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Renal Phys > Final Exam > Flashcards

Final Exam Flashcards

1
Q

What is extracellular fluid volume dependent on?

A

Intake and output of fluid and sodium

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2
Q

If the kidneys cannot maintain homeostatic balance of sodium, what 3 systemic adjustments can be made to help?

A
  1. Chg blood pressure
  2. Chg circulating hormones
  3. Chg in sympathetic nervous system
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3
Q

If the kidneys are damaged and have impaired sodium excretion, what changes can help alleviate this?

A

Increase blood pressure to maintain normal sodium excretion (but long term high BP is damaging as well)

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4
Q

What is pressure diuresis?

A

Blood pressure raises & the urinary output increases to compensate and protect the body from BP increase.

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5
Q

What is the term for when blood pressure raises and sodium excretion increases as a result?

A

Pressure natriuresis

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6
Q

T/F: Pressure natriuresis and pressure diuresis usually occur concurrently.

A

True

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7
Q

If fluid intake is greater than urine output, where will the fluid accumulate temporarily?

A

Blood & interstitial spaces (thus incr blood volume and extracellular volume)

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8
Q

T/F: Salt sensitive individuals will see an increase in BP with very little salt intake.

A

True

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9
Q

Activation of the sympathetic nervous system will cause a dilation or constriction of renal arterioles?

A

Constriction–> decreased GFR

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10
Q

What are the big 4 hormones regarding kidney influence?

A

Angiotensin II
Aldosterone
ADH (Vasopressin)
Atrial Natriuretic Peptide (ANP)

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11
Q

Which hormone is considered one of the body’s most powerful controllers of sodium excretion?

A

Angiotensin II

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12
Q

High levels of sodium lead to (increased/decreased) production of renin?

A

Decreased

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13
Q

Decreased renin leads to decreased levels of ____, causing an increase in secretion of sodium.

A

Angiotensin II

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14
Q

T/F: Angiotensin II causes blood volume to increase.

A

False: Angiotensin II has little impact on extracellular volume or blood volume

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15
Q

Salt sensitive people have __ levels of sodium with a ___ renin secretion.

A

High; high (these individuals need excessively high BP to cause renin secretion to decrease)

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16
Q

What effect does increased aldosterone have on sodium and water reabsorption?

A

Aldosterone–> Incr. sodium and water reabsorption

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17
Q

What effect does increased aldosterone have on potassium excretion?

A

Aldosterone–> Incr. potassium excretion

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18
Q

T/F: When fluid deprived, ADH levels would be increased.

A

True

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19
Q

What is the effect of increased ADH?

A

Incr. reabsorption of fluid

Excrete sodium

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20
Q

Is fluid diluted or concentrated when there is an increase in ADH?

A

Concentrated, (ADH=thirsty and hold onto your fluids)

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21
Q

What causes a release of atrial natriuretic peptide?

A

Stretch receptors in the cardiac atria

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22
Q

Atrial natriuretic peptide would have what effect on GFR and reabsorption rate of sodium?

A

GFR would increase,

Sodium reabsorption would decrease, (or increased sodium excretion)

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23
Q

T/F: In a healthy individual, a small increase in arterial pressure will cause an increase in sodium excretion to maintain balance.

A

True

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24
Q

If fluid and proteins are leaking into the interstitium (edema), how do the kidneys respond?

A

Retain salt and fluid to restore blood volume

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25
Q

T/F: Congestive heart failure will only cause extracellular fluid volume to increase.

A

False: Incr. extracellular fluid volume (by 200% or more)

AND incr. blood volume (by 15-20%)

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26
Q

How will nephrotic syndrome & liver cirrhosis affect extracellular fluid volume & blood volume?

A

(Both conditions have decreased protein)
Increased extracellular fluid volume
Normal blood volume

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27
Q

Where is 98% of the body’s potassium contained?

A

In cells

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28
Q

T/F: Insulin is important to help uptake potassium into cells after a meal therefore insulin shots are vital for those with diabetes.

A

True, without insulin shot they may experience symptoms of hyperkalemia

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29
Q

What is aldosterone’s role in potassium balance?

A

Aldosterone increases cellular uptake of potassium.

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30
Q

What is Conn’s Syndrome and what effect will that have on potassium?

A

Conn’s= excess aldosterone which will lead to hypokalemia

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31
Q

What effect will Addison’s Disease have on potassium?

A

Addison’s= deficient in aldosterone which will lead to hyperkalemia

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32
Q

What effect will beta-adrenergic stimulation (ex: epinephrine secretion) have on potassium?

A

Moves potassium into cells

33
Q

What is metabolic acidosis?

A

Increased extracellular potassium levels

Contrast w/ metabolic alkalosis, a decrease in extracellular potassium levels

34
Q

65% of potassium is reabsorbed in the ___ ___ and 25-30% is reabsorbed in the ___ ascending limb of the loop of Henle.

A

65%-proximal tubule

25-30%-THICK ascending limb

35
Q

Daily variations in potassium excretion are handled where?

A

Late distal tubules

Cortical collecting tubules

36
Q

What are principal cells and where are they found?

A

Specialized epithelial cells in the late distal and collecting tubules that secrete potassium for excretion.

37
Q

What is the 2 step process of principal cells excreting potassium?

A
  1. ATPase pump takes K from blood into cell (Na from cell into blood)
  2. ATPase creates high concentration of K, so K passively moves from cell into lumen for excretion
38
Q

What are the 3 factors that control potassium excretion via principal cells?

A
  1. Na-K ATPase Pump activity
  2. Electrochemical gradient for K between blood and tubular lumen? ( I think he meant cell and tubular lumen but whatever)
  3. Permeability of luminal membrane for K
39
Q

When there is a potassium depletion, no secretion of potassium occurs and reabsorption occurs in the ___ cells.

A

Intercalated

40
Q

Does aldosterone stimulate secretion or reabsorption of potassium?

A

Aldosterone–>secretion of K from principal cells

41
Q

What is the aldosterone-potassium control system?

A

Negative feedback system:

Incr. plasma K–> Aldosterone secretion–> K excretion

42
Q

What is the difference between acute and chronic acidosis with regards to potassium secretion?

A 
Acute= Decreases K secretion (by decreasing Na-K ATPase pump activity
Chronic= Increases K secretion
43
Q

T/F: Alkalosis would result in body increasing potassium secretion.

A

True

44
Q

T/F: All enzyme systems & body functions are altered by hydrogen ion concentration.

A

True

45
Q

T/F: H+ concentration should be kept high compared to other ions.

A

False; kept low and tightly regulated

46
Q

T/F: Arterial blood and venous blood should both have a pH of 7.35.

A

False: Arterial=7.4 & Venous=7.35

47
Q

What range is intracellular fluid pH kept at?

A

6.0-7.4

48
Q

Urine pH concentration ranges from __ to __.

A

4.5-8.0

49
Q

Alkalosis occurs when pH of arterial blood is above what?

A

7.4

50
Q

___ occurs when pH of arterial blood is below 7.4.

A

Acidosis

51
Q

What is considered the 1st line of defense in regulating changes in H+ concentration?

A

Acid-base buffering system of fluids (acts w/in seconds)

52
Q

T/F: The acid-base buffering system of fluids is the first line of defense at eliminating H+.

A

False: Doesn’t eliminate H+, only ties it up until it can be eliminated

53
Q

What are the 3 buffers used for acid-base regulation?

A

Bicarbonate
Phosphate
Proteins (for intracellular buffing)

54
Q

What is the 2nd line of defense in regulating acids/bases?

A

Respiratory center (acts w/in minutes)

55
Q

An increase in ventilation will eliminate __from extracellular fluid, thus eliminating H+ overall.

A

CO2

56
Q

What is the 3rd line of defense in regulating acids/bases?

A

Kidneys (act w/in hours to days)

57
Q

What is the most powerful of the acid/base regulating systems: fluid buffers, respiratory center, or kidneys?

A

Kidneys

58
Q

How can the kidneys control the acid/base balance?

A

Excreting acidic or basic urine (which is why the pH range varies from 4.5-8.0)

59
Q

What are the 3 mechanisms done by the kidney for regulating extracellular fluid H+ concentration?

A
  1. Secretion of H+
  2. Reabsorb bicarbonate (HCO3-)
  3. Production of new bicarbonate (HCO3-)
60
Q

Where can hydrogen ion secretion NOT occur?

A

Thin descending and Thin ascending limbs in loop of Henle.

61
Q

T/F: For each HCO3- absorbed, a H+ is secreted.

A

True

62
Q

Most bicarbonate reabsorption occurs in the __ __.

A

Proximal tubule (80-90%)

63
Q

Where does 10% of bicarbonate reabsorption occur?

A

Thick ascending limb (any remainder is taken up in the distal tubule and collecting ducts)

64
Q

H+ is secreted via what mechanism?

A

Secondary Active Transport

65
Q

In what regions are H+ secreted?

A

Proximal tubule, Thick Ascending Limb, & Early Distal Tubule

66
Q

T/F: Secretion of H+ is coupled w/ the transport of Na+ into the cell.

A

True

67
Q

How much acid is formed from metabolism daily?

A

80 Eq/L

68
Q

What are the 2 main buffers in the tubular fluid?

A

Phosphate

Ammonia

69
Q

During alkalosis, tubular secretion of H+ is increased or decreased?

A

Decreased (then not enough H+ to complete HCO3- reabsorption)

70
Q

During acidosis, tubular secretion of H+ is increased which will have what effect on bicarbonate?

A

Increased reabsorption of bicarbonate b/c of the surplus of H+.

71
Q

An increase in pressure of CO2 leads to ___ acidosis.

A

Respiratory Acidosis

72
Q

What is metabolic acidosis?

A

Acidosis that results due to a fall in bicarbonate

73
Q

T/F: Excess hydrogen ions in the renal tubules causes complete reabsorption of HCO3-

A

True

74
Q

How do the kidney’s correct alkalosis?

A

Incr the ratio of bicarbonate to H+ in the renal tubules

75
Q

If excess bicarbonate cannot be reabsorbed because H+ secretion levels are too low, what type of urine is produced?

A

Alkaline urine

76
Q

When does gluconeogenesis occur?

A

Fasting period

77
Q

Which amino acids are primarily used by the kidneys in gluconeogenesis?

A

Lactate, glutamine, glycerol

78
Q

Low carbohydrate levels trigger ___ release, which leads to ___ release allowing for protein mobilization.

A

Corticotropin, cortisol

Renal Phys (2 decks)

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