PV3 Renal Lecture 1

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cmatthews
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PV3 Renal Lecture 1
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2013-11-06 21:34:44
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BC CRNA PV3 Renal Lecture
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11/4/13
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  1. What do the ureters do and why can they get damaged during TAH?
    • Transport urine from the kidneys to the bladder
    • Proximity to uterus makes it possible to injure during TAH
  2. How long are the ureters?
    muscular tubes 25-30cm in length
  3. Describe the urinary bladder
    • Hollow viscus, muscular, very distensible
    • Temporary storage for urine
    • Always contains some urine.
    • Muscle contraction is very impt in emptying the bladder.
  4. How long is the urethra? What does it do?
    • Male 18-20cm long
    • Female 4cm long
    • transports urine from the bladder out of the body
  5. Where are the kidneys located?
    Kidneys are in retroperitoneal space in the superior lumbar region
  6. Which side of the kidney is convex and which side is concave?
    The lateral surface of the kidney is convex and the medial surface is concave.
  7. Which kidney sits lower?
    The right kidney sits lower than the left because it’s crowded by the liver.
  8. Ureters, renal blood vessels, lymphs, nerves all exit at the
    renal hilum
  9. What does the renal capsule do?
    The renal capsule is fibrous and will help to prevent kidney infection.
  10. What does the adipose capsule do?
    Adipose capsule will cushion the kidney and helps to connect it to the abdominal wall.
  11. What does the renal fascia do?
    Renal fascia is dense fibrous tissues that also anchors the kidney.
  12. How much does the kidney weigh?
    Kidney in adult weighs 150g (size of clenched fist)
  13. Describe the cortex of the kidney
    the light colored, granular superficial (outer) region
  14. Describe the medulla of the kidney
    exhibits cone-shaped medullary (renal) pyramids separated by columns
  15. Describe the pyramids of the medulla
    • Base of pyramid starts where the cortex and medulla meet.
    • Pyramids project in the space of the renal pelvis, funnel shaped continuation of the proximal ureter
  16. What constitutes a lobe of the kidney?
    The medullary pyramid and its surrounding capsule
  17. What is the renal pelvis?
    flat funnel shaped tube lateral to the hilus within the renal sinus---it will collect the urine
  18. Renal blood flow =__ % of cardiac output =____ ml/minute
    22% of CO; 1100ml/min
  19. Describe the renal blood supply (flow)
    Renal artery→interlobar arteries→ arcurate arteries→ interlobular (radial) arteries →Afferent arterioles Glomerulus →Efferent arterioles →Peritubular capillaries  venous system→ renal vein
  20. The kidney is unique because it has TWO capillary beds. Name them AND....what are they seperated by?????
    • Glomerular
    • Peritubular

    Seperated by the efferent arterioles
  21. How do the kidney's control homeostasis (in terms of hydrostatic pressure)
    Kidney can control hydrostatic pressure in both sets of capillaries by altering resistance that will change GFR and/or tubular absorption
  22. How many nephrons are there ?
    1million/kidney
  23. What does the nephron itself contain?
    Nephron itself consists of the Glomerulus (Bowman's capsule and capillary supply) and long tubule divided into parts (PCT, LoH, DCT, & collecting ducts)
  24. What is the renal corpuscule??
    Glomerulus + bowman’s capsule which is where the urine essentially gets filtered from the glomerular capillaries and goes into Bowman’s capsule and then goes into the tubules.
  25. The glomerular capillaries have hydrostatic pressure of about _______ (fairly high)
    60mmHg
  26. Where is the proximal tubule in the kidney?
    cortex of the kidney
  27. Where is the loop of Henle located in the kidney?
    In the medulla
  28. Describe how the filtrate goes from one of the nephron to the other
    Glomerulus→Bowman's capsule→PCT→Loop of Henle (descending, think ascending, thick ascending)→DCT→collecting ducts→renal pelvis
  29. What is the difference between the cortical and the juxtamedullary nephrons?
    Same parts but difference in how deep the Loop of Henle goes into the medulla of the kidney
  30. Where is the coritcal nephrons loop of Henle?
    Short Loop of Henle so it only goes a little way into the medulla
  31. __-__%  of nephrons are the juxtamedullary nephrons
    20-30%
  32. Which have longer loops of Henle the cortical or the juxtamedullary nephrons?
    Juxtamedullary nephrons have much longer loops of Henle compared to the cortical nephrons
  33. Where do the juxtamedullary nephrons lie in the kidney?
    The renal corpuscle (glomerulus and bowmans capsule) lies in the deepest part of the cortex and much further into the medulla.
  34. Which nephrons are  really important for generating an osmotic gradient in medulla and that becomes responsible for water reabsorption???
    juxtamedullary nephrons-create dilute or concentration urine depending on our needs for homeostasis
  35. What is different about the blood supply to the juxtamedullary nephrons?
    • They have long efferent arterioles.
    • These go down into the outer medulla and divide into special peritubular capillaries. Essentially wrap around the tubules (peritubules)
    • the ones
  36. What is the vasa recta ?
    With the juxtamedullary nephrons ---Specialized peritubular capillaries that lie SBS with the loop of Henle

    **becomes important when we talk about producing a concentrated urine.
  37. Most capillaries have two layers but the glomerular capillary has 3 layers. What are they??
    endothelium, basement membrane and the EPITHELIUM
  38. What is another name for the epithelium of the glomerular capillary?
    podocytes
  39. What is the puprose of having more layers in the glomerular capillary?
    The purpose of the 3 layers is that it can filter more water and solutes than the usual 2 layer capillary membrane can
  40. What is special about the Endothelium of the glomerular capillary? (two things!)
    • Endothelium itself is perforated by a lot of small holes (Fenestrae) looks like swiss cheese.
    • Freely permeable to everything the blood except cells and plasma proteins (WBC, RBC, plasma proteins, and plts).
    • Plasma proteins are large so don’t’ pass easily and they HAVE A NEGATIVE CHARGE and so does the endothelial cells.
    • So the charges repel so for that reason as well as the size, proteins won’t pass.
  41. Describe the basement membrane of the glomerular capillary
    • Gel like mesh.
    • Large spaces so water and solutes can pass through the space (think kitchen sponge).
    • Also has a negative charge so the proteins don’t go through.
  42. Epithelial layer of glomerular capillary rests on basement membrane and lines the outer surface of the glomerular capillary. Describe this layer
    • Cells aren’t really continuous, Slit pores, cells are separated so slit in between, which permits large volumes of fluid to go from the capillaries into bowman’s capsule.
    • Again proteins don’t go.
  43. What are the Mesangial cells? What do they do???
    • They act as phagocytes (Take foreign trapped material from basement membrane and get rid of it)
    • They also have myofilaments, can contract and essentially change the surface area.
  44. Are the Mesangial cells part of a layer in the glomerular capillary?
    • No, these are found between and within the loops of the glomerular capillaries.
    • They aren’t a layer.
  45. Name the 8 functions of the kidney and their role in homeostasis
    • 1. Excretion of metabolic waste products
    • 2. Regulation of water & electrolytes
    • 3. Regulation of osmolarity (loop of Henle and vasa recta)
    • 4. Regulation of acid-base
    • 5. Regulation of BP – renin (juxtamedullar apparatus involved)
    • 6. Secretion, metabolism, & excretion of hormones erythropoietin to stimulate RBC production
    • 7. Gluconeogenesis
    • 8. Activation of vitamin D
  46. Glomerular filtration means what???
    • means filtering of plasma like fluid through glomerular capillaries into renal tubular fluid via bowman's capsule. 
    • Blood-->urine
  47. Why, in general, is the concentration of substance in the plasma is the same of the concentration of those substances in the glomerular filtrate?
    • Most substance in the plasma (except proteins and cells) go through glomerular filtration system into the Bowman's capsule. 
    • Then what happens is as filtrate goes through the tubules both the volume of the fluid is reduced and the composition is altered by processes of tubular reabsorption
    • Substances go back into blood through the peritibular capillaries. Or it goes the other way, tubular secretion, meaning things that are usually actively secreted from the blood to the fluid for excretion.
  48. Excretion =???? (equation)
    Excretion = Filtration - reabsorption + secretion
  49. Quantitatively, which is more important, reabsorption or secretion??
    If we’re looking at quantitatively, reabsorption is more important than secretion
  50. What substances is secretion important for??
    Secretion is important for H+ and K+ secretion /excretion.
  51. What is the real goal of glomerular filtration?
    • To eliminate the waste products we want to get rid of while at same time retaining water and important electrolytes.
    • How we have ideal composition of all ECF (is through these processes)
  52. What is filtered in glomerular filtration?
    • Waste products of metabolism
    • Hormone metabolites
    • Electrolytes (mostly reabsorbed)
    • Amino acids (reabsorbed-mostly)
    • Glucose (reabsorbed-mostly)
  53. What are the following waste products from? 
    Urea
    Creatinine
    Uric acid
    Bilirubin
    • Urea – from amino acids
    • Creatinine – from muscle creatine
    • Uric acid – from nucleic acids
    • Bilirubin – from hemoglobin
  54. When does glucose spill into the urine?
    • When it's above the threshold
    • Glucose level must be below the renal threshold (if blood glucose level is below a certain point it won’t spill in the urine)
  55. TRUE or FALSE. Waste products are usually reabsorbed
    • FALSE
    • Waste products are generally poorly reabsorbed.
  56. What is the composition of the glomerular filtrate??
    • Like plasma but without plasma proteins & cells.
    • Remember protein bound things (like Ca+) are not filtrated when bound!
  57. GFR = ___L/day or ___ml/min
    180L/day or 125ml/min
  58. GFR generally correlates with what??? (hint: it's about 10% less in women)
    generally correlating w/surface area for filtration (About 10% less in women)
  59. What is GFR determined by?? (which forces?
    • Determined by opposing forces
    • Hydrostatic pressure, Colloid osmotic pressure, & Capillary filtration coefficient
  60. Why is GFR not determined by colloid osmotic pressure in Bowman's capsule?
    No colloid osmotic pressure because proteins not filtered into Bowman’s capsule so it’s essentially 0.
  61. What is the equation for filtration fraction? What does it signify?
    Filtration fraction = GFR/Renal plasma flow

    Filtration fraction: fraction of the plasma flowing though the glomerulus that actually does get filtered.
  62. TRUE or FALSE. The filtration fraction is similar to the fraction that goes through the renal circulation
    TRUE 20-22%
  63. Figure out the filtration fraction for a CO of 5L and a Hct of 45
    • Figure out the Filtration fraction: GFR/renal plasma flow
    • (to get renal plasma flow – CO is 5L and 20% of CO is renal blood flow = 1000ml)
    • Normal Hct is 45%, so then what we want is 0.55 (the plasma is 55%)
    • So 125/550 = 22%
  64. What is the formula for GFR?
    • GFR is related to surface area.
    • So filtration coefficient (Kf)
    • GFR= Kf x net filtration pressure
  65. Net filtration pressure is about 10mmHg. How do we get this number
    Glomerular hydrostatic pressure (60mmHg) - Bowman's capsule hydrostatic pressure (18mmHg) - Glomerular colloid oncotic pressure (32mmHg)
  66. How do we figure out the filtration coefficient?
    Filtration coefficient = permeability x the surface area available for filtration
  67. Our entire plasma volume is filtered and processed __x/day.
    60x
  68. Permeability of glomerular capillaries = ___ times that of other capillaries
    50x
  69. What makes the glomerular capillaries so permeable?
    • Size 
    • Charge
    • Size of capillary bed – mesangial cells
  70. Size matters when it comes to glomerular capillaries and permeability. Which molecules can freely pass and which ones can't?
    • Molecular diameters < 4 nm are freely filtered
    • Molecular diameters > 8 nm not filtered
  71. Albumin is not filtered via the glomerular capillary, is this due to size or negative charge?
    Albumin has negative charge & this more than molecular size prevents albumin from being filtered
  72. Why do we see proteins in the urine in kidney disease?
    In kidney disease as the cells are destroyed, the charge is lost on basement membrane (why protein is able to get through into the urine)
  73. Sometimes we see small amounts of protein in the urine and this can be normal, why??
    If small amount of protein, usually from shred epithelial cells into the urine (in small amts!!)
  74. When mesangial cells contract, how does this effect GFR?
    They contract and decrease the amount of area available for filtration
  75. What will cause Mesangial cells to contract?
    Angiotensin II and vasopressin, Norepi, histamine will cause contraction

    Dopamine causes relaxation.
  76. List 5 factors effecting GFR
    • Renal blood flow
    • Glomerular capillary hydrostatic pressure
    • Bowman’s capsule hydrostatic pressure
    • Glomerular capillary osmotic pressure
    • Changes in filtration coefficient
  77. Which law can be seen when calculating renal blood flow?
    Ohm's
  78. What is the calculation for renal blood flow?
    Renal blood flow = (Renal artery pressure – Renal vein pressure) divided by Renal vascular resistance
  79. What is renal artery pressure and renal vein pressure (usually)
    • Renal artery arterial pressure is essentially = Systemic arterial pressure.
    • Renal vein pressure is about 3-4mmHg.
  80. Resistance is a big factor in renal blood flow. What controls resistance?
    • Resistance is controlled by sympathetic NS  & hormones.
    • So an increase in resistance will reduce renal blood flow and vice versa as long as arterial and venous pressures are constant.
  81. How is autoregulation important in regards to renal blood flow?
    Autoregulation is impt here and over the range of arterial pressures (80-170mmHg) renal blood flow and GFR will remain constant (MAP)
  82. Renal blood flow is about __% of CO even though kidneys are about less than __% of Body weight.
    20%; 1%
  83. Why is renal blood flow is 10x more than required?
    reason is for kidneys to be able to eliminate waste products.
  84. How does SNS cause an increase in GFR even though there is vasoconstriction of the afferent and efferent arterioles?
    SNS activity will cause increased glomerular capillary hydrostatic pressure. We know that if SNS activity increases BP, it will also increase glomerular capillary hydrostatic pressure.So even though SNS stimulation will cause afferent and efferent vasoconstriction and therefore decrease glomerular filtration, that vasoconstriction will also increase glomerular capillary hydrostatic pressure (which favors filtration). The net result of these two things that are, in a sense, working in opposition is that GFR will decrease from SNS stimulation, but not as much as you would expect from the vasoconstriction alone
  85. Mild to moderate SNS stimulation has little effect on GFR except when???
    Translates to mild-mod SNS stimulation has little effect but more significant in setting of acute blood loss and SNS stimulation (would have more of an effect on GFR).
  86. As long as renal blood flow doesn’t fall below ___% of normal, acute RF can be reversed as long as the cause of the ischemia is corrected before there is cellular damage
    20
  87. Describe the hormonal control of renal blood flow that cause Vasoconstriction
    • Epi and Norepi: cause vasoconstriction of afferent and efferent arterioles, decrease RBF and decreased GFR.
    • Endothelin: (from damaged endothelial cells is potent vasoconstrictor)
    • Angiotensin II: works preferentially on the efferent arteriole and contributes to autoregulation
    • Renin: Secretion stimulated by SNS activity=Vasoconstriction
  88. Describe the hormonal control of renal blood flow that cause Vasodilation
    • Atrial Natriuretic Peptide : vasodilator. Produced in atrial cells of the heart. ↑ glomerular hydrostatic pressure → ↑ GFR
    • Prostaglandins & bradykinin : vasodilators→ ↑ GFR
    • Nitric oxide : vasodilator →↑ GFR
  89. Describe what stimulates Renin secretion
    • Juxtaglomerular apparatus is the site of secretion of renin.
    • If there is a decrease in RBF caused by SNS activity, that will also decreased flow of Na and Cl to macula densa which stimulate renin release and get RAAS and vasoconstriction from AII.
  90. What is the definition of Renal  Autoregulation?
    Renal blood flow & GFR relatively constant despite changes in BP
  91. What is the purpose of Renal Autoregulation?
    • Maintain oxygen & nutrient delivery
    • Removal of waste products
    • --Maintain constant GFR & control of water & solute excretion
  92. What is the mechanism of autoregulation?
    Feedback linking changes in [NaCl] at macula densa with control of arteriolar resistance
  93. What does the macula densa do?
    • These cells will sense the changes in volume that get delivered from the thick ascending limb to the distal tubule.
    • The signal from the macula dense has 2 effects:
    • It will decrease the resistance in the afferent arterioles which will increase glomerular hydrostatic pressure, helping returning GFR back to normal.
    • An increase in renin that is released in the RAAS (renin angiotensin aldosterone system).
  94. What stimulates the tubuloglomerular feedback mechanism?
    ↓ GFR → ↓ flow via L of H → ↓ NaCl concentration at macular densa (↑ reabsorption)
  95. What effects does the tubuloglomerular have when stimulated?
    • ↓ resistance of afferent arterioles→ ↑ glomerular hydrostatic pressure ↑ GFR to normal
    • ↑ renin →↑ angiotensin I → ↑ angiotensin II → vasoconstriction of efferent arterioles →↑ glomerular hydrostatic pressure returning GFR to normal
  96. What is the point of the tubuloglomerular feedback mechanism?
    • It provides feedback to both the afferent & efferent arterioles for autoregulation of GFR.
    • As long as the MAP is  75 or 80 – 160 or 170 [then GFR will change minimally.
  97. What is the myogenic mechanism?
    • Another piece of autoregulation (besides tubuloglomerular feedback)
    • Smooth muscle of afferent arterioles contracts in response to stretching produced by an ↑ transmural pressure
    • ↑ Perfusion pressure → ↑ contraction & ↑ resistance, results in decreased flow and GFR returns to normal
  98. Outside of autoregulation, renal blood flow is .....
    pressure-dependent
  99. Glomerular filtration generally stops when the MAP is <__-___mmHg (according to Morgan).
    40-50
  100. Glomerular Capillary Hydrostatic Pressure (GCHP) is a factor effecting GFR. What are the three variables that determine the GCHP?
    • Systemic BP
    • Afferent arteriolar tone (Vasoconstriction& Vasodilation)
    • Efferent arteriolar tone (Vasoconstriction & Vasodilation)
  101. What is the main means of physiologic regulation of GFR??
    Glomerular Capillary Hydrostatic Pressure
  102. If we increase resistance in afferent arterioles (constrict) will it increase or decrease glomerular capillary hydrostatic pressure?
    DECREASE it, so decrease GFR

    Dilation of afferent arterioles will do the opposite, increase GCHP and increase GFR
  103. What happens to the glomerular capillary hydrostatic pressure if we constrict the efferent arterioles?
    Increase GCHP and increase GFR

    Vasodilation will do the opposite (Decrease GCHP and decrease GFR)

    ***But only to a point....
  104. If we constrict the efferent arteriole, that will increase resistance to outflow. That also increases GCHP and will increase GFR to a point, the point being as long as that constriction of efferent arteriole doesn’t back up and decrease Renal blood flow too much. What happens then?
    • Severe efferent constriction causes a decrease in renal blood flow in that way, causes increase in the filtration fraction because of the decreased denominator of that filtration fraction.
    • So w/severe constriction of efferent arteriole there is a decrease in GFR. (but up until severe there would be an increase in GFR)
  105. Bowman’s Capsule Hydrostatic Pressure is another factor affecting GFR. What happens if this pressure increases? (what scenario may this happen??)
    • Increasing BCHP = decreased GFR (Pushing back into the glomerulus)
    • Example: ureteral calculi (or anything obstructing urinary tract)
  106. Glomerular capillary osmotic pressure is another factor effecting GFR. How does it do this?
    • Increased Glomerular capillary osmotic pressure (meaning an increase in plasma protein concentration) that will pull back more into the glomerular capillaries and will oppose filtration and because the glomerular capillary osmotic pressure follows plasma colloid osmotic pressure if there's a decrease in plasma colloid (or plasma protein concentration) that will increase filtration because there will be less opposition to filtration
    • Ex: ↑Albumin =↓filtration
  107. Changes in filtration coefficient is another factor that will effect GFR. How?
    • ↑ filtration coefficient → ↑ GFR \GFR is directly proportional to membrane permeability & surface area
    • Contraction of mesengial cells (from angiotensin 2, vasopressin, norepi, & histamine but NOT dopamine) ↓’s surface area → ↓ GFR
    • HTN, DM, etc. also ↓ effective surface area from thickening of glomerular capillary membrane so ↓ GFR
  108. List some conditions that may alter GFR
    • Chronic, uncontrolled HTN
    • IDDM
    • Kidney stones
    • Hypotension
    • Renal artery stenosis
    • ACE inhibitors
    • Sympathetic stimulation
  109. How does long term uncontrolled HTN alter GFR?
    Kf permeability coefficient will decrease because of thickness of glomerular capillary membrane, damaged capillary, loss of functioning, loss of surface area for filtration, decreased GFR
  110. How do kidney stones effect GFR?
    cause increase in hydrostatic pressure in Bowman’s capsule obstructing outflow. So for that reason decreased GFR.
  111. How does renal artery stenosis alter GFR?
    afferent arteriole constriction, so decreased glomerular capillary hydrostatic pressure and decreased GFR
  112. How doe ACE-I alter GFR?
    they’ll be a decrease in efferent arteriolar resistance (Angiontensin II preferentially causes vasoconstriction of efferent arteriole) so if we’re inhibiting that effect with an ACE-I or ARB we get less efferent arteriolar resistance, decreased glomerular capillary hydrostatic pressure and decreased GFR. So patients on ACE-I need renal function (GFR) followed.
  113. How does sympathetic stimulation alter GFR?
    similar to renal artery stenosis, increased in afferent arteriolar resistance, decreased glomerular capillary hydrostatic pressure and decreased GFR.
  114. TRUE or FALSE. Tubular reabsorption isn't selective & quantitatively small
    FALSE. Tubular reabsorption is selective & quantitatively large
  115. How does reabsorption occur?
    • Active transport
    • Co-transport with sodium (Glucose, Amino acids, &Organic acids)
    • Osmosis (water)
  116. Tubular secretion important for which two things?
    H+ and K+
  117. Where does reabsorption and secretion occur?
    In the tubules
  118. What two things are completely reabsorbed (unless over threshold) so they are not excreted (essentially excretion is zero)
    Glucose and AA
  119. What is poorly reabsorbed and are mainly excreted ?? (Which is a good thing)
    Certain waste products (urea, creatinine)
  120. What is highly reabsorbed but the rates of reabsorption and secretions of some ions can be variable and can be controlled
    many ions (esp. Na+)
  121. Describe the active transport in reabsorption
    • Na is actively transported by the Na/K ATPase pump.
    • This pump keeps a low intracellular gradient so the Na+ will go passively from the tubular lumen into the epithelial cells.
    • So the active transport sets up the intracellular gradient for passive transport of Na from the tubular lumen
  122. Describe co-transport in reabsorption
    • Na+ gets coupled w/other solutes.
    • Also coupled w/secretion of H+ ions.
    • If Na and other substances (like glucose, AA, etc.) going from tubular fluid back into circulation (reabsorbed) but for something like H+ going in opposite direction.
    • Co transport(going in same direction-reabsorption) vs. counter transport (going in opposite direction- H+ secreted while Na is reabsorbed)
  123. What is a major function of the proximal convoluted tubule?
    Na+ reabsorption (2/3 of it happens here)
  124. What two things will enhance Na reabsorption in the PCT?
    Angiotensin II and norepi will enhance NA reabsorption in early PCT
  125. Only about __-__% of glomerular filtrate actually gets to the Loop of Henle because so much gets reabsorbed in the PCT
    25-35%
  126. Describe the pathway of Na through primary active transport
    • Na – K – ATPase system moves Na from tubular epithelial cell → across basement membrane to interstitial fluid to the peritubular capillary
    • Negative potential inside the epithelial cell & concentration gradient cause diffusion of Na from tubular fluid into tubular epithelial cells (where it gets actively transported again)
  127. Describe facilitated diffusion of Na+ reabsorption
    • Carrier proteins on luminal surface of epithelial cell membrane
    • ↑ surface area in proximal tubule
  128. Describe the glucose secondary active transport
    • Na+ diffuses down concentration gradient created by Na-K-ATPase pump
    • Energy is released which then drives the transport of substance glucose against concentration gradient
    • So essentially all glucose and all AA are reabsorbed in this way.
  129. How is water reabsorbed? Does it require energy?
    Passive by osmosis, no ATP required
  130. Describe the "solvent" drag associated with water reabsorption
    • Water often moves w/Na.
    • As water moves across those junctions by osmosis it can carry solutes with it.
    • So changes in sodium reabsorption significantly influences reabsorption of sodium and other solutes.
  131. TRUE or FALSE. Water can only move if the membrane is permeable to it, regardless of concentration gradient
    TRUE
  132. Water moves through “tight junctions” but the permeability of these varies according to section of tubule. Describe each section and the permeability
    • PCT: highly permeable to water and ions.
    • Ascending loop of henle: in particular almost no water is reabsorbed, essentially impermeable to water despite a concentration gradient.
    • DCT and collecting ducts: permeability of water is dependent of ADH and insertion of aquaporins so water can get reabsorbed
  133. What receives filtrate from Bowman’s capsule?
    Proximal Convoluted Tubule
  134. The proximal convoluted tubule reabsorbs ___% of Na+ and water (most of it)
    65%
  135. Why does the proximal convoluted tubule have a high capacity for active and passive reabsorption?
    • because of the quality of tubular epithelial cells. Will also secrete organic acids, H+ and bases as well as bile salts, catecholamines as well.
    • -Many mitochondria  (suited to active transport)
    • -Large surface area
    • -Multiple carrier proteins
  136. Describe the thin descending portion of the loop of Henle
    • Very permeable to water
    • Mod permeable to solutes
    • Simple diffusion
  137. What are the three sections of the Loop of Henle?
    • Thin descending
    • Think ascending
    • Thick ascending
  138. Which part of the loop of Henle is Impermeable to water -** key to concentration of urine
    The ascending portion (both thin and thick)
  139. Why is there not much active reabsorption in the descending limb of the loop of henle
    few mitochondria
  140. What is different about the thick ascending loop of henle?
    • Highly metabolic (Na-K-ATPase pump)
    • Solute reabsorption (will reabsorb about 25% of filtered Na, Cl, K as well as large amount of Ca bicarb and Mg.)
  141. In the thick ascending limb of the loop of Henle, reabsorption of about __% of filtered Na, Cl, K as well as large amount of Ca bicarb and Mg happens.
    25%
  142. Where is the Loop diuretic site of action??
    in the THICK ASCENDING loop of Henle
  143. Where is the Juxtaglomerular complex?
    In the distal tubule
  144. Why is the distal tubule called the diluting segment? (hint for studying: Distal = Diluting)
    • Reabsorbs most ions!
    • 5% of filtered sodium
    • Na-Cl co-transporter
    • Impermeable to water
  145. Where is the Thiazide diuretic site of action?
    The distal tubule
  146. What do the principal cells in the late distal and cortical collecting duct do?
    • Reabsorb Na+ & water and secrete K+
    • Aldosterone mediated
  147. Where is the K+ sparing diuretic site of action?
    Late distal and cortical collecting ducts (the principal cells)
  148. What do the Intercalated cells of the late distal tubule and cortical collecting duct do?
    reabsorb K+ and bicarbonate & secrete H+
  149. Permeability to water in the late distal tubule and cortical collecting duct is controlled by....
    by ADH
  150. Where is the final site for processing urine?
    Medullary Collecting Duct
  151. How is the permeability to water controlled in the medullary collecting duct?
    by ADH
  152. What is a "bit unusual" about the medullary collecting duct?
    • Permeable to urea
    • unique because urea can get reabsorbed which increases the osmolarity of the interstitial fluid in the medulla which becomes important in making a concentrated urine
  153. How is the medullary collecting duct important in acid/base balance?
    Secretes H+ against a concentration gradient
  154. Regulation of Tubular Reabsorption is done by Peritubular capillary vs interstitial forces. Describe this
    • Hydrostatic – related to arterial BP
    • ↑ BP → ↓ reabsorption
    • Colloid osmotic – related to plasma colloid osmotic pressure
    • ↑ plasma proteins → ↑ COP → ↑ reabsorption
    • ↑ filtration fraction → ↑ plasma filtered → ↑ protein in remaining plasma → ↑ COP → ↑ reabsorption
  155. How does an increase in BP increase urine output?
    • ↑ urine output due to ↑ GFR
    • ↓ renal tubular reabsorption
    • ↑ peritubular capillary hydrostatic pressure →↑interstitial hydrostatic pressure →↑ urine output
    • ↓ angiotensin II → ↓ reabsorption → ↑ urine output
  156. What is the site of release, site of action, and effects of Aldosterone?
    • Site of release: Adrenal Cortex(zona glomerulosa)
    • Site of action: Collecting tubule & duct
    • Effects: ↑NaCl, water, reabsorption; ↑K+ secretion
  157. What is the site of release, site of action, and effects of Angiotensin II?
    • Site of release: From angiotensin I(renin-angiotensin system
    • Site of action: PCT, thick ascending L of H/distal tubule, collecting tubule
    • Effects: ↑NaCl, water, reabsorption; ↑H+ secretion
  158. What is the site of release, site of action, and effects of ADH (Vasopressin)?
    • Site of release: Posterior Pituitary(synthesized in hypothalamus)
    • Site of action: Distal tubule/collecting tubule & duct
    • Effects:↑ water reabsorption
  159. What is the site of release, site of action, and effects of Atrial Natriuretic Peptide
    • Site of release: Cardiac atrial muscle fibers
    • Site of action: Distal tubule/collecting tubule & duct
    • Effects: ↓ NaCl reabsorption
  160. What is the site of release, site of action, and effects of Parathyroid hormone?
    • Site of release: Parathyroid chief cells
    • Site of action: PCT, thick ascending L of H/distal tubule
    • Effects: ↓ PO4--- reabsorption↑ Ca++
  161. How does SNS stimulation effect the kidneys and their function?
    • SNS will affect Na reabsorption, will decrease Na and water excretion.
    • Because renal arterioles are constricted so GFR is decreased.
    • SNS will increase Na reabsorption in PCT as well as thick ascending loop of H.
    • SNS will stimulate renin release, RAAS, will increase Na reabsorption.

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