Renal I

Question 1

Kidney pain, SNS, and PNS innervation

Answer 1

Pain T10-L1. SNS T8-L1. PNS via vagus, S2-4

Question 2

%CO kidney receives

Answer 2

25%

Question 3

Po2 cortex v medulla

Answer 3

50 v 10-20

Question 4

Blood flow through nephron

Answer 4

Renal A- arcuate- interlobar- cortical radial a- afferrent arteriole- glomerular capillaries- 25% to Bowman’s capsule/rest—> efferent arteriole- peritubular capillaries or vasa recta - venous system

Question 5

Vessels supplying cortical nephrons

Answer 5

Short loops of henle, efferent arterioles drain into peritubular capillaries

Question 6

Vessels supplying juxtamedullary nephrons

Answer 6

Long henle, efferent arterioles drain into vasa recta

Question 7

How glomerulus affects gfr q

Answer 7

Efferent constricts- gfr increases. Afferrent constricts- decreases

Question 8

What is freely filtered vs excluded from glomerular diltrate

Answer 8

Free filter: h20, na, glucose, urea, cations. Exc: negative, hgb, albumin

Question 9

Areas of high metabolic activity in renal tubule, implication

Answer 9

Proximal convuluted tubule, DCT, thick ascending limb of henle. All at risk for ischemia

Question 10

Areas of h20 reabsorp, most to least

Answer 10

Proximal tubules 65%, loops of henle 15%, distal tubules and collecting ducts 10%

Question 11

Proximal convoluted tubule: substances resorbed

Answer 11

65% of na/k/cl/h20. Glucose, lactate, aa, ca.

Question 12

PCT: continuation of what, what secreted/exchanged here

Answer 12

Bowmans capsule, H sec for HCO3

Question 13

Loop of henle: contin of, forms what

Answer 13

PCT, hypertonic fluid

Question 14

Juxtaglomerular apparatus: what it contains, function

Answer 14

Macula densa- mesangial cells contract when exp to ang II- dec area of glomerulus. Granular cells sec renin w b1 stim- dec gfr w baroreceptor activ

Question 15

DCT: what is resorbed here, under influence of what

Answer 15

Na/cl/h20, adh/app (v2) and aldosterone

Question 16

DCT: secretes what

Answer 16

H ions and k

Question 17

Collecting duct: reabsorbs what thru what, secrets what

Answer 17

H20 (adh), na/h20 in each for K. Secretes H ions/reabsorbs hco3

Question 18

Two most imp parts of kidney for acid base balance

Answer 18

Late distal tubule and collecting duct

Question 19

Three responses via hormones to hypovolemia

Answer 19

SNS/Ang II (dec gfr/inc na reabsorption). Aldosterone- inc na reabsorption. ADH- in h20 reabs in collecting duct

Question 20

Renal responses to hypervolemia

Answer 20

ANP (inc gfr by dilating). Red sns/ang II (dilation, filter na). Dec aldosterone- dec na reabsorption. Dec vaso- less h20 reabsortpion

Question 21

Where aldosterone effects kidney

Answer 21

Distal tubule and collecting duct

Question 22

Where ADH/vaso effects kidney

Answer 22

Collecting duct

Question 23

SNS (alpha 1) and ang II stim high v low concentration effects

Answer 23

High= afferrent vasoconstriction 
Low= efferent vasoconstriction

Question 24

Vaso preferentially vasoconstricts

Answer 24

Efferent arterioles

Question 25

Adenosine gfr fx

Answer 25

Decreases renin release and afferrent vasoconstriction, dec renal bf

Question 26

Auto reg range for ribs and gfr

Answer 26

Map 80-200

Question 27

Myogenic mechanism of gfr auto reg

Answer 27

Inc bp- reflex afferrent vasoconstriction. Dec bp opposite fx

Question 28

Conditions when auto reg is severely reduced

Answer 28

Sepsis, ARF, CPB

Question 29

How prostaglandins work

Answer 29

Oppose actions of ang II, sns, and adh. Renal vasodilation, inc na and h20 excretion

Question 30

CRF: when long term dialysis req.

Answer 30

Creat >3 gfr <30

Question 31

Anemia in CRF: downside to EPO therapy. Hct and hgb goals

Answer 31

Can cause or exacerbate htn. Hct 36-40% hgb 12 females 13 males

Question 32

Coagulopathies in CRF can be related w what? 4

Answer 32

Desmopressin, EPO, cryo, and estrogen

Question 33

BP goal in crf

Answer 33

<130/85

Question 34

AKI: creat, creat clearance, and urine produc

Answer 34

>0.5, 50% decrease, <400 ml/day or no urine

Question 35

AKI: pre renal

Answer 35

Dec bp to kidneys from CHF, hypotension, or low blood vol

Question 36

AKI intra renal

Answer 36

Severe ischemia, nephrotoxic exposure, parenchymal disease

Question 37

AKI post renal

Answer 37

Obstruction of urinary collecting system

Question 38

When to reduce doses of drugs cleared unchanged by kidneys

Answer 38

Gfr <50 ml/min

Question 39

What can prolong NMB in renal failure

Answer 39

Lyte imbalance, aminoglycosides, diuretics, immunosuppresants, mg antacids

Question 40

Nml levels for gfr

Answer 40

Bun 5-10, creat 0.5-1, cr cl 110-150

Question 41

Nml levels for renal tubular function

Answer 41

Sp gravity 1.003-1.03, osmolariy urine 38-1400

Question 42

Nml bun/cr ratio, when it indications pre renal issue

Answer 42

10:1. >20:1

Question 43

When bun indicative of dec gfr. When cr cl estimates gfr

Answer 43

>50/ <25 ml/min

Question 44

Periop oliguria: urine volume, how to tell its pre renal

Answer 44

<0.5 ml/kg/hr. Urinary na <40, osmolarity >400, urine to plasma osmolarity >1.8

Question 45

How to determine periop oliguria intrarenal

Answer 45

Urinary na >40, osm 250-300, urine to plasma osm <1.1

Question 46

Where to avoid ivs in dialysis pt

Answer 46

Non dominant arm and upper portion of dominant arm

Question 47

What kinds of drugs does dialysis clear

Answer 47

Low weight, <90% protein bound, water soluble

Question 48

How to tx dialysate hypersensitivity

Answer 48

Ethylene oxide or polyacrylonitrile