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Renal

The Renal System ____

removes unwanted substances, maintains homeostasis, and regulate hormones

The kidneys are enclosed in a fibrous capsule of ___

connective tissue

Kidneys consist of a ___

outer cortex and inner medulla

The Kidneys cortex consist of the nephrons ___

glomeruli, proximal, and distal tubules

The Kidneys medulla consist of the nephrons ___

loops of henle and collecting ducts

The Glomerulus is the kidneys ___.

filter

The Proximal Convoluted Tubule

reabsorbs

The Loops of Henle

maintain pH through NaCL and water reabsorption

The Distal Convoluted Tubule

controls electrolyte and pH balance

The Collecting Ducts

Is the last place of possible reabsorption

The glomerulus consist of capillaries, each formed by ~ __ glomerular loops

40

The glomerulus has a ___ __ __ that is negatively charged to repel other vital substances such as proteins

semipermeable basement membrane

The Glomerulus' basement membrane has a size cutoff of ~ __kDa

66

The Glomerulus is surrounded by the ___.

Bowman's Capsule

The Glomerulus is supplied by an ___ and an ___ carries the blood out.

afferent arteriole, efferent arteriole

The __ __ is the most metabolically active part of the nephron

proximal tubule

the proximal tubule absorbs ~ __% of the bodys H2O, Na, and Cl

75

the proximal tubule absorbs ~ __% of the bodys glucose

100

the proximal tubule absorbs basically all of the bodys ___ __

amino acids

reabsorption in the nephrons require either ___ or ___ transport

active or passive

The __ ___ is the limit of how much of something can be reabsorbed

renal threshold

A secondary function of the proximal tubules is to secrete substances such as __ and __

drugs and acids

The loops of henle have a ____ and ____ limb

ascending and descending

The loops of henle is affected by many ____ and _____

diuretics and antidiuretics

The ascending limb of the loops of henle reabsorbs __ and ___

sodium and chloride

The descending limb of the loops of henle reabsorbs ___ (waterfall)

water

The distal tubules maintain ____ and _____ homeostasis

electrolyte and acid-base

In order to maintain homeostasis, the distal tubules use ___ and __

aldosterone and ADH/AVP

The ___ __ are the last possible site for concentrating or diluting urine and/or reabsorbing

collecting ducts

Urine has a normal pH of ____

4.7-7.8

Urine has a normal specific gravity of ______

1.003-1.035

Adequate homeostasis is maintained with ___ml/day of urine

500

If you have Anuria, you void < ___ ml/day of urine

100

If you have Oliguria, you void < ___ ml/day of urine

400

If you have Polyuria, you void > ___ L/day of urine

3

The primary function of the kidneys is the production of __, ____, and ____ (hormones; RED)

Renin, Erythropoietin, and 1,25 vitamin D3

____ boosts rbc production by acting on bone marrow cells

Erythropoietin

______ is the active form of vitamin D and it regulates phosphate and calcium balance as well as bone calcification

1,25 vitamin D3

Chronic renal insufficiency of 1,25 vitamin D3 could lead to ___

osteomalacia

The secondary function of the kidneys is to act upon or degrade hormones that arrive at the kidneys. Examples of hormones that are involved are _______

insulin, aldosterone, and ADH/AVP

___ is produced by the hypothalamus and stored in the posterior pituitary gland

ADH/AVP

ADH/AVP __ _ and ____

restricts water and vasoconstricts

ADH/AVP can stimulate the distal ____ __ to reabsorb more water

collecting tubules

Water intake is regulated by __

thirst

____ is produced by the cortex of the adrenal glands and triggers sodium reabsorption in the kidneys

Aldosterone

The ___ maintains systemic blood pressure and contains Renin inside granules

JGA

The ____ increases blood pressure and sodium reabsorption

RAAS

Describe the RAAS

Renin is released from the JGA in response to decreased afferent arteriole pressure or low sodium delivery to the macula densa. it then cleaves a plasma protein (Angiotensinogen) creating Angiotensin I, which is converted (using ACE) into Angiotensin II

_____ is a powerful vasoconstrictor (increases BP) that also stimulates Aldosterone release. As well as triggering ADH/AVP release and inhibits Renin release

Angiotensin II

Proteins get broken down into amino acids, which are turned into ammonia, which is converted to ___

urea

____% of Urea is passively reabsorbed in the collecting ducts

40-60

Accumulation of urea may cause ___ __

kidney disease

Elevated ammonia may impact your ___

CNS

To test urea, ____ ___ are the most frequently used method; specifically uses the coupled use of urease and glutamate dehydrogenase which is then measured at 340nm to see NADH disapperance.

enzymatic methods

Urea can use ___, ___, or __ for testing

plasma, serum, or urine

With plasma for Urea testing, _____ ____ tubes must be avoided

ammonium heparin

Specimen for urea testing should be _____ a few hours prior to testing if not able to be analyzed immediately

refrigerated

____ is the final product of creatine decomposition and is used as metabolic fuel for muscle contraction.

Creatinine

Creatine decomposition is catalyzed by ____ ____

Creatine Kinase

Creatinine is filtered and not reabsorbed, so it is a good reference to determine ____ ____ ___

Kidney function level

Testing methods for creatinine levels are _________

the Kinetic Jaffe Method, the Jaffe Reaction, and different Enzymatic methods.

The ____ _____ uses picric acid to turn creatinine present in a sample into a red-orange chromagen

Jaffe Reaction

The ____ ____ ____ mixes serum with an alkaline picrate and absorbance rate of change is measured.

Kinetic Jaffe method

The Kinetic Jaffe method is still routinely used despite possible positive interference from _____ ___ and ______

a-keto acids and cephalosporins

Creatinine also uses coupled enzymatic methods, using enzymes like _____, ____, and _____, for testing

creatininase, creatinase, and peroxidase

Creatinine may be measured in ____, ___, or __

plasma, serum, or urine

Urine samples for creatinine measurement should be refrigerated or frozen if it will be stored for _+ days

4

____ ____ is the primary waste product of purine metabolism

Uric Acid

The purines that are metabolised to create Uric Acid is ___ and ___

Adenine and Guanine

Uric Acid is constantly reabsorbed and excreted while traveling throughout the nephrons. To be exact ____% is actively reabsorbed in the proximal tubules and only ___% is finally excreted.

98-100; 6-12

Uric Acid can cause ____ ____ and ___

Kidney Stones and gout

Uric Acid is tested primarily by using ____ (enzyme causing oxidation of Uric Acid to Allantoin) (This is a highly specific testing method)

uricase

Uric Acid also is tested using ____ ____ ____ (using uricase with peroxidase/catalase) and measuring ____ ____ from uric acid oxidation

coupled enzyme methods; hydrogen peroxide

For Uric Acid testing, _____ ____, ___, or ___ are all acceptable

Heparinized plasma, serum, or urine

Some ___ may affect Uric Acid results

drugs

Uric Acid samples are stable once they have been _________

Seperated from RBC's

Uric Acid samples may be refrigerated for ___ days

3-5

___ and ______ additives must be avoided when testing Uric Acid

EDTA and Fluoride

____ is the clearance of different substances or markers

GFR

GFR is the most specific and sensitive measure of ______ _____

functioning nephrons

The ideal marker for GFR is _____ and testing for it is refered to as the "gold standard." It however is extremely expensive

Inulin

The most common test for GFR is _____ _____

Creatinine Clearance

Creatinine levels and kidney function have an ___ relationship

Inverse

_____ _____ is a quantitative measure of the amount of creatinine eliminated. It can also be used to determine kidney function.

Creatinine Clearance

For Creatinine Clearance, _____ is the ideal substance because it is an edogenous metabolic product that is not reabsorbed

Creatinine

In order to determine Creatinine Clearance. you compare ___ _____ ______ to ___ _____ _____

serum creatinine concentration to urine creatinine concentration

Sample for Creatinine Clearance testing is obtained from a _____ ____ ____ and a _____ ______that was collected during the 24-hour urine collection. (preferably at the 12 hour mark)

24-hour urine test and a serum sample

For the 24-hour urine test, you discard the ___ ____ ____ and collect all after, including the 2nd first morning void.

first morning void

Sources of error in the 24-hour urine test are from ____________

patient not following instructions, losing specimen, exercise, hydration (if good should have flow rate of ⪰ 2ml/min) , and also us using an incorrect referance value

_________ is small amounts of albumin (30-300mg) in the urine

Microalbuminuria

Microalbuminuria uses _______ or _________ _______ commonly for testing, as well as a random urine sample test.

nephelometry or immunoturbidimetry immunoassys

Measuring for albumin in urine from 24-hour urine samples is important for ______ ______ control

Diabetes mellitus

______ is a protein associated with acute skeletal and cardiac muscle injury (associated with rhabdomyolysis)

Myoglobin

Myoglobin is easily and rapidly measured by _______

Immunoassays

______ provides an in depth assessment of renal status

Urinalysis

The specimen for a urinalysis test is collected in the _____ and analyzed within 1 hour or else refrigerated at 2-8 ℃ for no more than 8 hours

morning

A Urinalysis test includes a physical characteristic examination, chemical analysis, and a ______ ______ ______

microscopic sediment examination

The darker the urine color, the more ______ it is

concentrated

Urine should be an ___ color and other colors represent different conditions

amber

The more cloudy a urine sample is, the ____ __ ___; also could show hematuria or bacteria present

higher the pH

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