Guyton and Hall Chapter 27

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1.

CIN is due to?

Generation of oxygen free radicals

toxic to renal tubular cells
Free radicals are atoms with
unpaired electrons produced
through the body's utilization of
oxygen.

6.

Describe the hormonal

control of
aldosterone.

secreted by zona glomerulosa cells

of the adrenal cortex
effects principal cells cause:
-reabsorption of NaCl
-Loss of K+

7.

Describe the hormonal

control of atrial
natriuretic factor.

-Secreted by atrial cells

-inhibits Na Cl and water
reabsorption in distal tubule and
cortical collecting duct
-inhibits renin secretion
-inhibits ADH secretion
-dilates afferent arteriole, constricts
efferent arteriole casueing mild
increase in GFR and little change in
RBF

8.

Describe the hormonal

control of the
parathyroid hormone

-Decrease phosphate reabsorption

in proximal tubule
-Increase Mg++ reabsorption in
loop of Henle
-Increased reabsorption of Ca++ in
distal tubule

9.

Describe the hormonal

control of
thromboxane (TXA2)

Contraction of mesangial cells

decreases surface area for filtration
causes decreased GFR
Decreases RBF

10.

Describe the hormonal

control of vasopressin
(ADH)

Increases water permeability of

distal tubule, collecting tubule and
collecting duct epithelial cells
acts on principal cells
Posterior pituitary hormone

11.

Describe the
medullary collecting
duct

Permeable to water if ADH present

Microvascular obstruction by
crevated RBCs in medullary cells
Osmotic diuresis with ed NaCl load
to distal tubule
Vasoconstriction
2.

Describe homonal
control of
prostaglandins

Normally play a minor role but if

blood loss then become more active
Antagonize ADH
Block distal tubule reabsorption of
Na+

3.

Describe ion and

solute movement in
the thick segment of
the loop of Henle

Ca++ - passive paracellular

reabsorption
Dependent on Na+ reabsorption
Counter transport of H+
Impermeable to water & urea
Tubular fluid becomes hypo-osmotic

4.

Describe
nephrotoxicity of
volatile agents

d/t free Floride levels

Inhibits concentrating ability of
kidney
Causes proximal tubular swelling &
necrosis

Can secrete H+ (H+ATPase pump)

12.

Describe tubular
reabsorption

done through Glomerulotubular

balance
Intrinsic ability of tubules to
increase reabsorption rate in
response to increased tubular load

13.

Describe tubular
reabsorption through
trascellular and
paracellular

Active and passive

transcellular: directly across cell
membrane
paracelluar: through slit pores
ultrafiltration (bulk flow):
movement from interstitium to
capillary

14.

facilitated diffusion in
tubules

requires a carreir protein

-glucose (GLUT1, GLUT2 in
proximal tubule)

15.

Filtration rate

Glomerur filtration rate x plasma

concentration

Concentration & duration

dependent
If free Fl- < 50 um / L seldom a
problem
If free Fl- > 150 um / L, then high
incidence of renal failure
5.

Describe sympathetic
stimulation?

Decreases sodium and water

excetion by constricting both
afferent and efferent arteriole
causes decrease in GFR
Increased renin release causes
angiotensin II formation causes
incresaed absorption and
decreased excretion of sodium

Permeable to urea

16.

glomerular filtrate flows

through:

Proximal tubule

24.

Loop of Henle

How much of the filtrate

is the reabsorbed in the
proximal tubule?

65% of all filtrate reabsorbed.

Extensive brush border loaded
with carrier proteins

Distal tubule
Cortical & medullary
collecting duct

Na+K+ATPase pumps on
basolateral sides of tubular cell
but not apical side (brush border)

Minor & major calyx

50% of urea reabsorbed

17.

glomerular filtration is very

large, is reabsorption large or
small?

large

25.

In the hormonal contral

of bradydinin, what
occurs?

decreases renal vasoconstriction

causing increased RBF and
increased GFR

18.

gradient time transport

No Tm, instead simple

diffusion

26.

In the hormonal control

of of Intropin
(dopamine), what
occurs?

DA1 receptors on renal and

splanchnic vasculature and
proximal tubule
-stimulation causes renal
vasodilation, increased RBF,
increased GFR, natriuresis, and
diuresis

27.

Is filtration selective?

no, filtration is nonselective

Permeability of the
membrane

28.

Is reabsorption
selective?

yes, reabsorption is highly

selective

How does airway pressure

effect RBF, GFR? How do you
stop it?

15 cm H2O PEEP decreases

CO, RBF, GFR and UO by 20
to 30%
-Blunt by hydration

29.

Is tubular fluid iso, hypo

or hypertonic?

isotonic

30.

Osmolality of contrast

...

31.

How do prevent CIN?

Adequate hydration

osmosis in tubules

H2O

32.

Minimize amount of contrast

used

secondary active
transport antiport

counter transport
NHE

33.

simple diffusion in
tubules

amino acids, K, many others

Use least toxic contrast agent

34.

Threshold

Level at which a substance begins

to appear in the urine

35.

Urinary excretion

glomerular filtration-tubular
reabsorption + tubular secretion

36.

What are anesthesia

considerations?

GA or central neuroaxis block: if

hypotension then decreased
urine output
d/t change in Pc regardless of
maintenance of RBF & GFR by
autoregulation

Rate of transport depends

on
Concentration gradient
Time in the tubule

19.

20.

Give acetylcysteine
(Mucomyst)
Antioxidant effect
21.

How long can you induce

hypotension before there is
renal impairment?

if duration in < 2 hours then

no permenent impairment
of renal function.

22.

How much HCO3 is

reabsorbed in the proximal
tubule?

80%

23.

How much HCO3 is

reabsorbed in the thick
segment of the loop of Henle?

~10 tp 15% reabsorbed

37.

what are the 3 steps to

sodium reabsorption?

1 - Na+ diffusion across luminal

(apical side)
membrane d/t electrochemical
gradient
2 - Na+ movement across
basolateral
membrane via primary active
transport
3 - Diffusion into peritubular
capillary via
ultrafiltration (bulk flow)
substances are moving together
as a group.

38.

What are the associated

factors of contrast
induced nephropathy
(CIN)?

Baseline renal function

-90% of CIN d/t preexisting renal
dysfunction
-diabetes mellitus
-contrast agent dose
------if <100mL then CIN not likely

39.

What are the effects of

increased arterial
pressure?

Pressure natriuresis
Pressure diuresis
Increased urine output,
decrease sodium and water
reabsorption d/t increased Pc
and increased Pisf
-increased Pisf favors sodium
diffusion back into tubular
lumen

40.

41.

42.

What are the four

surfaces of the tubular
epithelial cell?

Apical (luminal) side: faces tubule

Basal side: faces peritubular
capillaries
Lateral side: faces clefts btwn
cells
Cell membrane: has high Kg (g
means conductanc)

What are the primary

active transporters in the
kidney?

NaK ATPase
HK ATPase
Ca ATPase
H ATPase

What are the types of

secondary active
symport in the kidney?

Co-transport (symport)
-Na glucose (SGLT)
-Na amino acids
Counter transport (antiport)
-Na H (NHE)
Moves down a gradient

43.

What does do the type A

intercalated cells do in
the cortical collecting
duct?

also called Brown cells

secrete H+ (H+ATPase pump)
reabsorb K+ and HCO3-

44.

What do PGs do to the

mesangial cells and what
effect is there on GFR?

relaxes mesangial cells, causing

increase in GFR

45.

What do type B
intercalated cells of the
cortical colllecting duct?

Secrete HCO3

46.

What effect do PGE2 and

PGI 2 have on norepi and
ang II

these oppose the action of

norepi and ang II.
-cause relaxation of efferent
arteriole causing decresed GFR
but maintain RBF
-also casue dilation of afferent
arteriole causing increased RBF

47.

What effect on
peritubular Pc and RBF
does the constriction of
the efferent arteriole have
when constricted by Ang
II

Decrease peritubular Pc causes

increase Na+ and water
reabsorption
Decrease in RBF out of
glomerulus causes increase
filtration fraction (FF) causing
increased peritubular IIc causes
reabsorption of Na+ and water

48.

what is NHE

Sodium hydrogen exchange

49.

What is peritubular
capillary pressure
influenced by?

arterial pressure
tone in afferent and efferent
arteriole

50.

What is peritubular
colloid asmotic pressure
influenced by?

Systemic plasma colloid

pressure
Filtration fraction (FF)
-as FF increases protein levels in
plasma not filtered increases

51.

what is SGLT

sodium glucose transport

52.

What is the threshold and

Tm for glucose? What is
the normal plasma level
and normal GFR for
glucose?

Threshold for glucose: 200 mg /

mL
Tm for glucose: 375 mg / mL
Normal plasma level: 1 mg / mL
Normal GFR: 125 mL / min, so
well
below Tm & threshold

53.

What is the transport

mechanism in the kidney?

Primary active transport, can

move against a gradient

54.

What is the tubular load?

Total amount of substance

filtered through glomerular
membrane into tubule each
minute

55.

What is tubular
transport maxim (Tm)

Maximum rate at which a

substance can be reabsorbed
Not all nephrons have the same
Tm
If a substance requires facilitated
diffusion, it will always have a Tm

56.

What occurs at the

cortical collecting
duct?

61.

What occurs in the late

distal tubule?

Active transcellular
reabsorption of Ca++

62.

What occurs in the

second half of the
proximal tubule?

2nd half of proximal tubule has

high concentration of Cl- d/t
above

63.

What occurs in the thick

segment of the loop of
Henle?

25% of Na+, Cl-, & K+

reabsorbed on basal side
(interstitium)
Na+K+ATPase pump

Impermeable to urea
Permeable to water if ADH
(vasopressin)

Na+, K+, 2 Cl- moved into

tubular cell via co-transport on
apical (tubular) side
Loop diuretics inhibit this
process

Aldosterone causes principal cells

to
Reabsorb Na+ & H2O
64.

What occurs to
angiotensin II with
increase arterial pressure?

decreased formation

65.

What occurs to hydrogen

and calcium in the
proximal tubule?

Counter transport of H+ ions

66.

What oppose the action

of prosaglandins?

NSAIDS cause decreased RBF

and decreased GFR
-especially in elderly or anyone
with questionable renal
function

67.

What peritubular
capillary dynamics favor
reabsorption?

Interstitial fluid pressure (Pif) = 6

mmHg)

Secrete K+ on the apical side

ONLY RESPONDE TO Aldosterone!
57.

What occurs at the

diluting segment of the
early distal tubule?

Reabsorb Na+, Cl-, Ca++, Mg++

Impermeable to water & urea
Tubular fluid becomes hypoosmotic
Site of action for thiazide diuretics
Inhibit NaCl co-transport in
luminal membrane

58.

What occurs in the

ascending segment of
the thin loop of Henle?

Virtually impermeable to water

More permeable to Na+ & ClSome reabsorption but primarily
secretion of urea
Almost nonexistent in cortical
nephrons

59.

What occurs in the

descending segment of
the thin loop of henle?

Some reabsorption but primarily

secretion of urea
Tubular fluid becomes
hyperosmotic
60.

What occurs in the first

half of the proximal
tubule?

Capillary oncotic pressure (piec)

= 32 mmHg
68.

No brush border, no active

transport, few mitochrondia,
simple diffusion
Very permeable to water
Less permeable to most ions

1st half of proximal tubule Na+

reabsorbed by symport with
glucose, amino acides, & other
solutes

Ca++: passive paracellular

reabsorption
Dependent on Na+
reabsorption (cotransport)

What peritubular
capillary dynamics
oppose reabsorption?

Capillary pressure (Pc) = 13

mmHg

Interstitial fluid oncotic pressure

(pie isf) = 15 mmHg
69.

What separates the

proximal tubule from
every other portion of
kidney

only segment with glucose

transporters

70.

When does Azotemia

occur?

Azotemia occurs in 24 to 48
hours after exposure, peaks in 3
to 5 days
Excess of urea & other nitrogen
compounds in the blood d/t
dcreased glomerular filtration

71.

Where does angiotensin II have its effect?

Constricts afferent & efferent arteriole

Efferent arteriole more sensitive
Directly stimulates Na+ reabsorption in proximal tubule
Stimulates aldosterone secretion

72.

Where do loop diuretics work?

Loop of Henle furosemide, ethacrinic acid, Bumetinide

sodium will move either way, depending on gradient. Lasix and Bumix effect this
activity, water stays in lumen

73.

Where do osmotic diuretics have effect?

Proximal tubule
Inhibit reabsorption of water and solutes by increasing olmolarity of tubular fluid

74.

Where is the site of action for aldosterone

inhibitors?

Cortical collecting duct

Potassium sparing diuretics
Inhibit action of aldosterone on principal cells lead to:
decrease in Na+ reabsorption
decrease in K+ secretion

75.

Where is the site of action for carbonic

anhydrase inhibitors?

Proximal tubule, inhibits:hydrogen ion scretion, HCO3 reabsorption reduces:

sodium reabsorption

76.

Where is the site of action for Na+ channel

blockers?

Cortical collecting duct

K+ sparing diuretics
Block Na+ channels on luminal (apical) side lead to:
decrease in Na+ reabsorption
decrease in K+ secretion