Renal-- Midterm Flashcards

Front 1

With decreasing plasma flow, what happens to the GFR?

Back 1

The GFR falls because colloid osmotic pressure rises more quickly and net filtration pressure is diminished along a greater length of the glom. capillaries

Front 2

True/False: Bowman's space exerts a COP.

Back 2

False--except in disease states, there shouldn't be anything in Bowman's to exert colloid osmotic pressure

Front 3

Catecholamines cause what change in GFR and RBF?

Back 3

They cause both to decrease

Front 4

Constricting the efferent arteriole causes what effect?

Back 4

Slight initial increase in GFR but then it falls due to increasing COP and decreased RBF

Front 5

Clearance of PAH is equal to what?

Back 5

Renal Plasma Flow

Front 6

What % of renal plasma flow is filtered?

Back 6

20%

Front 7

The concentrations of solutes and small electrolytes in the plasma are the same, less than, or greater than their concentrations in the Bowman's space?

Back 7

The SAME(unless they are bound to plasma proteins)

Front 8

What happens to COP as FF rises? What effect does this have on net filtration force?

Back 8

It also rises--this diminishes the net filtration force

Front 9

What stimulates renin release? What else does this phenomenon stimulate?

Back 9

Decrease in NaCl concentration in the mecula densa cells
Decrease in the afferent arteriole resistance

Front 10

What is pressure natiuresis?

Back 10

As you raise pressure then urine/salt output tends to RISE
This must be due to decreased reabsorption as arterial pressure rises

Front 11

An increase in NaCl concentration causes what effect?

Back 11

Causes the afferent arteriole to constrict and RBF to fall

Front 12

What three things cause renin release? What are the effects of renin?

Back 12

Decreased arterial BP, decreased extracellular fluid volume due to dehydration, and increased sympathetic activity
Renin = increased angiotensin II = increased aldosterone AND increased contraction of systemic vascular smooth muscle = increased TPR; increased systemic BP; and increased Na+, E.C. fluid V, and K+ secretion, which causes increased C.O. and increased veinous return

Front 13

Loop diuretics inhibit _______
Thiazide diuretics inhibit ______
Amilorides inhibit _______

Back 13

Loop diuretics inhibit Na/K/Cl cotransporters
Thiazides inhibit Na/Cl cotransporters
Amilorides inhibit ENaC

Front 14

What is reciprocal induction?

Back 14

The metanephric blastema and the arched collecting tubules induce each other to develop to metanephric vesicles-->tubules

Front 15

What does the male UG sinus form?

Back 15

Lining of bladder, lining of urethra, prostatic utricle, and prostate

Front 16

What does the female UG sinus form?

Back 16

Lining of bladder, lining of urethra, vagina, periurethral glands, greater vestibular glands, and vaginal vestibule

Front 17

What forms the trigone?

Back 17

A portion of the mesonephric ducts pierces the wall of the bladder

Front 18

True/False: The mesonephric ducts persist in both males and females as the ureters.

Back 18

FALSE--THEY ONLY PERSIST IN THE MALES AS THE EJACULATORY DUCTS AND THE DUCUTS DEFERENS(disappear in females)

Front 19

What are the cells of Leydig formed from?

Back 19

Underlying mesenchyme

Front 20

Describe the male development of the primitive germ cells.

Back 20

They migrate through the mesentery of the hindgut to invade the genital ridge
The primitive sex cords surround the germ cells to become the testis cords, which become the seminiferous tubules
The primordial germ cells eventually become the Spermatogonium

Front 21

Describe the female development of the primitive germ cells

Back 21

Primitive sex cords degenerate and the 2nd set are called the cortical sex cords, which surround the primordial germ cells(these become follicular cells)

Front 22

What develops into the faecal cells in the female?

Back 22

The underlying mesenchyme--they secrete steroids

Front 23

Female phallus = ?

Back 23

clitoris and bulbs of the vestibule

Front 24

In the female, the labioscrotal swellings form what? What do the urogenital folds form? What does the UG sinus develop into?

Back 24

Labioscrotal = labia majora
Urogenital folds = labia minora
UG Sinus = vaginal vestibule

Front 25

In the male, the UG folds forms what? The labioscrotal folds form what? The phallus forms what?

Back 25

UG folds = penile raphe
Labioscrotal folds = scrotum
Phallus = erectile tissue

Front 26

The male mesonephric duct becomes what?

Back 26

Epididymis, ductus deferens, ejaculatory duct, and seminal vesicles

Front 27

The female mesonephric duct continues as what?

Back 27

The uterine tubes that communicate with the body cavity and the caudal parts pinch together to form the uterus

Front 28

Where is the highest permeability to water found?

Back 28

In the proximal straight tubule

Front 29

True/False: At the end of the Loop of Henle, the state of the tubule fluid is always hyperosmotic to plasma.

Back 29

FALSE--it is ALWAYS HYPOOSMOTIC

Front 30

Why doesn't the ratio rise further than 1 in the CCT?

Back 30

Because in the cortex the osmolality is always about 300(even in a state of antidiuresis) so there is no driving force to increase the ratio more

Front 31

What is the concentration of sodium in the innermost medulla?

Back 31

Only around 600 mosml--you need urea as well

Front 32

What causes the concentrated medulla?

Back 32

Half sodium and half urea

Front 33

True/False: Hyperosmotic plasma is necessary for release of ADH

Back 33

FALSE--ADH can be released in response to a low ECF

Front 34

Talk about ANP. Why is it released? What does it cause? What does it inhibit?

Back 34

Released in response to stretch of atrial walls
Causes systemic relaxation of vascular smooth muscle
Causes relaxation of afferent and constriction of efferent TO INCREASE GFR and RBF
It inhibits Na+ reabsorption ONLY IN THE MEDULLARY COLLECTING DUCT

Front 35

What happens when NaCl concentration increases in the macula densa cells?

Back 35

This triggers release of ATP and consequently Ca++ release that causes constriction of the afferent arteriole

Front 36

What two mechanisms control renal circulation?

Back 36

Myogenic mechanism--pressure stretching in the afferent and efferent vascular walls causes CONSTRICTION
Increased tension in endothelial cells = Increased intracellular calcium and increased constriction

Front 37

Renin primarily vascoconstricts what?

Back 37

The efferent arteriole

Front 38

What three things activate renin release?

Back 38

Decreased arterial BP
Decreased E.C. fluid due to V dehydration

Front 39

Angiotensin II has what two effects?

Back 39

Contraction of vascular smooth muscle in systemic arterioles causes increased TPR and increased systemic BP
Increased aldosterone release from adrenal cortex and increased Na+ reab, increased E.C. fluid V, and increased K+ secretion

Front 40

What happens when NaCl decreases in the macula densa?

Back 40

Increased efferent resistance(through renin) and decreased afferent arteriole resistance

Front 41

Do dehydration patients respond well to diuretics? Why not?

Back 41

No because in their case proximal tubule reabsorption is dramatically increased and diuretics work in the Loop and DCT

Front 42

The kidney capsule is composed of what?

Back 42

Myofibroblasts

Front 43

What are the minor calyces lined with?

Back 43

Transitional epithelium

Front 44

What nephron parts are contained within the inner zone of the medulla?

Back 44

Contains only collecting duct and the thin limbs of the Loop of Henle

Front 45

True/False: Podocytes are simple columnar epithelium.

Back 45

FALSE--both endothelial inner cells of the glomerular capillaries AND podocytes are considered endothelium

Front 46

What cells take care of molecules that are trapped on the endothelial side of the glomerulus?

Back 46

They are phagocytosed

Front 47

What PAS+ cells are found in the center of glomeruli?

Back 47

Mesangial cells--extraglomerular PAS+ cells are called Lacis cells

Front 48

JGA cells have what appearance?

Back 48

Halo and granular(because they release renin

Front 49

What do peritubular cells secrete?

Back 49

EPO

Front 50

What are the layers of the bladder?

Back 50

Trans epith, lamina propria, inner longitudinal smooth muscle, outer circular smooth muscle, and outermost longitudinal muscle, and adventitia

Front 51

Is the entire female urethra lined with transitional epithelium?

Back 51

No the outermost is lined with stratified squamous

Front 52

The male membraneous and penile urethra are lined with what?

Back 52

Pseudostratified or stratified squamous epithelium

Front 53

Thiazides enhance what? What are they used for primarily?

Back 53

Ca++ absorption so hypercalcemia occurs
They are used as an antihypertensive agent

Front 54

Your ability to concentrate urine is dependent on what two things?

Back 54

Water permeable distal nephron segments and a hyperosmotic medullary interstitium

Front 55

Where is ADH released from and what is the primary stimulus?

Back 55

Superoptic nuclei of the hypothalamus due to hyperosmolarity

Front 56

What happens at very high levels of vasopressin?

Back 56

Vasoconstriction

Front 57

What stimulates the uptake of urea into the urea cycle in the nephron?

Back 57

ADH

Front 58

Increase in protein intake causes what change in the urine?

Back 58

More concentrated due to urea formation

Front 59

On a molecular level, what causes ADH release?

Back 59

AP firing from supraoptic nucleus causes Ca++ release which causes exocytosis & ADH release

Front 60

Describe the different variants of diabetes insipidus

Back 60

Congenital: mutation in gene or preprotein causing ADH not to cleave off or be released
Acquired: head trauma or injury
Nethrogenic insipidus = defect in ADH receptors or SIADH(small cell lung carcinoma)

Front 61

Where are the osmometers?

Back 61

Cell bodies in the paraventricular nuclei and hypothalamic nuclei of the hypothalamus--they contract when osmolarity is high and this causes more AP's to fire and more ADH to be released

Front 62

What are the release ranges for thirst and for ADH?

Back 62

275 = begin ADH release(290 max)
280-300 = thirst

Front 63

Plasma sodium concentration is a good indicator of what?

Back 63

Plasma OSMOLALITY

Front 64

True/False: It takes only a few hours for the body to adjust to changes in salt intake.

Back 64

FALSE--it takes DAYS to adjust and in that time an increase in body weight may occur due to the positive sodium balance stimulating thirst and expansion of the extracellular fluid volume

Front 65

An acute increase in BP causes what with respect to sodium?

Back 65

Acute Increase in arteriole pressure = increase in Na output(mechanism unknown)
This does not occur chronically in a non-salt sensitive individual(their RAS system and SNS balance)

Front 66

What is a major way to stimulate increased Na+ reabsorption in the PT?

Back 66

Angiotensin II and catecholamines stimulate the activity of the Na/H exchanger in the proximal tubule and increase Na+ reabsorption

Front 67

What three hormones are released in response to hypovolemia?

Back 67

Vasopressin, renin, and NOREPI

Front 68

What effect does norepi have in the nephron?

Back 68

It increases Na and H2O reab. in the PT and increases AA and EA tone to decrease GFR in extreme situations

Front 69

With hypervolemia, what changes in peritubular factors affect Na+ balance?

Back 69

Decreased COP in the peritub. or increased Hstatic pressure cause reduced water uptake and therefore reduced sodium transport...so sodium excretion increases

Front 70

Hyperkalemia leads to what? Hypokalemia leads to what?

Back 70

Arrhythmias, increased neuromuscular reflex
Cardiac arrest

Front 71

A person is suffering from hyper-reflex reactions and just had a seizure. What should you give them?

Back 71

Insulin and glucose(activate Na/K ATPase), BETA-adrenergic agonist, or Aldosterone(augments Na/K ATPase)

Front 72

Hypokalemia will be seen with ____emia. Hyperkalemia will be seen with _____emia

Back 72

Hypokalemia with alkalemia and hyperkalemia with acidemia
K+ switches place with H+

Front 73

How does spironolactone work? What are some other potassium sparing diuretics?

Back 73

Blocks aldosterone receptors
Triamterene and Amiloride--block Na+ channels

Front 74

What are the two main effects of PTH in the kidney?

Back 74

Increase Ca++ reab in the DCT and reduce phosphate reab in the PCT

Front 75

What is the primary innervation of the bladder?

Back 75

Parasympathetic nerves that run in the splanchnic nerve from the sacral region of spinal cord as well as sympathetic innervation from the lumbar region
Pudendal nerve carries inhibitory fibers controlling the external sphincter, a voluntary striated muscle in the urogenital diaphram

Front 76

At high enough ADH levels, you get what?

Back 76

Vasoconstriction

Front 77

Why does NaCl PASSIVELY diffuse out of the ascending L of H?

Back 77

Because of urea

Front 78

Where is urea transported in the distal nephron?

Back 78

Inner medullary collecting duct

Front 79

What causes a shift of K+ out of cells? Into them?

Back 79

Ischemia, cell damage, exercise, hyperosmolarity, hypokalemia, acidemia, and ALPHA Adrenergic Agonists

Insulin, aldosterone, and BETA adrenergic agonists; hyperkalemia, and alkalemia

Front 80

The hypokalemia association with alkalemia and vice versa is due to the acidic state CAUSING K+ movement

Back 80

The hypokalemia association with alkalemia and vice versa is due to the acidic state CAUSING K+ movement

Front 81

What are the three innervations of the bladder?

Back 81

Pudendal nerve controls external urinary sphincter and runs in the somatic efferent fibers
Parasympathetic nerves running in the splanchnic nerve cause contraction of detrussor
Sympathetic nerves from the lumbar region cause relaxation

Front 82

What happens as the bladder fills?

Back 82

Stretch receptors present in the detrussor muscles send visceral signals to the sacral cord which causes a reflex constriction
These reflexes can be dampened if you voluntarily constrict the external urinary sphincter(through the pontine center)
If you relax voluntary control then there is facilitation through the facilitary fibers from the pontine regulatory center

Front 83

What is an atonic bladder? What is an automatic bladder? What is a neurogenic bladder?

Back 83

Atonic--destruction of sensory afferents preventing the activation of the reflex arc and intermittent contractions
Automatic bladder--micturation reflex not regulated by higher brain centers so NO VOLUNTARY CONTROL
Neurogenic bladder--selective loss of only inhibitory input from higher brain(frequent small volume urination)

Front 84

What happens to NH4+ that is produced in the PT?

Back 84

it gets taken back up in the TAL to enter the urea cycle in the liver or is coupled to glutamine formation

Front 85

What determines whether the body goes through ureagensis or glutamine metabolism?

Back 85

Alkalosis state = urea pathway which consumes HCO3
Acidosis = glutamine pathway which produces NH4+ and generates HCO3

Front 86

What occurs in stsates of respiratory acidosis? Metabolic acidosis? Chronic acidosis?

Back 86

Respiratory--inhibition of bicarb secretion
Metabolic--activation of H+ secretion
Chronic acidosis--more NH3/4 being excreted for a given pH value due to increased NH3 enzyme expression

Front 87

What are the effects of respiratory alkalosis? Metabolic alkalosis? Chronic metabolic alkalosis?

Back 87

Respiratory = Inhibit H+ secretion
Metabolic = Increase bicarb back leak
Chronic = Increase proportions of BETA vs. alpha interc. cells

Front 88

Hypokalemia causes what effect on HCO3 absorption?

Back 88

INCREASES HCO3 absoprtion

Front 89

What are the three methods mineralcorticoids stimulate H+ secretion?

Back 89

1. Lead to a state of hypokalemia
2. Increased Na+ reabsoprtion = more negative Vte which drives H+ secretion into the lumen
3. Targets H+ pump in the alpha interc. cell and causes H+ secretion