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Flashcards in Renal Deck (82):
1

What is the main prostaglandin secreted by the kidneys?

Prostacyclin

2

What is the maximum possible concentration of urine?

1200 m.osmol/L

3

What percentage of glomeruli are superficial cortical glomeruli?

85%

4

What percentage of glomeruli are juxtamedullary glomeruli?

10%

5

Where do juxtamedullary glomeruli have their Bowman's capsules?

In the cortex, near the junction with the medulla

6

How many afferent arterioles are there per nephron?

1

7

What percentage of cardiac output goes to the kidneys?

20%

8

Where is the macula densa?

At beginning of distal convoluted tubule

9

What do macula densa cells detect?

NaCl concentration

10

What do macula densa cells release to cause constriction of the afferent arteriole?

Adenosine

11

Where does creatinine come from?

Turnover of muscle cells and protein degradation

12

What percentage of renal plasma flow is filtered by the glomerulus?

20%

13

What is the hydrostatic pressure in the glomerular capillary?

50mmHg

14

What is the net filtration pressure across the glomerulus?

10mmHg

15

What happens to GFR when afferent arteriole constricts?

Decreases

16

What happens to GFR when efferent arteriole constricts?

Increases

17

What does angiotensin II do?

Constriction of efferent arteriole to cause increase in GFR

18

What happens to GFR when MAP increases from 80 to 180?

Nothing

19

Where does autoregulation in the kidney occur?

Afferent arteriole

20

Which cells of the kidney release renin?

Granular cells

21

Where are granular cells in the kidney?

In the wall of the afferent arteriole where it enters the glomerulus

22

What does renin do?

Catalyses angiotensinogen --> angiotensin 1

23

What causes granular cells to release renin?

Decreased NaCl, sympathetic drive and pressure.

24

The clearance of substance X is.....

The volume of plasma cleared of X per time

25

What do we call infection of the bladder and lower UT?

Cystitis

26

What do we call infection of kidney and renal pelvis?

Pyelonephritis

27

How far along the urinary tract should be sterile?

Everything above bladder sphincter

28

What's the most common pathogen in UTI?

E. coli

29

How do must bacteria get into the urinary tract to cause infection?

Ascend up the urethra

30

What is the major innate immune mechanism in the urinary tract?

Constant flushing effects of urine and regular emptying of bladder

31

What is the most important thing to remember when taking a urine sample from a catheter bag?

Never collect it from the bag itself; collect freshly passed urine from the catheter itself

32

Why must a urinalysis be performed promptly?

More time would allow the bacteria to replicate and quantitative analysis is important in urine samples

33

What do we call pus in the urine?

Pyuria

34

What is sterile pyuria?

Pus in urine, but without bacterial growth

35

What antibiotics should be used for a UTI?

Cephalexin OR co-amoxyclav OR trimethoprim

36

What antibiotics should be used for pyelonephritis?

Cephalexin OR co-amoxyclav OR trimethoprim

37

What is the definition of recurrent UTI in women?

>2 UTIs in 6 months

38

What percentage of water is reabsorbed by the kidneys after it has been filtered?

99%

39

Where is water reabsorption in the kidney regulated?

Collecting ducts

40

Where is calcium mainly reabsorbed in the nephron?

Proximal convoluted tubule

41

What percentage of creatinine is reabsorbed in the kidney?

None

42

How is Na reabsorbed in the thick ascending limb of the nephron?

Na/K/2Cl co-trasnporter

43

What percentage of nephrons are juxta-medullary?

15%

44

What size are the fenestrations in glomerular capillaries?

70-100nm

45

What size are the podocyte interdigitating slits in the glomerulus?

3-5nm

46

What type of epithelium lines the proximal convoluted tubule?

Simple cuboidal

47

What type of epithelium lines the thin descending loop of Henle?

Simple squamous

48

What type of epithelium lines the ureters?

Transitional epithelium

49

Which substance is responsible for constriciton of the efferent arteriole in the kidney?

Angiotensin II

50

Where is reasborption greatest along the nephron?

Proximal convoluted tubule

51

What is the most important solute to be reabsorbed in the nephron?

Sodium

52

What measure is the most important for defining renal failure in clinical practice?

GFR

53

Urine output of less than 500ml per day indicates what?

Renal failure

54

Define acute renal failure

A sudden fall in GFR over hours to days

55

When does kidney function begin to decline?

40 years of age

56

What is the most accurate measure of daily fluid balance?

Daily weight measurement

57

What is the most common cause of acute renal failure?

Acute tubular necrosis

58

Define oliguria

59

In which 2 ways can the kidney regulate HCO3- levels?

Can reabsorb HCO3- in PCT. Can synthesise HCO3- in DCT

60

What is a normal pH in the body?

7.35-7.45

61

How do you calculate the anion gap?

Na + K - Cl - HCO3

62

What makes up most of the unmeasured ions in the anion gap?

Albumin

63

Name 3 types of acidosis with a large anion gap

Renal failure. Diabetic ketoacidosis. Lactic acidosis

64

What is a normal HCO3- level?

21-28 mmol/L

65

What happens to bicarbonate levels in metabolic alkalosis?

Increased

66

What happens to bicarbonate levels in metabolic acidosis?

Decreased

67

What happens to bicarbonate levels in respiratory alkalosis?

Decreased

68

What happens to bicarbonate levels in respiratory acidosis?

Increased

69

What effect does metabolic acidosis have on potassium levels?

K+ levels increase in metabolic acidosis

70

Define Grave's disease

Type II hypersensitivity in which host generates Ig to TSH receptor on thyroid gland, which stimulates thyroid hormone release. Leads to hyperthyroidism.

71

Define myasthenia gravis

Type II hypersensitivity in which host generates Ig to muscle nicotinic ACh receptors. When bound, this stops ACh from activating muslce, leading to weakness.

72

Define vasculitis

Type III hypersensitivity in which immune complexes are deposited in vessel walls

73

What are the 4 features of nephrotic syndrome?

Proteinuria. Hypoalbuminaemia. Oedema. Hyperlipidaemia

74

Which part of the nephron is impaired with proteinuria?

Glomerular filter

75

Define glomerulonephritis

Injury to the glomerulus that is almost always immune mediated

76

What is focal vs diffuse glomerulonephritis?

Every glomerulus is abnormal vs no all

77

What is segmental vs global glomerulonephritis?

All or most part of each glomerulus is involved with not

78

What is the leading cause of end stage renal failure in Australia?

Diabetic nephropathy

79

What is suggested by cresents in the urinary space outside the glomerular tuft?

Severe acute injury to the glomerulus

80

What is the "triple whammy"?

Combination of ACE inhibitor, diuretic and NSAID

81

How do NSAIDs impair renal function?

By interfering with vasodilation from PGI2

82

What is the mechanism of action of potassium-sparing diuretics?

Block Na transporter in collecting tubules and ducts

Plus or minus:

Inhibit synthesis of Na/K cotransporter in collecting tubules and ducts