Renal

Question 1

Do you want to be hypertonic or hypotonic in the medulla?

Answer 1

Hypertonic

Question 2

Do you want to be hypertonic or hypotonic in the Cortex?

Answer 2

Hypotonic

Question 3

What occurs in the PCT

Answer 3

Reabsorption of Salts, Water, Glucose, AA

Secretion of Organic Wastes, Metabolites, Drugs/Toxins

Question 4

Where in the kidneys is urine concentrated?

Answer 4

Collecting Ducts (Hypertonic interstitium/vasa recta)
Loop of Henle (Na/water balance)
Juxtamedullary Nephrons (think loop)

Question 5

Where is the best place for urine concentration?

Answer 5

Loop of Henle

Question 6

What is permeable in the DESCENDING loop?

Answer 6

Water (it is moving out)

It is impermeable to NaCL (stays in)

Question 7

What is permeable in the ASCENDING loop?

Answer 7

NaCl (moving out)

Impermeable to water (staying in)

Question 8

What 2 places in the kidneys are responsible for blood pressure and blood volume?

Answer 8

DCT
Juxtamedullary Nephrons

Question 9

What is the MOA of the DCT?

Answer 9

Maintanance of blood pressure and blood volume.
Triggers Renin from the JGA.
Aldosterone works here
Hypotonic

Question 10

What is the purpose of the glomerulus?

Answer 10

Filtering

Losing proteins, glucose, blood cells into the urine

Question 11

Urea is secreted by what in the kidneys?

Answer 11

Collecting Ducts

Question 12

Where is there bulk water movement and what hormone is involved?

Answer 12

Collecting Ducts
ADH inserts aquaporins

Question 13

Where is the hypertonic interstitium located?

Answer 13

Collecting Ducts

Question 14

What does the hypertonic interstitium do?

Answer 14

Concentration of urine in the vasa recta

Question 15

In DI the kidneys are not responding to ____________, therefore they are not absorbing water

Answer 15

ADH

Question 16

What is located in the Cortex?

Answer 16

-Afferent/Efferent Arterioles
-Glomerulus
-PCT/DCT
-Proximal portions of the Collecting Duct & Interstitium

Question 17

What occurs in the Minor and Major Calyx?

Answer 17

Precipitation of urine into renal pelvis

Question 18

What is the primary blood supply to kidney and it’s importance?

Answer 18

Renal Artery-> Leads to GFR

Question 19

What is located in the Nephron?

Answer 19

Afferent/Efferent arterioles
Glomerulus

Question 20

What lab work monitors Glomerulus fxn?

Answer 20

GFR, BUN/Crt

Question 21

What is used for the Na/K to Cl transport?

Answer 21

Loop Diuretics

Question 22

Where does Spironolactone works?

Answer 22

DCT

Question 23

Where is the main place for Na reabsorption->water reabsorption?

Answer 23

PCT

Question 24

What does the (Loop) Medullary Interstitium regulate?

Answer 24

Regulates interstitium Na concentration

Question 25

The tubules are all about __________ & ___________.

Answer 25

Absorption; Secretion

Question 26

What happens to diseases of the tubules?

Answer 26

Na/Water imbalances Acid/base imbalances Loss of cells into the urine (cast formation)

Question 27

What labs should be monitored during tubular disease?

Answer 27

FENa (overall volume in the urine, urine concentration) Look for casts (proteins or cells)

Question 28

What are the 2 types of glomerular diseases?

Answer 28

Nephrotic & Nephritic Syndromes Glomerulus vs Tubular Interstitium

Question 29

What are the problems that affect GFR?

Answer 29

Glomerular dx AKI/ATN Infection/Obstruction downstream

Question 30

What is azotemia?

Answer 30

Elevated BUN/Creatine related to dec GFR

Question 31

What are the 3 types of Azotemia?

Answer 31

Pre-renal Renal Post-renal

Question 32

What causes pre-renal azotemia

Answer 32

Dec blood flow to the kidneys

Question 33

Examples of Pre-renal causes

Answer 33

**Renal artery stenosis Hemorrhage Shock Coagulation d/o CHF Volume depletion

Question 34

What causes renal azotemia?

Answer 34

Diseases of glomerulus, tubules, or interstitium

Question 35

Examples of renal azotemia

Answer 35

Vasculitis Glomerular injury (DM, autoimmune) Ischemia to the nephron (renal vascular disease) Toxic injury (mercury, methemoglobin) Drugs (NSAIDs, Efferent Arteriole dilating ACE inhibitors)

Question 36

S/Sx of renal azotemia

Answer 36

**Casts, protein in urine, oliguria, edema, HTN

Question 37

What causes post-renal azotemia?

Answer 37

Obstruction/infections downstream of the kidneys causing backup and changes in pressure profiles. Can damage kidneys

Question 38

Examples of post-renal azotemia?

Answer 38

*Urethral reflex, reduced blood flow, pylenonephritis, Nephrolithiasis, UTI (WBC/RBC)* Ureter or urethra compression (neoplasm)

Question 39

What is azotemia+clinical signs?

Answer 39

Uremia

Question 40

What is a common sign of Uremia?

Answer 40

Ammonia

Question 41

Why is FENa important?

Answer 41

Na is filtered freely in glomerulus and about 99% is reabsorbed in the tubules. Value should be <1% If elevated, indicates tubule damage (AKI/ATN and maybe even CKD

Question 42

What is the normal GFR?

Answer 42

>60mL/minute

Question 43

What is the normal UOP with normal GFR?

Answer 43

1ml/kg/hour

Question 44

What determines GFR or filtration/Net filtration Pressure?

Answer 44

Hydrostatic pressure of the capillaries Interstitial Hydrostatic Pressure (In Bowman's capsule) Plasma/Capillary Oncotic Pressure (Colloid/Osmotic Pressure) Bowman's Oncotic Pressure

Question 45

What is the normal NFP?

Answer 45

10-12

Question 46

What are the 2 mechanisms of maintaining GFR?

Answer 46

Intrinsic and Extrinsic

Question 47

What primarily occurs during the Intrinsic pathway (Autoregulation)?

Answer 47

Myogenic tone AA vs EA (constriction & dilation) -Inc in pressure=inc in resistance to drop flow -Dec in pressure= dec resistance to increase flow Both are maintaining GFR

Question 48

Which pathways does Tubuloglomerular Feedback (TBF) occur?

Answer 48

Intrinsic

Question 49

What happens if the TBF senses a drop in the RBF?

Answer 49

Causes the granular mesangial cells to release renin->dilation of AA->increases RBF (However this is not the primary effect of renin)

Question 50

What does Nitric Oxide and Prostaglandins do to the AA?

Answer 50

Dilate them to inc RBF

Question 51

Process of RAAS system

Answer 51

Renin->Angiotensin cascade->Angiotensin 2-> constriction of the efferent arteriole->dropping RBF->inc GFR (as long as AA stays dilated)

Question 52

Angiotensin does alot, what all can it do?

Answer 52

-Increases in PVR/SVR and redistributes blood -Inc in reabsorption of Na in PCT & DCT->inc vol->in BP -Releases aldosterone from Cortex of the Adrenal Glands

Question 53

What triggers the release of ADH?

Answer 53

Drop in volume->drop in AA pressure->drop in RBF->high osmolarity->Osmo receptors sense in the hypothalamus of the brain->releasing ADH (Vasopressin)