-
What are the 3 hormones that the kidney secretes?
- renin
- erythropoietin
- 1,23 Vitamin D (active form)
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Which nephrons serve to create concentrated urine?
Juxtamedullary nephrons
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What structure in the Juxtamedullary nephrons serves to create concentrated urine?
Vasa recta
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What is the name for the peritubular capillaries in a juxtamedullary nephron?
Vasa recta
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What part of the glomerular capillary presents the most significant barrier to filtration of plasma proteins?
basement membrane --lamina rara interna, lamina densa, lamina rara externa
-
What is attached to the basement membrane by foot processess that allows for filtration slits?
Podocytes
-
In exercising muscles why are K+ released ?
for vasodilation purposes
-
What are 3 loop diuretics?
- Furosemide
- Bumetenide
- Ethacrynic acid
-
Where do loop diuretics act?
thick ascending limb of Henle
-
Thiazide diuretics act where?
early DCT
-
What are 2 thiazide diuretics?
- chlorothiazide
- Hydrochlorothiazide
-
Where do K+ sparing diuretics act?
Late DCT
-
What are 3 K+ sparing diuretics?
- spironolactone
- Triamterene
- Amiloride
-
What are some conditions that causes hyperkalemia?
- exercise
- cell lysis
- insulin deficiency
- acidosis
- alpha adrenergic receptors
- beta 2 adrenergic antagonists
- hyperosmolarity
-
What conditions hypokalemia?
- insulin excess
- beta 2 adrenergic agonist
- alpha adrenergic antagonist
- alkalosis
- Hypoosmolarity
-
Which cells reabsorb K+ in the DCT?
alpha intercalated cells
-
Which cells secrete K+ in the DCT?
principal cells
-
How does aldosterone stimulates secretion of K+?
- Na+ enters principal cell
- forces Na/K ATPase pump to pump Na out K in
- High conc. of K+ in the cell creates a gradient for secretion of K+
-
How do diuretics like loop diuretics and thiazide diuretics stimulate secretion of K+?
- inhibited reabsorption of Na+ upstream of principal cells creates a gradient of Na for principal cell uptake
- -increased Na reabsorption causes increased K+ secretion
-
Alkalosis causes increases or decreases K+ secretion?
increases K+ secretion
-
Acidosis increases or decreases K+ secretion?
decreases
-
When is phosphaturia and cAMP in urine seen?
high levels PTH
-
What are the findings in pseudoparathyrodism?
- high PTH
- no cAMP in urine
- no phosphaturia
-
A defect where would produce pseudoparathyrodism?
- Gs protein
- Adenyly cyclase
-
How does PTH inhibits phosphate absorption?
Na+/phosphate transporter is inhibited
-
What is the only diuretic that increases calcium absorption?
thiazide
-
What hormone affects reabsorption of urea?
ADH
-
What are the 3 actions of ADH?
- -increases water permeability of principal cells in the DCT and CD
- -increases Na+/Cl-/K+ cotransporter of the thick ascending limb
- -increases urea absorption in the inner medullary CD
-
What kind of receptors are present on the basolateral membrane of peritubular capillary for ADH?
V2 receptors
-
PTH and ADH use what kind of receptor/signalling cascade?
G protein/cAMP/protein Kinase A
-
ADH uses what type of aquaporin?
Aquaporin
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What is the diluting segment?
thick ascending limb
-
What are the loop diuretics?
- furoseramide
- bumatenide
- erthcrynic acid
-
What are the K+ sparing diuretics?
- Spironolactone
- triamterene
- Amiloride
-
What is the cortcal diluting segment?
Early DCT
-
ADH antagonist?
Demeclocycline
-
ADH acts on what cells in the late DCT and Collecting duct?
Principal cells
-
How is Nephrogenic Diabetes treated?
with thiazide diuretics
-
What is the action of Thiazide diuretcs?
- stop Na+ absorption in the early DCT
- decrease GFR
- increased Na+ and H20 absorption in PCT
-
How is central or Neurogenic Diabetes Insipidus treated?
dDAVP---ADH analog
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What are the diluting segments of the nephron?
- thick ascending limb
- early DCT
-
In the presence of ADH is the water clearance positive or negative?
negative
-
In the absence of ADH, is the water clearance positive or negative?
positive
-
What hormone could cause clearance of H20 to be zero?
Loop Diuretics---furosemide, bumatenide, ethacrynic acid
-
In what segment of the nephron is free water generated?
thick ascending limb
-
What effect do loop diuretics have on the absorptions or calcium, magnesium, sodium?
they inhibit them
-
What is the normal range of arterial pH?
7.37-7.42
-
What is the pH range that is compatible with life?
6.8-8.0
-
What catalyzes the formation of carbonic acid?
carbonic anhydrase
-
What are the fixed acids?
- sulfuric--from methionine, cystein
- phosphoric acid---phosphilipids
-
The buffering capacity is greatest where?
within one unit of the pk
-
In respiratory acidosis, is there hypocalcemia or hypercalcemia?
hypercalcemia
-
In respiratory alkalosis is there hypo or hypercalcemia?
hypocalcemia
-
Why does acid-base disturbance produce changes in Ca conc.?
- Because H binds to albumin which leaves Ca free in plasma---hypercalcemia
- In alkalosis--no H binds to albumin so Ca binds to albumin producing Alkalosis
-
What is the most significant intracellular buffer?
Hemoglobin
-
Hemoglobin in its oxygenated or deoxygenated form is a more effective buffer?
What purpose does it serve?
- -deoxygenated
- - as Hb becomes deoxygenated, it takes up CO2 which reacts with H20 to produce H+..which is buffered by the deoxygenated Hb
-
What are two mechanisms for excreting fixed H+?
- -as NH4+
- - as urinary phosphate
-
Excretion of H+ is accompanied by what?
synthesis and reabsorption of HCO3-
-
Where is HCO3- reabsorbed?
In the proximal tubule
-
What produces isotonic urine?
loop diuretics
-
The excretion of H+ in the late DCT and Collecting Duct is accomplished thru what 2 mechanisms?
- H+ ATPase stimulated by aldosterone
- H+/K+ ATPase
-
Which cells secrete H+ in the late DCT and Collecting Duct?
alpha intercalated cells
-
Metabolic acid-base disturbances involve what?
HCO3-
-
Respiratory acid-base disturbances involve what?
CO2
-
When the acid-base disturbance is metabolic, what is the compensatory response?
respiratory
-
When the acid-base disturbance is respiratory, what is the compensatory response?
renal (metabolic)
-
What are two Beta 2 agonists?
-
Do high or low lung volumes increases the resistance to airflow?
High lung volumes
-
What effect on resistance does viscosity have?
viscosity increases resistance
-
Hypoxia causes what in pulmonary circulation?
vasoconstriction
-
Hypoxia in coronary circulation causes what?
vasodilation
-
What happens to the alveoli in an infant with RDS?
alveoli collapse due to absence surfactant
-
Spirometry cannot measure which volume?
residual volume
-
What is vital capacity?
- Inspiratory reserve volume
- tidal volume
- Expiratory reserve volume
-
What is functional residual capacity?
Residual volume + expiratory reserve volume
-
Highest airway resistance is where?
medium-sized bronchi
-
What growth factor is released in exercising muscle to decrease diffusion distant for Oxygen between capillaries and tissues?
Vascular endothelial Growth Factor (VEGF)
-
Tingle body macrophages are characteristic of what?
Benign reactive lymphadenitis
-
What cells secrete renin?
juxtaglomerular cells
-
What glycoprotein is present on platelet that interacts with GpIb on the vascular endothelium?
GpIa
-
What factor along with Gp Ib helps in adhesion of platelets to exposed collage?
von Willebrand Factor
-
What is the most potent activator of platelets?
Thrombin
-
What activates phospholipase c in platelets?
Thrombin
-
Binding of thrombin to platelets does what?
activates Phospholipase C
-
What are the products of Phospholipase C action?
-
Activation of protein kinase C in platelets causes what?
release of platelet granules
-
IP3 released in platelets serves what functions?
- release of Ca which binds to MLCK--shape change
- activation of Phospholipase A--arachidonic acid--Thromboxane A2--->platelet aggregation
-
What is the difference between primary and secondary hemeostasis?
- Primary--platelet adhesion, aggregation
- Secondary--coagulation
-
Tenase complex cleaves what bond in Factor X?
Arginine--Isoleucine
-
What glycoprotein is used for platelets to aggregate?
Gp IIb
-
What activates factor XII?
Kalikrein
-
What activates Factor VII in Extrinsic pathway?
Tissue Factor
-
What is the function of tissue factor complex?
Cleaves VII --->VIIa
-
Tissue factor and tenase complex cleave what bond in Factor X?
arginine--isoleucine
-
What vitamin is needed for carboxylation of gamma-carboxy glutamyl residue?
Vitamin K
-
Which factor acts as a transglutaminase?
Factor XIII
-
What factor acts as a cofactor to Xa and Prothrombin?
Factor V---Leiden
-
What factor activates factor XIII?
Thrombin
-
What protein is involved in the dissolution of the secondary hemostatic plug?
plasmin
-
What degrades active plasmin in blood?
alpha-2-antiplasmin
-
Pepsinogen is normally bound to what?
Fibrin
-
Activators of plasminogen cleave what bond on the plasminogen molecule?
Arg-valine
-
What are 3 activators of Plasminogen?
- Hageman factors
- tPA
- uPA---urokinase
-
What are the 2 major inhibitors of clotting?
- Anti-Thrombin III
- Alpha 2 macroglobulin
-
Anti-Thrombin III inhibits what factors?
7, 9,10,11,12
-
What is the mode of action of Heparin?
Heparin binds to ATIII which allows ATIII to inhibit factors 7,9,10,11,12
-
What agent inhibits Heparin?
Protamine
-
Deficiency of ATIII could lead to what?
Venous thromboembolism
-
What activates Protein C?
Thrombin and Thrombomodulin
-
Protein C acts with what other protein?
Protein S
-
Protein S + Protein C acts to inhibit what clotting factors?
V and VII
-
Von Willebrand disease is said to be a disease of the intrinsic pathway, why?
because vWF carries factor VIII
-
What is defective in von Willebrand Disease?
platelet to collagen adhesion via Gb- Ib
-
Bernard-Soulier Syndrome is characterized by absence of what?
What is the characteristic shape of platelets?
- -absence of Gp-bI
- --giant platelets
-
A Disorder in which Gp-IIb is deficient is called?
Glanzmann's Thrombocytopenia
-
Whats the common form of inherited Hypercoagubility?
deficiency of factor V--Leiden
-
PTT tests the function of which pathway?
intrinsic
-
PT tests the function of which pathway?
extrinsic
-
What effect does Angiotensinogen II have on GFR?
Constricts efferent arteriole so it increases GFR
-
Increased blood flow thru the afferent arteriole would have what effect on the arterioles?
constriction of afferent arteriole---> maintaining GFR
-
What hormone mediates the uptake of Urea?
Aldosterone
-
What 2 substances are used to measure GFR?
-
Why are Creatinine and Inulin used to measure GFR?
because they are neither reabsorbed nor secreted
-
If GFR is high, what is the conc of creatinine in the serum?
low
-
If the GFR is low, what is the concentration of creatinine in the serum?
High
-
What is used to measure RBF?
creatinine
-
What is used to measure RPF?
BUN/PAH
-
What is used to measure afferent arteriole?
creatinine
-
What is used to measure efferent arteriole?
BUN/PAH
-
If you are dependent on filtration what test should be followed?
creatinine
-
If you are dependent on secretion, what test should be followed?
BUN
-
If a drug is totally filtered what is it dependent on?
GFR---> creatinine
-
If a drug is secreted what is it dependent
GFR
-
What causes Fanconi's syndrome?
faulty Na transporter protein in PCT
-
High urine, CA, Mg, PO4, aa, glu are characteristic of what condition?
Fanconi's syndrome
-
Macula Densa senses what?
osmolarity
-
Glutaminase is located where?
late collecting duct
-
Spironolactone blocks what?
aldosterone receptor
-
Triamterene and amelioride block what?
sodium channels
-
What is the difference in skeletal and smooth muscle with regards to Ca2+ action?
- skeletal muscle--Ca binds to troponin c
- smooth muscle--Ca binds to calmodulin
-
Vascular smooth muscles have what ADH receptor, VI and V2?
VI
-
Streptococcus pyogens produces what that increases body temperature?
IL-1
-
CFTR is what type of gated channel?
ATP
-
What are neurophysins?
carrier-proteins used to transport hormones along a tract
-
In what condition would one see Osteitis Fibrous Cystica?
Renal failure
-
How would renal failure cause Osteitis Fibrosa Cystica?
- decreased Ca absorption due to low vitamin D
- increased PTH hormones
-
Pulsatile release of GnRH is used to treat what?
infertility
-
What factors stimulate the secretion of ADH?
increased osmolarity and decreasedblood volume
-
Which ETC complexes utilize iron?
Complex I thru IV
-
Which complex utilizes Cu in the ETC?
IV
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