Term
| What are the kidneys fxn's? |
|
Definition
1. Remove waste
2. Regulate blood composition
3. Excrete foreign substances |
|
|
Term
| What is regulated in the blood by the kidneys? |
|
Definition
1. Amount of water
2. Quantity and concentration of ions
3. Acid-base balance |
|
|
Term
| What are some systems affected by kidney fxn? |
|
Definition
| GI, neurologic, muscle, heart, pretty much all systems |
|
|
Term
| What shape is the kidney? |
|
Definition
bean shaped, in back of abdomen at level of the lower ribs.
Each weighs 1/4 lb.
Dimensions: 4 x 2.5 x1.5 inches |
|
|
Term
| What is the major renal vein? |
|
Definition
| blood returns to heart through inferior vena cava |
|
|
Term
| What is the major renel artery? |
|
Definition
| major branch from aorta; 20% of systemic blood flow goes to kidney |
|
|
Term
| What is the blood flow through the kidney? |
|
Definition
|
|
Term
| What is the kidney medulla? |
|
Definition
| containts light colored pyramids |
|
|
Term
| What is the kidney pelvis? |
|
Definition
| flat funnel shaped cavity that collects the urine into the ureters |
|
|
Term
| what is the kidney cortex? |
|
Definition
| Outer 1/3 of kidney, contains most of the filtration units |
|
|
Term
| What does 'pilo' refer to? |
|
Definition
|
|
Term
|
Definition
| cortex and medulla, perpendicular to surface of kidney |
|
|
Term
| How many nephrons per kidney? |
|
Definition
|
|
Term
| What doe each nephron do? |
|
Definition
| produce urine, clean the blood |
|
|
Term
| What has vasculature similar to the eye? |
|
Definition
| The kidney, so DM and SLE have similar effects on these structures |
|
|
Term
|
Definition
| ball of capillaries, long thin tube with a hair pin loop, closed at one end |
|
|
Term
| Where are peritubular capillaries? |
|
Definition
|
|
Term
| Who do peritubular capillaries absorb? |
|
Definition
| water, solutes, which leave renal tubules |
|
|
Term
| What provides blood to renal tissue? |
|
Definition
|
|
Term
|
Definition
| pinhead sized filtration capsule 1million per kindey |
|
|
Term
| What is Bowman's Capsule? |
|
Definition
| hollow sphere around glomeruli that drain into the tubules |
|
|
Term
|
Definition
| where the urine drains from the glomeruli |
|
|
Term
| Where is the vascular pole? |
|
Definition
| where blood enters the glomeruli |
|
|
Term
| What are juxtaglomerular cells? |
|
Definition
| baroreceptors that sense pressure change that produce, store and excrete renin |
|
|
Term
| Where are enlarged smooth muscle cells of afferent arterioles found in the kidneys? |
|
Definition
|
|
Term
| Where are Bowman's capsules located? |
|
Definition
|
|
Term
| What are glomelular capillaries |
|
Definition
| ball of capillaries with fenestrated endothelium and incomplete basement membrane |
|
|
Term
| What are mesangial cells? |
|
Definition
| Cells w/ phagocytic and contractile fxn to control blood flow |
|
|
Term
| What holds the glomelular 'ball' together |
|
Definition
|
|
Term
| What capillary has an incomplete basement membrane? |
|
Definition
|
|
Term
|
Definition
| modified epithelial cells that support glomelular capillaries |
|
|
Term
| What are podocytes similar to? |
|
Definition
| choriocapillaris and RPE cells |
|
|
Term
| What gets through fenestrated structures more readily? |
|
Definition
| positively charged ions, substances found in high conc. Systemically, smaller size all facilitate movement across membrane |
|
|
Term
| Why should protein NOT be able to get into the glomerulus? |
|
Definition
| proteins are large molecules, SHOULD be too large to get through |
|
|
Term
| Is the glomelular capillary system high pressure? |
|
Definition
| yes, and it is leaky so exudates are forced through |
|
|
Term
| What are the two important factors that control glomelular filtration rates? |
|
Definition
|
|
Term
| Is there parasympathetic innervation in the afferent tubule? |
|
Definition
|
|
Term
| What does sympathetic stimulation of the kidney do? |
|
Definition
| constricts arteriole and releases rein from juxtaglomelular cells |
|
|
Term
| What does constriction of renal blood flow do? |
|
Definition
| slows blood flow and reduces filtration pressure |
|
|
Term
| What does angiotensin II do under sympathetic stimulus? |
|
Definition
| constriction of efferent ateriole |
|
|
Term
| What triggers angiotensin II? |
|
Definition
|
|
Term
| What do PG's, nitric oxide, and endothelin do? |
|
Definition
| chemical mediators that influence renal blood vessels |
|
|
Term
| Where is the afferent arteriole of the glomerulus? |
|
Definition
|
|
Term
| Where is the efferent arteriole of the glomerulus? |
|
Definition
| downstream of glomerulus 'Efferent is the Exit' |
|
|
Term
| Does the kidney try to maintain constant filtration? |
|
Definition
|
|
Term
| What is the mechanism of initial filtration? |
|
Definition
| 2-3x higher pressure than any other capillary bed is found in glomeruli; this forces substances through capillaries |
|
|
Term
| What is the glomerulus selective for? |
|
Definition
| smaller substances, positive substances, configuration of the the substance |
|
|
Term
|
Definition
| water, ions, glucose, AA, bicarbonate |
|
|
Term
|
Definition
| substance filtered by glomeruli are brought back into the body |
|
|
Term
|
Definition
| ions, glucose, amino acids from the lumen of nephron |
|
|
Term
| What facilitates reabsorption? |
|
Definition
| specialized transporters on epithelial cells of nephrons |
|
|
Term
| Are transporters active or passive? |
|
Definition
|
|
Term
| How is Na+ related to reabsorption? |
|
Definition
| Na+ is sometimes exchanged with substances, enters together via shared transporters or can undergo solvent drag with reabsorbed substances |
|
|
Term
| What are the two major modifers of absorption? |
|
Definition
| concentration, rate of filtrate flow |
|
|
Term
| What does a higher flow of filtrate cause? |
|
Definition
| Less time for transporters to glean their targeted substance |
|
|
Term
| Where does reabsorption of water occur? |
|
Definition
| alon tubules in a passive mechanism |
|
|
Term
| What % of total filtrate volume becomes urine? |
|
Definition
|
|
Term
| What is reabsorbed in the proximal tubule? |
|
Definition
| 80% of glomelular filtrate |
|
|
Term
| What is reabsorbed in the Loop of Henle? |
|
Definition
| water and salt, 6% of filtrate reabsorbed here |
|
|
Term
| What is reabsorbed in the distal tubule? |
|
Definition
| 9% of filtrate. Variable reabsorption and active secretion occurs |
|
|
Term
| What is reabsorbed in the collecting tubule? |
|
Definition
|
|
Term
| What is excretion sometimes called? |
|
Definition
|
|
Term
| What is the distal tubule sometimes called? |
|
Definition
| Distal convoluated tubule |
|
|
Term
| What is excreted in the glomerulus? |
|
Definition
| water, ions, glucose, AA, bicarbonate |
|
|
Term
| What % of Na is reabsorbed? |
|
Definition
|
|
Term
| What does Na reabsorption depend on? |
|
Definition
|
|
Term
| how much water and Cl- is reabsorbed? |
|
Definition
|
|
Term
| How much K+ is reabsorbed? |
|
Definition
|
|
Term
| Where is the filtrate isotonic? |
|
Definition
| entrance to the loope of Henle |
|
|
Term
| What is the only thing reabsorbed in the descending loop of Henle? |
|
Definition
|
|
Term
| What is the osmolarity of the filtrate as it leaves the Loop of Henle? |
|
Definition
|
|
Term
| What reabsorbs water reclaimed in the loop of Henle? |
|
Definition
|
|
Term
| What does ''water flows down hill'' remind? |
|
Definition
| That water flows out (reabsorbed) in the descending loop of Henle |
|
|
Term
| As it enters the Ascending loop of Henle, what is the osmolarity? |
|
Definition
|
|
Term
| Is the ascending loop of Henle permeable to water? |
|
Definition
| No. 'Water can't flow uphill' |
|
|
Term
| What is reabsorbed in the Ascending Loop of Henle? |
|
Definition
|
|
Term
| What does the reabsorption of salt do to the medulla? |
|
Definition
|
|
Term
| What is the osmolarity of exit filtrate from the Acending loop of Henle? |
|
Definition
|
|
Term
| Where are macula densa cells? |
|
Definition
| Specialized epithelial cells that connect the distal convoluated tubule |
|
|
Term
| What do macula densa cells do? |
|
Definition
| Sense the levels sodium and chloride in filtrate. |
|
|
Term
| What do macula dense cells do if NaCl is low in the filtrate? |
|
Definition
| encourage relase of renin from juxtaglomelular cells |
|
|
Term
| What does parathyroid hormone induce in the distal tubule? |
|
Definition
| increased Ca++ absorption |
|
|
Term
| Are early cells of the distal tubule permeable to water? |
|
Definition
|
|
Term
| Is filtrate hypotonic or hypertonic in the distal tubule? |
|
Definition
|
|
Term
| What is Na exchanged for in the distal tubule? |
|
Definition
| K+ is excreted actively, partly in exchange for Na+ |
|
|
Term
| How is Na reabsorbed in the collecting duct? |
|
Definition
|
|
Term
| What does aldosterone increase in the collecting duct? |
|
Definition
| K+ excretion/Na+ reabsorption exchange |
|
|
Term
| What does ADH do to the collecting duct? |
|
Definition
| allows water to pass through walls of collecting ducts |
|
|
Term
| What is the osmolarity of urine in the collecting duct? |
|
Definition
|
|
Term
| What is passively reabsorbed in the collecting duct? |
|
Definition
|
|
Term
| What is the major stimulus for ADH secretion? |
|
Definition
|
|
Term
| What measures blood volume? |
|
Definition
| baroreceptors found in a multitude of places like Aorta, pulmonary vessels, carotid artery |
|
|
Term
| What mechanism do baroreceptors use to measure pressure? |
|
Definition
| measure stretch of BV walls |
|
|
Term
| What does decreased blood volume cause? |
|
Definition
| low BP and increased osmolarity |
|
|
Term
| Where are osmoreceptors found? |
|
Definition
|
|
Term
| What are osmoreceptors most sensitive to? |
|
Definition
| Na+ and mannitol, glucose to a lesser effect |
|
|
Term
| What does ADH cause in the kidney? |
|
Definition
| increased water reabsorption |
|
|
Term
| What is the autocrine system? |
|
Definition
| hormones that bind to receptors and affect the fxn of the cell type that produced it. |
|
|
Term
| What is a vasoactive peptide? |
|
Definition
|
|
Term
| What are the type of endothelins? |
|
Definition
|
|
Term
| What do endothelins cause? |
|
Definition
increased BP through vasoconstriction
can cause vasodilation in a minority of instances
Tends to cause salt and water retention |
|
|
Term
|
Definition
| A molecular gas that has three forms that act on the kidney |
|
|
Term
| What does nitric oxide cause in the kidney? |
|
Definition
more water to be excreted
helps macula densa cells to provide feedback |
|
|
Term
| What may normotensive glaucoma be related to? |
|
Definition
|
|
Term
|
Definition
| increase blood flow to kidney; prevent vasoconstriction |
|
|
Term
| What can impair water reabsorption through blocking ADH in the collecting duct? |
|
Definition
|
|
Term
| What can prescribing PG's as an optometric drug cause systemically? |
|
Definition
|
|
Term
| What prevents water and sodium reabsorption and prevents K excretion? |
|
Definition
|
|
Term
| How is angiotensin II formed? |
|
Definition
| renin combines w/ angiotensinogen --> angiotensin I --> AG II |
|
|
Term
|
Definition
| A potent vasoconstrictor that increases ADH release |
|
|
Term
|
Definition
|
|
Term
| What is the general effect of increased angiotensin II? |
|
Definition
|
|
Term
| Where is ADH released from? |
|
Definition
|
|
Term
| What increases aldosterone release from adrenal cortex? |
|
Definition
|
|
Term
| What is released in response to hypoxia by the kidney? |
|
Definition
|
|
Term
|
Definition
| stimulate bone marrow to produce RBC's |
|
|
Term
|
Definition
| Stimulates absorption of calcium in intestine |
|
|
Term
| What is the pH target for blood? |
|
Definition
|
|
Term
|
Definition
| neutralized by bicarbonates |
|
|
Term
| What regulates bicarbonate regeneration? |
|
Definition
|
|
Term
| How does the kidney influence blood pH? |
|
Definition
| excretes H+ or Bicarbonate |
|
|
Term
| What is a sign of kidney disease? |
|
Definition
|
|
Term
| What is a common problem with kidney dx? |
|
Definition
|
|
Term
| What is the glomelular filtration rate? |
|
Definition
| Amt of filtrate formed in all nephrons |
|
|
Term
| What % of renal plasma flow is filtered? |
|
Definition
|
|
Term
| what is the normal glomelular filtration rate? |
|
Definition
|
|
Term
| What is glomelular filtration rate use to assess? |
|
Definition
|
|
Term
| How is a glomelular filtration rate measured? |
|
Definition
| collected blood is timed to see how fast substances are removed from the body |
|
|
Term
| What test requires the pt to be in a clinic for hours to perform the test? |
|
Definition
| glomelular filtration rate |
|
|
Term
|
Definition
| byproduct of muscle metabolism |
|
|
Term
| What does the kidney do to creatinine? |
|
Definition
| filters it out, but does not reabsorb it out of the tubules |
|
|
Term
| What is the normal value for a creatinine clearance test? |
|
Definition
|
|
Term
| What is an abnormal value for creatinine clearance? |
|
Definition
| <60 = significant indicator of kidney dx |
|
|
Term
| How is the creatinine clearance test performed? |
|
Definition
| urine is collected for 24 hrs w/ a blood draw at the end |
|
|
Term
| What is the normal serum level of creatinine? |
|
Definition
|
|
Term
| What can influence normal creatinine serum levels? |
|
Definition
| gender and size of individual |
|
|
Term
| If creatinine serum level is doubled, what does this mean? |
|
Definition
| kidney fxn has fallen to half of normal rate |
|
|
Term
| If creatinine serum level is triple, what does this mean? |
|
Definition
| kidney fxn has fallen to 25% of normal rate |
|
|
Term
|
Definition
| tests urea as an indicator of kidney fxn |
|
|
Term
|
Definition
| end product of protein metabolism |
|
|
Term
| What is the rate of urea excretion? |
|
Definition
| roughly 50% excreted, 50% reabsorbede |
|
|
Term
| What is a normal value for urea in the BUN test? |
|
Definition
|
|
Term
| What increases in the BUN test with decreasing kidney fxn? |
|
Definition
|
|
Term
|
Definition
| an asymptomatic malfunction that is indicative of poor urea release in kidney |
|
|
Term
| What is abnormally seen in urinalysis? |
|
Definition
| protein, blood or glucose |
|
|
Term
| What is the first sign of kidney involvement in DM? |
|
Definition
|
|
Term
|
Definition
| neutrophil gelatinase associated lipocalin |
|
|
Term
|
Definition
acute damage to the kidney
indicator of necessity for dialysis to allow kidney to heal/recover |
|
|
Term
| What does increased potassium and phosphate levels indicate? |
|
Definition
|
|
Term
| What does decreased calcium, pH and bicarbonate levels indicate? |
|
Definition
|
|
Term
|
Definition
flourescine imaging of the urethra, bladder, and ureteral orifices
allows for biopsy |
|
|
Term
| What can ultrasound evaluate in the kidney? |
|
Definition
| structure, tumors, abnormalities |
|
|
Term
| What % of US adults have chronic kidney dx? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How many die per year due to renal problems? |
|
Definition
|
|
Term
| How many americans require dialysis or kidney transplantation to live? |
|
Definition
|
|
Term
| How many people are waiting for a kidney? |
|
Definition
|
|
Term
| How many people receive kidney transplants each year? |
|
Definition
|
|
Term
| Is CKD increasing or decreasing in the US? |
|
Definition
|
|
Term
| What does CKD increase the risk for? |
|
Definition
| ARMD 3-5x greater, dry eye 15x greater |
|
|
Term
| What can optometric prescribed medications cause? |
|
Definition
|
|
Term
| What may be adjusted if CKD is suspected in a pt? |
|
Definition
| decreased dosage of meds may be required to protect kidneys |
|
|
