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Renal Week 2 > Renal Potassium > Flashcards

Renal Potassium Flashcards

1
Q

describe the plasma changes with an acute potassium load

A

plasma levels spike and come back to normal quickly

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2
Q

describe the intracellular changes with an acute potassium load

A

increase quickly then decreases as renal excretion of K occurs

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3
Q

what is the main short term reservoir for excess K+?

A

skeletal muscle

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4
Q

what brings K+ into the skeletal muscle cells in an acute load?

A

Na/K ATPase

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5
Q

what are four causes of an increase in action of Na/K ATPase following an acute load of K+?

A

increased aldosterone release from the adrenal gladn
insulin receptor activation
Glucose receptor activation
epinephrine activation

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6
Q

is acidosis associated with hyper or hypokalemia?

A

hyperkalemia

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7
Q

is alkalosis associated with hyper or hypokalemia?

A

hypokalemia

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8
Q

name two locations in nephron for potassium secretion

A

DCT and CD

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9
Q

what are the three mechanism of potassium reabsorption? where do these occur?

A

solvent drag in PCT
NKCC channel in ascending loop
DCT and CD adjustment

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10
Q

do principal cells secrete or reabsorb potassium?

A

secrete

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11
Q

do alpha intercalated cells secrete or reabsorb potassium?

A

reabsorb

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12
Q

through what channel does alpha intercalated cells reabsorb potassium?

A

H+K+antiporter in lumen

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13
Q

through what channel does principal cells secrete potassium?

A

ROMK channels

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14
Q

with serum potassium above 3 mEq, if you give 10 mEq of potassium how much does potassium increase in serum?

A

0.1 per 10 mEq

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15
Q

with serum potassium below 3 mEq, if you give 10 mEq of potassium how much does potassium increase in serum?

A

uncertain…the relationship is not linear below 3 mEq in serum

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16
Q

what is the location of the main site of potassium excretion regulation in the kidneys?

A

the cortical collecting duct

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17
Q

what two processes can be impaired that lead to hyperkalemia?

A

redistribution of potassium

excretion of potassium

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18
Q

what three things increase in concentration when increase in plasma potassium and need skeletal muscle storage?

A

insulin
aldosterone
epinephrine

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19
Q

what is the role of the principal cell in potassium handling? name the channel

A

in DCT the principal cell leads to K+secretion through ROMK channels

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20
Q

what channel in the alpha intercalatd cells is in charge of potassium handling? which direction does the potassium move?

A

K+/H+ antiporter…K+ is reabsorbed

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21
Q

with an increase in dietary potassium, what channel does the gut tell the kidney to put more of?

A

ROMK channels

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22
Q

name five ways to stimulate potassium secretion

A 
increase intake
increase tubular flow rate
make tubular lumen more electronegative
increase plasma K+
increase aldosterone
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23
Q

in an acidotic state with alpha intercalated cells being active…what molecule do the cells produce and reabsorb and what molecule is secreted? what other molecule is reabsorbed due to excretion of other molecule?

A

H+ is secreted
HCO3 is produced
K+ is reabsorbed via antiport with H+

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24
Q

in acidosis….H+ wants to move into the cell…what moves out to cancel the charge change? what does this lead to?

A

potassium…hyperkalemia during acidosis

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25
Q

in alkalosis…H+ wants to move out of the cells…what molecule will enter the cell? what does this lead to?

A

potassium wants to move in to cancel charge change…leads to hypokalemia during alkalosis

26
Q

do beta agonists lead to hyper or hypokalemia?

A

hypokalemia

27
Q

do alpha agonists lead to hyper or hypokalemia?

A

hyperkalemia

28
Q

does increased insulin lead to hyper or hypokalemia?

A

hypokalemia

29
Q

does increased tonicity lead to hyper or hypokalemia?

A

hyperkalemia

30
Q

does cell growth lead to hyper or hypokalemia? what about cell death?

A

cell growth hypo

cell death hyper

31
Q

what is the common drug to know that leads to hyperkalemia?

A

digoxin

32
Q

does alkalosis lead to hyper or hypokalemia?

A

hypokalemia

33
Q

does mineral acidosis lead to hyper or hypokalemia?

A

hyperkalemia

34
Q

does organic acidosis lead to hyper or hypokalemia?

A

neither because organic acids bring in a + and - charge

35
Q

give two examples of organic acidosis?

A

ketoacidosis and lactic acidosis

36
Q

name the four causes of hypokalemia that are from distribution changes

A

insulin increase
alkalosis
B2 agonists
Cell growth

37
Q

name the seven causes of hyperkalemis that are from distribution changes

A 
B2 blockade
A agonists
insulin deficiency 
increased tonicity
cell injury 
digoxin
mineral acidosis
38
Q

how does decreased flow affect urinary K+ excretion?

A

it decreases it

39
Q

how does decreased aldosterone affect urinary K+ excretion?

A

it decreases it

40
Q

do amiloride and triamterene cause hyper or hypokalemia? acidosis or alkalosis?

A

hyperkalemia with metabolic acidosis

41
Q

what are three causes of lab errors in hyperkalemia?

A

hemolysis
severe thrombocytosis
excessive tourniquet time

42
Q

name three ways that you can have decreased renal excretion leading to hyperkalemia

A

very low GFR in renal failure
decreased urine flow…hypovolemia
hyperkalemic distal RTA

43
Q

name four drugs that inhibit renin release. do they cause hyper or hypokalemia?

A

cyclosporine
tacrolimus
beta blockers
NSAIDS

all cause hyperkalemia

44
Q

name two drug classes that act in RAAS pathway that contribute to hyperkalemia

A

ACE inhibitors and ARBs

45
Q

name two drugs that impair aldosterone release from adrenal gland and lead to hyperkalemia

A

ketoconazole

heparin

46
Q

name two aldosterone blockers that lead to hyperkalemia

A

spiranolactone and epleronone

47
Q

what is the common EKG finding with hyperkalemia?

A

tall T waves

48
Q

what is IV calcium used as a therapy for? why?

A

hyperkalemia…corrects the RMP

49
Q

what is a hormone you can give for hyperkalemia? what about a drug?

A

insulin

beta blockers or diuretics

50
Q

can dialysis be done for hyperkalemia?

A

yes

51
Q

does increased aldosterone lead to hyper or hypokalemia?

A

hypokalemia

52
Q

does increased flow in the cortical collecting duct lead to hyper or hypokalemia?

A

hypokalemia

53
Q

do diuretics not acting on ENaC channels cause hyper or hypokalemia? how?

A

hypokalemia because the volume goes down and aldosterone is ramped up so more K+ is secreted

54
Q

what is used to measure whether hyponatremia is from the kidneys or elsewhere?

A

the urine potassium creatinine ratio

55
Q

what is the urine potassium creatinine ratio equation? what is it used for?

A

urine potassium (100)/urine creatinine

used to see if hyponatremia from kidney or elsewhere

56
Q

what urine potassium creatinine ratio tips off to kidney loss of potassium?

A

above 20

57
Q

what urine potassium creatinine ratio tips off to outside kidney loss of potassium?

A

less than 15

58
Q

does vomiting lead to hyper or hypokalemia?

A

hypokalemia

59
Q

with vomiting, where is the K+ lost? in the vomit or in the kidney?

A

kidneys

60
Q

hypertension, hypokalemia, low renin, high aldo…what is the cause of hypokalemia?

A

primary hyperaldosteronism

61
Q

how do you treat hyperkalemia?

A

give potassium bolus

62
Q

do barter and gitelman syndrome cause hyper or hypokalemia?

A

hypokalemia

Renal Week 2 (4 decks)

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