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Kidney + Liver + Endocrine > Kidney > Flashcards

Kidney Flashcards

(68 cards)

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1
Q

What is the outer part of the kidney? What does it contain?

A

Renal Cortex

-Most parts of the nephron

-Glomerulus
-Bowmans Capsule
-Proximal Tubules
-Distal Tubules

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2
Q

What is the inner part of the kidney?

A

Renal Medulla

Contains loops of Henle and collecting ducts

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3
Q

What is the functional unit of the Kidney? How does it work?

A

Nephron

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4
Q

Photo of Nephron

A
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5
Q

What are the two key hormones that govern how the kidney regulates ECF and composition?

A

Aldosterone - Controls ECF through the absorption of water and Na

Antidiuretic Hormone - Controls plasma osmolarity through the absorption of water and not Na

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6
Q

How do the kidneys control long term blood pressure?

A

Through the thirst mechanism

Intake of Na
Output of water

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7
Q

How do the kidneys control short term blood pressure?

A

Baroreceptor

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8
Q

How do the kidneys control intermediate term blood pressure?

A

Renin-angiotensin-aldosterone system

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9
Q

Are Kidneys capable of phase 1 and 2 biotransformation?

A

Yes

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10
Q

How do kidneys eliminate toxins and metabolites?

A

Glomerular filtration and tubular secretion

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11
Q

What two systems regulate the acid-base balance in the body?

A

Lungs - CO2 (volatile acids)

Kidneys - titrates nitrogen (Non-volatile acids)

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12
Q

What stimulates the kidney to release erythropoietin?

A

It is released in the response to inadequate O2 to the kidney

-Anemia
-Reduced intravascular volume
-Hypoxia
-High altitude
-CV/Resp failure

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13
Q

What does EPO do??

A

Stimulates cells in the bone marrow to produce erythrocytes

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14
Q

What is Calcitriol and what does it do?

A

Stimulates the

-intestine to absorb calcium from food
-bone to store Ca
-Kidney to reabsorb Ca and Phosphate

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15
Q

How much blood flow do the Kidneys receive?

A

20-25% of the CO

1000ml/Min

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16
Q

Kidney blood flow photo

A
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17
Q

Where does kidney filtration occur?

A

Glomerular capillary bed

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18
Q

Where does reabsorption and secretion occur?

A

Peritubular bed

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19
Q

When does glomerular filtration become pressure dependent?

A

When MAP is outside the range of autoregulation (50-180)

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20
Q

What happens when renal perfusion is too high or too low?

A

Too low- renal blood flow is increased by reducing renal vascular resistance

Too high- renal blood flow is increased by increasing renal vascular resistance

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21
Q

What is the myogenic mechanism of renal autoregulation>

A

When pressure is too high the afferent arteriole constricts to protect

When pressure is too low the afferent arteriole dilates to allow more blood in

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22
Q

What does the juxtaglomerular apparatus do?

A

Regulates tubuloglomerular feedback about sodium and chloride in the distal tone

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23
Q

How does surgical stress affect the kidney?

A

Vasoconstriction and sodium retention which results in decreased

RBF
GFR
UO
Sodium excretion

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24
Q

What does Renin release do?

A

Converts Angiotensinogen to Ang 1

which gets converted by the lungs to Ang 2

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25
What three conditions increase renin release?
Decreased renal perfusion SNS activation through beta 1 Tubuloglomerular feedback (decreased NA and Chloride
26
Increased Renin leads to increased Ang 2, What is seen in the body as a response?
1. Peripheral vasoconstriction 2. Efferent vasoconstriction 3. Increased aldosterone which retains Na and secretes K 4. Increased ADH from the posterior pituitary 5. Increased thirst
27
Where is aldosterone produced and what is it's function?
A steroid produced in the zona glomerulosa of the adrenal gland Na reabsorption H2O reabsorption K excretion H+ excretion
28
Where is ADH produced and stored? Function?
Produced - hypothalamus Stored - Posterior pituitary due to increased osmolarity of the ECF and decreased blood volume
29
How does ADH increase blood pressure?
V2 stimulation in the collecting ducts (Increased cAMP) V1 stimulation in the peripheral vasculature (Alpha 1 stim)
30
What clinical situations will increase ADH?
-PEEP -Positive pressure ventilation -Hypotension -Hemorrhage
31
What 3 mechanisms promote renal vasodilation?
1. Prostaglandins 2. ANP 3. Dopamine 1 stimulation
32
Dopamine 1 receptor?
DA1 - present in the kidney and splanchnic circulation 2nd messenger cAMP Vasodilation, increased renal blood flow, increased GFR, Diuresis, Na excretion
33
Dopamine 2 receptor?
Presynaptic SNS nerve terminal Decreased cAMP Decreases norepi release
34
How does fenoldapam use?
Selective DA1 agonist which increases renal blood flow May offer renal protection
35
What is a normal GFR?
125mL/min
36
What are the 3 determinants of glomerular hydrostatic pressure?
1. Arterial BP 2. Afferent arteriole resistance 3. Efferent arteriole resistance
37
When the afferent arteriole is constricted, what happens to the RBF, GFR, and filtration fraction?
Decreased Renal Blood flow Decreased GFR No change in filtration
38
When the efferent arteriole is constricted, what happens to the RBF, GFR, and filtration fraction?
Decreased renal blood flow Increased GFR Increased filtration
39
What happens with an increased in plasma protein to the RBF, GFR, and filtration fraction?
No change in RBF Decreased GFR Decreased filtration
40
What happens with a decrease in plasma protein to the RBF, GFR, and filtration fraction?
No change in RBF Increased GFR Increased filtration
41
What is reabsorption?
Substance is transferred from the tubule to the peritubular capillaries
42
What is secretion?
Substance is transferred from the peritubular capillaries to the tubule
43
What is excretion?
Substance is removed from the body to the urine
44
What part of the nephron is most sodium reabsorbed?
Proximal tubule
45
What occurs in the proximal tubule?
Bulk of solutes and water are reabsorbed
46
What happens in the descending loop of Henle?
High permeability of H2O tubular fluid is concentrated
47
What happens in the ascending loop of Henle?
No permeability of H2O Tubular fluid is diluted
48
What happens in the collecting duct?
Regulates the final concentration of urine (Aldosterone and ADH)
49
What happens in the distal tubule?
Fine tunes solute concentration (Aldosterone and ADH)
50
What are carbonic anhydrase inhibitors and how do they work?
Acetazolamide, Dorzolamide Works in the proximal tubule with a loss of bicarb and sodium
51
Uses for carbonic anhydrase inhibitors. Side effects?
Glaucoma Altitude sickness Central sleep apnea syndrome Hypokalemia Metabolic acidosis
52
What is the MOA of osmotic diuretics? Examples
Mannitol Glycerin Isosorbide They are sugars that undergo filtration but not reabsorption (Stops water from being reabsorbed in the loop of Henle)
53
Key notes for osmotic diuretics?
Used for free radicals and intracranial HTN Can cause pulmonary edema, volume overload, and cerebral edema if the BBB is disrupted
54
Examples of loop diuretics and how they work?
Lasix, Bumex, Ethacrynic acid They poison the Na-K-2Cl transporter in the ascending loop of Henle
55
Clinical uses of loop diuretics? Side effects?
HTN CHF Acute pulmonary edema Hypercalcemia Reduced electrolytes Ototoxicity Reduced lithium clearance
56
Examples of thiazide diuretics? MOA?
Hydrochlorothiazide Metolazone Indapamide Inhibits Na-Cl transported in the distal tube
57
Clinical uses of thiazide diuretics? Side effects?
HTN CHF Osteoporosis DI Hyperglycemia Hypercalcemia Hyperuricemia Hypokalemia Hypovolemia
58
MOA and examples of potassium sparing diuretics?
Spironolactone, Amiloride, Triamterene Collecting ducts
59
Clinical uses and side effects of K sparing diuretics?
Reduce potassium loss Secondary hyperaldosteronism Libido changes Hyperkalemia Metabolic acidosis Nephrolithiasis
60
List three tests of GFR and normal values for each?
BUN (10-20) Creatine (0.7-1.5) Creatine Clearance (110-150)
61
List four tests of tubular function and give the normal values for each
Fractional excretion of NA (1-3%) Urine osmolality (65-1400) Urine sodium (130-260) Urine specific gravity (1.003 - 1.030)
62
What does a BUN of less than 8 signify ?
Overhydration Decreased Urea Production -malnutrition -Severe liver disease
63
What does a BUN of 20-40 signify?
Dehydration Increased protein Catabolism
64
What does a BUN > 50 signify?
Decreased GFR
65
What is the BUN: Creatine ratio?
Helps evaluate the state of hydration Normal is 10:1 Greater than 20:1 indicates prerenal azotemia
66
What does BUN undergo; filtration, reabsorption or both
Filtration and Reabsorption
67
What does creatine undergo; filtration, reabsorption or both
Filtration NOT reabsorption
68
**What is the best indicator if GFR?
Creatine clearance

Kidney + Liver + Endocrine (6 decks)

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