3. urinary tract obstruction All typically reversible |
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Chronic renal failure (CFR)
define and causes |
irreversible and usually progressive renal injury
causes- diabetes mellitus and hypertension |
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What percentage is GFR in end stag erenal disease?
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less than 10
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hemodialysis -
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dialysis across an artifical membrane
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peritoneal dialysis-
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dialysis by diffusion through capillaries
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How often does someone with End stage renal disease have to have dialyisis?
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3-4 hrs per session -3x per week
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How often is fluid exchanged in perotoneal dialysis? what is another name for it? Pro and con
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2-3 L of fluid exchanged - 4-6 times per day.
name- chronic ambulatory peritoneal dialysis pro - your mobile con -increased chance of infection |
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Why is a patient with chronic renal failures body weight always fluxuating? - method with less flux
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b/c homeostasis can not be maintained with interval dialysis - body weight increases when needing to dialysis and decreases during dialysis
peritenial |
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Renal pyramid structure -
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base originates at corticomeduallary boarder apex terminates in a papolla
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How many nephrons in kidney?
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1 million
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name parts of nephron in order
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Glomerulus, proximal convluted tubule, loop of henle, distal tubule, collecting tube
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name of capillaries that surround nephron
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peritubular capillaries
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Percentage of plasma entering the glomerular capillaries that is filtered?
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20% -- the filtraction fraction
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If the plasma is filtered it leaves the __ and goes into the _
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leaves the glomerular capillaries and into bowmans space
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tubular secretion-
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movement of a substance from the peritubular capillaries into the luman of the nephron -- restricted to solutes that are big, charge or protein binding
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Can solutes move two ways in the glomerular filtration?
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no - only one way --into bowmans space
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T/F -Afferent hemocrit is the same as efferent
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F - Effererent higher becauase of hte loss of plasma
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Name 2 things that are avidly reabsorbed
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glucose and protein
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T/F Bowman's capsule is an extension of the proximal tubule?
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T
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Name the 3 layers of the glomerular capillaries.
Benefit? |
1. fenestrated endothelium -structure
2. basement membrane - collagen 3. epithelial podocytes- connected by slit membranes gives you selectibility |
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What is the charge on the basement membrane?
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net negative - can impede filtration
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What size can be filtered freely across the glomerular capillaries?
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<5000 Da
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What forces drive fluid into bowmans space? oppose/
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glomerular capillary hydrostatic pressure,
bowman's space hydrostatic pressure and glomerular capillary oncotic pressure |
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What is GFR in humans?
How many times in plasma filtered per day? |
180 L/day
60X |
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What is the primary determinate of GFR?
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glomerular capillary hydrostatic pressure --direct relationship
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What does sympathic nerves do to filtration?
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increase sympathetic and decrease filtration
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How is GFR primarily regulated? what mechanism is this achieved?
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by the afferent arteriolar - increase sympathetic->increases vasoconstriction -> decreases GFR
angiotensin - increase plasma levels -> increase vasoconstriction --> decrease GFR |
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How are most substances transported between nephron and peritubular capillaries?>
Where does secretion occur mostly? |
transcellulary and at the proximal tubular
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Name of the 2 membranes a substance would have to cross from luman.
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luminal membrane and basolateral membrane
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For Na reaborption in the cortical collecting tubule -what does it depend on?
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Na/K pump located ONLY on basolateral membrane - maintaines low intracellular Na conc.
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What fraction of filtrate is reabsorbed in the proximal tube?
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2/3 -- many solutes reabsorped completely
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How is secretion and reabsorption limted?
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most all require channels or carrier mediated -there is a max
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What is the clerence concept? equation
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the volume of plasma from which that substance is completely removed C= urine con X flow/ plasma conc
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Requirements for substances to be able to measure GFR -2 examples
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1. freely filtered 2. not reabsorbed or secreted 3. not metabolized by kidney -- inulin and creatintine (amount filtered =amount excreted)
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Effect of parasympathetic activity on bladder
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increase para and increase contraction of detrusor muscle (bladder)
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Effect of sympathetic activity on bladder
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increase sympathetic and decrease opening of internal urethral sphincter
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Name 3 parts of bladder and their innervation
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1. detrusor - parasympathic
2. internal urethral sphinceter- sympathetic 3. external urethral - somatic motor |
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What makes up the distal nephron?
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distal tubule and collectign tubule
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What part of the loop of Henle is the site for nacl reaborption?
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Asesnding Limb
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Diuresis -
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losing too much h20 20-25 L/day osmolarity =50/70
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Antidiuresis
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not enough H20 losing .5L/day
osmolarity =1200-1400 |
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The range of osmolarity for the medula
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300 - 1400
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Type of hormone is ADH? where is it synthesized and released? regulated by/
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peptide hormone - made in hypothalamus and released by posterior pituitary --regulated by hypothalamic osmoreceptors (more importatn) and volume receptors
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Type of hormone is aldosterone? where is it synthesized and released? regulated by/
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Steroid - made by adrenal cortex - increases Na reabsorption in cortical collecting tubule ONLY (distal nephron)
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What is the rate limiting step of aldosterone?
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release of renin! - an enzyme created by the afferent arteriole of the kidney that changes angiotensinogen into angiotension I
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What does converting enzyme do?
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angiotension I ---> angiotension II found in lungs
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How does Angiotensin II transformed into Aldosterone?
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By the adrenal cortex
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What cells is renin secreted by?
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grandular cells of the afferent arteriole
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Name 3 mechanisms how renin can be regualated/
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1. low arterial pressure =increase renin
2. increase activity of renal sympathetic nerves 3. drop in GFR which decreases flow to macula dense |
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Why does changes in h20 excretion occur faster than changes in NaCl excretion?
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mechanism of ADH is much faster than aldosterone
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How do diuretics work?
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by inhibiting specific enzymes, proteins, channels that are involved in transepithelial Na reabsorption == increased nacl and h20 excretion
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Drug names of thick ascending loop diuretics
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furosemide and bumetanide --work by inhibiting luminal Na, K Cl cotransport
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How is regulation of Na, H20, and K maintained?
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Na and H20 ==rate of reabsorption
K - rate of secretion in late distal end and cortical collecting tubuel |
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How much K is absorbed in the proximal tubule?
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90% but up to 80% can be excreted by secretion
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What systems are necessary to maintain Ca
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renal intestinal and bone
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How does PTH work?
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PTH increases Ca Levels by increasing ca reabsorption in kidney, forming vit d in kidney (which goes on to increase intestinal ca reabsorption) and breaking down bone
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What 2 ways is H+ produced normally?/
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1. volatile acid-- CO2 generated through oxidative metabolism
2. fixed - inorganic and organic generated through break down of proteins - excersise, diabetes |
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What are the 3 lines of defense for preventing acidification of body fluids?
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1. physiochemical buffering
2. respiratory compensation 3. renal compensation |
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What is the ratio in the HH equation that you want to always keep
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ratio =20 HC03 : 1 C02
normal 24 HCO3 :1.2 CO2 |
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How does the kidneys maintain plasma HC03 levels?
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1. reabsorption of filtered HC03 --99% is reabsorbed
2. generation of new HC03 |
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What does the kidney's generation of new HCO3 depend on?
where does it primarily occur? |
1. avilability of urinary buffers to accept secreted H
2. distal nephron |
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What is the most important urinary buffer?
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NH3/NH4 b/c there is an almost limitlesss supply of NH3 generation from glutamine metabolism in the proximal tubule
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What is respiratory acidosis caused by?
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Hypoventilation and the increased CO2 content
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What molecule is used to compensate respiratory disturbances? metabolic?
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respiratory = HCO3
metabolic =CO2 |
