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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
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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
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Amount Amount Amount Amount
excreted = filtered + secreted - reabsorbed
Formation of urine
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Figure 14.08Forces
involved infiltration
(oncotic pressure)
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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
@
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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
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Plasma concentration of sodiumis NOT a marker for total body
sodium.
PNa only reflects the relative
relationship of total body Na and water.
Attention!!
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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)
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Vasa recta:
blood vessels in themedulla
Its hairpin-loopstructure, minimizesexcessive loss of solute
from the interstitium.
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with vasopressin with vasopressin
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with vasopressin with vasopressin
50
50
50
50
50
50
without vasopressin
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Osmoreceptorcontrol of
vasopressinsecretion
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Baroreceptorcontrol of
vasopressinsecretion
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K + secretion can
occur whenrenin-aldosteronesystem is
activated by other causes
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Table 14.07
(loss of CO2)
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Addition of new HCO3
-
to the plasma-2Mainly inproximal
tubule
This process isalso called ³H+
excretion bound to NH3´
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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
]
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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
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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
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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.
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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.
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Sample Final Question 2
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.
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Sample Final Question 2
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.
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Sample Final Question 3
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.
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Sample Final Question 3
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.
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Sample Final Question 4
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.
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Sample Final Question 4
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.
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Sample Final Question 5
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.
e) None of the above statements is TRUE.
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Sample Final Question 5
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.
e) None of the above statements is TRUE.
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Sample Final Question 6
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.
e) None of the above statements is F ALSE.
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Sample Final Question 6
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.
e) None of the above statements is F ALSE.
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Sample Final Question 7
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.
e) None of the above statements is TRUE.
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Sample Final Question 7
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.
e) None of the above statements is TRUE.
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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).
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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).
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Sample Final Question 9 (Type B)
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.
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Sample Final Question 9 (Type B)
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.
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Sample Final Question 10 (Type B)
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.
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Sample Final Question 10 (Type B)
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.
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Sample Final Question 11 (Type B)
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.
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Sample Final Question 11 (Type B)
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.
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Sample Final Question 12 (Type B)
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.
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Sample Final Question 12 (Type B)
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.
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Sample Final Question 13 (Type B)
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.
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Sample Final Question 13 (Type B)
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.
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Sample Final Question 14 (Type B)
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.
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Sample Final Question 14 (Type B)
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.
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Sample Final Question 15 (Type B)
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.
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Sample Final Question 15 (Type B)
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.
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Sample Final Question 16 (Type B)
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.
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Sample Final Question 16 (Type B)
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.