Module 3 pp. Renal Physiology Quiz

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Questions and Answers

What blood vessels carry blood away from the glomerular capillaries?

  • Vasa recta
  • Peritubular capillaries
  • Afferent arterioles
  • Efferent arterioles (correct)

Which of the following blood vessels supply the loop of Henle?

  • Efferent arterioles
  • Peritubular capillaries
  • Vasa recta (correct)
  • Afferent arterioles

What is the primary function of the renin-angiotensin-aldosterone system (RAAS)?

  • Regulation of red blood cell production
  • Regulation of blood glucose levels
  • Regulation of blood pressure (correct)
  • Regulation of body temperature

Which of the following perioperative conditions might activate the RAAS?

<p>Hypovolemia (C)</p> Signup and view all the answers

Which of the following drugs can inhibit RAAS activation?

<p>ACE inhibitors (C)</p> Signup and view all the answers

Which of the following substances are typically reabsorbed from the tubular filtrate back into the plasma?

<p>Glucose (B)</p> Signup and view all the answers

Which of the following is NOT a mechanism involved in the movement of substances from tubular filtrate back to plasma?

<p>Secretion (C)</p> Signup and view all the answers

What is the primary mechanism responsible for the movement of substances from plasma into the tubular filtrate?

<p>Filtration (A)</p> Signup and view all the answers

What happens to the glomerular filtration rate (GFR) if the efferent arteriole dilates more than the afferent arteriole?

<p>GFR decreases (A)</p> Signup and view all the answers

What happens to the GFR if the efferent arteriole constricts more than the afferent arteriole?

<p>GFR increases (B)</p> Signup and view all the answers

Which of the following is NOT a local mediator produced in response to renal ischemia and stress to maintain renal blood flow and urine output?

<p>Insulin (B)</p> Signup and view all the answers

Which of the following describes the movement of substances from the tubular filtrate back to the plasma?

<p>Reabsorption (D)</p> Signup and view all the answers

Which of the following substances are typically moved from the plasma into the tubular filtrate?

<p>Organic anions (B)</p> Signup and view all the answers

What is the daily glomerular filtration rate?

<p>180 L/day (A)</p> Signup and view all the answers

What is the effect of increased renal blood flow on the glomerular filtration rate?

<p>Increased glomerular filtration rate (A)</p> Signup and view all the answers

What is the primary mechanism for the movement of water and small dissolved molecules from the plasma into Bowman's capsule filtrate?

<p>Bulk flow/Passive movement (D)</p> Signup and view all the answers

What is the effect of efferent arteriole vasodilation on the glomerular filtration rate?

<p>Decreased glomerular filtration rate (C)</p> Signup and view all the answers

What is the effect of NSAIDs on renal blood flow?

<p>Decrease in renal blood flow (C)</p> Signup and view all the answers

What is the mechanism for how the kidneys help to balance the bloodstream's pH?

<p>They excrete acids and reabsorb bases (A)</p> Signup and view all the answers

Which of the following is NOT true about the glomerular filtrate?

<p>It goes directly into the collecting duct (D)</p> Signup and view all the answers

What is the primary function of the renal corpuscle?

<p>Filtration of blood plasma (B)</p> Signup and view all the answers

What is the primary action of atrial natriuretic peptide (ANP) on the body?

<p>Decreases blood volume and blood pressure (A)</p> Signup and view all the answers

Which of the following hormones is produced by the vessel wall endothelial cells?

<p>C-type natriuretic peptide (CNP) (A)</p> Signup and view all the answers

What is the effect of natriuretic peptides on renal blood flow (RBF) and glomerular filtration rate (GFR)?

<p>Increases RBF and GFR (C)</p> Signup and view all the answers

Which of the following is NOT a common action of natriuretic peptides?

<p>Increased cardiac contractility (A)</p> Signup and view all the answers

What is the role of renal prostaglandins during ischemia?

<p>Promote vasodilation to increase blood flow (D)</p> Signup and view all the answers

Which of the following is NOT a function of renal prostaglandins?

<p>Promoting blood clotting (A)</p> Signup and view all the answers

Which of the following statements accurately describes the role of the kidneys in acid-base balance?

<p>The kidneys mainly regulate the metabolic component of acid-base buffering and maintain plasma pH. (D)</p> Signup and view all the answers

Which of the following is a primary mechanism by which the kidneys regulate urine pH?

<p>Binding of H+ ions to buffers like ammonia (NH3) and phosphate (HPO4) (A)</p> Signup and view all the answers

Which of the following is NOT a common side effect of Thiazide diuretics?

<p>Hypermagnesemia (D)</p> Signup and view all the answers

Which of the following drugs is a selective D1-agonist?

<p>Fenoldopam (D)</p> Signup and view all the answers

What is the primary mechanism of action of Thiazide diuretics?

<p>Blocking the Na+/Cl- cotransporter in the distal convoluted tubule (A)</p> Signup and view all the answers

Which of the following is a side effect of Potassium-Sparing Diuretics?

<p>Hyperkalemia (A)</p> Signup and view all the answers

Which of the following statements is TRUE regarding the effect of dopamine receptor agonists on renal function?

<p>They increase renal blood flow (RBF) and glomerular filtration rate (GFR) at all doses, but this effect is countered by their vasoconstrictive actions at high doses. (A)</p> Signup and view all the answers

Which of the following is NOT a known use of Thiazide diuretics?

<p>Treatment of acute kidney injury (C)</p> Signup and view all the answers

Which of the following statements is TRUE regarding the effect of Aldosterone antagonists on sodium reabsorption?

<p>They decrease sodium reabsorption by inhibiting the Na+/K+ ATPase. (A)</p> Signup and view all the answers

Which of the following is NOT a class of diuretics discussed in the content?

<p>Osmotic diuretics (C)</p> Signup and view all the answers

Which of the following is a known side effect of Thiazide diuretics that can be linked to their effect on calcium?

<p>Hypercalcemia (B)</p> Signup and view all the answers

Which of the following is considered a first-line treatment for hypertension?

<p>Thiazide diuretics (A)</p> Signup and view all the answers

What is the primary mechanism by which Potassium-Sparing Diuretics decrease potassium excretion?

<p>Blocking aldosterone receptors in cortical collecting duct and distal convoluted tubule. (C)</p> Signup and view all the answers

Which of the following drugs is an example of a potassium-sparing diuretic that acts as an epithelial sodium channel (ENaC) blocker?

<p>Amiloride (C)</p> Signup and view all the answers

Which of the following conditions are Thiazide diuretics commonly used to treat?

<p>Hypertension and hypocalcemia (C)</p> Signup and view all the answers

What is the primary mechanism by which Dopamine Receptor Agonists decrease sodium reabsorption?

<p>Inhibiting the Na+/H+ exchange (C)</p> Signup and view all the answers

Which of the following is often recommended for treating hypertension in patients with sulfa allergy?

<p>Calcium channel blockers (B)</p> Signup and view all the answers

What is the mechanism of action of loop diuretics?

<p>Block the Na+/K+/2Cl- cotransporter in the thick ascending limb of the loop of Henle (B)</p> Signup and view all the answers

Which of the following is NOT a potential side effect of loop diuretics?

<p>Hypernatremia (D)</p> Signup and view all the answers

What is the primary mechanism by which loop diuretics reduce preload?

<p>Venodilation (A)</p> Signup and view all the answers

Which of the following is a common reason for acute tolerance to loop diuretics?

<p>Activation of the RAAS (A)</p> Signup and view all the answers

Which of the following drugs is NOT a loop diuretic?

<p>Hydrochlorothiazide (A)</p> Signup and view all the answers

What is a potential side effect of loop diuretics that can exacerbate an existing condition like gout?

<p>Hyperuricemia (C)</p> Signup and view all the answers

What is the typical onset of action for furosemide?

<p>5-10 minutes (B)</p> Signup and view all the answers

Which of the following is a common reason why loop diuretics may be less effective at lowering hypertension compared to thiazides?

<p>Loop diuretics cause less vasodilation than thiazides (D)</p> Signup and view all the answers

Flashcards

Atrial natriuretic peptide

A hormone promoting Na+ and water excretion, and vasodilation.

Brain natriuretic peptide

A hormone primarily from ventricular muscles that affects fluid balance.

C-type natriuretic peptide

A hormone produced by vessel wall endothelial cells with similar functions.

Natriuretic peptide actions

Common actions include increased GFR and inhibiting renin release.

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Renal prostaglandins

Hormones that help regulate blood flow and trigger RAAS during ischemia.

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Acid-base balance

The kidneys regulate plasma and urine pH for homeostasis.

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Urine pH regulation

Kidneys maintain urine pH above 4.5 by buffering.

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Metabolic buffering

The process of regulating plasma pH by kidneys through buffers.

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Glomerular Filtration

The process of filtering blood in the kidneys to form urine.

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Reabsorption

Movement of substances from tubular filtrate back into plasma.

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Secretion

Movement of substances from plasma into tubular filtrate.

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Active Mechanisms

Energy-requiring processes for reabsorption and secretion, e.g. Na/K ATPase.

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Passive Mechanisms

Processes that occur without energy, such as diffusion and osmosis.

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Renal Ischemia

Reduced blood flow to the kidneys, affecting their function.

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Efferent Arteriole

Blood vessel that carries blood away from the glomerulus.

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GFR Changes with Arteriole Size

GFR increases with efferent dilation and decreases with efferent constriction.

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Renal Corpuscle

The structure in the kidney responsible for filtration of blood plasma into urine filtrate.

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Glomerular Filtration Rate (GFR)

The rate at which the kidneys filter blood, usually about 180 L/day.

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Filtration Process

Passive transfer of water and small molecules from blood into Bowman’s capsule.

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Hydrostatic Pressure

The force exerted by fluids that promotes filtration in the kidneys.

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Colloid Osmotic Pressure

Pressure that pulls water back into the bloodstream, opposing filtration.

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Renal Blood Flow (RBF)

The volume of blood that passes through the kidneys per unit time, essential for filtration.

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Impact of NSAIDs on RBF

NSAIDs can reduce renal blood flow by inhibiting prostaglandin production.

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Increased ICP

Increased Intracranial Pressure; a serious condition indicating pressure inside the skull is too high.

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Loop Diuretics

Diuretics that block Na/K/2Cl cotransporter in the thick ascending limb of the loop of Henle.

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Natriuresis

The excretion of sodium in the urine, often increased by loop diuretics.

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Potency of Loop Diuretics

Loop diuretics are the most potent diuretics available, effectively promoting diuresis.

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Uses of Loop Diuretics

Commonly used for hypertension, edema, hyperkalemia, and hypercalcemia.

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Side Effects of Loop Diuretics

Includes hyponatremia, hypocalcemia, hypomagnesemia, metabolic alkalosis, and more.

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Furosemide Dosing

Administered up to a maximum of 200 mg per dose; highly bound to albumin.

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Onset of Furosemide

Furosemide has an onset of action within 5 to 10 minutes after administration.

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Loop of Henle Blood Supply

The loop of Henle is supplied by the vasa recta.

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RAAS

Renin-Angiotensin-Aldosterone-System; regulates blood pressure and fluid balance.

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Conditions Activating RAAS

Conditions like hypovolemia or hypotension activate RAAS.

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Drugs Inhibiting RAAS

Medications like ACE inhibitors and ARBs prevent RAAS activation.

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Thiazide Diuretics

Medications that block Na/Cl cotransport in the distal convoluted tubule.

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Effects of Thiazide Diuretics

Decrease Na+, Cl-, and water reabsorption, leading to natriuresis and diuresis.

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K+ Excretion in Thiazides

Thiazide diuretics increase K+ excretion while increasing Ca2+ reabsorption.

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Thiazide Uses

First line treatment for hypertension and conditions like edema and hypocalcemia.

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Thiazide Side Effects

Can cause hyponatremia, hypercalcemia, and metabolic disorders among others.

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Potassium-Sparing Diuretics

Diuretics that decrease K+ excretion and primarily act in the collecting duct.

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ENaC Blockers

Potassium-sparing diuretics that block epithelial sodium channels, such as amiloride.

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Aldosterone Receptor Antagonists

Block the effects of aldosterone, decreasing Na+ reabsorption, includes spironolactone.

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Potassium-Sparing Side Effects

Hyponatremia, risk of metabolic acidosis, and potential gynecomastia are common.

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Dopamine Receptor Agonists

Medications that increase renal blood flow and inhibit Na+/H+ exchange.

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Fenoldopam

Selective D1-agonist that lowers systemic vascular resistance and protects kidneys.

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Dopamine Effects at Higher Doses

At increased doses, dopamine activates sympathetic pathways causing vasoconstriction.

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Thiazide and K+ Relationship

Thiazide diuretics result in increased potassium excretion, opposite of potassium-sparing diuretics.

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Dopamine Action Summary

Increases cAMP, natriuresis, and maintains group renal blood flow with potential sympathetic effects.

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Diuretic Class Effects

Different classes of diuretics target different parts of the nephron and have unique side effects.

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Study Notes

Renal Pharmacology: Diuretics

  • Diuretics are commonly prescribed drugs that promote the loss of sodium and water in the urine, reducing plasma volume and blood pressure.
  • Common uses include hypertension, heart failure, kidney disease, and liver cirrhosis.
  • Diuretics can also be used to manage intracranial pressure (ICP) and intraocular pressure (IOP).

Renal Anatomy & Physiology Review

  • Functions: The kidneys form, concentrate, and dilute urine; regulate fluid and electrolyte homeostasis (maintaining balance of fluids and electrolytes); control osmolarity (concentration of solutes in body fluids) and plasma/extracellular fluid (ECF) volume; and manage acid-base balance.
  • Clearance: The kidneys remove substances from the systemic circulation and eliminate toxins and metabolites. They also produce hormones like renin and vitamin D3.

Basic (Internal) Renal Anatomy

  • Renal Anatomy: The kidneys are bean-shaped organs located in the retroperitoneal space. Structures within the kidney include the hilum, renal papilla, renal capsule, major calyx, minor calyx, and renal pelvis. The nephron is the functional unit of the kidney.
  • Nephron: The nephron is composed of the glomerulus, Bowman’s capsule, and the renal tubule, including the proximal convoluted tubule, loop of Henle (descending and ascending limbs), and distal convoluted tubule.
  • Blood Vessels: The renal blood flow is essential for kidney function, with the renal artery supplying the kidney and the renal vein draining it. Afferent and efferent arterioles influence glomerular filtration rate (GFR).

Regulation of Renal Blood Flow

  • Regulation of Renal Blood Flow (RBF) is crucial; approximately 25% of cardiac output flows through the kidneys per minute.
  • Autoregulation: The kidney maintains a relatively constant RBF despite changes in blood pressure, using both myogenic mechanisms (contraction of smooth muscle cells) and tubuloglomerular feedback.

Hormonal Influence

  • Hormones: Several hormones influence renal function:
    • Aldosterone regulates sodium reabsorption and potassium secretion in the distal tubules.
    • Antidiuretic hormone (ADH) increases water reabsorption in the collecting ducts.
    • Renin-Angiotensin-Aldosterone-System (RAAS): Crucial for blood pressure regulation and fluid balance. It involves the conversion of angiotensinogen to angiotensin II, which causes vasoconstriction and stimulates aldosterone release.

Acid-Base Balance

  • Kidney's Role: The kidneys play a critical role in maintaining blood pH by excreting or reabsorbing hydrogen ions (H+) and bicarbonate ions (HCO3-).
  • Buffers: Various substances (like ammonia and phosphate) act as buffers to regulate blood pH.
  • Urine pH: The kidneys regulate urine pH to maintain a balance, usually greater than 4.5

Urine Filtrate Formation

  • Filtration: Fluids and small solutes are filtered from the blood into Bowman's capsule.
  • Reabsorption: Useful substances are reabsorbed back into the bloodstream.
  • Secretion: Certain substances are actively secreted from the blood into the filtrate.
  • Excretion: Waste products are excreted from the body in the urine.

Filtration - Renal Corpuscle

  • Hydrostatic pressure and osmotic pressure competing forces influence filtration from blood across the glomerular membrane.
  • Glomerular filtration rate (GFR): Varies with age, sex, and body size. GFR is influenced by RBF and the constriction or dilation of the afferent and efferent arterioles.

Diuretics

  • Introduction: Diuretics increase urine production. These are potent diuretics and primary uses include hypertension and water retention from conditions like heart failure, renal failure, liver failure, and acute tubular necrosis. Diuretics are generally prescribed as an adjunct to treatment of a more serious condition.
  • Types of Diuretics:
    • Osmotic
    • Loop
    • Thiazide
    • Potassium-Sparing

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