Patho > Renal > Flashcards

Renal Flashcards

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1
Q

the difference between regular capillary and the renal capillaries

A

In average capillary, the filtration and reabsorption happens along same capillary (arterial end vs venous end).
The renal capillary system filters at the glomerulus and reabsorbs at the peritubular capillaries

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2
Q

whats a healthy daily lymphatic flow (volume / time)

A

2-3L/day

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3
Q

valves in the lymphatic system are similar to

A

the valves in our large veins

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4
Q

how does lymph get propelled thru the body and into our venous system

A

muscle contraction/relaxation. valves prevent backflow. pressure decreases on the back end of the lymph vessel and valves close

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5
Q

What is the interstitial fluid hydrostatic pressure around the peripheral capillary beds? Explain

A

-3mmHg (subatmospheric), caused by the lymphatic system moving the fluid along

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6
Q

functional cells of the lymph system

A

endothelial cells, form valves

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7
Q

anywhere we have ___ we have lymphatics

A

interstitia

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8
Q

what happens if surgeon severs lymph pathway

A

edema will ensue for maybe forever.

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9
Q

describe where lymph empties

A

the top of the thorax

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10
Q

to what degree is lymph system able to keep up

A

somewhere between 10 and 30 fold of the normal lymphatic flow but completely immobile person will lose function of lymph system and edema will ensue

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11
Q

3 main components of plasma oncotic pressure

A

albumin: 21.8 mmHg
globulin: 6.0 mmHg
fibrinogen : 0.2 mmHg

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12
Q

Donnan effect

A

Albumin proteins have negative charge, holds on to protons, calcium, anions, Na, K, etc. which causes an additional osmotic pressure due to increasing the solute level

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13
Q

explain what happens to the capillary in hypertension

A

pressure in the front end of the cap will be high, increasing cap hydrostatic pressure, increasing fluid filtered at arterial end

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14
Q

changes that would increase capillary filtration/increased lymph

A

Hypertension (increased hydrostatic cap) and decreased plasma osmotic pressure

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15
Q

if RA pressure rises above 0 due to decreased in function, what happens with lymph

A

venule hydrostatic pressure will increase to achieve gradient of 10 between venule and RA. Decreases reabsorption, increases lymph flow

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16
Q

dilating the afferent arteriole would result in? What meds do this?

A

increased flow to glomerulus, increased hydrostatic pressure in glomerulus, increased filtration rate, increases urine output.
NO donors, beta blockers

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17
Q

where does angiotensin II work in the nephron? what does it do?

A

The efferent arteriole. Increased angiotensin II to constrict EA to increase GFR by increasing glomerular cap pressure and decreasing peritubular cap pressure. Decreased ang II –>EA relaxation–>decreased GFR

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18
Q

how much resistance does afferent arteriole have compared to efferent arteriole?

A

efferent arteriole has more resistance as it drops the hydrostatic pressure from 60 down to 13 (47mmHg difference) whereas the afferent arteriole drops pressure from 100 to 60 (40 mmHg difference) .

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19
Q

Normal inward forces of the peritubular capillaries

A

plasma oncotic pressure: 32mmHg
renal interstitial hydrostatic pressure: 6mmHg

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20
Q

in the kidney, if something is filtered and NOT reabsorbed, what will happen to it?

A

excreted.

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21
Q

normal outward forces at the peritubular capillaries

A

interstitial oncotic pressure: 15mmHg
peritubular hydrostatic pressure: 13mmHg

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22
Q

____ happens when we have transporters that are set up to pump stuff into the tubule

A

secretion

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23
Q

what are two things dr schmidt mentioned that get secreted into tubule

A

K and H via Na-K atpase and Na-H exchangers

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24
Q

excretion =

A

filtration + secretion - reabsorption

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25
net filtration at the glomerulus = ____mmHg, net reabsorption at the peritubular capillaries is ___mmHg
10, 10
26
what are 2 ways things become excreted?
filtered in the glomerulus (passive) or ACTIVELY secreted later by the peritubular cells
27
relaxing efferent and afferent arterioles causes blood flow to ___
increase greatly
28
constriction of both afferent and efferent arterioles would cause blood flow to ____
decrease
29
angitensin II increases ___ but does not increase our _____
GFR but not urine output bc it decreases the peritubular pressure which promotes more reabsorption
30
GFR is mostly controlled by the ____arteriole while renal blood flow is mostly controlled by the ____arteriole
efferent, afferent
31
when pressures are higher coming into the afferent arteriole, it will ____. if pressures are lower coming into the afferent arteriole, it will ____
constrict, dilate
32
smallest functional unit in the kidney
nephron
33
how many nephrons in the healthy adult? what age do you start losing nephrons? are they typically replaced?
2 millions, 45 years old, no not really replaced
34
how much blood flow does each kidney get? mL/min
1100 mL/min = 550 mL per kidney per minute
35
whats being filtered in the kidney? what percent of it gets filtered and processed?
a portion of the plasma ( red blood cells are too fat to move through the capillaries), 20% is filtered.
36
How do we calculate the amount of plasma filtered by using the Hct?
Hct 0.4 (40% of whole blood) so 0.6 (60%) is plasma. 20% of that 60% is filtered
37
Normal GFR (collection of all the plasma that is being filtered in all 2 million nephrons)
125mL of plasma/minute
38
calculate the GFR
1100 mL/min , 60% is plasma, 20% is filtered
39
how is glomerular oncotic capillary pressure 32mmHg when systemic cap oncotic pressure is 28mmHg?
its 28 mmHg in the beginning of the cap, 36mmHg at the end of the glomerular capillary bc the colloids become concentrated since fluid is lost but nothing is reabsorbed at the glomerulus
40
we lose a lot of ____in the beginning of the glomerular capillary, and have less and less filtered the further along we get
fluid because the colloids have been concentrated, reducing the amount of fluid that we lose at the tail end of the capillary
41
what is the colloid osmotic pressure at the beginning of the peritubular capillaries? what does that cause?
36 mmHg, massive reabsorption
42
constriction of ONLY the afferent arteriole will ___
decrease renal blood flow, decrease GFR, decrease P cap (glomerular capillary), decrease pressure at peritubular ccapillary
43
constriction of ONLY the efferent arteriole will ____
increase glomerular capillary pressure, increase GFR, decrease blood flow to the peritubular capillary
44
dilation of the efferent arteriole will ____
glomerular cap pressure upstream will decrease, GFR will decrease, overall increase in renal blood flow
45
dilation of the afferent arteriole will ____
increase pressure downstream (glomerular cap pressure), increase GFR, increase overall blood flow
46
autoregulatory range of renal blood flow
80-180
47
GFR will ____ beyond pressures around 180mmHg
slightly increase but mostly plateau
48
moving down the capillary length, what 2 values remain the same? what 2 pressures change and by how much?
glomerular capillary pressure remains at about 60mmHg, bowmans capsule (tubule) hydrostatic pressure will remain around 18mmHg. Glomerular oncotic pressure will increase (as fluid is filtered, colloids remain) from 28-36. Net Filtration Pressure will in turn decrease.
49
the majority of the vascular resistance in the kidney is from the ____
efferent arteriole
50
the second most resistance is from the ____
afferent arteriole
51
increased resistance leads to ____ of pressure downstream
decrease
52
glomerular capillary beds are in what portion of the kidney
cortex
53
peritubular capillary beds are located:
95% in the outer medulla, 5% in the deep inner medulla
54
what is the other name for the 5% of peritubular capillaries
vasa recta
55
the ____ carries the blood into the deep parts of the inner medulla
descending vasa recta (DVR)
56
the ____ ascend the inner medulla
ascending vasa recta (AVR)
57
what is the significance of the splitting of the vasa recta in the multiple AVRs?
our body wants to conserve some of the stuff in the renal interstitium that helps us reabsorb fluid. it does so by slowing the flow down on the way up via the AVR
58
if we want to reabsorb water, it would be good if we had a lot of ____ in the interstitium
colloids, urea, collagen, filaments
59
really high renal blood flow, or high GFR will do what to the urea from the insterstitium?
it will drag more urea into the PT capillary, "washing out the urea compounds" that we use to hang on to water. this can occur in the DVR as well as the AVR
60
the splitting of the AVR helps prevent ____
the interstitium from being "washed out" so that we can concentrate the urine and hold on to water in the blood stream
61
the ____ are almost perfectly autoregulated, making the plateau nearly flat
the cortical nephrons (95% of the nephrons)
62
the ____ nephrons are poorly autoregulated
medullary nephrons (5% of nephrons)
63
the poor autoregulation (linear) of the medullary nephrons ends up being a good thing because :
A little bit of overperfusion will wash out some of the urea, dilute interstitia, and increase water loss, decreasing blood pressure. A little bit of under-perfusion would lead to a build up of urea, which causes water conservation. But if too low, the tissues of the deep medulla will suffer ischemia
64
COX-2's effect on medullary blood flow
increase prostaglandin production, which helps maintain a respectable blood flow to the medulla of the kidney.
65
66
renal blood flow:
1,100 mL/min
67
Hct:
40% = 0.40
68
plasma :
0.60 = 60%
69
renal plasma flow:
60% of 1100 = 660 mL/min
70
GFR
125mL/min
71
filtration fraction (FF)
portion of plasma that is filtered (GFR/RPF) = 125/660 = 20% of plasma that flows thru the kidney is filtered.
72
of the 20% of plasma that is filtered, ____% is reabsorbed
99%
73
so ____mL/min of fluid is reabsorbed
124
74
how many mL/min is excreted (normal urine production rate
1mL/min
75
I am freely filterable and EXTREMELY secreted
PAH, used to assess RPF
76
I am freely filtered and NOT REABSORBED AT ALL
Inulin, used to assess GFR
77
why is creatinine used to assess eGFR and not true GFR
creatinine is freely filtered but some is secreted, so 0.1-0.15 is secreted and must be considered when calculating GFR
78
I am freely filtered and fully reabsorbed
glucose
79
I am freely filtered and partially reabsorbed
Urea
80
1 dL =
100 mL
81
10 dL
1 Liter
82
blood concentration of creatinine NORMAL
1mg/dL
83
normal filtered creatinine amount
1.25mg/min
84
normal secreted creatinine amount
0.10-0.18 mg/min
85
total creatinine in the urine
1.4 mg/min
86
the major site for sodium and water reabsorption is the ____
proximal tubule
87
in the proximal tubule, sodium entry is majorly coupled with secretion of ____ via the ____
H+ ions, NHE-3 antiporter
88
sodium enters the prox tubule cells through symport along with what substances?
glucose, amino acids, phosphates, and other organics
89
although ___ are great for pain relief, they rend to reduce ____ that are important for maintaining medullary blood flow when RBF is low
COX-2 inhibitors, prostaglandins
90
clearance rate formula:
Cs = Us X V per minute/ Ps
91
Excretion rate formula:
(GFR X Ps) - (U per minute X V)
92
Filtration fraction equation and what it tells us
GFR/RPF = FF tells us what fraction of the plasma flowing thru the glomerulus is filtered into the bowmans capsule
93
excess ADH would cause what type of Na derangement
makes body hold on to WATER, holding on to too much water may cause a dilutional hyponatremia
94
low sodium relative to water from primary loss of sodium
sodium loss leads to water moving away from extracellular fluid. may be caused by diuretics, diarrhea, vomiting, hypo-aldosteronism (addison's disease)
95
central DI
not secreting ADH
96
nephrogenic DI
inability to respond to ADH
97
INTRACELLULAR edema can occur from 3 things:
hyponatremia (forces fluid into cells), depression of metabolic systems, lack of adequate nutrition. bc membrane pumps dont have energy to work so Na stays in the cells, promoting water movement into the cells.
98
extracellular edema occurs due to
abnormal leakage of the plasma, failure of lymphatics or hypernatremia in extracellular space
99
increased filtration caused by :
increased Kf (leaky cap membrane), decreased colloid osmotic capillary pressure, increased hydrostatic capillary pressure
100
safety factors to prevent edema
-interstitial fluid pressure is negative bc of lymph flow -interstitial "gel" prevents free flowing of fluid, keeps it stable and in the right spot -
101
describe the layers of the glomerular capillary wall
1) endothelial layer - 10% of surface has fenestrations 2)middle layer - spongey-like 3)epithelial basement membrane - podocytes with pedicles, slit pores and slit diaphragms. negative charge held by these layers allows for filtration of small, cationic filtrate, prevents proteins
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