Glomerular Filtration: An Overview

Mary Jo Holechek

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

G
lomerular filtration is the first
step in the complex process of
urine formation. For filtration
to occur, a rapid renal blood
flow (RBF) at a consistent pressure
is essential. There are many factors
that can alter RBF and, thus, the rate
of glomerular filtrate generation. At
any given time, especially under the
condition of stress, multiple factors
act and counteract to maintain a nor-
mal glomerular filtration rate (GFR)
despite changes in RBF. This article
will examine the unique characteris-
tics of the renal circulation, describe
the physiology of glomerular filtration,
review the extrinsic and intrinsic fac-
tors that can alter renal hemodynam-
ics, and discuss a clinical situation in
which multiple factors are interacting
in an effort to maintain the RBF
and GFR despite systemic pressure
changes.
Renal Circulation
Blood flows into the kidneys at a
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
Baltimore Chapter of ANNA and on the manu-
script review board of the Nephrology Nursing
Journal.
Acknowledgment: The author would like to
acknowledge Dr. Milagros Samaniego, Assistant
Professor, Department of Medicine, Division of
Nephrology, Johns Hopkins Hospital, Baltimore,
MD, for her careful review of this manuscript and
Romeo Paredes for his assistance with the develop-
ment of the figures.
The renal artery pressure is capillaries and Bowman’s space.
approximately 100 mmHg. This The glomerulus is a bundle of
high pressure is maintained up to capillaries that are highly porous
the afferent arteriole, the location compared to systemic capillaries. The
of the first major point of vascular portion of the blood that is not filtered
resistance. Across the afferent arte- across the filtration barriers in the
The formation of urine is a process that begins with glomerular filtration and is greatly influ-
enced by changes in renal hemodynamics. Selective filtration of the blood is possible because
of the unique characteristics of the glomerulus and renal circulation. Many factors interact to
maintain a consistent blood flow allowing filtration and urine formation to continue despite
systemic changes in blood pressure. Factors that impact on renal hemodynamics include the
autoregulatory mechanism, the renin-angiotensin mechanism, eicosanoids, kinins, the sympa-
thetic nervous system (SNS), catecholamines, antidiuretic hormone, endothelin, nitric oxide,
atrial natriuretic peptide, and dopamine. Knowledge of the effects of these factors will allow
the nephrology nurse to predict, identify, and assist in the treatment of clinical conditions
that can alter renal hemodynamics and glomerular filtration.
Goal:
Discuss the principles of glomerular filtration and renal hemodynamics
and provide nephrology nurses with the ability to predict, identify and
assist in the treatment of clinical conditions that can alter glomerular
filtration and renal hemodynamics.
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).
This offering for 1.7 contact hours is being provided by the American Nephrology Nurses’ Association
(ANNA), which is accredited as a provider and approver of continuing education in nursing by the American
Nurses’ Credentialing Center-Commission on Accreditation (ANCC-COA). This educational activity is approved
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
Provider No. 00910; the Florida Board of Nursing, BRN Provider No. 27F0441; the Alabama Board of Nursing,
BRN Provider No. P0324; and the Kansas State Board of Nursing, Provider No. LT0148-0738. This offering is
accepted for RN and LPN relicensure in Kansas
The Nephrology Nursing Certification Commission (NNCC) requires 60 contact hours for each recertification
period for all nephrology nurses. Forty-five of these 60 hours must be specific to nephrology nursing practice.
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
Renal Circulatory Anatomy: The renal artery branches into the seg-
mental artery, interlobar artery, arcuate artery, interlobular artery,
afferent artery, and finally, the glomerulus.
Note: From Richard, C.J. (1986). Comprehensive nephrology nursing (p. 12). Boston:
Little, Brown & Co. Copyright 1986 by C.J. Richard. Reprinted by permission.
glomerular capillaries returns to the
central circulation via the peritubular
capillary (PTC) network. (See the first
article in the physiology series for a
discussion of the PTC network.)
Glomerular Filtration
Glomerular anatomy. The
porous glomerular capillaries rest
between the afferent and efferent
arterioles (see Figure 2). Their func-
tion is to filter large quantities of
water and solutes from the plasma.
As blood flows through the glom-
erulus a portion is sieved through the
filtering layers of the glomerular cap-
illaries into the Bowman’s space. The
286
filtration barrier is composed of three
layers that allow for the filtration of
solutes (eg., blood urea nitrogen, cre-
atinine, electrolytes) and water, but
prevent the loss of blood components
such as red and white blood cells and
plasma proteins. The three layers are
the glomerular capillary endothelium,
glomerular basement membrane, and
visceral layer of Bowman’s capsule
(epithelial cell layer) (see Figure 2).
The first layer of the filtration
barrier is the capillary endothelium,
which has large fenestrations that
allow the free filtration of substances
with diameters up to 100 nm, thus
excluding blood cells and large
NEPHROLOGY NURSING JOURNAL  June 2003
plasma proteins. The surface of
the endothelial cells has a negative
charge that inhibits the movement of
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
foot processes have anionic sialo-
proteins on their borders that form
the slit pores, generating a highly
negatively charged region through
which the filtrate must pass. These
negative charges assist in preventing
plasma proteins from entering the
tubular fluid since plasma proteins
carry negative charges. These nar-
row slits combined with the negative
charges of the podocytes provide the
final barrier to molecule movement
through the glomerular membrane.
The glomerulus is a selective filtra-
tion membrane. The factors that deter-
mine which molecules are filtered are
molecular size, electrical charge, pro-
tein binding, configuration, and rigid-
ity. Small molecules with molecular
weights (MW) less than 7,000 Daltons
(eg., water, MW 18; and all ions
 Vol. 30, No. 3

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,
phosphate, magnesium, and calcium)
are filtered without restriction. Larger
molecules, such as myoglobin with a
MW of 17,000 Daltons, are filtered to
a lesser degree. Very large molecules,
such as plasma proteins with molecular
weights approaching 70,000 Daltons,
are restricted from passing through
the normal glomerulus.
As the filtration barrier has a net
negative electrical charge, the move-
ment of large negatively charged
molecules is restricted more than
molecules with a positive or neutral
charge. As a result, proteins, which
are negatively charged, are not freely
filtered by the glomerulus. Likewise,
drugs, ions, or small molecules bound
to protein are not filtered. Round mol-
NEPHROLOGY NURSING JOURNAL  June 2003
Figure 2
Glomerular Anatomy
ecules do not filter as easily as ellipsoid
molecules. The more rigid a molecule,
the less easily it filters. Normal glo-
merular filtrate is essentially protein
free but contains crystalloids (eg.,
sodium, chloride, creatinine, urea, uric
acid, and phosphate) in the same con-
centration as plasma.
A final anatomical aspect of the
glomerulus is the mesangial cells,
which are located between the capil-
lary loops. They support the capillary
structures and carry out some phago-
cytic activities. They also demonstrate
contractile properties and can alter the
total filtration surface area. Mesangial
cells contract when exposed to vaso-
constrictive substances, such as angio-
tensin II, thus decreasing the effective
filtration surface area and glomerular
 Vol. 30, No. 3
filtration rate. The special filtering
characteristics of the glomerulus cou-
pled with the unique renal circulation
allow for effective glomerular filtration
to occur.
Glomerular Filtration Rate
and Filtration Fraction
Glomerular filtrate moves into the
Bowman’s space and then into the
tubular component of the nephron.
In the average 70 kg adult, glomeru-
lar filtration rate (GFR) is approxi-
mately 125 ml/minute. This means
that about 180 L of glomerular filtrate
is produced in a 24-hour period,
which is more than 30 times the aver-
age total blood volume. All but one
to two liters are reabsorbed from the
nephron into the peritubular capillary
287
Glomerular Filtration: An Overview
and vasa recta network. The forma-
tion of such a large amount of filtrate
assures adequate filtration of plasma,
but requires very efficient reabsorp-
tive processes to prevent volume and
electrolyte depletion.
GFR, which indicates the volume
of filtrate moving from the glomeru-
lar capillaries into Bowman’s space
per unit of time, is calculated by
determining the renal clearance of
a marker substance. Clearance (CL)
is defined as the volume of plasma
from which a substance is completely
removed or cleared by the kidneys
per unit of time. The ideal marker
for measuring CL does not bind to
proteins, is freely filtered at the glom-
erulus, and is neither reabsorbed,
secreted, synthesized, nor metabo-
lized by the tubules. Substances that
do not meet these requirements can
result in falsely elevated or decreased
values of GFR. As there is no natu-
rally occurring ideal marker, endog-
enous creatinine (Cr) often is used to
measure clearance; however, since a
small amount of creatinine is secreted
into the tubule, GFR measured with
creatinine clearance (CrCL) will
be overestimated. Since individual
GFRs vary widely, a change in GFR
over time is more important than the
absolute value of the GFR. Thus, if
the CrCL method is used, it should
be used for all measurements of GFR
to allow for comparison of values
over time.
Inulin is a marker that meets all
the requirements of an ideal marker
for measuring GFR, but is not often
used because it is an exogenous sub-
stance that must be infused for sev-
eral hours at a constant rate making it
both impractical and costly.
A more practical method to deter-
mine the CrCL involves the collec-
tion of a 24-hour urine and midpoint
plasma Cr (P Cr). CrCL is calculated
using Equation 1 where UCr is the
urine creatinine concentration, mg/
dl; Uv is the average urine flow rate,
ml/min; and P Cr is the plasma creati-
nine concentration, mg/dl.
Equation 1
CrCL = UCr Uv
288
______
P Cr
Another method for determin-
ing CrCL involves the intravenous
injection of a radioactive marker.
Clearance of the radioactive marker
is assessed by serial scans. The results
using this method correlate closely
with inulin clearance. The CrCL
estimates the GFR and gives a gross
indication of how well the kidneys are
functioning based on their ability to
remove a marker substance.
As using inulin is impractical,
urine collections are often inaccurate,
and renal scans are costly and require
special equipment, the use of alterna-
tive methods to estimate GFR have
been proposed. The National Kidney
Foundation, in its Kidney Disease
Outcome Initiative Guidelines, recom-
mends the use of the Cockcroft-Gault
formula (see Equation 2) or the more
complicated Modification of Diet in
Renal Disease (MDRD) study formula
(available at www.kidney.org).
Equation 2: Cockcroft-Gault
Formula
GFR =
(140-Age) x Body weight (kg)
72 x Serum creatinine
(X 0.85 for females)
Both consider the effects of age,
gender, and body weight on creati-
nine, but no special lab or diagnos-
tic tests are required. The MDRD
formula also factors in the effects of
race, albumin, and serum urea nitro-
gen. There are hand-held personal
data assistant programs and Web-
based calculators with these formulas
that easily complete the calculations
after the raw data has been entered.
Use of one of these standardized for-
mulas with a programmed calculator
ensures accurate, consistent results
when tracking a GFR over time.
The glomerular filtrate is derived
from the plasma portion of whole
blood. The term filtration fraction
(FF) describes the percentage of the
plasma that becomes glomerular fil-
trate. Since plasma volume is about
55% of total blood volume, normal
NEPHROLOGY NURSING JOURNAL  June 2003
renal plasma flow (RPF) is approxi-
mately 660 ml/min (1200 ml/min x
0.55 = 660 ml/min). The FF can then
be determined using Equation 3.
Equation 3
FF = GFR = 125 ml/min ~
=19%
RPF 660 ml/min
Thus, almost 20% of the plasma
passing through the glomerulus
becomes glomerular filtrate in the
average adult.
Pressures influencing normal
glomerular filtration. Glomerular
filtration is controlled by four pres-
sures, the algebraic sum of which
defines the net filtration pressure.
These pressures are:
1. Glomerular capillary hydrostatic
pressure (P GC), which is the pres-
sure exerted against the capillary
wall by fluid within the capillary
lumen. This pressure is gener-
ated by the blood pressure. This
value ranges from 40-60 mmHg
and favors the movement of fluid
from the capillary lumen to the
Bowman’s space (see Figure 3).
2. Glomerular capillary colloid
osmotic pressure (∏GC), which is
about 18 mmHg. This force, gen-
erated by plasma proteins within
the capillaries, retards the move-
ment of fluid out of the capillary
lumen.
3. Bowman’s space hydrostatic pres-
sure (P BS), which is the pressure
exerted against the outer layer of
the capillary walls by fluids within
Bowman’s space. This value is
about 10 mmHg and also retards
the movement of fluid out of the
capillary lumen.
4. Bowman’s space colloid osmotic
pressure (∏BS), which is normally
0 mmHg because normal filtrate is
void of protein.
Net filtration pressure (NFP),
which is the sum of these negative
and positive pressures, can be calcu-
lated with the following formula (see
Equation 4). An average P GC of 45
mmHg is used.
Equation 4
NFP = (P GC - P BS ) - (∏GC - ∏BS)
 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)
- (18 mmHg - 0 mmHg)
= 17 mmHg
These pressures are based on
animal models but are thought to be
similar to those in humans. Therefore,
for adequate filtration to occur, an
NFP of approximately 17 mmHg is
required to produce approximately
125 ml/min of glomerular filtrate.
As blood progresses through the
glomerulus toward the efferent arte-
riole, the ∏GC increases from 18 to
approximately 35 mmHg, reflecting
the removal of protein free fluid from
the glomerular capillary. P GC, P BS, and
∏BS remain essentially unchanged
along the capillary loop. As a result,
NFP decreases along the length of the
capillary and in some species is zero
before or at the end of the capillary.
The point at which NFP falls to zero
is called filtration equilibrium and is
the point at which glomerular filtra-
tion ceases.
Conditions altering glomeru-
lar filtration rate. The GFR can
be altered by changes in any of the
above four pressures or the ultrafiltra-
tion coefficient. Theoretically, there
is a direct relationship between the
renal plasma flow rate (the primary
determinant of P GC) and the GFR. If
RPF increases due to volume expan-
sion or other causes, GFR should
also rise. However, a change in RBF
rarely occurs in isolation and is usu-
ally accompanied by changes in affer-
ent or efferent arteriolar resistance
designed to maintain a consistent P GC
and, therefore, GFR at normal levels.
Through a process called autoregula-
tion, the kidney is adept at maintain-
ing a normal GFR over a wide range
of vascular pressures.
Changes in the glomerular col-
loid osmotic pressure (∏GC) can also
alter GFR. Serum protein is the
major determinant in colloid osmotic
pressure. If ∏GC increases due to
increased protein concentration, as in
hypovolemic states, NFP and, thus,
GFR will fall in an effort to prevent
further intravascular volume loss.
If the ∏GC decreases due to protein
losses, as in severe malnutrition or
hypoalbuminemic states, GFR can
increase.
When P BS increases, as in urinary
tract obstruction, GFR falls. GFR
decreases as glomerular filtrate out-
flow from the tubule is obstructed
and the pressure of the increased fil-
trate volume in the Bowman’s space
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
does in nephrotic conditions where
protein is filtered into the Bowman’s
space because of changes in the filter-
ing membrane, GFR can increase.
The presence of plasma proteins in
Bowman’s space favors increased
filtration due to the increased colloid
osmotic pressure within that compart-
ment.
A final factor that can alter GFR
is a change in the ultrafiltration coef-
ficient (Kf) of the glomerular capillary
membrane. The Kf is the product of
the surface area and hydraulic perme-
ability of the glomerular membrane.
Vasoactive substances such as angio-
tensin II can cause the mesangial
cells to contract thereby decreasing
the available surface area for filtration
resulting in a decreased GFR.
Glomerular filtration is the criti-
cal initial step in urine formation. In
order for adequate solute and water
removal to occur, glomerular filtrate
must be generated at a constant rate.
Changes in RPF, hydrostatic and
osmotic pressures, available filter-
ing surface area, and glomerular
membrane permeability can upset
the internal environment by increas-
ing or decreasing GFR. Fortunately,
there exists a complicated system
where factors both extrinsic and
intrinsic to the kidneys act simultane-
ously to minimize the effects of these
changes.
Summary
Glomerular filtration is a complex
process that is impacted by numerous
intrinsic and extrinsic factors that can
alter renal hemodynamics and RBF.
These factors interact in an attempt
to maintain a consistent glomerular
filtration rate under a wide variety of
normal and pathologic conditions. If
these integrated systems fail, serious
problems can develop with renal
function and urine production and
excretion. Understanding the physi-
ology of glomerular filtration and the
interactions of factors altering renal
hemodynamics will help the nephrol-
ogy nurse in predicting, identifying,
and assisting in the treatment of clini-
cal conditions that alter glomerular
filtration and renal hemodynamics.
290
and hypertensive kidneys. Current
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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.
Volume I (pp. 277-311). Philadelphia: Glassock (Eds.), Textbook of nephrol-
ogy: Volume I (4th ed.) (pp. 43-55).
W.B. Saunders Co.
Philadelphia: Lippincott, Williams
Gabbai, F.B., & Blantz, R.C. (2001).
Glomerular filtration. In S.G. Massry & Wilkins.
& R.J. Glassock (Eds.), Textbook of Preisig, P., Chmielewski, C., Keen, M.,
nephrology: Volume I (4th ed.) (pp. Holechek, M.J., Ludlow, M.K., &
56-60). Philadelphia: Lippincott, Yucha, C.B. (1998). Renal physiol-
Williams & Wilkins. ogy. In J. Parker (Ed.), Contemporary
Goraca, A. (2002). New views on the role nephrology nursing (pp. 127-176).
of endothelin. Endocrine Regulations, Pitman, NJ: American Nephrology
36, 161-167. Nurses’ Association.
Horio, M., Orita, Y., & Fukunaga, M. Rose, B.D., & Rennke, H. (1994). Renal
pathophysiology. Baltimore: Williams
(2001). Assessment of renal function.
& Wilkins.
In R.J. Johnson & J. Feehally (Eds.),
Comprehensive clinical nephrology (pp. Thomson, S. (2002). Adenosine and
3.1-3.6). London: Mosby. puringenic mediators of tubuloglo-
Jackson, B.A., & Ott, C.E. (1999). Renal merular feedback. Current Opinions
system. Madison, CT: Fence Creek in Nephrology and Hypertension, 11,
Publishing. 81-86.
Koeppen, B.M., & Stanton, B.A. (2001). Unwin, R.J., & Capasso, G. (2000). Renal
Renal physiology (3rd ed.). St. Louis: physiology. In R.J. Johnson & J.
Mosby. Feehally (Eds.), Comprehensive clini-
Levey, A., Bosch, J., Lewis, J., Greene, cal nephrology (pp. 2.1-2.12). London:
Mosby.
T., Rogers, N., & Roth, D. (1999).
Vander, A.J. (1995). Renal physiology (5th
A more accurate method to estimate
glomerular filtration rate from serum ed). New York: McGraw-Hill Inc
creatinine: A new prediction equa-
tion. Annals of Internal Medicine, 130,
461-470.
Levin, E.R. (1995). Endothelins. New
England Journal of Medicine, 333, 356-
363.
Maddox, D.A., & Brenner, B.M. (2000).
Glomerular ultrafiltration. In B.M.
Brenner (Ed.), The kidney: Volume I
(pp. 319-359). Philadelphia: W.B.
Saunders.
Meyers, B.D. (2001). Determinants of the
glomerular filtration of macromole-
cules. In S.G. Massry & R.J. Glassock
(Eds.), Textbook of nephrology: Volume I
(4th ed.) (pp 61-64). Philadelphia:
Lippincott, Williams & Wilkins.
Miyataka, M., Rich, K.A., Ingram, M.,
Yamamoto, T., & Bing, R.J. (2002).
Nitric oxide, antiinflammatory drug
on renal protoglandin and cyclooxy-
genase2. Hypertension, 39, 785-789.
Osborn, J.L., Greenberg, S., & Plato, C.F.
(2001). The neural control of renal
function and extracellular fluid vol-
ume. In S.G. Massry & R.J. Glassock
(Eds.), Textbook of nephrology: Volume
I (4th ed.) (pp. 65-69). Philadelphia:
Lippincott, Williams & Wilkins.
Pallone, T.L., & Mattson, D.L. (2002).
Role of nitric oxide in the regula-
tion of the renal medulla in normal
NEPHROLOGY NURSING JOURNAL  June 2003  Vol. 30, No. 3
 Glomerular Filtration: An Overview
Mary Jo Holechek, MS, CRNP, CNN
(See posttest instructions on the answer form, on page 292.)
1. A rapid renal blood flow rate is
necessary to assure
A. the kidneys are oxygenated.
B. efficient clearance of metabolic
waste products.
C. the metabolic needs of the kid-
neys are met.
D. medullary blood flow is main-
tained.
2. The first point of major vascular
resistance in the renal arterial
system is the
A. efferent arteriole.
B. vasa recta.
C. afferent arteriole.
D. peritubular capillaries.
3. The glomerular capillary bed dif-
fers from other capillary beds in
that it is
A. a highly porous, high pressure
system.
B. not affected by systemic arte-
rial pressure changes.
C. freely permeable to blood pro-
tein.
D. an impermeable, low pressure
system.
4. High pressure in the glomerular
capillaries is essential to
A. prevent hypotension.
B. ensure perfusion of the vasa
recta and peritubular capillary
network.
C. overcome other opposing
pressures in the glomerulus
and Bowman’s space.
D. prevent the movement of plas-
ma proteins into Bowman’s
space.
5. Approximately what percentage
of the cardiac output circulates
through the kidneys per min-
ute?
A. 10%-15%
B. 20%-25%
C. 30%-35%
D. 40%-45%
6. The major barrier to filtration of
molecules in the glomerulus is
A. glomerular capillary endothe-
lium.
B. glomerular basement mem-
brane.
C. visceral layer Bowman’s capsule.
D. anionic sialoproteins.
NEPHROLOGY NURSING JOURNAL  June 2003
Posttest — 1.7 Contact Hours
Posttest Questions
7. Factors that determine which
molecules are filtered include
A. molecular size only.
B. molecular size and charge
only.
C. molecular size, charge, and
protein binding only.
D. molecular size, charge, protein
binding, and rigidity.
8. Constriction of the mesangial
cells results in a(n)
A. decrease in phagocytic activ-
ity.
B. increase in the glomerular fil-
tration rate (GFR).
C. decrease in the surface area
available for filtration.
D. increase in catecholamine
activity.
9. Which of the following would
be found in normal glomerular
filtrate?
A. Urea only.
B. Urea and sodium only.
C. Urea, sodium, and creatinine
only.
D. Urea, sodium, creatinine, and
albumin.
10. The normal GFR for an adult is
A. 75 ml/min.
B. 100 ml/min.
C. 125 ml/min.
D. 150 ml/min.
11. Efficient reabsorption processes
of glomerular filtrate are required
to prevent
A. volume overload.
B. dehydration.
C. hypertension.
D. hyperkalemia.
12. The GFR reveals
A. how rapidly blood flows through
the kidney per unit of time.
B. the volume of solutes removed
from the blood per unit of time.
C. the rate at which solutes and
water are reabsorbed by the
peritubular capillary network
per unit of time.
D. the volume of filtrate moving
from the glomerular capillaries
into Bowman’s space per unit
of time.
 Vol. 30, No. 3
13. The production of massive
amounts of glomerular filtrate is
essential to
A. assure adequate filtration of
the complete plasma volume.
B. maintain a normal systemic
blood pressure.
C. assure efficient removal of
blood proteins.
D. prevent circulatory collapse.
14. What is an ideal marker to mea-
sure glomerular filtration?
A. Creatinine.
B. Urea.
C. Inulin.
D. Potassium.
15. You are seeing Mrs. Sue in the
clinic. She is 73 yrs old and
weighs 72 kg. Her serum creati-
nine is 2.3. What is her estimated
GFR?
A. 25 ml/min.
B. 29 ml/min.
C. 33 ml/min.
D. 40 ml/min.
16. A GFR determined using creati-
nine as the marker should
A. predict the GFR exactly.
B. slightly overestimate the GFR.
C. slightly underestimate the GFR.
D. not be used to estimate the
GFR.
17. The NKF recommends the use
of which method to estimate the
GFR?
A. 24 hour urine.
B. inulin clearance.
C. prediction equation.
D. urea clearance.
18. Glomerular filtration is opposed
by which of the following forces?
A. Glomerular capillary hydro-
static pressure.
B. Bowman’s capsule oncotic
pressure.
C. Glomerular capillary oncotic
pressure.
D. Peritubular capillary hydrostatic
pressure.
19. You are seeing a patient in the
clinic. The patient is malnour-
ished and hypoalbuminemic.
You would predict the GFR to
A. be decreased.
B. not be affected.
C. be increased.
D. fall to 0 ml/min.
291
Glomerular Filtration and Renal Hemodynamics

ANSWER FORM ANNJ305

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

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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