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Renal Review Flashcards

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1
Q

What are the renal functions?

A 
Filtration
Secretion
Reabsorption
Endocrine 
Metabolic
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2
Q

What renal functions are associated with maintenance of body composition?

A

Filtration
Secretion
Reabsorption

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3
Q

What renal functions are associated with excretion of toxins and metabolic end products?

A

Filtration
Secretion
Reabsorption

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4
Q

What is the order of renal arteries to veins?

A 
Renal artery
Afferent arterioles
Glomerulus
Efferent arteriole
Peritubular capillaries
Venules
Renal vein
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5
Q

What kind if movement is glomerular filtration?

A

Passive diffusion

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6
Q

What molecular properties affect their ability to be filtered?

A

Size

Charge

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7
Q

What direction is solute movement involved in tubular reabsorption?

A

Lumen to blood

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8
Q

What are the major solutes involved in tubular reabsorption?

A 
Na
Cl
HCO3
Glucose
AA
Protein
Phosphates
Ca
Mg
Urea
Uric acid
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9
Q

Where does tubular reabsorption occur?

A

Proximal tubule
Loop of Henle
Distal tubule and collecting duct

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10
Q

Where is the bulk of filtrate absorbed?

A

Proximal tubule

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11
Q

What is the direction of solute movement in tubular secretion?

A

Blood to lumen

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12
Q

Where does tubular secretion occur?

A

Proximal tubule

Distal tubule and collecting duct

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13
Q

What are the major solutes involved in tubular secretion?

A

H
K
NH4
Organic acids and bases

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14
Q

What is produced in the endocrine system?

A

Renin
Erythropoietin
Prostaglandins and kinins

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15
Q

Where is renin produced and released from?

A

Granular cells in the wall of renal afferent arterioles

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16
Q

When is erythropoietin produced and secreted?

A

Oxygen tension in the blood decreases

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17
Q

What are prostaglandins and kinins used for?

A

Production and metablism

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18
Q

What is the metabolic function of the kidney?

A

Activation of vitamin D3
Gluconeogensis
Metabolism of endogenous compounds

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19
Q

How does sodium absorption occur?

A

Active transport via Na-K-ATPase transport

Na out, K into cells

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20
Q

Where is the Na, K, 2Cl-cotransport located?

A

Thick ascending limb of LoH

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21
Q

What drugs work on the Na, K, 2Cl-cotransporter?

A

Furosemide
Bumetinide
Torsemide

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22
Q

Where is the Na/Cl cotransport located?

A

Distal tubule

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23
Q

What drugs affect the Na/Cl-cotransporter?

A

HCTZ

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24
Q

Where is the Na channel located?

A

Collecting duct

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25
What drugs work on the Na channel?
Amiloride | Triamterene
26
How does the sympathetic nervous system affect regulation of NaCl excretion?
- Increased renal tone = Increased salt reabsorption and decreased renal blood flow - Increased sympathetic outflow -> promotes activation of RAAS
27
How does RAAS affect regulation of NaCl excretion?
- Decreased arterial pressure = increased renin production - Increased renin -> increased angiotensin II -> vasoconstriction of efferent arteriole -> increased GFR - Angiotensin II -> Increased Na and H2O reabsorption and Increased aldosterone production and release
28
How does ANP affect regulation of NaCl excretion
Increased ANP -> Decreased Na absorption and Increased GFR -> increased Na excretion
29
ANP stands for
Atrial naturetic peptide
30
What systems help to regulate NaCl excretion?
Sympathetic nervous system RAAS ANP Vasopressin
31
How does vasopressin affect regulation of NaCl excretion?
ADH Regulated primarily by body fluid osmolarity Promotes water retention
32
What is the concentration and dilution of urine dependent on?
ADH production | Hyperosmotic medullary interstitium
33
What is the primary intracellular electrolyte?
Potassium
34
How does aldosterone affect potassium regulation?
Increased secretion
35
How does decreased H concentration affect potassium regulation?
Increased secretion
36
How does dietary intake affect potassium regulation?
Increased dietary intake = Increased secretion | Decreased dietary intake = decreased secretion (increased absorption)
37
How does tubular flow rate affect potassium regulation?
Increased flow = increased secretion | Decreased flow = decreased secretion (increased absorption)
38
What are the 3 mechanisms of regulating acid-base homeostasis?
Extracellular buffering Respiratory regulation Renal regulation
39
What is normal plasma ph?
7.35 - 7.45
40
Which organ compensates for primary respiratory abnormalities?
Kidneys
41
What organ compensates for primary renal abnormalities?
Lungs
42
What is the only means of renal H elimination?
H secretion
43
What type of process is H secretion?
Passive (dependent on gradient b/n blood and urine)
44
Below what urine pH does H secretion stop?
< 4.5
45
Where is HCO3 reabsorbed?
Proximal tubules
46
What type of transproter is used with HCO3 absorption?
Counter-transport with H secretion
47
What type of transport is used for glucose absorption?
Co-transport protein carrying Na and glucose
48
What is the maximal capacity of the Na/Glucose co-transporter?
Plasma glucose of 200
49
What type of transport is used for amino acid absorption?
Co-transport protein carrying Na and amino acids
50
How do we evaluate GFR?
``` Inulin SCr BUN Cockroft-Gault MDRD4 CKD-EPI Timed urine collection ```
51
What is the most accurate measure of GFR?
Inulin
52
Where is SCr produced?
Creatine produced in liver -> stored in muscle as creatine phosphate -> released as creatinine -> kidney
53
How much of SCr is secreted?
10%
54
How can SCr vary?
Age Gender Body mass
55
Where is BUN produced?
Liver
56
What is BUN production dependent on?
Dietary protein and hepatic function
57
What percent of urea is reabsorbed?
50%
58
Where is urea reabsorbed?
Proximal tubule
59
What BUN:SCr ratio is indicative of prerenal cause?
>/= 20:1
60
What BUN:SCr ratio is indicative of renal (intrinsic) cause?
< 20:1
61
What is the primary use of MDRD4?
Stage patients with CKD
62
When can MDRD4 be used?
Stable renal function only
63
When can CKD-EPI be used?
Stable renal function
64
What is the primary use of CKD-EPI?
Stage patients with CKD
65
What are the different parts of a UA?
Macroscopic analysis Microscopic analysis Chemical analysis
66
What are the parts of a microscopic analysis?
Cells Casts Crystals (uric acid)
67
What cells are observed in a microscopic analysis?
Epithelial Microorganisms RBC WBC
68
What are hyaline casts?
Clear, not indicative of renal disease
69
What are cellular casts?
WBC RBC Tubular epithelial cells Seen with intrinsic renal disease
70
What are granular casts?
Seen with ischemic renal damage or toxic insults
71
What are the parts of chemical analysis?
``` pH Specific gravity Bilirubin/urobilinogen Blood/Hgb Leukocytes Nitrites Glucose Ketones Protein ```
72
Other renal tests
KUB CT scan Ultrasound Biopsy

Renal (8 decks)

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