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APEX: Flashcards > Kidney > Flashcards

Kidney Flashcards

1
Q
A
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2
Q

Nephron

A
  • functional unit of kidney
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3
Q

Renal cortex

A
  • outer section
  • contains:
    1. glomerulus
    2. bowman’s capsule
    3. proximal tubules
    4. distal tubules
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4
Q

Renal medulla

A
  • inner section
  • contains:
    1. LOH
    2. collecting ducts
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5
Q

Identify structures of nephron

A
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6
Q

Identify structures of kidney

A
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7
Q

6 functions of kidney

A
  1. Maintain ECF & composition
    - aldosterone (Na+/H2O reabsorption)
    - ADH (H2O reabsorbed but not Na+)
    - K+, Cl-, Phos, Mg, H+, HCO3, glucose, urea
  2. BP regulation
    - RAAS
  3. Excretion of toxins/metabolites
  4. Maintain acid-base balance
  5. Hormone production
  6. Blood glucose homeostasis
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8
Q

Hormones produced by kidney

A
  1. erythropoietin
    - triggers for release: anemia, reduced IV vol, hypoxia
    - stimulates bone marrow to produce erythrocytes
  2. prostaglandins
  3. calictriol
    - 25-hydroxycholecalciferol converted to calcitriol (active vit D)
    - stimulates intestinal absorption Ca+
    - tells kidney to reduce Ca+ & phos excretion
    - increases deposition of Ca+ into bone
  4. renin
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9
Q

hormone that controls plasma osmolarity

A

ADH

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10
Q

hormone that control ECF volume

A

aldosterone

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11
Q

2 organs responsible for acid-base balance

A
  1. kidney
  2. lung
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12
Q

Pathway of blood flow through kidney

A

afferent arteriole > glomerular capillary bed > efferent arteriole > peritubular capillary bed

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13
Q

Kidneys receive _______ % of CO

A

20-25%

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14
Q

Renal blood flow formula

A

RBF = (MAP - Renal venous pressure) / Renal vascular resistance

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15
Q

Renal cortex receives ____% of RBF

A
  • 90%
  • PO2 50 mmHg
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16
Q

Renal medulla receives ____% of RBF

A
  • 10%
  • PO2 10 mmHg
  • more sensitive to ischemia
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17
Q

Pathway of blood through kidney

A

ARTERIAL
Renal a. > renal segment a. > interlobar a.> arcuate a. > interlobular a. > afferent arteriole > glomerular capillary bed > efferent arteriole > peritubular capillary bed

VENOUS
venules > interlobular vein > arcuate vein > interlobar vein > renal segmental vein > renal vein

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18
Q

RBF Autoregulation

A
  • low renal perfusion > autoregulation increases RBF by decreasing renal vascular resistance > RBF increases
  • too high renal perfusion > autoregulation decreases RBF by increasing renal vascular resistance > RBF decreases

RBF limits ~ 50-180 mmHg

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19
Q

6 mechanisms that autoregulate RBF

A
  1. myogenic
  2. JG apparatus + tubuloglomerular feedback
  3. RAAS
  4. prostaglandins
  5. ANP
  6. SNS
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20
Q

Most important contributors to renal autoregulation

A
  1. myogenic mechanism
    - contricts/dilates afferent arteriole if renal artery pressure high/low
  2. tubuloglomerular feedback
    - JG apparatus in distal tubule b/t afferent & efferent arteriole detects Na+/Cl- composition in DCT & affects arteriolar tone
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21
Q

Kidney response to ischemia/sepsis/surgical stress

A

Vasoconstriction & Na+ retention
- SNS, RAAS, ADH
- decreased RBF, GFR UOP, Na+ excretion

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22
Q

RBF decreases by ____% per decade after the age 50

A

10%

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23
Q

JG apparatus

A
  • located in distal tubule
  • decreased RBF > decreased Na+/Cl= delivery to JG app (sensed by macula densa) > afferent arterioles dilate > GFR increases
  • low Cl- delivery > renin released from juxtaglomerular cells > RAAS activates > AG2 constricts efferent arteriole > GFR increases
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24
Q

RAAS

A
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25
Q

Conditions that increase renin release

A
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26
Q

Aldosterone

A
  • produced in zona glomerulosa of adrenal gland
  • stimulates Na/K ATPase in principal cells of distal tubules & collecting ducts
  • facilitates Na+ & H2O reabsorption & K+ & H+ excretion
  • release is increased by high K+ & low Na+
  • Conn’s dz = excess aldosterone (Na+ retention & K+ loss)
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27
Q

ADH (vasopressin)

A
  • produced in the supraoptic & paraventriular nuclei of hypothalamus
  • released from posterior pituitary gland
  • 2 mechanisms that control release: increased osmolarity, decreased blood volume
  • stimulates V1 in peripheral vasculature (vasoconstriction)
  • stimulates V2 in collecting ducts- aquaporins reabsorption of H2O
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28
Q

Prostaglandins

A
  • produced in afferent arteriole
  • promote RBF
  • arachidonic acid is liberated from cells in r/t ischemia, hypotension, NE, & AG2.
  • NSAIDs inhibit cyclooxygenase & can reduce RBF by inhibiting production of vasodilating prostaglandins
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29
Q

natriuretic peptide

A
  • atrial distension > ANP & BNP release
  • inhibit renin release
  • promote Na+/H2O excretion
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30
Q

dopamine receptors

A
  • DA1 (kidney, splanchnic circ)
  • DA2 (presynaptic adrenergic n. terminal)
  • DA1: increase cAMP > vasodilation, increased RBF & GFR, diuresis, Na+ excretion
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31
Q

Fenoldopam

A
  • selective DA1 agonist
  • increases RBF
  • renal vasodilator
  • facilitates Na+ excretion
32
Q

normal GFR

A

125 ml/min

33
Q

glomerular filtration

A
  • H2O, electrolytes, glucose freely filtered
  • plasma proteins not filtered
  • kidney disease destroys basement membrane which allows proteins to enter tubules
34
Q

Net filtration pressure

A

NFP = glomerular hydrostatic P - Bowman’s capsule hydrostatic P - Glomerular oncotic P

35
Q

Most important determinant of GFR

A

glomerular hydrostatic pressure

36
Q

BP

A
  • increased MAP increases GFR
  • decreased MAP decreases GFR
37
Q

Constriction of afferent arteriole _____GFR

A

reduces

38
Q

Dilation of afferent arteriole ______ GFR

A

increases

39
Q

Constriction of efferent arteriole

A
  • mild reduces flow toward peritubular capillaries & increases GFR
  • excessive reduces RBF & GFR
40
Q

Dilation of efferent arteriole

A

increases flow towards peritubular capillaries & reduces GFR

41
Q

reabsorption

A

substance transferred from tubule to peritubular capillaries

42
Q

secretion

A

substance transferred from peritubular capillaries to tubule

43
Q

excretion

A

substance removed from body in urine

44
Q

urine excretion rate

A

= filtration - reabsorption + secretion

45
Q

proximal convoluted tubule

A
  • 65% Na+ reabsorption
  • 65% H2O reabsorption
  • 65% K+, Cl-, HCO3 reabsorption

Diuretics:
- acetazolamide, dorzolamide (carbonic anyhdrase inhibitors)
- osmotic diuretics: mannitol (also LOH)

46
Q

descending LOH

A
  • highly permeable to H2O (20% reabsorbed)
  • more concentrated w/ Na+
  • LOH = countercurrent multiplier - creates osmotic gradient
  • vasa recta = countercurrent exchanger = maintains medullary osmotic gradient
47
Q

ascending LOH

A
  • NOT permeable to H2O
  • Na/2K/Cl co transporter
  • Na+ reabsorption
  • more dilute

Diuretics:
- Loop diuretics (furosemide, bumetanide)

48
Q

DCT

A
  • 5% Na+ reabsorbed
  • K, Cl, HCO3 reabsorbed
  • late DCT impermeable to H2O except in presence of ADH or aldosterone
  • JGA lives here
  • PTH promotes Ca+ reabsorption

Diuretics:
- thiazide (HCTZ, chlorthalidone, metalazone, indapamide)

49
Q

Collecting duct

A
  • 5% Na+ reabsorbed
  • aldosterone & ADH act here

Diuretics: K+ sparing (spironolactone, amiloride, triamterene)

50
Q

carbonic anhydrase inhibitors

A
  • inhibit carbonic anhydrase in proximal tubule
  • reduces HCO3, Na+, H2O reabsorption
  • ex: acetazolamide, dorzolamide
51
Q

osmotic diuretics

A
  • inhibit H2O reabsorption in proximal tubule (primary) & LOH
  • pull ECF volume into intravascular space
  • ex:
    1. Mannitol 0.25-1 gram/kg
    2. glycerin
    3. isosorbide
52
Q

Loop diuretics

A
  • inhibit Na/K/2Cl transporter in ascending LOH
  • ex: furosemide, bumetanide, ethacrynic acid
53
Q

thiazide diuretics

A
  • inhibit Na/Cl co-transporter in DCT
  • activates Na-Ca antiporter (increases Ca+ reabsorption)
  • hyperglycemia
  • HCTZ, chlorthalidone, metolazone, indapamide
54
Q

K sparing diuretics

A
  • inhibit K secretion & Na reabsorption in collecting ducts
  • spironolactone subclass - inhibit aldosterone > inhibit K secretion/Na reabsorption in collecting ducts
  • amiloride, triamterene
55
Q

Best indicator of GFR

A

Creatinine clearance

56
Q

Best test of tubular function

A

urine osmolality

57
Q

prerenal AKI

A
  • cause = hypoperfusion
  • Tx: IVF, HD support, PRBCs
  • avoid NSAIDs
58
Q

intrinsic AKI

A
  • cause = parenchymal dysfunction
    1. normally ATN -ischemia, drugs
    2. contrast, abx, NSAIDs
  • Tx: restore perfusion, supportive
59
Q

postrenal AKI

A
  • cause = obstruction
    1. clogged foley, ureteral stone, neurogenic bladder
  • Tx: relieve obstruction
60
Q

most common cause CKD

A

DM

61
Q

second most common cause CKD

A

HTN

62
Q

stages of kidney disease

A
63
Q

uremic syndrome

A

-s/s = anemia, fatigue, n/v, anorexia, coagulopathy

64
Q

uremic bleeding

A
  • at risk for increased bleeding
  • elevated bleeding time
  • PT/PTT/PLT normal
  • 1st line tx = desmopressin
  • dialysis w/i 24 hours of surgery (improves bleeding time)
65
Q

Other s/s CKD

A
  • anemia
  • HTN
  • CAD
  • CHF
  • gap metabolic acidosis
  • hyperkalemia
  • renal osteodystrophy
  • ANS dysfunction
  • CNS s/s
  • infection
66
Q

indications for dialysis

A
  1. volume overload
  2. hyperkalemia > 6
  3. severe metabolic acidosis
  4. symptomatic uremia
  5. OD w/ a drug that is cleared by dialysis
67
Q

Impaired renal function: anesthetic drug considerations

A
  • sevo Compound A
  • sux ok w/ normal K+
  • cisatracurium > atracurium (benzyliso’s)
  • roc, vec, pancuronium prolonged DOA
  • sugammadex not recommended
  • morphine = resp depression
  • meperidine = sz
  • hydromorphone = sz
  • fentanyl, sufentanil, remi better choices
  • precedex safe
68
Q

prevention of contrast-induced nephropathy

A
  • nonionic/low osmolar contrast
  • lowest volume of contrast possible
  • no other nephrotoxic drugs
  • NS IVF before contrast dye
  • HCO3
  • n-acetylcysteine
69
Q

Compound A

A
  • produced when sevo is exposed to soda lime
  • FGF of 1 L/min safe for up to 2 MAC hours
70
Q

nephrotoxic agents

A
  • amnioglycosides (gent, tobramycin, amikacin)
  • amphotericin B
  • vanc
  • sulfonamide
  • tetracylcines
  • cephalosporins
  • NSAIDs
  • caclineurin inhbitors
  • IVP dye
  • sevo
  • myoglobin
71
Q

TURP

A
  • spinal preferred (T10 level)
  • height of solution bag no more than 60 cm above OR table
  • limit surgery to 1 hour
  • irrigation solution complications
    1. distilled water = TURP syndrome (low Na+, hemolysis, hemoglobinuria)
    2. glycine = blindness
    3. sorbitol = hyperglycemia
    4. LR/NaCL = electrocution (monopolar)
  • complications
    1. TURP
    2. bladder perforation (abd/shoulder pain)
  • supportive, H/H, transfusion, suprapubic cysto, ex lap
    3. bleeding
    4. hypothermia
72
Q

TURP syndrome

A
  • absorption of hypo-osmolar irrigation solution
  • S/S: HTN, bradycardia, AMS
  • circulatory overload
  • Na < 110 = SZ
  • Tx:
    1. O2 & CV support
    2. tell surgeon to stop
    3. electrolytes, Hct, Creat, gluc, EKG
    4. Na > 120 = restrict fluids, give lasix
    5. Na < 120 = 3% NaCl at 10 ml/hr
    6. versed for sz
    7. intubate if pt has difficult w/ oxygenation
73
Q

extracorporeal shock wave lithotripsy

A
  • delivers shocks in rapid succession to break up stone
  • absolute contraindications:
    1. pregnancy
    2. risk of bleeding
  • relative contraindications:
    1. PM/AICD
    2. UTI
    3. obesity
    4. calcified aneurysm or aorta or renal artery
  • complications: R on T phenomenon, bruising, hematuria
74
Q

percutaneous nephrolithotripsy

A
  • nephrostomy tube to access stone& ureteral stents placed
  • prone
  • GETA
  • irrigation fluid used
  • pneumo complication
75
Q

laser lithotripsy

A
  • uses laser to break up stone
  • laser precautions
  • irrigation fluids used
  • lithotomy
76
Q
A

APEX: Flashcards (13 decks)

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