renal exam 1

Aside from intracellular and extracellular fluid compartments, there is another small fluid compartment called the transcellular fluid compartment containing about 1-2 L. T/F

true

T/F The high rate of glomerular filtration depends on a high rate of kidney blood flow?

true

True or False. If a cell is placed into a hypotonic solution that has a lower concentration of impermeant solutes water will diffuse into the cell, causing it to swell.

true

So...when analyzing abnormalities in plasma Na concentration (low or high) and deciding on proper therapy, we should first determine whether the abnormality is a result of a

a primary LOSS/GAIN of Na, or a primary LOSS/GAIN of water!

Name the types of nephrons. select two a. cortical nephrons b. juxtamedullary nephrons c. Henle's nephrons d. collecting nephrons e. glomerular nephrons

a. cortical nephrons b. juxtamedullary nephrons

CORTEX:

outer section of the kidney; houses the glomerulus, Bowman's capsule, proximal tubules, and distal tubules (high blood flow, high pressure area)

•As with other visceral smooth muscle: peristaltic contractions in ureter are enhanced by _______________ stimulation, and they are inhibited by ______________ stimulation

parasympathetic sympathetic

Match the glomerular membrane portion with its definition. Endothelium

perforated by thousands of fenestrae and while they are large, they do not allow the passage of proteins

Match the glomerular membrane portion with its definition. Epithelial cells

portion that is not continuous, but has foot-like processes called pedicels or podocytes that encircle the other portion of the capillaries

Pitting edema is ______ edema

EXTRACELLULAR

Interstitial fluid hydrostatic pressure in joint spaces:

-3 to -5 mmHg

Interstitial fluid hydrostatic pressure in pericardial cavity:

-5 to -6 mmHg

Interstitial fluid hydrostatic pressure in pleural cavity:

-7 to -8 mmHg

Order from furthest to closest to the bladder: (1= furthest, 5=closest) -Ureter -Minor calyx -Renal pelvis -Major calyx -Duct of Bellini

1.Duct of Bellini 2.Minor calyx 3.Major calyx. 4.Renal pelvis 5.ureter

Normal Kf =

12.5 mL/min/mmHg of filtration pressure

total GFR for both kidneys a. 250 mL/min b. 300 mL/sec c. 125 mL/min d. 100 mL/sec

125 mL/min

Blood flow to kidneys is normally ____% of CO

22%

Renal blood flow comprises ___% of cardiac output 10% 12% 20% 22% 30%

22%

Compared to the brain, the kidneys normally consume O2 at __X the rate of the brain but have almost __X the flow of the brain.

2;7

After drinking a glass of water, how long will it take to achieve complete equilibrium of this fluid throughout the body (answer in minutes)?

30 min •It takes about 30 minutes to achieve complete equilibrium everywhere in the body after drinking water This is because fluid usually enters the body through the gut and must be transported by the blood to all tissues before complete equilibrium can occur

Transfer of fluid across cell membranes occurs rapidly. That being said, it takes about ___ minutes to achieve equilibrium everywhere in the body after drinking water. 5 mins. 10 mins 20 mins 30 mins.

30 minutes

Autoregulation of the kidneys operates within arterial BP of: __ to _ mmhg 50-180 60-150 40-200 65-175

50-180

The renal CORTEX receives what percent most of the kidney's blood flow? a. 10% b. 25% c. 65% d. 90%

90%

After the age 40, the number of functioning nephrons decreases by about ___% per decade thereafter. a. 10% b. 15% c. 20% d. 5%

A) 10%

______% of the plasma flowing through the kidneys is filtered through the glomerular capillaries; the other _____% is delivered to the peritubular capillaries a. 20; 80 b. 40; 60 c. 60; 40 d. 80; 20

A) 20%, 80% •Fraction of the renal plasma flow that is filtered, or the filtration fraction, averages about 0.2 •This means that 20% of the plasma flowing through the kidneys is filtered through the glomerular capillaries; the other 80% is delivered to the peritubular capillaries !!!

Osmolality is the measure of _____ per ______ a. Osmoles; kg b. Osmoles; L c. Kg; Osmoles d. L; Osmoles

A) Osmoles; kg

There is a ______ amount of Intracellular fluid in comparison the Extracellular fluid in the average adult. a. Increased b. Decreased c. Equal

A) increased •~ 28 of the 42 Liters of fluid in the body are inside the cells, collectively referred to as intracellular fluid •Makes up about 40% of TBW in an "average" person

Blood is composed of 60% ___ and 40% RBCs. Plasma Albumin Platelets Coagulation factors

A) plasma

To regulate short term control of blood pressure the kidneys can excrete this hormone directly. a. Renin b. Angiotensin c. Aldosterone

A) renin

Given the current TBW percent and liters for a 70kg adult male, calculate the amount of liters for a 80kg adult male. a. 48L b. 42L c. 30L d. 12L

A. 48L •In a 70 kg adult man: TBW is about 60% of body weight, or 42 liters •This is dependent on age, gender, and degree of obesity increase in age = decrease TBW that's fluid inc. in fat = decrease TBW that's fluid women = decrease TBW that's fluid

Factors That Can Increase Capillary Filtration (Select all that Apply) a. Increased capillary filtration coefficient b. Decreased capillary filtration coefficient c. Increased capillary hydrostatic pressure d. Decreased plasma colloid osmotic pressure

A. inc. capillary filtration coefficient C. inc. capillary hydrostatic pressure D. dec. plasma colloid osmotic pressure

Select all that apply. Which of the following are functions of the kidneys? a. Gluconeogenesis b. Regulate acid-base balance c. Erythropoietin secretion d. 1,25 Dihyroxyvitamin D3 production

ALL gluconeogenesis regulate acid-base balance erythropoietin secretion 1,25 dihyroxyvitamin D3 production

What are 3 waste products of metabolism by the kidneys?

Any 3: urea, creatinine, uric acid, end products of Hgb breakdown, metabolites of various hormones

Kidneys are the only means of excreting non-volatile acids such as (pick 2) a. Carbonic acid b. Sulfuric acid c. Lactic acid d. Acetoacidic acid e. Phosphoric acid

B) Sulfuric acid E) phosphoric acid

Which part of the kidney receives most of the kidney's blood flow? a. Renal medulla b. Renal cortex c. Juxtamedullary nephrons d. Vasa recta

B) renal cortex •The renal CORTEX (outer part) receives most of the kidney's blood flow, around 90% •Supports flow-dependent functions such as glomerular filtration and tubular reabsorption •The renal MEDULLA (inner part) and its juxtamedullary nephrons receives the other 10% (this area is very prone to ischemia!) •This area is supplied by a specialized portion of the peritubular capillary system called the VASA RECTA

renal blood flow, in the average person, through both kidneys is approximately ____ mL/min, or about ____ % of cardiac output. a. 2000, 30 b. 1100, 22 c. 1500, 22 d. 1100, 30

B. 1100, 22%

Blood flow to kidney is what percent of cardiac output a. 25 b. 22 c. 20 d.12

B. 22% •Blood flow to kidneys is normally about 22% of CO •1100 mL/min

Which of the following is not considered a homeostatic function of the kidney? a. Excretion of metabolic waste products and foreign chemicals b. Regulation of water and electrolyte balances c. Regulation of coagulation factors d. Regulation of erythrocyte production

C) Regulation of coagulation factors

which of the following correctly describes the progression of the venous system through the kidney? a. Renal vein, interlobular vein, arcuate vein, and interlobar vein b. Interlobar vein, arcuate vein, interlobular vein, and renal vein c. Interlobular vein, arcuate vein, interlobar vein, and renal vein d. Renal vein, interlobar vein, arcuate vein, interlobular vein

C) interlobular vein, arcuate vein, interlobar vein, and renal vein •The peritubular capillaries empty into the vessels of the venous system, which run parallel to the arteriolar vessels •The venous system blood vessels progressively form the interlobular vein, arcuate vein, interlobar vein, and renal vein •Renal vein leaves the kidney in the hilum, beside the renal artery and ureter

Where the loop of henle located? (Kind of screwed this question up she said she'd modify it if she used it) a. Nephron b. Cortex c. Medulla d. Calyx

C,A) medulla, nephron

The kidney's (Can / Cannot) regenerate new nephrons

Cannot

Which of the following is an important stimulus of erythropoietin production? a. Hypercarbia b. Anemia c. Polycythemia d. Hypoxia

D) hypoxia •Kidneys secrete erythropoietin, which stimulates RBC production by hematopoietic stem cells in the bone marrow •An important stimulus: hypoxia •Kidneys normally account for almost all erythropoietin secreted into the circulation •This is why severe anemia develops with severe kidney disease or removal of kidneys with hemodialysis placement (decreased erythropoietin production)

Cell membranes are typically highly permeable to ______ a. Sodium b. Potassium c. Chloride d. Water

D) water •ICF is separated from the ECF by a cell membrane that is highly permeable to water but is NOT permeable to most of the electrolytes in the body

Which of the following is not part of the transcellular fluid? a. Synovial fluid b. Intraocular space fluid c. Pericardial fluid d. Plasma. e. CSF

D. plasma •Another small compartment exists, called transcellular fluid Includes synovial, peritoneal, pericardial, and intraocular space fluid, as well as CSF Considered a specialized type of extracellular fluid, even though composition of these fluids may differ drastically from plasma or interstitial fluid All transcellular fluids together: ~ 1-2 Liters

When the Bowman's capsule hydrostatic pressure is increased, what happens to GFR and filtration? a. Stays the same b. Decrease and opposes filtration c.Increase and promotes filtration

Decrease and opposes filtration

The normal GFR is approximately ____L/day

GFR is about 180 L/day •The entire plasma can be filtered and processed about 60 times/day! •This high GFR allows the kidneys to accurately and rapidly control the volume and composition of body fluids

What forces determine the ECF balance between plasma and ISF?

Hydrostatic and colloid osmotic forces

If a cell is placed into a _____________ solution that has a lower concentration of impermeant solutes water will diffuse into the cell. If a cell is placed in a _____________ solution having a higher concentration of impermeant solutes, water will flow out of the cell into the extracellular fluid

Hypotonic, Hypertonic

nonpitting edema is ___________ edema

INTRACELLULAR (occurs when the tissue cells swell instead of the interstitium)

When the Bowman's capsule hydrostatic pressure is decreased, what happens to GFR and filtration? a. Stays the same b. Decrease and opposes filtration c. Increase and promotes filtration

Increase and promotes filtration

What 2 main compartments is total body fluid distributed between?

Intracellular fluid, extracellular fluid

The osmolal concentration of a solution is called__________when the concentration is expressed as osmoles per kilogram of water and it is called_________________when it is expressed as osmoles per liter of solution.

Osmolality; Osmolarity

What are the 2 major regions of the kidney?

Outer cortex & inner medulla

The glomerulus and Bowman's capsule together form the _________.

Renal corpuscle each nephron contains a collection of glomerular capillaries called the glomerulus, where large amounts of fluid are filtered from the blood, as well as a long tubule in which the filtered fluid is converted into urine on its way to the pelvis •Glomerular capillaries have a higher hydrostatic pressure compared to other capillaries (about 60 mmHg) •They are covered by epithelial cells; total glomerulus is encased in Bowman's capsule •Glomerulus and Bowman's capsule together form the renal corpuscle

Humans have continuous loss of water via evaporation from diffusion from the ____ and from the ___________ _____

Skin; Respiratory tract

Osmotic pressure is a. The pressure of a solution against a semipermeable membrane that prevents water from diffusing across that membrane. b. The pressure of a solute against a permeable membrane that allows water to diffuse across that membrane. c. The pressure of a solution against a nonpermeable membrane that prevents water from diffusing across that membrane. d. The pressure of a solution against a semipermeable membrane that allows water to diffuse into the adjacent membrane.

The pressure of a solution against a semipermeable membrane that prevents water from diffusing across that membrane.

THE ONLY EFFECT of adding isotonic saline to ECF (0.9)

an increase in ECF volume

NET EFFECT of hypertonic saline to ECF: (3%)

an increase in ECF volume (greater than that which was added), a decrease in intracellular volume, and an increase in osmolarity in both compartments

•The peritubular capillaries empty into the vessels of the venous system, which run parallel to the

arteriolar vessels •The venous system blood vessels progressively form the interlobular vein, arcuate vein, interlobar vein, and renal vein •Renal vein leaves the kidney in the hilum, beside the renal artery and ureter

Which interstitial fluid pressure corresponds with the loss safety factor against edema, therefore resulting in accumulation of edema due to the large increase in compliance of the tissues. a. +6 mmhg b. 0 mmhg c. -3 mmhg d.-6 mmhg

ask jeff D

In a 70-kilogram man, the combined blood flow through both kidneys is what percentage of the cardiac output. a. 2 Percent b. 22 Percent c. 60 Percent d. 82 Percent

b. 22 percent

Glomerular capillary hydrostatic pressure is determined by which 3 variables? (pick 3) a. Cardiac output b. Afferent arteriolar resistance c. Arterial blood pressure d. Peripheral vascular resistance e. Efferent arteriolar resistance f. Central venous pressure

b. Afferent arteriolar resistance c. Arterial blood pressure e. Efferent arteriolar resistance

NET EFFECT of hypotonic saline to ECF (0.45)

both ECF and ICF volumes are increased, with the ICF volume increasing to a greater extent osmolarity decreases for both

Insensible water loss through the skin averages ____ /day, and can increase to ____ / day with burns. a. 700 mL, 8-10 L b. 1000 mL, 1200 mL c. 350 mL, 3-5 L d.500 mL, 1500 mL

c. 350 mL, 3-5 L

About 60% of blood is ____, and 40% is ____. a. red blood cells, plasma b. oxygen, carbon dioxide c. plasma, red blood cells d. sodium chloride, magnesium

c. plasma, red blood cells

Match the glomerular membrane portion with its definition. basement membrane

consists of a meshwork of a collagen and proteoglycan fibrillae that have large spaces for water and small solutes to filter through

All account for daily loss of body water except? a. insensible water loss via skin and respiratory tract b. fluid lost in sweat c. water lost in feces d. water lost by the kidneys e. hydrolysis reactions

e. hydrolysis reactions

•The distal ends of the capillaries of each glomerulus connect to form the

efferent arteriole •This leads to a second capillary network, the peritubular capillaries •These surround the renal tubules

The vasoconstrictor __________, is a peptide that can be released by damaged vascular endothelial cells of the kidneys.

endothelin

For CORTICAL nephrons: entire tubular system is surrounded by an

extensive network of peritubular capillaries

T/F The nephron (functional unit of the kidney) can be regenerated

false

True/False. The kidney can regenerate new nephrons?

false

The medial side of each kidney contains an indented region called the minor calyx. a. True b. False

false •Medial side of each kidney contains an indented region called the hilum •Renal artery and vein pass through here, along with lymphatics, nerve supply, and ureter •Ureter carries the final urine from the kidney to the bladder, where it is stored until the bladder is emptied

The kidney has two capillary beds. The ________ and the _________capillaries. Fill in the blank.

glomerular; peritubular

_________tonic solutions will cause a cell to shrink because it has a higher concentration of impermeant solutes and water flows from the area of low solutes to the area of high solutes until solute concentrations are equal. a. hyper b. hypo c. iso d. gin

hypertonic

MEDULLA:

inner section of the kidney; houses the Loops of Henle and the collecting ducts (low blood flow, low pressure area)

The bladder neck is about 2-3 cm long; wall is composed of detrusor muscle interlaced with elastic tissue; the muscle here is called the___________ a. Middle sphincter b. External sphincter c. Internal sphincter

internal sphincter

The extracellular fluid is divided into the_________and ___________

interstitial fluid and blood plasma

Filterability of Solutes Is (Directly / Inversely) Related to Their Size.

inversely

•At the end of the thick ascending limb is a short segment that contains in its wall specialized epithelial cells •This is the

macula densa (has an important role in nephron function) •Beyond the macula densa, fluid enters the DISTAL TUBULE (again lies in kidney CORTEX), then the CONNECTING tubule and the CORTICAL collecting tubule, which lead to the cortical COLLECTING DUCT •Initial parts of cortical collecting ducts join to form a single larger collecting duct running downward into the medulla •This is the MEDULLAR COLLECTING DUCT •These collecting ducts merge to form larger ducts, eventually emptying into the RENAL PELVIS through the tips of the renal papillae

The basement membrane has a strong ____(negative/positive)_____ charge which keeps out relatively ______(larger/smaller)___ proteins. Negative/larger Negative/ smaller Positive/larger Positive/smaller

negative; larger

_____________ Charged Large Molecules Are Filtered Less Easily Than _____________ Charged Molecules of Equal Molecular Size.

negatively; positively

The _____________ is the functional unit of the kidney

nephron

Each human kidney contains about 800,000 to 1,000,000___________ each of which is capable of forming urine.

nephrons

Do positively or negatively charged molecules filter more readily across the glomerular membrane?

positively charged •For any given molecular radius (even if smaller than the pores of the molecular membrane), positively charged molecules are filtered much more readily than negatively charged molecules •This is due to the strong negative electric charge of the basement membrane and the outer epithelial cells which provide an important means for restricting large negatively charged molecules (including plasma proteins) •With kidney disease, the basement membrane can be destroyed or damaged, allowing the loss of its negative charge and therefore the filtration of proteins such as albumin to be filtered •They will appear in the urine; this is proteinuria or albuminuria

What two areas of the body that lose water via evaporation that we are not consciously aware of: Skin Digestive tract Kidneys Respiratory tract

skin, respiratory tract

True or False: The blood contains both intracellular fluid and extracellular fluid.

true •Blood contains both ICF (fluid in RBCs) and ECF (fluid in plasma) •Blood is considered to actually be a separate fluid compartment since it is contained within a chamber of its own-the circulatory system •As we know, blood volume is especially important in control of CV dynamics •Average blood volume of adults: ~ 7% of body weight, or about 5 Liters •About 60% of blood is PLASMA, 40% is RBCs

Kidney's are the primary means for elimination of which metabolic waste products? select all that apply a. urea b. creatinine c. uric acid d. bilirubin e. metabolites of various hormones f. alcohol dehydrogenase

urea creatinine uric acid bilirubin metabolites of various hormones

•Beyond the bladder neck, urethra passes through the ____________ ________-- the muscle here is called the _________________ ____________-.

urogenital diaphragm; external sphincter •This is a voluntary skeletal muscle (not smooth muscle, like bladder body and neck); it is under voluntary control of the nervous system and can be used to consciously prevent urination even when involuntary controls are attempting to empty the bladder

For JUXTAMEDULLARY nephrons: long efferent arterioles extend from the glomeruli down into the outer medulla and further divide into specialized peritubular capillaries CALLED

vasa recta

Each kidney has about 250 very large collecting ducts, each of which collects urine from about

• 4000 nephrons

Total GFR for both kidneys =

•125 mL/min; net filtration pressure is experimentally calculated to be 10 mmHg

causes of hyponatremia

•A primary loss of NaCl usually --> hyponatremia and dehydration; associated with decreased ECF volume Conditions: diarrhea, vomiting, overuse of diuretics (inhibit the kidney's ability to conserve Na), Addison's disease (from decreased secretion of aldosterone, impairing the kidney's ability to reabsorb Na •Excess water --> dilution of Na in the ECF --> hyponatremia and overhydration Conditions: excessive secretion of ADH (causes kidney tubules to reabsorb more water)

Those that have glomeruli in the outer cortex are called

•CORTICAL nephrons •These have short loops of Henle, extending only a short distance into the medulla; comprise 70-80% of nephrons

Those that have glomeruli that lie deep in the renal cortex near the medulla are called

•JUXTAMEDULLARY nephrons •These have long loops of Henle that dip deep into the medulla (sometimes all the way to the tips of the renal papillae); comprise 20-30% of nephrons

causes of hypernatremia

•Primary loss of water from the ECF --> hypernatremia: and dehydration DI (inability to secrete ADH) •Excessive sodium in the ECF ---> hypernatremia and overhydration This is because this will cause at least some degree of water retention by the kidneys (the Na retention caused by an increase in aldosterone will also stimulate secretion of ADH, causing the kidneys to reabsorb greater amounts of water... so only mild case) Conditions: excessive secretion of aldosterone (retains Na), causes mild degree; Cushing's disease (cortisol is secreted from adrenal cortex, along with aldosterone)

Renal artery enters the kidney through the hilum, then branches progressively to form the

•interlobar arteries, arcuate arteries, interlobular arteries (aka radial arteries), and afferent arterioles •Afferent arterioles lead to the glomerular capillaries •This is where large amounts of fluid and solutes (except for those plasma proteins!) are filtered to begin formation of urine

The bladder neck is about 2-3 cm long; wall is composed of detrusor muscle interlaced with elastic tissue; the muscle here is called the

•internal sphincter •Its normal tone keeps bladder neck and posterior urethra empty of urine and prevents bladder emptying until the pressure in the body of the bladder rises above a critical threshold

Fluid filtered from the glomerular capillaries flows into Bowman's capsule, then into the

•proximal tubule (lies in the kidney cortex) •From there, fluid flows into the loop of Henle (which dips into the kidney medulla) •Each loop contains a descending and ascending limb •Walls of the descending limb and lower end of the ascending limb are very thin (this is the thin segment of the loop of Henle) •After the ascending limb returns partway to the kidney cortex, its wall becomes much thicker (this is the thick segment of the ascending limb)

A small triangular area exists above the bladder neck, called the

•trigone •This is where the bladder neck opens into the posterior urethra and the two ureters enter the bladder •Trigone has a smooth inner lining, whereas the rest of the bladder mucosa is folded to form a series of ridges called rugae