Exam 4, Biology 2011

Renal-GI-Metabolism-DM-Aging

I. Renal
1. Renal Anatomy:
 Differentiate between the renal cortex, medulla, renal pelvis, and ureter.
o Renal cortex: outside most area of the kidney, where glomerulus capillary and
bownman’s capsule is as well as nephrons
o Medulla: middle area of the kidney, where pyramids are at/ tubular vessels
o Renal pelvis: space that collects urine (bowels)
o Urteter: tube where urine exits
 Describe the anatomy of the nephron: differentiate between the renal corpuscle and the
renal tubule.
o Nephron: functional unit of the kidney- contains renal corpuscle and renal tubule
o Renal corpuscle: glomerulus and bowman’s capsule- forms the filtrate
o Renal tubule: tubes, in charge or reabsorprtion/ secretion only.
 Differentiate the function of the glomerular versus the peritubular capillaries.
o Glomerular capillaries: capillary bed surrounded by bowman’s capsule, has an
afferent arteriole before, efferent after
o Peritubular capillaries: surrounds the length of the renal tubules, site of
reabsorption and secretion
 What is the function of the juxtaglomerular apparatus? What is the function of the macula
densa cells and the juxtaglomerular cells?
o Juxtaglomerular apparatus: AKA distal tubule, specialized area of nephron that
contains granular cells and macula densa cells. It regulates the afferent arteriole,
amount of filtrate going in.
o Granular cells: secrete renin (which promotes aldosterone formation +
vasoconstriction), located close to afferent arteriole to cause constriction, and less
filtrate [graineries-> secrete things]
o Macula Densa cells: detect amount of flow rate of filtrate
2. What relationship do the processes of filtration, reabsorption, and secretion have with the
amount of substance excreted by the kidney?
a. E= F – R + S (EFRS)
b. Filtered load= GFR * Px
3. Define Clearance. What substances can be used to determine renal clearance rates and
why?How can clearance of a substance be used to indicate the overall health of the Kidney?
a. Clearance: the volume of plasma completely cleared of urine over time (Ux * V/ Px)
b. Substances include: those that are freely filtered, not secreted, not reabsorbed. Inulin
and Creatinine are popular choices
c. Clearance of creatinine in comparison to other substances how whether net secretion or
net reabsorption; In functional kidney, rate is 100 ml/min
 d. A kidney that has a GFR less than 100 ml/min is not working properly

4. Filtration:

What constitutes the filtering segment of the nephron? Renal Corpuscle, Bowman’s Space

* Describe the barrier for filtration. What is the major force that acts to promote filtration? Size (must
be low moledular weight) & Charge (negative cannot come in?)

Describe the composition of the filtrate (ultrafiltrate). No cells or proteins, low molecular weight

Describe mechanisms that can function to increase GFR and mechanisms to decrease GFR.

 Increase GFR: NO (from stress, ACh, Histamine, Bradykinin)-> vasodilation [If you get a NO,
try harder-> greater flow]
 Decrease GFR: SNS, Renin/Angiotensin, ANF (incrs BP, note doesn’t affect RBF)

What changes in urine concentration would indicate possible renal damage? If urine becomes
concentrated w/ RBC, proteins, glucose= issue; not suppose to. If too concentrated, means that GFR is
too slow

What is the average filtration rate in L/day & mL/minute? This rate would indicate that the plasma
portion of the blood was filtered approximately how many times per day? 180 l/day; 115-125 ml/min;
plasma volume is filtered 60xs

What is a normal filtration fraction? .15-.2; (15-20% of plasma is filtered); determined by GFR * Px

5. Reabsorption:

o Why is reabsorption of salts so important for reabsorption of water? Water reabsorption occurs by
osmosis, transports of salts creates a gradient for reabsorption of water.

o Describe where in the nephron each of the following occur (when all else fails put proximal)

Most absorption of water and salts- proximal tubule

Most absorption of proteins- proximal tubule, in luminal border

Most absorption of glucose- proximal tubule

* Co-transport of sodium, potassium and chloride? Why is this transporter mechanism so important?-
Thick ascending limb, creates the salt gradient in renal medulla-> without this patients can’t concentrate
urine?

Endocrine regulation of the amount of sodium or potassium reabsorption versus excretion? Distal
Tubule-Aldosterone, Collecting duct-aldosterone, ANF, ADH
o *Describe Tubular Transport Maximum. How is the tubular maximum related to the amount of a
substance that is excreted? What is meant by the term renal threshold? Using the concepts of tubular
maximum, describe why hyperglycemia results in glucose in the urine.

- It is the max transport rate of a substance, when it reaches that rate, additional incrs in
filtered load will result in excretion of substance in urine.
- Renal threshold: maximum concentration of a substance before it starts to get excreted into
urine
- Hyperglycemia is when there is too much glucose in the blood. At 1st, the kidneys are
reabsorbing the glucose, but it has a maximum transport rate of the substance and at this
renal threshold for glucose, glucose starts being excreted in urine.

o Describe the different mechanisms used by the renal tubular cells to reabsorb sodium.

- Co-transport w/ Na+ & glucose, Co-trans w/ Na+ & aa, anti-trans w/ Na+ & H+, anti w/ Na+
& K+ (+s need to be exchanged to balance things out)

o What determines the amount of water reabsorbed? How does a diuretic affect the overall urine
output?

- Amount of H20 reabsorbed det by amount Na+ reabsorbed

- *Diuretic-> gets fluids that are concentrated in areas of the body reabsorbed back into the
lymph nodes, if the person is well hydrated, there should be no change. It should incrs the
overall urine output because the increase in fluid will cause an endocrine response of less
reabsorption of water?

o What key hormones affect water, sodium and potassium reabsorption?

-Aldosterone: absorb Na+, secr K+, absorb H20

-ADH: reabsorb H20

-ANP: Na+ excretion

6. Endocrine Regulation and Renal Function: For each of the following chemical messengers, list the
organ that synthesizes and secretes the messenger, the stimulus for secretion and the effect of the
messenger bodily function

Vitamin D3- for reabsorbing Ca++, phosphate secretion-> inactive form stored in liver, turned active
when converted by PTH but released by kidneys; stimulus for secretion is low levels of Ca+

Renin- secreted by kidneys, enzyme responsible for pathway to make aldosterone which causes
vasoconstriction and reabsorption Na+/secr. K+, stimulated by low Pa, low plasma levels, SNS,

Aldosterone- product released by adrenal cortex, stimulus by angiotensin II (renin/angiotensin

pathway), effect is to reabsorb Na+/secrete K+ -> incrs water reabsorption in effect
 Antidiuretic hormone (vasopressin)- Makes collecting duct more porous, increases water reabsorption,
stimulus is low plasma levels

Atrial Natriuretic Peptide- secreted by heart, stimulus is low bp, result is K+ reabsorption and therefore
water reabsorption

Erythropoietin- secreted by Kidney, response is low O2 levels-> EPO, stimulates production of RBCs,
hopefully incrs O2 supplies

7. What role does the Kidney play in elimination of metabolic waste? Kidneys are essential site of
filtration, reabsorption, secretion. It eliminates organic waste like urea, uric acid, creatinine and excretes
H+ and HCO3- when acid-base levels are off kilter.

8. Define the following terms:

obligatory water loss- .444 L/day of H20

hyponatremia- too little sodium, what runners get when drink too much water, arrhythmia and death

hypernatremia- too much sodium, hypertension could lead to MI

hyperkalemia- too much potassium, lethal injection causes tachycardia and cardiac arrest

hypokalemia- too little potassium, bradycardia, hypotension

uremia- “urine in the blood”, when there is kidney failure

9. Why is health of the Kidneys so important for maintaining healthy bones?

-The kidney secretes vitamin D3 which is essential for Ca++ reabsorption in intestine. D3 is
stimulated when there are low levels of Ca++ in plasma. If the kidneys are not regulating acid
levels properly, a side effect would be that bone minerals would weaken as a buffer to lessen
the effects of acidosis.

10. Describe the mechanisms by which the body regulates acid – base balance. Include the role of the
Body buffer systems, the Respiratory systems, and the Renal-Urinary system. Describe renal tubular
buffers and be prepared to discuss under which conditions the tubules will reabsorb and/or secrete
bicarbonate versus hydrogen ion.

-Body buffer systems: FAST gets rid of H+ version of acid 1)ECF- bicarbonate, 2)Renal Tubular
fluids: bicarbonate, phosphates (2-), ammonium,

-Respiratory system: FAST Gets rid of CO2 version of acid, increased ventilation=incrs pH, when
Ph is high, ventilation decrs. E

-Renal-Urinary system; SLOW, but MOST EFFECTIVE- peeing alkaline or acidic urine: [H+] is
excreted as 1) free [H+], 2) NH4+, 3. H2PO4-. System involves reabsorbtion of [HC03-] or HC
11. Briefly describe each of the following Acid-Base disorders:

o Respiratory Acidosis

o Respiratory Alkalosis

o Metabolic Acidosis

o Metabolic Alkalosis

II. GI: Digestion and Absorption

1. Discuss the major organs of the GI tract and their primary role in digestion and absorption of nutrients.
Include in your discussion the major exocrine and endocrine secretions of the following organs:

Stomach

Pancreas

Liver

Small Intestine3

2. Differentiate between control of GI functions via the ANS, enteric system and endocrine control. How
does control of GI function relate to the phases (cephalic, gastric etc.) of GI absorption and digestion?

3. Describe the key mechanisms for digestion and absorption of carbohydrates, proteins and fats.

4. Describe the mechanisms and stimuli for acid secretion in the stomach.

5. Describe the role of microbiota (gut flora) in the gastrointestinal tract.

6. Describe the major functions of the Liver.

What are the sources of perfusion (blood flow) to the Liver?

Describe the basic anatomy of a liver lobule and hepatic plate.

7. What role does the Liver play in regulation of blood glucose?

What role does the Liver play in elimination of bilirubin and cholesterol?

Integration of CHO, Fats and Metabolism

1. Differentiate between the absorptive and postabsorptive metabolic phases of the body.

What hormones predominate in each phase and what is their role?

What metabolic pathways are stimulated during the postabsorptive phase?

 What metabolic pathways are stimulated during the absorptive phase?

2. Briefly describe/differentiate between the different glut transporters.

3. Describe the key mechanisms for digestion and absorption of carbohydrates, proteins and fats

4. Describe the major functions of CHO, proteins and fats in the body.

5. Discuss the major fuel sources used by the body during rest and exercise.

6. Describe the major pathways for the transfer of energy to ATP.

What role does the intensity and duration of exercise have on the energy flux through the above
pathways?

7. Differentiate between the synthesis and function of the following lipoproteins:

Chylocmicrons, VLDL, IDL, HDL, LDL.

8. Describe the major endocrine secretions of the pancreas:

Alpha cells secrete __________________. The major stimulus for secretion is ______________.

Beta cells secrete ___________________. The major stimulus for secretion is ______________.4

9. Describe the effects of insulin on muscle metabolism. What are glut-4 transporters? How is their
location and function related to insulin signaling? What are the effects of insulin signaling in muscle
cells? Fat cells?

Describe the role of the following proteins: AS160, AMPK, IRS

10. What Liver metabolic pathways that are stimulated with Insulin stimulation?

11. What role does insulin play on fat metabolism? What hormones mobilize fats?

12. What role does muscle contraction have on glucose transport into muscle cells? What is the
mechanism?

13. Define gluconeogenesis. Which organ is the primary organ for gluconeogenesis?

What hormone(s) stimulate gluconeogenesis?

III. Diabetes Mellitus

1. What is the metabolic consequence of an absolute lack of insulin? Why will insulin lack lead to coma
and death of not treated?
2. What are the clinical signs and symptoms of Diabetes Mellitus?

Differentiate between Type 1 vs. Type 2 Diabetes.

3. Differentiate between the Fasting oral blood glucose and the Oral glucose tolerance test.

Please note: For an Oral Glucose Tolerance Test (OGTT) a person is fasted and is given 75 grams of
carbohydrate to ingest.

4. Briefly describe how Diabetes is treated. Differentiate between the treatment of Type 1 and Type 2.

5. Define the term “Insulin Resistance”. Describe conditions that may cause insulin resistance.

What lifestyle changes can alter Insulin Resistance?

IV. Exercise Physiology: Upon completion of studying exercise material and completing the exercise case,
the student should be prepared to answer exam questions concerning the principles of exercise
physiology including the body’s response to an acute exercise bout and the benefits of exercise training.

1. Return to earlier concept in course: What determines a person’s Total Daily Energy Expenditure?

Have an understanding of the components of energy expenditure. How does body mass contribute to
RDEE? How does body mass affect the calories expended during a bout of exercise?

2. What role does exercise play in contributing to weight loss and helping to maintain weight loss?

Discuss the pros and cons of weight loss via the following 3 mechanisms:

o Caloric restriction (Diet) alone

o Exercise alone

o Caloric Restriction (Diet) and exercise

3. What changes in the flow of fuels (substrate utilization; CHO, FFA, Blood glucose) occur as an
individual transitions from rest to exercise?

What role does each of the following contribute to the fuel utilization?

Duration

Exercise Intensity

Level of Fitness

What changes in hormone secretion accompany the change in substrate utilization with exercise? Fill
in the chart with increase or decrease and state why the change occurred. (Table 5-1, Exercise text)

Hormone Change with exercise Why?

Epinephrine/Norepinephrine

Insulin

Glucagon

Cortisol

Growth Hormone-IGF16

4. Two aged-matched healthy college students of the same sex and comparable body size decide to
participate in a fund raising event to raise money for a local charity. They have the choice to participate
in a 3-mile walk or a 5K race.

Individual A= non-trained, no participation in regular exercise Couch Potato

Individual B = aerobic trained, regularly runs 4-6 miles, 5X per week FIT

Fill in the chart with the requested information comparing the response of each of these individuals (A
or B from above) to choosing either walking or running.

Indicate relative amounts of change, i.e., least, most, highest; you will be comparing the response

between the 2 individuals at each speed.

Individual Parameter Walking @ Running @

38.0 ml∙kg-1∙min-1 56.6 ml∙kg-1∙min-1

A heart rate highest highest

B heart rate lower lower

A stroke volume

B stroke volume

_____ ______________________________________________________________________________

A cardiac output

B cardiac output

_____________________________________________________________________________________

A fat utilization
B fat utilization

A CHO utilization

B CHO utilization

Answer the following regarding individuals A and B:

Which individual has the highest VO2max?

Which individual has the highest SVmax?

Who most likely has the lowest resting Heart Rate?

Which individual do you predict to have the lowest resting BP? Why can you not know for sure?

Which individual would have an earlier onset of lactate threshold?

Which individual is at highest risk for development of insulin resistance?

5. Pre-event feeding practices: do they influence the flow of fuels during exercise?

What advantage if any is there to consuming a diet rich in CHOs prior to an endurance event?

Does a diet low in CHOs change the flow of fuels during exercise? Explain

What are the consequences of a diet low in CHO on time to exhaustion? 7

Healthy Aging – Chapter 31 in Exercise Text –Read this chapter!

1. What factors contribute to an individual’s life span?

2. Discuss the changes in the following parameters from ages 20 90.

VO2max

Bone mineral density

Muscle mass

Muscle cross section area

4. What role does physical activity play in determining an individual’s healthy life span? How
powerful is the role of physical activity? What role does BMI play?