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Renal > Renal Review > Flashcards

Renal Review Flashcards

1
Q

What are the renal functions?

A 
Filtration
Secretion
Reabsorption
Endocrine 
Metabolic
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2
Q

What renal functions are associated with maintenance of body composition?

A

Filtration
Secretion
Reabsorption

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3
Q

What renal functions are associated with excretion of toxins and metabolic end products?

A

Filtration
Secretion
Reabsorption

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4
Q

What is the order of renal arteries to veins?

A 
Renal artery
Afferent arterioles
Glomerulus
Efferent arteriole
Peritubular capillaries
Venules
Renal vein
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5
Q

What kind if movement is glomerular filtration?

A

Passive diffusion

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6
Q

What molecular properties affect their ability to be filtered?

A

Size

Charge

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7
Q

What direction is solute movement involved in tubular reabsorption?

A

Lumen to blood

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8
Q

What are the major solutes involved in tubular reabsorption?

A 
Na
Cl
HCO3
Glucose
AA
Protein
Phosphates
Ca
Mg
Urea
Uric acid
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9
Q

Where does tubular reabsorption occur?

A

Proximal tubule
Loop of Henle
Distal tubule and collecting duct

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10
Q

Where is the bulk of filtrate absorbed?

A

Proximal tubule

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11
Q

What is the direction of solute movement in tubular secretion?

A

Blood to lumen

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12
Q

Where does tubular secretion occur?

A

Proximal tubule

Distal tubule and collecting duct

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13
Q

What are the major solutes involved in tubular secretion?

A

H
K
NH4
Organic acids and bases

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14
Q

What is produced in the endocrine system?

A

Renin
Erythropoietin
Prostaglandins and kinins

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15
Q

Where is renin produced and released from?

A

Granular cells in the wall of renal afferent arterioles

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16
Q

When is erythropoietin produced and secreted?

A

Oxygen tension in the blood decreases

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17
Q

What are prostaglandins and kinins used for?

A

Production and metablism

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18
Q

What is the metabolic function of the kidney?

A

Activation of vitamin D3
Gluconeogensis
Metabolism of endogenous compounds

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19
Q

How does sodium absorption occur?

A

Active transport via Na-K-ATPase transport

Na out, K into cells

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20
Q

Where is the Na, K, 2Cl-cotransport located?

A

Thick ascending limb of LoH

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21
Q

What drugs work on the Na, K, 2Cl-cotransporter?

A

Furosemide
Bumetinide
Torsemide

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22
Q

Where is the Na/Cl cotransport located?

A

Distal tubule

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23
Q

What drugs affect the Na/Cl-cotransporter?

A

HCTZ

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24
Q

Where is the Na channel located?

A

Collecting duct

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25
Q

What drugs work on the Na channel?

A

Amiloride

Triamterene

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26
Q

How does the sympathetic nervous system affect regulation of NaCl excretion?

A
  • Increased renal tone = Increased salt reabsorption and decreased renal blood flow
  • Increased sympathetic outflow -> promotes activation of RAAS
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27
Q

How does RAAS affect regulation of NaCl excretion?

A
  • Decreased arterial pressure = increased renin production
  • Increased renin -> increased angiotensin II -> vasoconstriction of efferent arteriole -> increased GFR
  • Angiotensin II -> Increased Na and H2O reabsorption and Increased aldosterone production and release
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28
Q

How does ANP affect regulation of NaCl excretion

A

Increased ANP -> Decreased Na absorption and Increased GFR -> increased Na excretion

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29
Q

ANP stands for

A

Atrial naturetic peptide

30
Q

What systems help to regulate NaCl excretion?

A

Sympathetic nervous system
RAAS
ANP
Vasopressin

31
Q

How does vasopressin affect regulation of NaCl excretion?

A

ADH
Regulated primarily by body fluid osmolarity
Promotes water retention

32
Q

What is the concentration and dilution of urine dependent on?

A

ADH production

Hyperosmotic medullary interstitium

33
Q

What is the primary intracellular electrolyte?

A

Potassium

34
Q

How does aldosterone affect potassium regulation?

A

Increased secretion

35
Q

How does decreased H concentration affect potassium regulation?

A

Increased secretion

36
Q

How does dietary intake affect potassium regulation?

A

Increased dietary intake = Increased secretion

Decreased dietary intake = decreased secretion (increased absorption)

37
Q

How does tubular flow rate affect potassium regulation?

A

Increased flow = increased secretion

Decreased flow = decreased secretion (increased absorption)

38
Q

What are the 3 mechanisms of regulating acid-base homeostasis?

A

Extracellular buffering
Respiratory regulation
Renal regulation

39
Q

What is normal plasma ph?

A

7.35 - 7.45

40
Q

Which organ compensates for primary respiratory abnormalities?

A

Kidneys

41
Q

What organ compensates for primary renal abnormalities?

A

Lungs

42
Q

What is the only means of renal H elimination?

A

H secretion

43
Q

What type of process is H secretion?

A

Passive (dependent on gradient b/n blood and urine)

44
Q

Below what urine pH does H secretion stop?

A

< 4.5

45
Q

Where is HCO3 reabsorbed?

A

Proximal tubules

46
Q

What type of transproter is used with HCO3 absorption?

A

Counter-transport with H secretion

47
Q

What type of transport is used for glucose absorption?

A

Co-transport protein carrying Na and glucose

48
Q

What is the maximal capacity of the Na/Glucose co-transporter?

A

Plasma glucose of 200

49
Q

What type of transport is used for amino acid absorption?

A

Co-transport protein carrying Na and amino acids

50
Q

How do we evaluate GFR?

A 
Inulin
SCr
BUN
Cockroft-Gault
MDRD4
CKD-EPI
Timed urine collection
51
Q

What is the most accurate measure of GFR?

A

Inulin

52
Q

Where is SCr produced?

A

Creatine produced in liver -> stored in muscle as creatine phosphate -> released as creatinine -> kidney

53
Q

How much of SCr is secreted?

A

10%

54
Q

How can SCr vary?

A

Age
Gender
Body mass

55
Q

Where is BUN produced?

A

Liver

56
Q

What is BUN production dependent on?

A

Dietary protein and hepatic function

57
Q

What percent of urea is reabsorbed?

A

50%

58
Q

Where is urea reabsorbed?

A

Proximal tubule

59
Q

What BUN:SCr ratio is indicative of prerenal cause?

A

> /= 20:1

60
Q

What BUN:SCr ratio is indicative of renal (intrinsic) cause?

A

< 20:1

61
Q

What is the primary use of MDRD4?

A

Stage patients with CKD

62
Q

When can MDRD4 be used?

A

Stable renal function only

63
Q

When can CKD-EPI be used?

A

Stable renal function

64
Q

What is the primary use of CKD-EPI?

A

Stage patients with CKD

65
Q

What are the different parts of a UA?

A

Macroscopic analysis
Microscopic analysis
Chemical analysis

66
Q

What are the parts of a microscopic analysis?

A

Cells
Casts
Crystals (uric acid)

67
Q

What cells are observed in a microscopic analysis?

A

Epithelial
Microorganisms
RBC
WBC

68
Q

What are hyaline casts?

A

Clear, not indicative of renal disease

69
Q

What are cellular casts?

A

WBC
RBC
Tubular epithelial cells
Seen with intrinsic renal disease

70
Q

What are granular casts?

A

Seen with ischemic renal damage or toxic insults

71
Q

What are the parts of chemical analysis?

A 
pH
Specific gravity
Bilirubin/urobilinogen
Blood/Hgb
Leukocytes
Nitrites
Glucose
Ketones
Protein
72
Q

Other renal tests

A

KUB
CT scan
Ultrasound
Biopsy

Renal (8 decks)

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