Renal Physiology and AKI (Week 5): pH, BP, Diuretics, Clinical AKI

Question 1

are ones that are in gas form, and this means carbon dioxide, CO2.

Answer 1

Volatile acids

Question 2

Can’t be expired. They are excreted by the kidneys.

Answer 2

Fixed acids

Question 3

help blunt the change in pH that would occur from adding acid or alkali to a solution.

Answer 3

Buffers

Question 4

What are an important intracellular buffer?

Answer 4

Proteins

Question 5

What are an important extracellular buffer?

Answer 5

Bicarbonates

Question 6

Proteins and bicarbonate, work instantly. They prevent
major swings in pH, but they do not get rid of the _________________

Answer 6

acid or base

Question 7

What can lead to acidosis?

Answer 7

Increasing the hydrogen ion concentration

Question 8

Where does bicarbonate reabsorption occur?

Answer 8

Proximal Tubules
(w/ little remaining for reabsorption in the loop of Henle and distal segments)

Question 9

There are two main
buffers in the kidney:

Answer 9

phosphate and ammonia.

Question 10

Why may cattle develop metabolic alkalosis with kidney failure?

Answer 10

Because cattle normally have renal bicarbonate excretion

Question 11

Don’t treat with bicarb unless the pH is less than ______

Answer 11

7.1

Question 12

the medical term used to describe having too much sodium in the blood

Answer 12

hypernatremic

Question 13

The main ways the
kidney controls it is via ________ , which maintains renal perfusion and promotes correction of HYPOtension, and via pressure natriuriesis, which dumps sodium and water to correct
HYPERtension

Answer 13

RAAS

Question 14

________________ is determined by cardiac output and total peripheral resistance, which is how tight the vessels are around the blood they contain.

Answer 14

Blood Pressure

Question 15

_____________ is determined by heart rate and the stroke volume, which is the amount of blood pumped out of the heart with each heart beat

Answer 15

Cardiac Output

Question 16

______________ is common with kidney disease

Answer 16

Hypertension

Question 17

Equation for blood
pressure

Answer 17

BP = TPR x SV x HR

Question 18

What are the most common causes of AKI?

Answer 18

ischemia and nephrotoxins

Question 19

Seizures are not a common sign of ____________ , unless it is very severe AKI, or a puppy with renal dysplasia

Answer 19

kidney disease

Question 20

Why don’t we usually measure GFR in patients with AKI?

Answer 20

Because GFR may be rapidly changing with AKI

Question 21

(T/F) An acute diagnosis of kidney disease is not the same as acute kidney disease

Answer 21

True

Question 22

Frequently the finding in a _________ patient is normal to slightly enlarged kidneys with no other distinguishing features

Answer 22

AKI

Question 23

generally block the action of one of the transporters in the kidney, generally something related to decreasing sodium reabsorption.

Answer 23

Chemical Diuretics

Question 24

alter the gradient for water reabsorption

Answer 24

Osmotic diuretics

Question 25

is a loop diuretic because it works in the loop of Henle. Most of the side effects relate to the clinical effect – blocking reabsorption of potassium along with sodium, and excessive volume loss, but ototoxicity is another potential side effect seen at extremely high doses

Answer 25

furosemide

Question 26

Drug that blocks aldosterone

Answer 26

Spironolactone

Question 27

What does aldosterone do?

Answer 27

reabsorb sodium and secrete potassium

Question 28

What happens if you block aldosterone?

Answer 28

You reabsorb less sodium, and if more sodium stays in the ultra-filtrate, more water stays, and you have a larger volume of urine

Question 29

Potassium-sparing Diuretics:

Answer 29

Spironolactone, epleronone, amiloride, and triamterene

Question 30

Unlike furosemide and thiazides, Spironolactone keeps the …

Answer 30

potassium levels from getting too low

Question 31

Diuretics to increase urine output ___________ the outcome of AKI.

Answer 31

do NOT improve

Question 32

is an osmotic diuretic that can be used if the patient hydration status is close to normal, but should be avoided with severe overhydration or dehydration.

Answer 32

Mannitol

Question 33

The mean arterial pressure should be maintained above ________________ , or the systolic pressure above _________________

Answer 33

60 to 80 mm Hg, 80 to 100 mm Hg

Question 34

In order to get rid of acid from the body, the kidneys must:

Answer 34

Both reabsorb filtered bicarbonate and secrete hydrogen ions

Question 35

How do the kidneys help control blood pressure?

Answer 35

• Low blood volume stimulates renin release which stimulates angiotensin formation, which constricts blood vessels, increasing blood pressure
• An increase in blood volume increases glomerular filtration, which increases urine volume to decrease blood volume which decreases blood pressure
• Low blood volume stimulates renin release which stimulates angiotensin formation, which stimulates aldosterone which causes sodium retention which causes water retention and thus increases blood pressure

Question 36

Administration of furosemide to an animal with AKI may:

Answer 36

Increase urine volume