pathophys exam 1

• darrow yannet diagram


  used to describe volume alterations in response to ECF
• isotonic solution darrow yannet diagram (.9)


  does not move
• hypertonic solution Darrow yannet diagram (3%)


  increases volume and osmolality of ECF and decreases volume of ICF but increases the osmolality of ICF. Water moves from ICF to ECF
• Hypotonic solution Darrow yannet diagram (.45%)


  decreases osmolality of ICF and ECF and increases volume of ICF and ECF. Water moves from ECF to ICF.
• ADH (antidiuretic hormone)

  produced in the hypothalamus and stored in the posterior pituitary and contains osmoreceptors to detect ECF osmolality
• High osmolality

  increases thirst, ADH release, and water intake
• Low osmolality

  Inhibits thirst, ADH release, and water intake
• SIADH (Syndrome of Inappropriate ADH)


  excessive ADH to overhydration to EDEMA, low urine output, hyponatremia and low osmolality
• Diabetes Insipidus

  low ADH and dehydration with excessive diluted urine output and excessive thirst. HYPERnateremia and high osmolality.
• Central Diabetes Insipidus

  lack of ADH production in hypothalamus
• Nephrogenic Diabetes Insipidus


  defect of renal ADH receptors in kidney
• Kidney

  retroperitoneal organs with adrenal gland on top that filters blood and flushes waste as urine or back into blood
• renal artery


  brings blood with waste from heart to kidney
• renal vein 


  carries clean blood to heart and drains into IVC on right side
• Right gonadal vein 


  drains directly into IVC
• Left gonadal vein


  goes into left renal vein then drains into IVC
• cortex

  outer layer of kidney with short cortical nephrons (90% of blood supply)
• medulla


  deeper layer of kidney with long juxtamedullary nephrons (10% of blood supply) last to be perfused and more susceptible to hypoxic injury
• cortical nephrons (80%)


  contains small glomeruli, short loop of henle, peritubular capillaries and is essential for bulk reabsorption and secretion
• juxtamedullary nephrons (20%)


  contain large glomeruli, long loop of henle with large network of vasa recta, and is essential for corticopapillary gradient formation and concentrated/diluted urine formation.
• renal corpuscle ("small body")


  filters glomeruli and Bowman's capsule which surrounds glomeruli and collects filtrates for urine formation, includes the vescular pole with mesangial cells, bowman's urinary space, and urinary pole
• proximal tubule


  located at urinary pole until start of LOH; 2 types- proximal convoluted tubule and proximal straight tubule
• Loop of Henle

  has a thick ascending limb and a thin descending limb
• glomeruli filtration

  filters blood that flows from Glomerular capillaries to Bowman's space
• net filtration in renal system

  only occurs in glomerulus and filtrate is free of proteins, red blood cells, and lipids but contains similar salt concentrations as plasma.
• Glomerular filtration barrier

  1. endothelium is fenestrated with glycocalyx
  2. basement membrane
  3. podocytes with foot processes and slits
• Endothelium layer in glomerular filtration barrier

  primary size barrier and blocks cells from entering through bowman's space
• basement membrane layer in glomerular filtration barrier

  contains negatively charged proteoglycan and acts as a primary charge barrier blocking negative charged proteins from entering and acts as a size barrier
• podocytes in glomerular filtration barrier

  attach to basement membrane by foot processes and acts as a size barrier and uses slits coated with negatively charged proteins to block cells from entering
• Damages in basement membrane barrier cause

  Nephrotic and Nephritic syndrome
• Nephrotic syndrome

  causes increased permeability of glomerulus leading to protein leaking, proteinuria, foamy urine, hypoalbuminemia, hyperlipidemia, and edema
• Nephritic syndrome

  basement membrane becomes thin and gets pores causing red blood cell cast and hematuria (inflammation)
• minimal change disease

  most common cause of nephrotic syndrome in children that causes glomeruli capillary to fuse and thin the foot processes as well as significant protein loss in urine
• edema


  plasma protein loss that leads to fluid flow from blood to ISF by osmosis in nephrotic syndrome
• red blood cell cast

  indicates glomeruli disease such as glomerulonephritis or small vessel vasculitis
• urine formation process


  filtration, secretion, reabsorption, excretion
• filtration

  passive move of substance into Bowman's space from glomeruli capillary, no protein or cells are in filtrate
• secretion


  delivery of a substance from peritubular capillaries to renal tubules, major function of cortical nephrons
• excretion


  delivery of a substance from renal tubules to peritubular capillaries, major function of cortical nephrons
• choice of substance when filtration=excretion

  insulin and creatinine