Xx - Renal Physiology Ii

Front 1

GFR measure by ?

Back 1

Inulin clearance

Front 2

INULIN is renally Filtered, Reabsorbed, or Secreted?

Back 2

only Filtered

Front 3

GFR decrease causes what serum concentration changes?

Back 3

BUN increase

Creatinine increase

Front 4

In Pre-Renal Azotemia, what is the ratio of BUN:Creatinine?

What does this ratio imply?

Back 4

> 20:1

implies decreased GFR

Front 5

Aging causes what changes to GFR?

This change in GFR causes what changes to serum [creatinine]?

Back 5

Aging decreases GFR

[Creatinine] unchanged due to decrease in muscle mass.

Front 6

GFR implies the Filtration across what?

Back 6

Glomerular Capillaries

Front 7

What is the driving force for GFR?

Back 7

Net Ultrafiltration Pressure

(across glomerular capillaries)

Front 8

Filtration Fraction (FF) is the fraction of ____ across _________.

Back 8

Renal Plasma Flow (RPF)

Glomerular capillaries

Front 9

FF equation ?

FF is normally what numerical value?

Back 9

= GFR / RPF

~ = 0.2

Front 10

If the FF is 0.2, then what does that mean?

What happens to the 0.8 part?

What does 0.8 part become?

Back 10

0.2 = 20% RPF filtered across GC

0.8 = 80% RPF leaves GC via EA

Then becomes the PTCC
(PTCC = PeriTubular Capillary Circulation)

Front 11

Increased FF means what for the RPF in the PTCC?
(causing what concentration change)

What does this ultimately cause physiologically & where?

Back 11

Less RPF to the PTCC (via EA)

(thus increasing [protein] in PTCC)

Increased Reabsorption @ PT

Front 12

Decreased FF means what for the RPF in the PTCC?
(causing what concentration change)

What does this ultimately cause physiologically & where?

Back 12

More RPF to the PTCC (via EA)

(thus decreasing [protein] in PTCC)

Decreased Reabsorption @ PT

Front 13

GFR equation in terms of Starlings

Renally, Filtration is always ______?

Back 13

Kf [(Pgc - Pbs) - (PPgc - PPbs)]

Favored

Front 14

Kf (Filtration Coefficient) is based on what structure?

Back 14

Glomerular Capillary BARRIER

Front 15

Glomerular Capillary Barrier is lined with what?

Why is this clinically significant?

Back 15

NEGATIVE Anion Glycoproteins

Plasma Proteins are also negatively charged, so they are restricted by the negative barrier.

Front 16

Loss of Negative charge (as seen in glomerular Dz's) on the glomerular capillary barrier manifests what Sign/Sx?

Back 16

Proteinuria

Front 17

Glomerular Capillary Hydrostatic Pressure (Pgc) is increased with what change to the AFFERENT Arteriole?

Back 17

AA Dilation

(thus increasing GFR)

Front 18

Glomerular Capillary Hydrostatic Pressure (Pgc) is increased with what change to the EFFERENT Arteriole?

Back 18

EA Constriction

(thus increasing GFR)

Front 19

Bowman's Space Hydrostatic Pressure (Pbs) increases with what vessel change?

(such change seen in what pathology?)

Back 19

Ureter Constriction

(as seen in Ureteral stones)

Front 20

What Starling variable is constant across the length of the glomerular capillary?

What Starling variable is increasing along the length of the glomerular capillary? why?

Back 20

Pgc (hydrostatic of GC)

PPgc (oncotic of GC)

as more is filtrated out, the [protein] increases at capillary blood

Front 21

What Starling variable is usually ZERO?

Back 21

Bowman's Space Oncotic Pressure (PPbs)

(b/c only small amt of protein is ever filtered)

Front 22

EA constriction (e.g. - via Angiotensin II) has what effect on (GC), GFR, RPF, and FF?

This FF change causes what @ PT?

Back 22

(Pgc increases, thus)

GFR increase
RPF decrease
thus FF increases

Increases Reabsorption @ PT

Front 23

AA constriction (e.g. - via Angiotensin II) has what effect on (GC), GFR, RPF, and FF?

This FF change causes what @ PT?

Back 23

(Pgc decreases, thus)

GFR decrease
RPF decreases also
thus, FF UNCHANGED

Reabsorption UNCHANGED @ PT

Front 24

Increased [Plasma Protein] has what effect on (Pressure), GFR, RPF, and FF?

This FF change causes what @ PT?

Back 24

(increases PPgc, thus)

GFR decreases
RPF UNCHANGED
thus FF decreases

Decreases Reabsorption @ PT

Front 25

Ureteral Stones has what effect on (Pressure), GFR, RPF, and FF?

This FF change causes what @ PT?

Back 25

(Increases Pbs, thus)

GFR decreases
RPF UNCHANGED
thus FF decreases

Decreases Reabsorption @ PT

Front 26

Filtered Load = ?

Back 26

GFR x [Plasma]

Front 27

Excretion Rate = ?

Back 27

Volume x [Urine]

Front 28

Reabsorption rate = ?

Back 28

Filtered Load - Excretion Rate

Front 29

Secretion rate = ?

Back 29

Excretion Rate - Filtered Load

Front 30

Net Secretion criteria in terms of Filtered Load?

Back 30

Filtered Load > Excretion Rate

Front 31

Net Reabsorption criteria in terms of Filtered Load?

Back 31

Filtered Load < Excretion Rate

Front 32

GLUCOSE is Filtered, Reabsorbed, or Secreted?

Back 32

Filtered and Reabsorbed

Front 33

PAH is Filtered, Reabsorbed, or Secreted?

Back 33

Filtered and Secreted

Front 34

Glucose is reabsorbed via what mechanism?

where?

Back 34

Na+/Glucose COTransporter

PT

Front 35

PAH is secreted via what mechanism?

where?

Back 35

Carrier transporter

PT

Front 36

ALL glucose is reabsorbed if.....?

Thus, at this level, the excretion of glucose is?

Back 36

Plasma [Glucose] < 250 mg/dL

Zero excretion

Front 37

Na+/Glucose Cotransporter starts losing affinity for glucose when?

This point at which this starts to happen is called what?

Back 37

Plasma [Glucose] > 250 mg/dL

Threshold for glucose ( = 250 mg/dL)

Front 38

Glucose will CEASE to Reabsorb if...?

This point at which this starts to happen is called what?

Back 38

Plasma [Glucose] > 350 mg/dL

Transport Maximum (Tm)

Front 39

What is Splay?

(include specific numerical values)

Back 39

(shaded) Region of Glucose Reabsorption curve between Threshold (250 mg/dL) and Tm (350 mg/dL)

Front 40

Once plasma glucose exceeds Tm, all additional increases in [Glucose] will ?

Back 40

be excreted

Front 41

SATURATION of Na+/Glucose Cotransporter occurs when plasma [Glucose] reaches what?

What is the value of this?

Back 41

Tm (Transport Maximum)

350 mg/dL

Front 42

PAH secretion occurs where on the renal tubules?

Back 42

PT

Front 43

Prior to PAH Tm, @ Low plasma [PAH], what character is the secretion rate?

Back 43

Any increases in plasma [PAH] will also cause Secretion rate increases

Front 44

Beyond PAH Tm, what is the character for PAH secretion rate?

Back 44

No more secretion

(even with increased plasma [PAH])

Front 45

Back 45

Front 46

Weak Acid excretion can be increased by?

Back 46

Alkalinizing urine

Front 47

Weak base excretion can be increased by?

Back 47

Acidifying the urine

Front 48

PAH excretion = ?

Back 48

Filtration Load + Secretion

(rem: PAH is Filtered & Secreted)

Front 49

Once the Tm for PAH is exceeded, the Excretion slope = ?

Back 49

Filtration slope