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259 Cards in this Set
- Front
- Back
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kidney filters ..liters of blood daily
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200 liters
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flow through both kidneys is about ...% of total cardiac output
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20-25%
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ultrafiltration of blood occurs in the....into the...
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glomerulus into the bowmans capsule
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reabsorption of nacl h20, K ca Mg occurs in the
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loop of henle
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reabsoption of lytes, amino acids, K, M , ca, po4, uric acid, urea an secretions of ions/anions, ammonia production occurs in the
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proximal tubule
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reabsorption of lytes, h20, K ca, mg and secretion of K, H+ and Ca occurs in
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distal tubule
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the collecting tubule occurs...
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reabsorptin, secretion H+, K, ammonia production
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secretion of renin occurs in the
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juxtaglomerular apparatus
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the external layer of the glomerulal capsule is also the
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structural layer
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the visceral layer of the glomerular capsule consists of
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modified branching epithelial podocytes
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the proximal convolute tubule is composed of
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cuboidal cells w numerous microvilli and mitchondria
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.....reabsorbs water and solutes from the filtrate and secretes substances into it
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proximal convolute tuble
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th distal convoluted tubule functions more in ..then..
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more secretion then absorption
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two types of cells in the connecting tubules
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intercalated cells and principal cells
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the ..cells of the connecting tubules function in maintaiing the acid base balance of thebody
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intercalated cells
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the...cells of the connecting tubules help maintain the body's water and salt balance
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principal
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every nephron has two capilary beds called
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glomerulus and peritubular capillaries
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each glomerulus is fed by..and drained by
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fed by an afferent arteriole an drained by an efferent arteriole
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each kidney generates..L of urine per day
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2 to 3
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why is blood pressure in the glomerulus high
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areterioles are high resistance vessels
afferent arterioles have larger diameters than efferent aretrioles |
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fluids and solutes are forced out of the blood throughout
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the entire length of the glomerulus
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the capillary beds are..beds that are ..pressure porous capillaries taht are adapted for absorption
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peritubular beds that are low pressure
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...are long straight efferent arterioles of juxtamedullary nephrons
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vasa recta
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blood pressure declines from 95 mmHg in renal arteries to..in renal veings
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8 mmhg
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afferent an efferent arterioles offer....resistance to blood flow
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high
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the....protects glomeruli from fluctiations in systemic blood pressure
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resistance from afferent arterioles
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the...reinforces high glomerular pressure
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resistance in efferent arterioles
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.....reduces hydrostatic pressure in peritubular capillaries
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reistance in efferent arterioles
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problems in the aorta can lead to ..renal failure
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pre renal
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...can act as mechanoreceptors
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juxtaglomerular
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..cells have secretory granules that contain renin
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juxtaglomerular
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...cells function as chemoreceptors or osmoreceptors
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macula densa
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...have phagocytic and contractile properties and influence capillary function
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mesanglial cells
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kidneys lie in the
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retroperitoneal space in the superior lumbar region
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..kidney is lower than
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right lower then left
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the ..is a filter that lies between the blood and the interior of the glomerular capsule
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filtration membrane
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the renal hyalis in the concave section leads to the
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renal sinus
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nerves, veins,arteries enter and exit through the
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renal hyalis
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two kidney layers are
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the cortex
the medulla |
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podocytes are..
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visceral membranes of the glomerular capsule
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the kidneys filter the body's entire plasma volume...x per day
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60 x/day
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the ultra filtrate contains...
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all plasma compnents except for protein
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the ...looses water , nutrients, and esential ions to become urine
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ultra filtrate
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urine formation and adjustment of blood composition involves three major compnents
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glomerular filtration, tubular reabsorptin, and secretion
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..are not filtered and are used to maintain oncotic pressure
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plasma proteins
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the glomerulus is more efficient than other capillary beds because
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its filtration membrane is more permeable
glomerual blood pressure is higher it has a higher net filtation pressure |
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..the pressure responsible for filtrate formation is the
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net filtration pressure
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the Net filtration pressure is equal to the
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glomerular hydrostatic pressure minus the oncotic pressure of the glomerular blood combine with the capsular hydrostatic pressure
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the..is the total amount of filtrate formed per minute by the kidneys
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glomerular filtration rent
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factors governing filtration rate at the capillary bed are
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total surface area available for filtration
filtration membrane permeability net filtration pressure |
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GFR is directly proportional to
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net filtration pressure
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autoreglatin of renal blood flow is effective over a wide range of mean arterial pressure of
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50-150 mmhg
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..bed has the higher pressures of any capilary bed in the body
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glomerular bed
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there is a linear relationship between a mAP > and urine outuput
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50
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glomerular or blood hydrostatic pressure is
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50 mmHG
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blood colloid osmotic pressure is
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30 mm hg
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capsular hydrostatic pressure is
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15 mmhg
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if the gfr is too thigh..
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needed stubstances cannot be reabsorbed quickly enough and are lost in urine
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if the gfr is too low
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everything is reabsorbed, including wastes that are normally disposed of
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there are three mechanisms to control the GFR
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renal autoregulatin/intrinsic system
neural controls hormonal mechanisms/renin angtiotenstin |
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the renal autoregulation is otherwise called
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intrinsic system
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neural controls of glomerural function are found in
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t8-l1
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cupped shaped end of renal tubule that completely sarrounds glomerulus
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bowmans capsule
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autoregulation entails two types of control
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myogenic-responds to change in pressure in the renal blood vessels
flow dependent tubuloglomerular feedback-senses changes in the juxtaglomerular apparatus |
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in the myogenic mechanism, increased perfusion pressure leading to
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increased contraction and resistance
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GFR is expressed in
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ml fitrate produced per minute
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decreased GFR in the tubuloglomerular feedback mechanisms leads to
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decreased flow via loop of henle leading to decreased sodium concentration at the macular densa
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decreased resistance of afferent arterioles leads to
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increased glomerular hydrostatic pressure
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increased renin leads to
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increased angiontensin II, increased vasconstriction of efferent aretrioles and increased glomerual hydrostatic pressure returning GFR to normal
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ammonia productin occurs in the
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promixal tubule and collecting tubule
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endothelin and other substances released during periods of hypoxemia will
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decrease GFR and promote retention of fluid
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epinephrine will...GFR
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decrease
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ANP which senses increased blood volume will
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increasing GFR and promoting loss of fluid
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dopamine and dopamine like drugs cause
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increase GFR and loss of urine
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max glucose transport mech
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375 ml/DL
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65% of the NA is
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actively reabsorbed
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acid base regulation begins in the
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proximal convoluted tubule
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% ..of nephrons are juxtomedullary
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15
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the osmalality of the medula
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is hyperosmoloar and so the ability of the kidney to produce concentrated urine dependent on the 15% of the juxtomedullar nephrons.
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...has the highst blood flow and o2 concentration
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renal cortex
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..is at highest risch for ischemic injury
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ascending limb in the renal cortex
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drugs that inhibit prostaglanding synthesis such as nsaids can cause
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intramedullary ischemia
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...should be used to increase renal output which also inhibits sodium reab in the thick ascending limb and decrease oxygen consumption
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dopamine
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extrinsic control occurs when the
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sympathetic nervous system is at rest or under stress in two different ways
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extrinsic control involves two components
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renal blood vessels are max dillated
autoregulatin mechanisms max prevail |
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under stress, the extrinsic control opperates by
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releasing norepi by the sna and epi by adrenal medulla. Afferent arterioles constrict and filtratin is filtered.
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..cells have microvilli and function to reg acid/base balance
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intercallated
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intercallated cells secrete ..and reabsorb
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H+ and reabsorb HCo3
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the renin angiotensin mechanism is stimulated by the
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SNS
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angiotensin II causes map to ..and stimulates the adrenal cortex to release
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rise aldosterone
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as a result of the renin aniotensin mechanism.. both ..and ..rise
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systemic and glomerular pressure
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..regulates K/Na pump
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aldosterone
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....receptors are located in the renal nerves
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B1 adrenergic
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cortical nephrons comromise...% of nerphrons
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85
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used to reduce norepi induced renal constriction
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dopamine and fenoldopam
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...flourane has been related to polyuric renal failure and is the result of
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methoxyflourance and is the result of the release of flouride ions from its metabolic components
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high plasma flouride concentrations following prolonged.... anes. may also occur in obese patients and those receiving..
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enflourane...receiving isoniazid therapy
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..breakdown of sevo formed at low flows can cause renal damage in lab animals.
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compound a
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increase in abdominal pressure during pneumometrium can cause...other procedures are
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oliguria or anuria...cardiopulmonary bypass, cross clamining of the aorta, dissection near the renal arteries.
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used to reduce norepi induced renal constriction
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dopamine and fenoldopam
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...flourane has been related to polyuric renal failure and is the result of
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methoxyflourance and is the result of the release of flouride ions from its metabolic components
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high plasma flouride concentrations following prolonged.... anes. may also occur in obese patients and those receiving..
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enflourane...receiving isoniazid therapy
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..breakdown of sevo formed at low flows can cause renal damage in lab animals.
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compound a
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increase in abdominal pressure during pneumometrium can cause...other procedures are
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oliguria or anuria...cardiopulmonary bypass, cross clamining of the aorta, dissection near the renal arteries.
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filtrate is formed in the
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bowman's capsule
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bowmans capsule where the...is at the..end
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filtrate is formed, at the proximal end
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six major anatomic and functinal divisions of the nephron include the
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glomerular capillaries, the proximal convoluted tubule, the loop of Henle, the distal renal tubule, the collecting tuble, the juxtaglomerular apparatus
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the large surface are the bowmans capsule is due to
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tufts of capillaries
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blood flow is provided for by a single ..arteriole and drained by...arteriole
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single affernet, drained by a single efferent
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...cells contain contractile proteins that respond to vasoactive substances, secrete various substances and take up immune complexes in the the basement membreane
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mesangial cells
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mesengial cells contract and reduce gfr in sesponse to
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angiotensin II, vasopressin, leukotrines, prostoglandin, histamine, norepi, endothelin, thromboxane.
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gfr is ...% of mAP
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60
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gfr is about mmhg
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60
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gfr is opposed by plasma oncotic pressure of... and renal instersitial pressure of
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25 mm HG and intersitial pressure of 10 mmg HG
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filtration pressure is directly proportional to..and indirectly proportional to
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directly proportional to efferent arterioral tone and inversly proportional to afferent arterioral tone
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..% of the ultrafiltrate formed in the bowmans capsule is reabsrobed
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60-75%
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major function of the proximal tubule
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na reabsorption
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...and...increase sodium reabs, ..and ...decrease sodium reabs
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angiotensin II and norepi increase, dopamine and fenoldopa decrease
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the na+ K- ATPase pump supplies the energy for reabsorption of most solutes by maintaining a low intracellular concentration of
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NA
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cortical nephrons outnumber juxtamedullary nephrons by
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7:1
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the loop of henle is responsible for maintaining a .... medullary interstitium and provide the collecting tubules iwth the
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hypertonic..ability to concentrate urine
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calcium reabsorption at the ascending loop of henle may be hindered by
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parathyroid hormone
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....is the major site for parathyroid hormone and vitamin D mediated calcium reabsoption
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distal tubule
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the collecting tubule can be divided into ..and...
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corticall and medullary portions
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...cells primarily secrete potassium and participate in aldosterone mediated NA_ reabsorbtion
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principal cells
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..cells are responsible for acid base regulation
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intercalated cells
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enectroneutrality is preseved in the p cells by reabsorbtion of and excretion of...
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secretion of K and reabsrobtion of CL
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ADH works primarily on the
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medullary collecting tubule
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ADH stimulates the expression of
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aquarporin 2 in the cell membrane
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dehydration increases ADH secretion, rendering the luminal membrane..
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permeable to water
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adequate hydration will suppress
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adh production, the fluid in the collecting tubules will pass through the medulla unchanged and remains hypotonic
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corticall collecting tubules are ...to urea and medullary collecting tubules are
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permeable, no
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regulation of renin depends on
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B1 adrenergic symp stimulation, changes in afferent arteriolar wall pressure and changes in chloride flow past the macula densa
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angiotensinogen is synthesized by the
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liver
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kidneys are the only organs in which
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oxygen consumption is determined by blood flow
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..is most vul to ischemia
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medulla
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..stimulation increases levels of angiotensin II
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sympathetic
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heart failure can cause redistribution of RBF to the ..which is clinically associated with
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medula, sodium retention
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renal plasma flow is normally measured by
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p-aminohippurate PAH clearence
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GFR is normally about...% of renal blood flow
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20%
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creatine cl is calc by
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creatine (urine) x urinary flow rate/creatine in plasm
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Approximately .. of systemic cardiac output flows through the kidneys each minute
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1/4 1200 ml
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nerve supply to kidney is via the
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renal plexus
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each nephron has two capillary beds...
..supports filtration ..suppports reabsorbtion |
glomerulus..fitration
peritubullar-reabs |
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each glomerulus is drained by an ..arteriole and fed by
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drained by efferent
fed by afferentt |
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.....acts as the initial receptacle for the filtrate.
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bowmans capsule
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max glucose filtration is
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375 mg/dl
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contractile proteins relax in response to ..and increase filtration
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anp, prostoglandin e2 and dopamine
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contractile proteins decrease filtration and contract in response to
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response to angiotensin II, vasopressin, norepi, histamines, endothelins, thromboxane A2, leukotrienes (C4 & D4) prostaglandin F2 and platelet-activating factor.
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..... of filtered Na is actively reabsorbed with water following passively.
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65%
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hypoalbumenia results in
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increased active metabolites
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hypoalbumenia results in
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increased active metabolites
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oliguria results when abdominal pressure is increased to over ...and anuria to over
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15 mmhg
30 mm hg |
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oliguria results when abdominal pressure is increased to over ...and anuria to over
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15 mmhg
30 mm hg |
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psuedohypoaldosteranism type one results in...and is a ...disease
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sodium loss, autosomal dominant
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psuedohypoaldosteranism type one results in...and is a ...disease
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sodium loss, autosomal dominant
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fanconis syndrome is autosomal ... and results in loss of
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recessive, amino acids, glucose and phosphate
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fanconis syndrome is autosomal ... and results in loss of
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recessive, amino acids, glucose and phosphate
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renal tubular acidosis results from in
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Altered sodium and chloride transport resulting in hyperchloremic metabolic acidosis
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renal tubular acidosis results from in
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Altered sodium and chloride transport resulting in hyperchloremic metabolic acidosis
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barters syndrome is autosomal
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recessive
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barters syndrome results in (3)
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Hypokalemic metabolic alkalosis
Increased plasma renin and aldosterone Polyuria and polydipsia |
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gitellmans syndrome is autosomal ..and results in....
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Gitelman’s syndrome –
Autosomal recessive Hypokalemic metabolic acidosis with significant hypomagnesemia |
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interstitial nephritis can be caused by
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Interstitial nephritis -- allergic reaction to drugs : sulfonamides, allopurinol, phenytoin and diuretics
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symptoms of acute interstitial nephritis are
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Hematuria & proteinuria
Rash, fever, eosinophilia |
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peylonephritis results from
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acute inflammation due to bacteril infection`
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chronic nsaids or tylenol use can cause
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chronic tubulointerstitial nephropathy
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chronic tubulointerstitial nephropathy is a common cause of
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chronic renal failure
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flank pain is characteristic of
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peylonephritis
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chronic peylonephritis may be caused by
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chronic ureteral reflux
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glomerulonephritis is r/t ..% of ESRD
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10-15
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primary glomerulonephritis is associated with...secondry is ass/w
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iga mediated or streptococcal
secondary is DM, HTN, SLE related |
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five clinical manifestations of glomerular nephritis
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5 clinical manifestations: hematuria, proteinuria, hypertension, edema, plasma creatinine concentrations
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acute glomerulonephritis is due to...
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deposition of antigen-antibody coomplexes in the glomeruli.
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nephrotic syndrome is characterized by a protein excretion of
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3.5 grams or more
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use of...drugs may slow down progression of glomerulonephritis
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immunosuppresive drugs
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nephrotic syndrome is associated with
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Na retention, hyperlipoproteinemia, thromboembolic (renal vein thrombosis) and infectious complications.
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is the most common cause of nephrotic proteinuria
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diabetic nephropathy
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..and..are associated with nephrotic syndrome
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pregnancy, cancer , aids
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....... compete with eachother for protein transport systems
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Organic ions compete with eachother for protein transport systems
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In chronic renal insufficiency organic acids accumulate and compete with drugs such as .... for ... thereby conferring an apparent resistance to loop diuretics
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lasix for secretor proteins (carriers)
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..diuretics such as...prevent water reabsorbtion
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osmotic, mannitol
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loop diuretics block the ..pump
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na/k
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thiazide diuretics block the...system
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na/cl
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To preserve blood vessels for vascular access, veinipuncture should be avoided in the ...... in pts with CRF
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To preserve blood vessels for vascular access, veinipuncture should be avoided in the nondominant arm and the upper part of the dominant arm in pts with CRF
|
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....grafts are preferred because of longer life span and lower incidence of thrombus and infection.
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Native grafts are preferred because of longer life span and lower incidence of thrombus and infection.
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most common fistula comp is
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Complications: most common intimal hyperplasia resulting in stenosis proximal to the venous anastomosis.
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for urgent dialysis . vascular access is obtained from a
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For urgent dialysis vascular access is obtained with a double-lumen dialysis catheter using the jugular or femoral vein.
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renal osteodystrophy is treated with
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vitamin d and ca
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renal osteodystrophy results in bone
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resorption with accompanied levels of low phosphate and ca
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...hypertension is the most significant risk factor accompanying renal failure
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systemic hypertension
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Signs and symptoms of chronic renal insufficiency may be .. until the later stages of the disease and may often be nonspecific and vague appearing such as fatigue, general malaise and anorexia.
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undetecable
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Kidneys demonstrate ... stages of adaptation to progressive impairment
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3
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in stage 2 of compensation to crf, K levels are maintained until the GRF is..
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GFR decreased to 10% of normal
|
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in stage 2 of compensation to CRF, K is no longer excreted in the distal tubles but now in the ..and..
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GI tract and collecting tubules
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sodium reg. and ECF homeostatsis occurs in....of renal compensation to CRF
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stage 3
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electrolyte disturbances in chronic renal failure are
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Hyperkalemia
Hyperphosphatemia Hypocalcemia Hypermagnesemia Increased uric acid Decreased albumin |
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renal ins. is defined as GFR of ...of normal
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25-40%
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uremic syndrome develops when GFR is ..% of normal
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10
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in prerenal failure urine sodium is ..in intrarenal it is
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high, low
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...hypertension is the most significant risk factor accompanying renal failure
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systemic hypertension
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Signs and symptoms of chronic renal insufficiency may be .. until the later stages of the disease and may often be nonspecific and vague appearing such as fatigue, general malaise and anorexia.
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undetecable
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Kidneys demonstrate ... stages of adaptation to progressive impairment
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3
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in stage 2 of compensation to crf, K levels are maintained until the GRF is..
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GFR decreased to 10% of normal
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in stage 2 of compensation to CRF, K is no longer excreted in the distal tubles but now in the ..and..
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GI tract and collecting tubules
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sodium reg. and ECF homeostatsis occurs in....of renal compensation to CRF
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stage 3
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electrolyte disturbances in chronic renal failure are
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Hyperkalemia
Hyperphosphatemia Hypocalcemia Hypermagnesemia Increased uric acid Decreased albumin |
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renal ins. is defined as GFR of ...of normal
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25-40%
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uremic syndrome develops when GFR is ..% of normal
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10
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in prerenal failure urine sodium is ..in intrarenal it is
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high, low
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specific gravity and osmalality is ..in prerenal failure
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high
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..urine is a sign of intrarenal acrf
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dilute
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high urine osm excludes the diagnosis of
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ACT
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The ... loop is highly metabolic and has great potential for nephrotoxic injury.
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medullary thick ascending
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Drugs that..., such as.... can upset this compensatory mechanism and cause medullary ischemia
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inhibit prostaglandin synthesis, such as NSAIDs
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during periods of intraoperative stress,inability to compensate occurs because kidney lacks .... vasoconstriction predominates through alpha and angiotensin activation.
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vasodilating beta2 receptors so
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dopamine is adminisetered at
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1-3 mcg/kg/min
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Loop diuretics inhibit .... in thick ascending limb decreasing oxygen consumption enhancing tubular oxygen balance.
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sodium resorbtion..
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..abx inhibit atp synthesis
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aminoglycosides
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allergic reactions to drugs cause
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acute interstitial nephritis, intrarenal azotemia
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in prerenal failure,...increases faster than..
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BUN faster than CR
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diagnosis of ARF is based on ...
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Dx- low urine Na, concentrated urine, increased BUN/Cr
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nephrotixicity of aminoglycosides in order...related to ...status
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destructiveness neomycin (6 sites) > gentamicin (5) > streptomycin (3). (related to cationic status)
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COX-1 is inhibited by NSAIDS such as Ketorolac for .... hours.
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8-24
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..most common cause of new onset ARF post op
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sepsis
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Positive-pressure ventilation & PEEP ... RBF, GFR, Na excretion and urine flow rate
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decrease
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peak FL levels above...are associated w nephroid tox
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150 mml/l
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Blockade of .... effective in suppressing the sympathoadrenal stress response
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T4 to T10
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... given for renal protective effect during aortic cross-clamping
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mannitol is given
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after reg anes, gfr is....is of control 24 hrs later
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2/3
|
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aortic cross clamping decreases renal blood flow by
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50%
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..largest causes of ESRD
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diab nephropathy
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... produces high osmolality in interstitial fluid (1400 mOsm/kg)
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loop of henle...
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.... – loops of capillaries that network around collecting ducts & ascending limbs of Loop of Henle I juxtamedullary nephrons
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vasa recta
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Typical waste excretion of urea, sulfate, phosphate, other waste products, & ions = .. mOsm/day
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600
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|
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formula for cr. cl
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Creatinine clearance = (140-age) X lean body weight
72 X plasma creatinine For women multiply by 0.85 |
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low bun can result in...
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Low BUN can be the result of severe liver disease (impaired urea synthessis) or low protein intake
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Elderly patients produce less serum creatinine therefore ... are suggest significant renal disease
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small changes
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urea is a product of..uric acid is product of..
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urea-amino acids
uric acids-nucleic acid |
|
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anp release...
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Blocks the vasoconstrictive actions of
Norepinephrine Angiotensin II |
|
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anp release promotes ..and may also cause
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Results in a prompt and sustained elevation in GFR
Promotes the filtration of Na and water loss May also wash out the medullary osmotic gradient |
|
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aginine vasopressin aka
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adh, antiduiretic hormone
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|
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arginine vasopressin is released by the posterior pituitary in response to...
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increased osmolality
Decreased extracellular volume Positive pressure ventilation Surgical stimulation (pain) |
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renin release is triggered by
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Reduced stretch of the granular JG cells
Stimulation of the JG cells by activated macula densa cells Direct stimulation of the JG cells via 1-adrenergic receptors by renal nerves Angiotensin II |
|
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when renal symp nervous system is at rest
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When the sympathetic nervous system is at rest:
Renal blood vessels are maximally dilated Autoregulation mechanisms prevail |
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decreased GFR leads to ..flow at Lof H and...conc. at macula densa
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***↓ GFR → ↓ flow via L of H → ↓ NaCl concentration at macular densa
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in the tubuloglomerular feedback mechanism...
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decreased nacl con at macula densa due to a decreased GFR leads to an increase of renin and constriction resulting in increased glomerular hydrostatic pressure normal GFR
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|
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myogenic mechanism
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Smooth muscle of afferent arterioles contracts in response to stretching produced by an ↑ transmural pressure
↑ Perfusion pressure → ↑ contraction & ↑ resistance |
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autoregulation involves two types of control
|
Autoregulation entails two types of control
Myogenic – responds to changes in pressure in the renal blood vessels Flow-dependent tubuloglomerular feedback – senses changes in the juxtaglomerular apparatus |
|
|
three types of renal controls
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Three mechanisms control the GFR
Renal autoregulation (intrinsic system) Neural controls (Activity of Renal Sympathetic Nerves --T8-L1) Hormonal mechanism (the renin-angiotensin system) |
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..is the location of nervous control of renal nerves
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t8-l1
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Autoregulation of renal blood flow is effective over a wide range of mean arterial pressure...
|
50-150
|
|
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Factors governing filtration rate at the capillary bed are:
|
Factors governing filtration rate at the capillary bed are:
Total surface area available for filtration Filtration membrane permeability Net filtration pressure |
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ultra filtrate contains all plasm comp. except
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protein
|
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The kidneys filter the body’s entire plasma volume .. times each day
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60
|
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the basement membrane is neg charge so...
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cations (+) are filtered whereas anions are not.
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In glomerulonephritis ... are destroyed allowing polyanionic proteins are filtered resulting in proteinuria
|
the negatively charged glycoproteins
|
|
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in the Myogenic reflex increased arterial pressure stretches the afferent arteriolar wall -->
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reflex constriction
|
|
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Blood pressure declines from ..mm Hg in renal arteries to ..mm Hg in renal veins
|
95,8
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