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Glomerular Filtration: An Overview

Mary Jo Holechek

rate of about 1,000-1,200 ml per min- riole, the arterial pressure falls to
Editor’s Note: This article ute, representing approximately 20%- about 40-60 mmHg. Although this
continues a renal physiology con- 25% of the cardiac output. This rapid is a significantly lower pressure than
tinuing education series to run in blood flow rate exceeds the metabolic present in the systemic circulation,
the Nephrology Nursing Journal. The and oxygen needs of the kidneys but this pressure is higher than that in
articles, which are updates of man- facilitates efficient clearance of meta- the glomerular capillary bed. This
uscripts that previously appeared bolic waste products. pressure is referred to as hydrostatic
in the journal, are written by To understand glomerular filtra- pressure. Maintaining a hydrostatic
experts in nephrology and contain tion, it is essential to consider the pressure of about 50 mmHg is the
the most up-to-date information special characteristics of the renal cir- key to glomerular filtration, as it is
and research available. culation. Figure 1 illustrates the gross needed to overcome other opposing
renal circulatory anatomy. pressures present in the glomerular

G
The renal artery pressure is capillaries and Bowman’s space.
lomerular filtration is the first approximately 100 mmHg. This The glomerulus is a bundle of
step in the complex process of high pressure is maintained up to capillaries that are highly porous
urine formation. For filtration the afferent arteriole, the location compared to systemic capillaries. The
to occur, a rapid renal blood of the first major point of vascular portion of the blood that is not filtered
flow (RBF) at a consistent pressure resistance. Across the afferent arte- across the filtration barriers in the
is essential. There are many factors
that can alter RBF and, thus, the rate
of glomerular filtrate generation. At The formation of urine is a process that begins with glomerular filtration and is greatly influ-
any given time, especially under the enced by changes in renal hemodynamics. Selective filtration of the blood is possible because
condition of stress, multiple factors of the unique characteristics of the glomerulus and renal circulation. Many factors interact to
act and counteract to maintain a nor- maintain a consistent blood flow allowing filtration and urine formation to continue despite
mal glomerular filtration rate (GFR) systemic changes in blood pressure. Factors that impact on renal hemodynamics include the
despite changes in RBF. This article autoregulatory mechanism, the renin-angiotensin mechanism, eicosanoids, kinins, the sympa-
will examine the unique characteris- thetic nervous system (SNS), catecholamines, antidiuretic hormone, endothelin, nitric oxide,
tics of the renal circulation, describe atrial natriuretic peptide, and dopamine. Knowledge of the effects of these factors will allow
the physiology of glomerular filtration, the nephrology nurse to predict, identify, and assist in the treatment of clinical conditions
review the extrinsic and intrinsic fac- that can alter renal hemodynamics and glomerular filtration.
tors that can alter renal hemodynam-
ics, and discuss a clinical situation in
which multiple factors are interacting Goal:
in an effort to maintain the RBF Discuss the principles of glomerular filtration and renal hemodynamics
and GFR despite systemic pressure and provide nephrology nurses with the ability to predict, identify and
changes. assist in the treatment of clinical conditions that can alter glomerular
filtration and renal hemodynamics.
Renal Circulation
Blood flows into the kidneys at a Objectives:
1. Define and explain the process of glomerular filtration.
2. Identify factors that can influence the glomerular filtration process.
3. List methods to measure or estimate glomerular filtration rate (GFR).
Mary Jo Holechek, MS, CRNP, CNN, is an
Abdominal Organ Transplant Nurse Practitioner
at the Johns Hopkins Hospital, Transplant Surgery
Service, Baltimore, MD. She is a member of the This offering for 1.7 contact hours is being provided by the American Nephrology Nurses’ Association
Baltimore Chapter of ANNA and on the manu- (ANNA), which is accredited as a provider and approver of continuing education in nursing by the American
script review board of the Nephrology Nursing Nurses’ Credentialing Center-Commission on Accreditation (ANCC-COA). This educational activity is approved
Journal. by most states and specialty organizations that recognize the ANCC-COA accreditation process. ANNA is an
approved provider of continuing education in nursing by the California Board of Registered Nursing, BRN
Acknowledgment: The author would like to Provider No. 00910; the Florida Board of Nursing, BRN Provider No. 27F0441; the Alabama Board of Nursing,
acknowledge Dr. Milagros Samaniego, Assistant BRN Provider No. P0324; and the Kansas State Board of Nursing, Provider No. LT0148-0738. This offering is
Professor, Department of Medicine, Division of accepted for RN and LPN relicensure in Kansas
Nephrology, Johns Hopkins Hospital, Baltimore,
The Nephrology Nursing Certification Commission (NNCC) requires 60 contact hours for each recertification
MD, for her careful review of this manuscript and
Romeo Paredes for his assistance with the develop- period for all nephrology nurses. Forty-five of these 60 hours must be specific to nephrology nursing practice.
ment of the figures. This CE article may be applied to the 45 required contact hours in nephrology nursing.

NEPHROLOGY NURSING JOURNAL  June 2003  Vol. 30, No. 3 285


Glomerular Filtration: An Overview

Figure 1 plasma proteins. The surface of


Renal Circulatory Anatomy: The renal artery branches into the seg- the endothelial cells has a negative
mental artery, interlobar artery, arcuate artery, interlobular artery, charge that inhibits the movement of
afferent artery, and finally, the glomerulus. negatively charged substances such as
plasma proteins, as like-charges repel
each other.
The second layer, the glomeru-
lar basement membrane, represents
the major barrier to the filtration of
macromolecules. The glomerular
basement membrane is made of
fibrous proteins such as collagen,
fibrin, and laminin, which intertwine
to form a meshwork. As the fibers
cross each other, small openings are
created through which selective filtra-
tion occurs. The crossed fibers act as
a size barrier and restrict the filtration
of large molecules. This layer also
contains anionic sialoproteins that
further inhibit filtration by repelling
other negatively charged ions.
The third layer, composed of epi-
thelial cells, is the visceral layer of the
Bowman’s capsule. These epithelial
cells, called podocytes, are attached
directly to the exterior surface of the
basement membrane. The podocytes
branch into multiple finger-like pro-
jections called foot processes. These
foot processes, which cover the outer
surface of the basement membrane,
are in close proximity to each other
forming narrow elongated, slit-type
openings about 25-60 nm wide.
These openings, called slit pores, are
covered by thin diaphragms. The
Note: From Richard, C.J. (1986). Comprehensive nephrology nursing (p. 12). Boston: foot processes have anionic sialo-
Little, Brown & Co. Copyright 1986 by C.J. Richard. Reprinted by permission. proteins on their borders that form
the slit pores, generating a highly
negatively charged region through
glomerular capillaries returns to the filtration barrier is composed of three which the filtrate must pass. These
central circulation via the peritubular layers that allow for the filtration of negative charges assist in preventing
capillary (PTC) network. (See the first solutes (eg., blood urea nitrogen, cre- plasma proteins from entering the
article in the physiology series for a atinine, electrolytes) and water, but tubular fluid since plasma proteins
discussion of the PTC network.) prevent the loss of blood components carry negative charges. These nar-
such as red and white blood cells and row slits combined with the negative
Glomerular Filtration plasma proteins. The three layers are charges of the podocytes provide the
Glomerular anatomy. The the glomerular capillary endothelium, final barrier to molecule movement
porous glomerular capillaries rest glomerular basement membrane, and through the glomerular membrane.
between the afferent and efferent visceral layer of Bowman’s capsule The glomerulus is a selective filtra-
arterioles (see Figure 2). Their func- (epithelial cell layer) (see Figure 2). tion membrane. The factors that deter-
tion is to filter large quantities of The first layer of the filtration mine which molecules are filtered are
water and solutes from the plasma. barrier is the capillary endothelium, molecular size, electrical charge, pro-
As blood flows through the glom- which has large fenestrations that tein binding, configuration, and rigid-
erulus a portion is sieved through the allow the free filtration of substances ity. Small molecules with molecular
filtering layers of the glomerular cap- with diameters up to 100 nm, thus weights (MW) less than 7,000 Daltons
illaries into the Bowman’s space. The excluding blood cells and large (eg., water, MW 18; and all ions

286 NEPHROLOGY NURSING JOURNAL  June 2003  Vol. 30, No. 3


Figure 2
Glomerular Anatomy

Note: From Marsh, D.J. (1983). Renal physiology (p. 41). New York: Raven Press. Copyright 1983 by Raven Press. Reprinted
by permission.

including sodium, potassium, chloride, ecules do not filter as easily as ellipsoid filtration rate. The special filtering
phosphate, magnesium, and calcium) molecules. The more rigid a molecule, characteristics of the glomerulus cou-
are filtered without restriction. Larger the less easily it filters. Normal glo- pled with the unique renal circulation
molecules, such as myoglobin with a merular filtrate is essentially protein allow for effective glomerular filtration
MW of 17,000 Daltons, are filtered to free but contains crystalloids (eg., to occur.
a lesser degree. Very large molecules, sodium, chloride, creatinine, urea, uric
such as plasma proteins with molecular acid, and phosphate) in the same con- Glomerular Filtration Rate
weights approaching 70,000 Daltons, centration as plasma. and Filtration Fraction
are restricted from passing through A final anatomical aspect of the Glomerular filtrate moves into the
the normal glomerulus. glomerulus is the mesangial cells, Bowman’s space and then into the
As the filtration barrier has a net which are located between the capil- tubular component of the nephron.
negative electrical charge, the move- lary loops. They support the capillary In the average 70 kg adult, glomeru-
ment of large negatively charged structures and carry out some phago- lar filtration rate (GFR) is approxi-
molecules is restricted more than cytic activities. They also demonstrate mately 125 ml/minute. This means
molecules with a positive or neutral contractile properties and can alter the that about 180 L of glomerular filtrate
charge. As a result, proteins, which total filtration surface area. Mesangial is produced in a 24-hour period,
are negatively charged, are not freely cells contract when exposed to vaso- which is more than 30 times the aver-
filtered by the glomerulus. Likewise, constrictive substances, such as angio- age total blood volume. All but one
drugs, ions, or small molecules bound tensin II, thus decreasing the effective to two liters are reabsorbed from the
to protein are not filtered. Round mol- filtration surface area and glomerular nephron into the peritubular capillary

NEPHROLOGY NURSING JOURNAL  June 2003  Vol. 30, No. 3 287


Glomerular Filtration: An Overview

and vasa recta network. The forma- ______ renal plasma flow (RPF) is approxi-
tion of such a large amount of filtrate P Cr mately 660 ml/min (1200 ml/min x
assures adequate filtration of plasma, 0.55 = 660 ml/min). The FF can then
but requires very efficient reabsorp- Another method for determin- be determined using Equation 3.
tive processes to prevent volume and ing CrCL involves the intravenous
electrolyte depletion. injection of a radioactive marker. Equation 3
GFR, which indicates the volume Clearance of the radioactive marker
of filtrate moving from the glomeru- is assessed by serial scans. The results FF = GFR = 125 ml/min ~
=19%
lar capillaries into Bowman’s space using this method correlate closely RPF 660 ml/min
per unit of time, is calculated by with inulin clearance. The CrCL
determining the renal clearance of estimates the GFR and gives a gross Thus, almost 20% of the plasma
a marker substance. Clearance (CL) indication of how well the kidneys are passing through the glomerulus
is defined as the volume of plasma functioning based on their ability to becomes glomerular filtrate in the
from which a substance is completely remove a marker substance. average adult.
removed or cleared by the kidneys As using inulin is impractical, Pressures influencing normal
per unit of time. The ideal marker urine collections are often inaccurate, glomerular filtration. Glomerular
for measuring CL does not bind to and renal scans are costly and require filtration is controlled by four pres-
proteins, is freely filtered at the glom- special equipment, the use of alterna- sures, the algebraic sum of which
erulus, and is neither reabsorbed, tive methods to estimate GFR have defines the net filtration pressure.
secreted, synthesized, nor metabo- been proposed. The National Kidney These pressures are:
lized by the tubules. Substances that Foundation, in its Kidney Disease 1. Glomerular capillary hydrostatic
do not meet these requirements can Outcome Initiative Guidelines, recom- pressure (P GC), which is the pres-
result in falsely elevated or decreased mends the use of the Cockcroft-Gault sure exerted against the capillary
values of GFR. As there is no natu- formula (see Equation 2) or the more wall by fluid within the capillary
rally occurring ideal marker, endog- complicated Modification of Diet in lumen. This pressure is gener-
enous creatinine (Cr) often is used to Renal Disease (MDRD) study formula ated by the blood pressure. This
measure clearance; however, since a (available at www.kidney.org). value ranges from 40-60 mmHg
small amount of creatinine is secreted and favors the movement of fluid
into the tubule, GFR measured with Equation 2: Cockcroft-Gault from the capillary lumen to the
creatinine clearance (CrCL) will Formula Bowman’s space (see Figure 3).
be overestimated. Since individual 2. Glomerular capillary colloid
GFRs vary widely, a change in GFR GFR = osmotic pressure (∏GC), which is
over time is more important than the (140-Age) x Body weight (kg) about 18 mmHg. This force, gen-
absolute value of the GFR. Thus, if 72 x Serum creatinine erated by plasma proteins within
the CrCL method is used, it should the capillaries, retards the move-
be used for all measurements of GFR (X 0.85 for females) ment of fluid out of the capillary
to allow for comparison of values Both consider the effects of age, lumen.
over time. gender, and body weight on creati- 3. Bowman’s space hydrostatic pres-
Inulin is a marker that meets all nine, but no special lab or diagnos- sure (P BS), which is the pressure
the requirements of an ideal marker tic tests are required. The MDRD exerted against the outer layer of
for measuring GFR, but is not often formula also factors in the effects of the capillary walls by fluids within
used because it is an exogenous sub- race, albumin, and serum urea nitro- Bowman’s space. This value is
stance that must be infused for sev- gen. There are hand-held personal about 10 mmHg and also retards
eral hours at a constant rate making it data assistant programs and Web- the movement of fluid out of the
both impractical and costly. based calculators with these formulas capillary lumen.
A more practical method to deter- that easily complete the calculations 4. Bowman’s space colloid osmotic
mine the CrCL involves the collec- after the raw data has been entered. pressure (∏BS), which is normally
tion of a 24-hour urine and midpoint Use of one of these standardized for- 0 mmHg because normal filtrate is
plasma Cr (P Cr). CrCL is calculated mulas with a programmed calculator void of protein.
using Equation 1 where UCr is the ensures accurate, consistent results Net filtration pressure (NFP),
urine creatinine concentration, mg/ when tracking a GFR over time. which is the sum of these negative
dl; Uv is the average urine flow rate, The glomerular filtrate is derived and positive pressures, can be calcu-
ml/min; and P Cr is the plasma creati- from the plasma portion of whole lated with the following formula (see
nine concentration, mg/dl. blood. The term filtration fraction Equation 4). An average P GC of 45
(FF) describes the percentage of the mmHg is used.
Equation 1 plasma that becomes glomerular fil-
trate. Since plasma volume is about Equation 4
CrCL = UCr Uv 55% of total blood volume, normal NFP = (P GC - P BS ) - (∏GC - ∏BS)

288 NEPHROLOGY NURSING JOURNAL  June 2003  Vol. 30, No. 3


Figure 3
Pressures Influencing Normal Glomerular Filtration.

Note: Adapted from Richard, C. (1986). Comprehensive nephrology nursing (p. 23). Boston: Little, Brown & Co. Copyright
1986 by C.J. Richard. Reprinted by permission.

= (45 mmHg - 10 mmHg) The point at which NFP falls to zero ing a normal GFR over a wide range
- (18 mmHg - 0 mmHg) is called filtration equilibrium and is of vascular pressures.
= 17 mmHg the point at which glomerular filtra- Changes in the glomerular col-
tion ceases. loid osmotic pressure (∏GC) can also
These pressures are based on Conditions altering glomeru- alter GFR. Serum protein is the
animal models but are thought to be lar filtration rate. The GFR can major determinant in colloid osmotic
similar to those in humans. Therefore, be altered by changes in any of the pressure. If ∏GC increases due to
for adequate filtration to occur, an above four pressures or the ultrafiltra- increased protein concentration, as in
NFP of approximately 17 mmHg is tion coefficient. Theoretically, there hypovolemic states, NFP and, thus,
required to produce approximately is a direct relationship between the GFR will fall in an effort to prevent
125 ml/min of glomerular filtrate. renal plasma flow rate (the primary further intravascular volume loss.
As blood progresses through the determinant of P GC) and the GFR. If If the ∏GC decreases due to protein
glomerulus toward the efferent arte- RPF increases due to volume expan- losses, as in severe malnutrition or
riole, the ∏GC increases from 18 to sion or other causes, GFR should hypoalbuminemic states, GFR can
approximately 35 mmHg, reflecting also rise. However, a change in RBF increase.
the removal of protein free fluid from rarely occurs in isolation and is usu- When P BS increases, as in urinary
the glomerular capillary. P GC, P BS, and ally accompanied by changes in affer- tract obstruction, GFR falls. GFR
∏BS remain essentially unchanged ent or efferent arteriolar resistance decreases as glomerular filtrate out-
along the capillary loop. As a result, designed to maintain a consistent P GC flow from the tubule is obstructed
NFP decreases along the length of the and, therefore, GFR at normal levels. and the pressure of the increased fil-
capillary and in some species is zero Through a process called autoregula- trate volume in the Bowman’s space
before or at the end of the capillary. tion, the kidney is adept at maintain- opposes the forces favoring filtration.

NEPHROLOGY NURSING JOURNAL  June 2003  Vol. 30, No. 3 289


Glomerular Filtration: An Overview

If ∏BS rises above 0 mmHg, as it and hypertensive kidneys. Current


does in nephrotic conditions where Additional Readings Opinion in Nephrology and Hypertension,
protein is filtered into the Bowman’s Dworkin, L.D., Sun, A.M., & Brenner, 11, 93-98.
space because of changes in the filter- B.M. (2000). The renal circulations. Paul, R.V., & Ploth, D.W. (2001). Renal
In B.M. Brenner (Ed.), The kidney: circulation. In S.G. Massry & R.J.
ing membrane, GFR can increase.
Volume I (pp. 277-311). Philadelphia: Glassock (Eds.), Textbook of nephrol-
The presence of plasma proteins in ogy: Volume I (4th ed.) (pp. 43-55).
W.B. Saunders Co.
Bowman’s space favors increased Philadelphia: Lippincott, Williams
Gabbai, F.B., & Blantz, R.C. (2001).
filtration due to the increased colloid Glomerular filtration. In S.G. Massry & Wilkins.
osmotic pressure within that compart- & R.J. Glassock (Eds.), Textbook of Preisig, P., Chmielewski, C., Keen, M.,
ment. nephrology: Volume I (4th ed.) (pp. Holechek, M.J., Ludlow, M.K., &
A final factor that can alter GFR 56-60). Philadelphia: Lippincott, Yucha, C.B. (1998). Renal physiol-
is a change in the ultrafiltration coef- Williams & Wilkins. ogy. In J. Parker (Ed.), Contemporary
ficient (Kf) of the glomerular capillary Goraca, A. (2002). New views on the role nephrology nursing (pp. 127-176).
membrane. The Kf is the product of of endothelin. Endocrine Regulations, Pitman, NJ: American Nephrology
36, 161-167. Nurses’ Association.
the surface area and hydraulic perme-
Horio, M., Orita, Y., & Fukunaga, M. Rose, B.D., & Rennke, H. (1994). Renal
ability of the glomerular membrane. pathophysiology. Baltimore: Williams
(2001). Assessment of renal function.
Vasoactive substances such as angio- & Wilkins.
In R.J. Johnson & J. Feehally (Eds.),
tensin II can cause the mesangial Comprehensive clinical nephrology (pp. Thomson, S. (2002). Adenosine and
cells to contract thereby decreasing 3.1-3.6). London: Mosby. puringenic mediators of tubuloglo-
the available surface area for filtration Jackson, B.A., & Ott, C.E. (1999). Renal merular feedback. Current Opinions
resulting in a decreased GFR. system. Madison, CT: Fence Creek in Nephrology and Hypertension, 11,
Glomerular filtration is the criti- Publishing. 81-86.
cal initial step in urine formation. In Koeppen, B.M., & Stanton, B.A. (2001). Unwin, R.J., & Capasso, G. (2000). Renal
order for adequate solute and water Renal physiology (3rd ed.). St. Louis: physiology. In R.J. Johnson & J.
Mosby. Feehally (Eds.), Comprehensive clini-
removal to occur, glomerular filtrate
Levey, A., Bosch, J., Lewis, J., Greene, cal nephrology (pp. 2.1-2.12). London:
must be generated at a constant rate. Mosby.
T., Rogers, N., & Roth, D. (1999).
Changes in RPF, hydrostatic and Vander, A.J. (1995). Renal physiology (5th
A more accurate method to estimate
osmotic pressures, available filter- glomerular filtration rate from serum ed). New York: McGraw-Hill Inc
ing surface area, and glomerular creatinine: A new prediction equa-
membrane permeability can upset tion. Annals of Internal Medicine, 130,
the internal environment by increas- 461-470.
ing or decreasing GFR. Fortunately, Levin, E.R. (1995). Endothelins. New
there exists a complicated system England Journal of Medicine, 333, 356-
where factors both extrinsic and 363.
intrinsic to the kidneys act simultane- Maddox, D.A., & Brenner, B.M. (2000).
ously to minimize the effects of these Glomerular ultrafiltration. In B.M.
Brenner (Ed.), The kidney: Volume I
changes. (pp. 319-359). Philadelphia: W.B.
Saunders.
Summary Meyers, B.D. (2001). Determinants of the
Glomerular filtration is a complex glomerular filtration of macromole-
process that is impacted by numerous cules. In S.G. Massry & R.J. Glassock
intrinsic and extrinsic factors that can (Eds.), Textbook of nephrology: Volume I
alter renal hemodynamics and RBF. (4th ed.) (pp 61-64). Philadelphia:
These factors interact in an attempt Lippincott, Williams & Wilkins.
to maintain a consistent glomerular Miyataka, M., Rich, K.A., Ingram, M.,
filtration rate under a wide variety of Yamamoto, T., & Bing, R.J. (2002).
Nitric oxide, antiinflammatory drug
normal and pathologic conditions. If on renal protoglandin and cyclooxy-
these integrated systems fail, serious genase2. Hypertension, 39, 785-789.
problems can develop with renal Osborn, J.L., Greenberg, S., & Plato, C.F.
function and urine production and (2001). The neural control of renal
excretion. Understanding the physi- function and extracellular fluid vol-
ology of glomerular filtration and the ume. In S.G. Massry & R.J. Glassock
interactions of factors altering renal (Eds.), Textbook of nephrology: Volume
hemodynamics will help the nephrol- I (4th ed.) (pp. 65-69). Philadelphia:
ogy nurse in predicting, identifying, Lippincott, Williams & Wilkins.
and assisting in the treatment of clini- Pallone, T.L., & Mattson, D.L. (2002).
Role of nitric oxide in the regula-
cal conditions that alter glomerular tion of the renal medulla in normal
filtration and renal hemodynamics.

290 NEPHROLOGY NURSING JOURNAL  June 2003  Vol. 30, No. 3


Glomerular Filtration: An Overview
Mary Jo Holechek, MS, CRNP, CNN
Posttest — 1.7 Contact Hours
Posttest Questions
(See posttest instructions on the answer form, on page 292.)

1. A rapid renal blood flow rate is 7. Factors that determine which 13. The production of massive
necessary to assure molecules are filtered include amounts of glomerular filtrate is
A. the kidneys are oxygenated. A. molecular size only. essential to
B. efficient clearance of metabolic B. molecular size and charge A. assure adequate filtration of
waste products. only. the complete plasma volume.
C. the metabolic needs of the kid- C. molecular size, charge, and B. maintain a normal systemic
neys are met. protein binding only. blood pressure.
D. medullary blood flow is main- D. molecular size, charge, protein C. assure efficient removal of
tained. binding, and rigidity. blood proteins.
D. prevent circulatory collapse.
2. The first point of major vascular 8. Constriction of the mesangial
resistance in the renal arterial cells results in a(n) 14. What is an ideal marker to mea-
system is the A. decrease in phagocytic activ- sure glomerular filtration?
A. efferent arteriole. ity. A. Creatinine.
B. vasa recta. B. increase in the glomerular fil- B. Urea.
C. afferent arteriole. tration rate (GFR). C. Inulin.
D. peritubular capillaries. C. decrease in the surface area D. Potassium.
available for filtration.
3. The glomerular capillary bed dif- D. increase in catecholamine 15. You are seeing Mrs. Sue in the
fers from other capillary beds in activity. clinic. She is 73 yrs old and
that it is weighs 72 kg. Her serum creati-
A. a highly porous, high pressure 9. Which of the following would nine is 2.3. What is her estimated
system. be found in normal glomerular GFR?
B. not affected by systemic arte- filtrate? A. 25 ml/min.
rial pressure changes. A. Urea only. B. 29 ml/min.
C. freely permeable to blood pro- B. Urea and sodium only. C. 33 ml/min.
tein. C. Urea, sodium, and creatinine D. 40 ml/min.
D. an impermeable, low pressure only.
system. D. Urea, sodium, creatinine, and 16. A GFR determined using creati-
albumin. nine as the marker should
4. High pressure in the glomerular A. predict the GFR exactly.
capillaries is essential to 10. The normal GFR for an adult is B. slightly overestimate the GFR.
A. prevent hypotension. A. 75 ml/min. C. slightly underestimate the GFR.
B. ensure perfusion of the vasa B. 100 ml/min. D. not be used to estimate the
recta and peritubular capillary C. 125 ml/min. GFR.
network. D. 150 ml/min.
C. overcome other opposing 17. The NKF recommends the use
pressures in the glomerulus 11. Efficient reabsorption processes of which method to estimate the
and Bowman’s space. of glomerular filtrate are required GFR?
D. prevent the movement of plas- to prevent A. 24 hour urine.
ma proteins into Bowman’s A. volume overload. B. inulin clearance.
space. B. dehydration. C. prediction equation.
C. hypertension. D. urea clearance.
5. Approximately what percentage D. hyperkalemia.
of the cardiac output circulates 18. Glomerular filtration is opposed
through the kidneys per min- 12. The GFR reveals by which of the following forces?
ute? A. how rapidly blood flows through A. Glomerular capillary hydro-
A. 10%-15% the kidney per unit of time. static pressure.
B. 20%-25% B. the volume of solutes removed B. Bowman’s capsule oncotic
C. 30%-35% from the blood per unit of time. pressure.
D. 40%-45% C. the rate at which solutes and C. Glomerular capillary oncotic
water are reabsorbed by the pressure.
6. The major barrier to filtration of peritubular capillary network D. Peritubular capillary hydrostatic
molecules in the glomerulus is per unit of time. pressure.
A. glomerular capillary endothe- D. the volume of filtrate moving
lium. from the glomerular capillaries 19. You are seeing a patient in the
B. glomerular basement mem- into Bowman’s space per unit clinic. The patient is malnour-
brane. of time. ished and hypoalbuminemic.
C. visceral layer Bowman’s capsule. You would predict the GFR to
D. anionic sialoproteins. A. be decreased.
B. not be affected.
C. be increased.
D. fall to 0 ml/min.

NEPHROLOGY NURSING JOURNAL  June 2003  Vol. 30, No. 3 291


Glomerular Filtration and Renal Hemodynamics

ANSWER FORM ANNJ305


Glomerular Filtration: An Overview
By Mary Jo Holechek, MS, CRNP, CNN

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Note: If you wish to keep the journal intact, you may photocopy the answer sheet or access this posttest at www.nep
hrologynursingjournal.net.

Submit Online submissions through a partnership with HDCN.com are accepted on this posttest at $20 for
ANNA members and $30 for nonmembers. CE certificates will be available immediately upon
Online! successful completion of the posttest.

Posttest Answer Grid Goal: Discuss the principles of glomerular filtration and renal hemodynamics and
Please circle your answer choice: provide nephrology nurses with the ability to predict, identify and assist in the treat-
ment of clinical conditions that can alter glomerular filtration and renal hemodynam-
1. a b c d 11. a b c d ics.

Strongly Strongly
2. a b c d 12. a b c d Evaluation disagree agree
1. The objectives were related to the goal. 1 2 3 4 5
3. a b c d 13. a b c d 2. Objectives were met
a. Define and explain the process of glomerular 1 2 3 4 5
4. a b c d 14. a b c d filtration.
b. Identify factors that can influence the 1 2 3 4 5
glomerular filtration process.
5. a b c d 15. a b c d c. List methods to measure or estimate 1 2 3 4 5
glomerular filtration rate (GFR).
6. a b c d 16. a b c d 3. I verify that I have completed this activity:
(Signature)_____________________________________________________________
7. a b c d 17. a b c d Comments _____________________________________________________________
________________________________________________________________________
8. a b c d 18. a b c d ________________________________________________________________________
Suggeste topics for future articles? ______________________________________
________________________________________________________________________
9. a b c d 19. a b c d
________________________________________________________________________

10. a b c d

292 NEPHROLOGY NURSING JOURNAL  June 2003  Vol. 30, No. 3

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