PHLT 304 Exam 3 Questions With Verified Answers

Functions of kidneys - Answer - Maintenance of body fluids and salt levels - Excretion of wastes and foreign particles - Hormone synthesis Renin - Answer angiotensin system: controls water and salt reabsorption by kidneys; regulates blood pressure (BP) Erythropoietin - Answer produced by kidneys in response to tissue hypoxia; stimulates production of blood cells Kidneys participate in conversion of vitamin D - Answer a prehormone from diet (or skin synthesis) to the active form of vitamin D (calcitriol) needed in the body Hypoxia - Answer oxygen deficiency Nephron - Answer unit of filtration in the kidney Average # of nephrons per kidney - Answer = 900,000 to 1 million; range is approx. 200,000 - 2.5 million per kidney Uremia - Answer accumulation of toxic constituents in the blood; usually occurs with severe kidney disease Chronic Kidney Disease (CKD) - Answer Permanent damage to the kidneys causing them to function at less than normal Potential Complications of CKD - Answer - high blood pressure - heart disease (#1 killer in patients with CKD) - Weak Bones - Anemia - Poor Nutrition Symptoms of chronic kidney disease - Answer - Fatigue, tiredness - Insomnia, sleep apnea - Chronic pain - Encephalopathy, dementia - Anorexia, edema, interdialytic weight gain - Decreased libido, infertility - Cognitive problems Stages of Chronic Kidney Disease (CKD) - Answer - Stage 1: Below normal to mild loss of kidney function - Stage 2: Mild to moderate loss of kidney function - Stage 3: Moderate to severe loss of kidney function - Stage 4: Severe loss of kidney function - Stage 5: Kidney failure - Dialysis Causes of kidney disease - Answer - many commonly used drugs are nephrotoxic (toxic to the kidneys), including certain analgesics, antidepressants, antihistamines, antimicrobials, benzodiazepines, cardiovascular agents, proton pump inhibitors, diuretics, herbal products, and drugs of abuse. - Drugs can be an important cause of acute renal failure, particularly among older adults who have co-morbidities and take multiple medications What are the most important causes of kidney disease? - Answer - Diabetes - High blood pressure Risk factors of kidney disease - Answer - Diabetes - High blood pressure - Heart disease - Obesity - Family history of CKD - Age 60 and older - Overuse of pain medicines (e.g., aspirin, naproxen, ibuprofen) - Overuse of alcohol - Use of street drugs (cocaine, heroin, amphetamines) Dietary protein - Answer - Recommended daily allowance for dietary protein: 0.83 g per kg of ideal body weight per day - High protein diet: more than approx. 1.2 - 1.5 g/kg per day - Current average protein intake in the U.S. (NHANES data) is 1.2-1.4 g/kg per day Effects of a high protein diet on kidney health (currently being studied) - Answer - High dietary protein intake can cause hypertension in the glomerulus - Patients with CKD or high risk for CKD may experience harm to the kidneys from high protein intake - Long-term high protein intake may lead to CKD in previously healthy individuals (currently under study) Prevention of kidney disease - Answer - Manage diabetes - Lower high blood pressure - Stop smoking & minimize exposure to secondhand smoke • Smoking can affect medicines that treat high blood pressure • Smoking slows blood flow to the kidneys and can make kidney disease worse - Stay hydrated • Urine should be light yellow or colorless - Eat a healthy diet, exercise & manage your weight - Reduce salt intake: high sodium increases blood pressure - Don't overuse NSAIDs & drugs that affect the kidneys Blood pressure - Answer the force of blood pushing against blood vessel walls as the heart pumps out blood Blood pressure and your kidneys - Answer - Hypertension is both an important cause and a consequence of chronic kidney disease - Approx. 10% of US has CKD - Over 300,000 end stage renal disease (ESRD) cases in US - Predominantly people in oldest quartile Hypertension - Answer - High blood pressure - Affects 60 million Americans - Blood pressure is related to the amount and size of the blood vessels and resistance within and around the vessels • Hypertension medications decrease pressure and change blood flow and resistance to lower BP Systolic blood pressure - Answer - Top number - Pressure through arteries when heart contracts Diastolic blood pressure - Answer - Bottom number - Pressure through arteries between contractions Normal blood pressure - Answer 120/80 mmHg Hypertensive blood pressure - Answer 140/90 mmHg Renal failure - Answer loss of kidney function resulting in its inability to remove waste products from the body and maintain electrolyte balance What is one of the most common causes of drug-induced renal injury? - Answer widespread use of NSAIDs Kidney stones - Answer - Solid crystalline masses formed in the kidney, resulting from an excess of insoluble salts or uric acid crystallizing in the urine; may become trapped anywhere along the urinary tract. - Form with high levels of certain minerals in urine Kidney stones symptoms - Answer - Sharp pain in back, side, groin or lower abdomen - If stone is very small: may not have symptoms Kidney stones treatment - Answer - medical care to break up and/or remove stones - sonication Types of Kidney stones - Answer - Calcium oxalate - Calcium - Phosphate - Uric Acid - Struvite - Cystine Tips from the national kidney foundation - Answer - Hydrate with plenty of water - To prevent calcium oxalate stones: Pair oxalate-rich foods (e.g., peanuts, spinach, beets, chocolate, sweet potatoes) with calcium-rich foods in the same meal so they bind in stomach and intestines before kidneys - Reduce sodium - To prevent uric acid stones: Limit red meat, shellfish, alcohol, sugar Macronutrients in the body - Answer - Macronutrients from food: protein, carbohydrates, fat - See circulating forms (in blood) - Brain needs continuous supply of glucose Insulin - Answer hormone secreted by beta cells of pancreas Maintenance of normal glucose levels 1 - Answer In a healthy person, insulin helps regulate blood sugar levels and store excess glucose for energy: After you eat, carbohydrates are converted to glucose, and the glucose enters the bloodstream -> pancreas then produces insulin -> insulin allows glucose to enter the body's cells to provide energy Maintenance of normal glucose levels 2 - Answer Insulin is released in response to higher blood glucose levels, and it lowers blood sugar by: - Increasing glucose uptake by muscles - Increases conversion of glucose to glycogen (glycogenesis) - Suppresses glycogenolysis and gluconeogenesis (conversion of glycogen or amino acids to glucose) - Suppresses lipolysis (breaking down stored fat for fuel) Glucagon helps maintain blood glucose levels between meals: - secreted by alpha cells of pancreas in response to low blood sugar - Stimulates glycogenolysis in liver -> causes a rise in blood glucose, keeping blood sugar levels within the appropriate range Maintenance of normal glucose levels 3 - Answer If blood sugar is too high: - Insulin secretion -> glycogenesis in liver converts glucose to glycogen If blood glucose drops too low: - Glucagon secretion -> glycogenolysis in liver breaks down glycogen to glucose and releases glucose to blood - Gluconeogenesis: conversion of amino acids to glucose the brain needs continuous supply of ? - Answer glucose glycogenesis - Answer liver converts glucose to glycogen if blood glucose drops too low .... Glycogenolysis in liver breaks down glycogen to glucose and releases this where ? - Answer into the blood gluconeogenesis - Answer conversion of amino acids to glucose glucagon is secreted by - Answer alpha cells of pancreas glucagon is released in response to - Answer low blood sugar glucagon function - Answer Stimulates glycogenolysis, causing an increase in blood glucose and free fatty acids Type 1 Diabetes - Answer autoimmune disease; deficiency in production and secretion of insulin Insulin is secreted by - Answer beta cells of pancreas insulin is released in response to ? - Answer higher blood glucose levels insulin lowers blood sugar by: - Answer - increasing glucose uptake by muscles - increases conversion of glucose to glycogen(glycogenesis) - suppresses glycogenolysis and gluconeogenesis (conversion of glycogen or amino acids to glucose) -suppresses lipolysis (breaking down stored fat for fuel) hyperglycemic - Answer high blood sugar hypoglycemic - Answer low blood sugar Type 1 Diabetes mellitus (T1DM) - Answer - was called juvenile diabetes - insulin deficiency due to loss of pancreatic islet - Beta cells - loss of beta cells due to autoimmunity in 70-90% of patients - remainder of cases, cause of beta cell destruction not known - idiopathic --> has strong genetic component - generally leads to absolute insulin deficiency - no prevention - no cure what % of people with diabetes have type 1? - Answer ~5-10% is the incidence of type 1 diabetes increasing worldwide? - Answer Yes - type 1 diabetes incidence rate varies between countries --> highest in Scandinavia, less common in Europe, North America and Australia; least common in Asia Management of Type 1 Diabetes - Answer - taking insulin - carb, fat, and protein counting - frequent blood sugar monitoring - eating healthy foods - exercising regularly and maintaining a healthy weight without insulin, glucose builds up where? - Answer in the bloodstream Precursor to type 2 diabetes - Answer insulin resistance Type 2 Diabetes - Answer - fasting plasma glucose 126 mg/dl or higher - lifestyle disease, reduced insulin sensitivity in target tissue - mostly muscle, fat, and liver - body doesn't make enough insulin or doesn't use insulin well - Too much glucose stays in the blood and not enough reaches the cells insulin resistance - Answer - muscle, fat, and liver cells don't respond well to insulin & can't easily take up glucose from blood - Pancreas produces more insulin to help glucose enter cells - Blood glucose levels remain healthy as long as there is enough insulin to overcome the cells' weak response to insulin - if liver becomes fatty, it doesn't respond well to insulin signals to shut down glucose production - excess fuel can cause fatty tissue deposits in muscle, interfering with insulin - insulin resistance is NOT a shortage of insulin; instead, cells don't respond properly to insulin pre-diabetes - Answer - fasting plasma glucose between 100 - 125 mg/dl - blood sugar levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes how many people in the US have pre-diabetes? - Answer 88 million (over 1 in 3 people); 84% of people don't know they have it Risk factors for type 2 diabetes: - Answer - age >56 - family history - overweight/obese - low physical activity - hypertension - gestational diabetes - diet - smoking - medication side effects Diet: WHO Recommended limits on sugar intake - Answer - WHO Guideline: reduce daily intake of free sugars to < 10% of total energy intake; says < 5% would provide additional health benefits - GOAL: stop the increase in obesity, diabetes, and chronic disease Free sugars - Answer - sugars added to foods & drinks (e.g., glucose, fructose, table sugar) - Sugars naturally present in honey, syrups, fruit juices, & fruit juice concentrates NOT Free sugars - Answer sugars naturally present in fresh fruits, vegetables, and milk gestational diabetes - Answer - during pregnancy, hormonal changes can decrease the body's sensitivity to the effect of insulin - can lead to type 2 diabetes - more common in overweight mothers - loss of vision - risk to child - Usually goes away after delivery (if doesn't go away, then it is called Type 2 diabetes) - Half of women who had gestational diabetes develop Type 2 diabetes later epinephrine is stimulated by - Answer immediate stress and exercise functions of epinephrine - Answer - suppresses insulin secretion - promotes glucagon secretion increases circulating levels of glucose and fatty acids by: - increasing glycogenolysis - increasing gluconeogenesis - increasing fat mobilization cortisol is stimulated by - Answer chronic stress effects of cortisol are similar to those of? - Answer epinephrine; increases circulating levels of substrates (fuel); ensures the mobilization of fuels for the body stress hormones function as ______________hormones - Answer anti- insulin hormones; buildup of fuel in the cells subsistence efficiency ration (SER) - Answer food intake compared to calories expended in physical activity - paleolithic times: ratio was ~3:1 - now: ratio is ~7:1 - more food + less activity --> more substrate (fuel) in cells --> precursor to metabolic dysregulation in cells consequences of too much fuel in cells - Answer - increased production of reactive oxygen species that is implicated in development of type 2 diabetes - accumulation of visceral (deep abdominal fat) around the organs - this fat is very metabolically active - insulin resistance As of 2015, how many people globally have diabetes? - Answer > 415 million Countries with highest numbers of diabetes - Answer - Highest prevalence: Pacific Islands, Middle East - Largest number: China, India rule of halves - Answer - diagnosis - care - make targets - achieve goals how to reduce risk of type 2 diabetes - Answer - change in eating habits - weight loss - increase physical activity ( makes you more sensitive to insulin) - reduce stress - sleep - healthy diet Infertility - Answer Not able to get pregnant or stay pregnant after 1 year (up to age 35) Risk factors for infertility - Answer - Age - Chemical exposure including tobacco, alcohol, certain medications - Stress - Chronic disease: diabetes, heart disease, obesity, high blood pressure, autoimmune disorders _____% of men and ____% of women of reproductive age in the US have experienced fertility problems - Answer 9% of men and 11% of women