renal tutorial ppt

8/7/2019 Renal Tutorial ppt

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P E G G Y C H E N & J O Y C E L A M

Renal Tutorial



Figure 14.02

Glomerulus

(glomerular capillaries)

Bowman¶s space inBowman¶s capsule

Proximal convoluted tubule

Proximal straight tubule

Descending thin limb of Henle¶s loop

Ascending thin limb of Henle¶s loop

Thick ascending limb of Henle¶s loop(containing macula densa at end)

Distal convoluted tubule

Cortical collecting duct

Medullary collecting duct

Renal pelvis

Renal corpuscle

Renal tubule

Proximal tubule

Loop of Henle

Distal convoluted tubule

Collecting duct system



Amount Amount Amount Amount

excreted = filtered + secreted - reabsorbed

Formation of urine



Figure 14.08Forces

involved infiltration

(oncotic pressure)



Concept of clearance

Clearance: the volume of plasma from which that substance is completely

removed (³cleared´) by the kidneys perunit time.

Clearance of S (Cs) =Mass of S excreted per unit timePlasma concentration of S (Ps)

Mass of S excreted per unit time= Urine concentration of S (Us) x Urine volume per unit time (V)

Cs =UsV Ps

@



GFR ?

Urine volume = 2.4 L/day Inulin concentration in the urine

= 300 mg/L

Amount of inulin excreted in the urine= 2.4 L/day x 300 mg/L=720 mg/day

CIN = 720 mg/day z 4 mg/L = 180 L/day

@ GFR = CIN

= 180 L/day



Plasma concentration of sodiumis NOT a marker for total body

sodium.

PNa only reflects the relative

relationship of total body Na and water.

Attention!!



Renal regulation of sodium

-control by GFR

�Na+ and H2O loss due todiarrhea

¡ Plasma volume

¡ Venous pressure

¡ Venous return

¡ Atrial pressure

¡ Ventricular end-diastolic vol

¡ Stroke volume

¡ Cardiac output

¡ Arterial blood pressure� Activity of renalsympathetic nerves

Reflexesmediated by

venous, atrialand arterial

baroreceptors

� Constriction of a.a.

¡ Net GF pressure

¡GFR

Direct effect

¡Na+ and H2O excreted

Kidneys Vander¶s, 10th ed.Fig. 14-18, page 547.(9th ed. Fig. 14-17page 535)



Action of ANP



Vasa recta:

blood vessels in themedulla

Its hairpin-loopstructure, minimizesexcessive loss of solute

from the interstitium.



with vasopressin with vasopressin



with vasopressin with vasopressin

50

50

50

50

50

50

without vasopressin



Osmoreceptorcontrol of

vasopressinsecretion



Baroreceptorcontrol of

vasopressinsecretion



K + secretion can

occur whenrenin-aldosteronesystem is

activated by other causes



Table 14.07

(loss of CO2)



Addition of new HCO3

-

to the plasma-2Mainly inproximal

tubule

This process isalso called ³H+

excretion bound to NH3´



Resp acidosis

Resp alkalosisMet acidosis

Met alkalosis

H+ HCO3- PCO2

Classification of acidosis and alkalosis

CO2 + H2O H2CO3 HCO3- + H+

pH = 6.1 + log10

[HCO3-]

[CO2

]



Loop diuretics

� Acts on the thick ascending limb of the loopof Henle.

� Inhibits cotransport of

sodium, chloride andpotassium (Na+-K +-2Cl-

cotransporter).

� One of the commonly

used diuretics.� e.g. furosemide



Potassium-sparing diuretics

� Inhibit sodium reabsorptionin the CCD, and also inhibitspotassium secretion there.Thus, unlike the otherdiuretics, plasma

concentration of potassiumdoes not decrease.

� Either block the action of aldosterone or block the(aldosterone-regulated)epithelial sodium channel inthe CCD.

� e.g. amiloride,spironolactone



Sample Final Question 1

A patient brought into the laboratory a urine sample collected for aperiod of 24 hrs. In the sample, urine concentration of creatinine was 7.5 mmol/L, urine volume was 2 L. Serum creatinine measuredat the same time was 150 micromol/L. What is the estimatedglomerular filtration rate of this patient?

a) 180 L per day.

b) 120 L per day.

c) 100 L per day.

d) 80 L per day.

e) None of the above values are CORRECT.




A patient brought into the laboratory a urine sample collected for aperiod of 24 hrs. In the sample, urine concentration of creatinine was 7.5 mmol/L, urine volume was 2 L. Serum creatinine measuredat the same time was 150 micromol/L. What is the estimatedglomerular filtration rate of this patient?

a) 180 L per day.

b) 120 L per day.

c) 100 L per day.

d) 80 L per day.

e) None of the above values are CORRECT.




If a healthy person drinks a large amount of water,

a) plasma concentration of anti-diuretic hormone (ADH) will become high.

b) plasma osmolality will become high.

c) urine osmolality will become low.

d) plasma concentration of aldosterone will become high.

e) None of the above is CORRECT.




If a person has a lung disease and is not able to eliminate carbondioxide effectively, it leads to an acid-base disorder. Which of thefollowing is F ALSE about this person¶s acid-base problem?

a) If the renal compensation is appropriate, HCO3- should be low.

b) Blood pH should be low.

c) This condition is called ³respiratory acidosis´.

d) Plasma concentration of hydrogen ion should be high.

e) None of the above statements is F ALSE.




If a person has a lung disease and is not able to eliminate carbondioxide effectively, it leads to an acid-base disorder. Which of thefollowing is F ALSE about this person¶s acid-base problem?

a) If the renal compensation is appropriate, HCO3- should be

low.

b) Blood pH should be low.

c) This condition is called ³respiratory acidosis´.

d) Plasma concentration of hydrogen ion should be high.





Regarding the renin-angiotensin system, which of the followingstatements is TRUE?

a) Angiotensin converting enzyme converts renin to angiotensin I.

b) Renin secretion will increase when parasympathetic nerve isstimulated in the kidney.

c) Renin is secreted by macula densa cells.

d) Angiotensin I is produced by the liver.

e) None of the above statements is TRUE.




Regarding the renin-angiotensin system, which of the followingstatements is TRUE?

a) Angiotensin converting enzyme converts renin to angiotensin I.

b) Renin secretion will increase when parasympathetic nerve isstimulated in the kidney.

c) Renin is secreted by macula densa cells.

d) Angiotensin I is produced by the liver.





Which of the following statements regarding the body fluid isTRUE?

a) Water consists about 60% of body weight.

b) The majority of body water is in the extracellular space.

c) Sodium is the major intracellular solute.

d) Plasma concentration of Na+

is a marker of total body sodium.





Regarding tubular handling of Na+, which of the following statements isF ALSE?

a) Na+ reabsorption is an active process and requires Na+-K +-ATPase on the basolateral membrane.

b) In the cortical collecting duct, Na+ enters cells mainly via Na+ channel.

c) Quantitatively, proximal tubule is the most important segment of the tubulefor Na+ reabsorption.

d) Hormonal control of Na+ reabsorption occurs mainly at the thick ascendinglimb of Henle¶s loop.





Regarding tubular handling of Na+, which of the following statements isF ALSE?

a) Na+ reabsorption is an active process and requires Na+-K +-ATPase on the basolateral membrane.

b) In the cortical collecting duct, Na+ enters cells mainly via Na+ channel.

c) Quantitatively, proximal tubule is the most important segment of the tubulefor Na+ reabsorption.

d) Hormonal control of Na+ reabsorption occurs mainly at thethick ascending limb of Henle¶s loop.





Which of the following statements regarding potassium is TRUE?

a) Potassium is a major extracellular ion.

b) Approximately 20% of the daily intake of potassium is excreted inthe urine.

c) Cortical collecting duct is a major site of potassium secretion in thetubule.

d) Aldosterone stimulates potassium reabsorption in the distalconvoluted tubule.





Which of the following statements regarding potassium is TRUE?

a) Potassium is a major extracellular ion.

b) Approximately 20% of the daily intake of potassium is excreted inthe urine.

c) Cortical collecting duct is a major site of potassiumsecretion in the tubule.

d) Aldosterone stimulates potassium reabsorption in the distalconvoluted tubule.




Sample Final Question 8 (Type B)

Which of the following components of the blood is/arefiltered freely into the Bowman¶s space?

a) Red blood cells.

b) Chloride ion.

c) Triglyceride.

d) Free calcium ion (not bound to albumin).




Which of the following components of the blood is/arefiltered freely into the Bowman¶s space?

a) Red blood cells.

b) Chloride ion.

c) Triglyceride.

d) Free calcium ion (not bound to albumin).




Which of the following statements is/are TRUE?

a) Filtered load of Na is always larger than urinary excretion of Na.

b) Filtered load of creatinine is approximately equal to urinary excretion of creatinine.

c) Filtered load of glucose is usually larger than urinary excretion of glucose.

d) Filtered load of PAH (para-amino hippurate) is usually largerthan urinary excretion of PAH.




Which of the following statements is/are TRUE?

a) Filtered load of Na is always larger than urinary excretion of Na.

b) Filtered load of creatinine is approximately equal tourinary excretion of creatinine.

c) Filtered load of glucose is usually larger than urinary excretion of glucose.

d) Filtered load of PAH (para-amino hippurate) is usually largerthan urinary excretion of PAH.




Renal artery is a vessel, which gives blood supply to the kidney. When the lumen of the renal artery becomes narrow, bloodsupply to the kidney is reduced. Such condition is called³renal artery stenosis´. What is/are the consequence(s) of renal artery stenosis?

a) Plasma concentration of renin will increase.

b) Plasma concentration of aldosterone will increase.

c) Tubular reabsorption of sodium will increase.

d) Extracellular fluid volume will increase.




Which of the following segments of nephron is/areproximal (closer to the glomerulus) to the ascending limbof Henle¶s loop?

a) Cortical collecting duct.

b) Thin descending limb of Henle¶s loop.

c) Distal convoluted tubule.

d) Proximal convoluted tubule.




Which of the following statement(s) regarding the kidneysis/are CORRECT?

a) When the kidney function is impaired, people get

anemic.

b) Kidneys are positioned within the peritoneal cavity.

c) When the kidney function is impaired, serum calcium

concentration usually falls.

d) Antibiotics are never excreted in the urine.




Which of the following statement(s) regarding the kidneysis/are CORRECT?

a) When the kidney function is impaired, people

get anemic.

b) Kidneys are positioned within the peritoneal cavity.

c) When the kidney function is impaired, serum

calcium concentration usually falls.

d) Antibiotics are never excreted in the urine.




Which of the following combination(s) are TRUE?

a) Diarrhea-metabolic acidosis.

b) Renal failure-metabolic acidosis.

c) Vomiting-metabolic alkalosis.

d) Hyperventilation-respiratory alkalosis.




Which of the following statements regarding diureticsis/are TRUE?

a) Furosemide acts at the thin descending limb of Henle¶s

loop.

b) Potassium-sparing diuretics stimulates Na reabsorptionat the cortical collecting duct.

c) Diuretics increase extracellular fluid volume.

d) Diuretics are commonly used to treat hypertension.




Which of the following statements regarding diuretics is/areTRUE?

a) Furosemide acts at the thin descending limb of Henle¶s loop.

b) Potassium-sparing diuretics stimulates Na reabsorption atthe cortical collecting duct.

c) Diuretics increase extracellular fluid volume.

d) Diuretics are commonly used to treat hypertension.




Which of the following statements regarding the anatomy of the kidney is/are F ALSE?

a) Each kidney contains ~one million nephrons.

b) Foot processes are part of the tubular epithelial cells.

c) Macula densa cells are located at the terminal portion of the thick ascending limb of Henle¶s loop.

d) The fluid in the Bowman¶s space usually has a highconcentration of protein.




Which of the following statements regarding the anatomy of thekidney is/are F ALSE?

a) Each kidney contains ~one million nephrons.

b) Foot processes are part of the tubular epithelialcells.

c) Macula densa cells are located at the terminal portion of thethick ascending limb of Henle¶s loop.

d) The fluid in the Bowman¶s space usually has a highconcentration of protein.




Regarding the countercurrent multiplier system, which of thefollowing statement(s) is/are F ALSE?

a) When the tubular fluid enters from the proximal tubule to thedescending limb of Henle¶s loop, the tubular fluid is isoosmotic.

b) As the tubular fluid moves along the descending limb of Henle¶sloop, water is reabsorbed and the fluid becomes hyperosmotic.

c) The thick ascending limb of Henle¶s loop is impermeable to water.

d) The hair-pin loop structure of the vasa recta is suitable for theeffective removal of solutes from the interstitium.




Regarding the countercurrent multiplier system, which of thefollowing statement(s) is/are F ALSE?

a) When the tubular fluid enters from the proximal tubule to thedescending limb of Henle¶s loop, the tubular fluid is isoosmotic.

b) As the tubular fluid moves along the descending limb of Henle¶sloop, water is reabsorbed and the fluid becomes hyperosmotic.

c) The thick ascending limb of Henle¶s loop is impermeable to water.

d) The hair-pin loop structure of the vasa recta is suitablefor the effective removal of solutes from the interstitium.

renal tutorial ppt

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