1
Q
What do you call the area where the kidney is located?
A
Retroperitoneum (Posterior Abdominal Wall)
2
Q
What is the estimated mass of the kidney?
A
Approx. 150g
3
Q
Give the size of the kidney: L x W x Depth
A
12.5 cm x 6 cm x 2.5 cm
4
Q
What do you call the functional units of kidney?
A
Nephrons
5
Q
How many functional units can be found in each kidney?
A
Aprrox 1 to 1.5 million nephrons
6
Q
Give the two types of nephrons
A
Cortical Nephron & Juxtamedullary Nephron
7
Q
This type of nephron makes up approximately 85% of the total nephron
A
Cortical Nephron
8
Q
This type of nephron has primary function of urine concentration
A
Juxtamedullary Nephron
9
Q
What type of nephron is responsible to the removal of waste products and reabsorption of nutrients
A
Cortical Nephron
10
Q
What type of nephron contributes to the specific gravity of urine?
A
Juxtamedullary Nephron (because it is responsible for the concentration of urine)
11
Q
What are the three processes involved in urine formation?
A
- Glomerular filtration
- Tubular reabsorption
- Tubular secretion
12
Q
What enzyme produced by the kidney that can also act as hormone?
A
Renin
13
Q
True or False: Kidney stimulates red blood cell production
A
True
14
Q
What is the metabolically active part of the tubules?
A
PCT
15
Q
What is the total renal blood flow?
A
1200 mL / min
16
Q
What is the total renal plasma flow?
A
600 to 700 mL / min
17
Q
True or False: Human kidney receives 29% of the blood pump
A
False (25%)
18
Q
What do you call the pressure that is created by the varying sizes of the arterioles, which is important in glomerular filtration and maintain consistency of the glomerular capillary pressure?
A
Hydrostatic Pressure
19
Q
What arteriole contributes to the hydrostatic pressure in glomerular filtration?
A
Afferent arteriole (reason: has larger size)
20
Q
What is the average hydrostatic blood pressure in the kidney?
A
55 mmHg (approx. half of the mean arterial blood pressure)
21
Q
What are the two forces involved in glomerular filtration?
A
- Hydrostatic Pressure
- Oncotic Pressure
22
Q
What is the major contributor of oncotic pressure?
A
Albumin or protein
23
Q
Give the order of blood flow in the nephron
A
Renal artery - Afferent arteriole - Glomerulus - Efferent arteriole - Peritubular capillaries - Vasa recta - Renal vein
(MNEMONICS: RAGE PVR)
24
Q
Give the order of urine formation from the nephron (Urinary Filtrate Flow)
A
- Glomerulus
- Bowman’s Space
- Proximal Convoluted Tubules
- Loop of Henle (descending - ascending)
- Distal Convoluted Tubules
- Collecting Duct
- Renal Calyx / Calyces
- Ureter
- Bladder
- Urethra
25
The glomerulus is consist of how many lobes in the capillary tuft
8 capillary lobes
26
What is the characteristic of the capillary walls in the glomerulus why plasma filtrate can pass through?
Fenestrated
27
Molecular weights of less than _________ can pass through the glomerulus
70,000 dalton
28
What is the specific gravity of the plasma filtrate leaving the glomerulus?
1.010
29
True or False: Plasma filtrate filtered by the glomerulus is produce through a non selective filter
True (this type of non selective filter is chemical filtration)
30
In the cellular structure of glomerulus, plasma filtrate must pass through three cellular layers. What are these?
1. Capillary wall membrane
2. Basement Membrane
3. Visceral epithelium of Bowman’s capsule
31
What do you call the shield the coats the cellular structure of glomerulus that repels negatively charged molecules?
Shield of Negativity
32
What do you call the intertwining foot processes located at the inner layer of bowman’s capsule
Podocytes
33
What maintains the glomerular blood pressure?
Juxtaglomerular apparatus
34
What cell is found in the afferent arteriole and is responsible in secreting renin enzyme
Juxtaglomerular Cells
35
This is found in the distal convoluted tubules, which serves as sensor of change in blood pressure
Macula Densa
36
Give the effect on blood pressure: dilation of afferent arteriole, constriction of efferent arteriole
Decrease
37
Give the effect on blood pressure: constriction of afferent arteriole, dilation of efferent arteriole
Increase
38
What do you call the compensatory mechanism that regulates blood pressure when BP and Sodium is low
Renin-Angiotensin-Aldosterone System
39
What are the two components or glomerular apparatus
Macula Densa (tissue)
Juxtaglomerular Cells
40
What is the primary electrolyte activated in RAAS?
Sodium
41
What part of the adrenal gland releases sodium-retaining hormone to cause reabsorption of sodium and excretion or potassium in the distal convoluted tubules
Adrenal Cortex (Zona Glomerulosa)
42
What do you call the blood-borne substrate for Renin Enzyme?
Angiotensinogen
43
What do you call the product formed form enzymatic reaction of renin with angiotensinogen
Angiotensin I
44
What do you call the enzyme that reacts with Angiotensin I to form Angiotensin II
Angiotensin Converting Enzyme (ACE)
45
What is the most potent vasoconstrictor among the components of the RAAS?
Angiotensin II
46
Give the 4 effects of RAAS
1. Dilation of afferent arteriole and constriction in efferent arteriole
2. Sodium reabsorption at PCT
3. Release of aldosterone for sodium retention
4. Release of ADH (Vasopressin) for water reabsorption
47
What is the best indicator for overall glomerular function
Clearance Tests
48
Among all the clearance test for glomerular filtration, which is the Gold Standard or the Reference Method?
Inulin Clearance Test
49
This is a type of fructose polymer that is extremely stable and not reabsorbed nor secreted by the tubules. This is a gold standard among the clearance tests for glomerular filtration
Inulin
50
What is the earliest clearance test for glomerular filtration? It is also not reliable because the substance is reabsorbed
Urea Clearance Test (not reliable because 40% to 70% is reabsorbed)
51
What is the most common clearance test for glomerular filtration
Creatinin clearance test
52
What is the greatest source of error in any clearance test for glomerular filtration that uses urine?
Improperly timed urine specimens.
53
When can blood be collected in creatinine clearance test?
Anytime within 24 hour urine collection
Ideal time: MIDPOINT of 24-hour urine collection
54
What is the preferred storage temperature for blood sample used for creatinine clearance test?
Refrigerated or Frozen Temperature
55
True or False: the patient is required to drink at least 8 cups of water on the day of urine collection for 24-hr urine specimen
True
56
How many increase in serum creatinine if the patient has recent intake of trimethoprim-sulfamethoxazole?
0.4 to 0.5 mg/d
57
Which among the following medicine increases creatinine levels?
A. Gentamicin
B. Cephalosporin
C. Cimetidine
D. Trimethoprim-sulfamethoxazole
D. Trimethoprim-sulfamethoxazole
58
Why do we need to refrigerate 24-hour urine during the collection process?
Bacteria will breakdown creatinine at low temperature (room temp). Will lead to false low result
59
What is the effect if there is a high meat diet of the px during the 24-hr urine collection?
False increase of Creatinine
60
True or False: Urine creatinine clearance test is not reliable in px that are athletes, persons involved in heavy exercise, and px with muscle disease
True
61
True or False: creatinine clearance is affected by sex and race
True
62
What is the relationship or Plasma Cystatin C to GFR?
Inversely Proportional
63
What clearance test is used to differentiate reduced function in glomerular function and tubular function?
Beta-2-Microglobulin (however, it is a better marker for reduced renal tubular function than glomerular filtration)
64
True or False: Cystatin C and Beta-2- Microglobulin are readily reabsorbed by renal tubular cells and broken down after reabsorption
True
65
What are the two mechanisms if tubular reabsorption?
Active transport
Passive transport
66
This type or tubular reabsorption mechanism requires the substance to combine with a carrier protein. Needs energy to initiate transport
Active transport
67
This type of tubular reabsorption mechanism is characterized by movement of substance from higher concentration to lower concentration
Passive transport
68
B2-microglobulin is increased in serum, but decrease (or none) in urine. What renal function is impaired?
Glomerular Filtration
69
B2-microglobulin is normal in serum, but increase in urine. What renal function is impaired?
Tubular Reabsorption
70
What substances are transported using active transport in renal tubules
Sodium (PCT, Thick ascending limb, DCT, Cortical CD)
Chloride (Thick ascending limb, & DCT)
Glucose
Amino acid
Salts
71
What substances are transported through passive transport in renal tubules?
Water
Urea
Sodium (Thin ascending limb)
Chloride (PCT & Cortical CD)
72
What substances can be reabsorbed in the PCT?
Salts (or elecs like Na, K, Mg, Ca, Phos, Sulfate, HCO3)
Water
Amino Acids (some proteins)
Glucose
Urea (can also be Uric Acid)
73
Passive reabsorption of water takes place in all parts of the nephron except in
Thin and Thick Ascending Limb (Loop of Henle)
74
Sodium is actively transported in all parts of the nephron except in…
Thin Ascending Limb (Loop of Henle)
75
What is the glucose renal threshold?
160-180 mg/dl
76
What is the sodium renal threshold?
110-130 mmol/L
77
What part of the renal tubules where urine concentration begins?
Descending and Ascending Loop of Henle
78
What part of renal tubules where the final concentration of urine happens?
Collecting Duct
79
What do you call the movement of water across a semipermeable membrane in an attempt to achieve an osmotic equilibrium between two compartments or solutions of differing concentrations
Osmolality
80
True or False: The process of osmolality requires energy
False (passive transport)
81
What hormone stimulates water reabsorption in the kidney?
Anti-Diuretic Hormone
Vasopressin
82
What is the normal urine to serum ratio?
1:1 to 3:1
83
This test for tubular reabsorption measures only the number of particle in the solution
Osmolality Test
84
Urine Osmolality: >800 mOsm
Urine-Serum Ratio: 3:1
Neurogenic DI
85
Urine Osmolality: <400 mOsm
Urine-Serum Ratio: 1:1
Nephrogenic DI
86
This test measures the number and size of particles on solution
SG
87
Give two kinds of water deprivation test
Fishberg
Mosenthal
88
This kind of water deprivation test compares the volume and SG of day and night urine samples
Mosenthal
89
The patient is first deprived with fluids for 24 hours before measuring the SG. What kind of water deprivation test is being described?
Fishberg
90
It involves the passage of substances from the blood in the peritubular capillaries to the tubular filtrate
Renal Secretion
Tubular Secretion
91
What substances are secreted in tubules?
Hydrogen ions
Ammonia
Potassium
Uric Acid
Urea
Some drugs
Weak acid and bases
92
The only part of the tubules that secrets urea
Loop of Henle
93
What part/s if the tubules can ammonia be secreted
PCT, DCT, CD
94
What is the most commonly used test for renal secretion and blood flow
Para amino hippuric acid Test (PAH test)
Clinical Microscopy
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