Renal Review PPT-josh Flashcards Preview

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Flashcards in Renal Review PPT-josh Deck (80):
1


there are 2 kidneys with how many regions?


2

2


What are the 2 regions?


Cortex

Medulla

3


what is the functional unit of the kidney?


Nephron

4


What are 3 improtant functions of the nephron?


Hold filtrate

Excrete end products of metabolism

Absorb Important sunstances

5

The kidney gets what % of CO?


20-25%

6


how many mLs of blood does the kidney receive?


1100-1200 mL

7


what part of the kidney receives the most blood?


Cortex

8


The renal artery divides at the __1__, into several lobar arteries, they run b/t the __2__ of the medulla and turn into the __3__ then into __4__ and to the __5__.

 

  1. hilus
  2. pyramids
  3. interlobular arteries
  4. afferent arterioles
  5. glomerulus

9


Unfiiltered blood exits the kidney via what, to the venous system?


efferent arteriole

10


filtered blood goes where?


back to the body

11


waste is excreted from the kidneys as what?


urine

12


renal blood flow if determined by the ________ ______ ______ across the vascular bed


arteriovenous pressure difference

13


what is the formula to calculate renal blood flow?


Renal blood flow = (MAP - VP) x VR

  • MAP- mean arterial pressure
  • VP- venous pressure
  • VR- vascular resistance

14


Renal blood flow is regulated by what 2 ways?


intrinsic autoregulation

Neural regulation

15


Autoregulation of the kidneys is with a MAP of what?


75-160mmHg

16


w/ neural regulation afferent and efferent arterioles are inervated by the SNS, stimulation of which is associated w/ what? and thus should be avoided


vasoconstriction

17


4 main functions of the kidney?

 

  • maintenance of ECF composition
  • Maintenance of ECF volume
  • Endocrine functions
  • Regulation of Arterial BP

18


Fx of the Kidneys:

what is maintained in the maintenance of ECF composition?

 

  • Ionic composition (electrolytes)
  • Osmolality (Na+ comcentration
  • Conservation of non-ionic components (glucose, amino acids, proteins, water, vitamins)
  • Excretion of products of metabolism (urea, creatine, lactic acid, uric acid)

19



Fx of the Kidneys:

how does the kidney perform maintenance of ECF volume


regulation of Na+ and h2o excretion

20



Fx of the Kidneys:

what endocrine fx does the kidneys perform?

 

  • erythropoietin
  • RAAS
  • Vit D

21


What are the main structures of teh nephron? do it in order as if you were fluid going through it!

 

  • arteriole from renal artery
  • Bowman's capsule
  • Glomerulus
  • Proximal tubule
  • Loop of henle
  • Distal tubule
  • Collecting ducts

22


What structures are in teh Cortex and what structures are in the Medulla?

 

  • Cortex
    • Renal corpuscle (bowmans capsule)
    • proximal tubule
    • Distal tubule
  • Medulla
    • Loop of henle
    • Collecting duct

23

What are the 3 steps of Urine formation and excretion


Glomerular filtration

Tubular reabsorption

Tubular secretion

24


Glomerular Filtration:

GFR get what % of RBF?


20% (125mL/min)

25


Glomerular Filtration:

the GFR is regulated by what?


Juxtaglomerular complex

26



Glomerular Filtration:

What 3 things can increase GFR?

 

  • Increased RBF
  • Dilation of Afferent arteriole
  • Increased resistance inefferent arteriole

27



Glomerular Filtration:

what 2 things can decrease GFR?

 

  • afferent arteriole constriction
  • Efferent arteriole dilation

28


What reabsorbs the bulk of the glomerlar filtrate?


Proximal tubule

29

what iare the  main function of the Loop of henle?

 

  • establishes and maintains an osmotic gradient in the medulla of the kidney
  • regulation of water balance
  • Concentration/dilution of urine

30


The descending loop is highly permeable to ________ but impermeable to ______


Water

Solutes

A image thumb
31


The ascending loop is nearly impermeable to _____, but highly permeable to ___ and ____


water

Na+ and Cl-

A image thumb
32


The ECF is controlled by what hormone?


Aldosterone

33


ECF Volume and Osmolality:

Volume is controlled by aldosterone via ______ reabsorption


Sodium

34



ECF Volume and Osmolality:

where is aldosterone produced?


Adrenal Cortex

35



ECF Volume and Osmolality:

Osmolality is controlled by what?


ADH

36



ECF Volume and Osmolality:

osmolality is controlled by ADH via ___ reabsorption


Water

37



ECF Volume and Osmolality:

ADH is released from what?


the neurohypophysis (AKA posterior putuitary)

38


*****

Where does aldosterone work?


distal tubule

39


******

where does ADH work?


Collecting ducts

40


Osmolality: ADH

explain what the body does if ADH is pressent? and also when it is absent?

  • ADH present
    • Collecting duct is highly permeable to H20= you get small amount of very concentrated urine
  • ADH Absent
    • Collecting duct is not pearmeable to water= you get large amounts of dilute urine

41


what part of kidney os responsible for the fine tunning, makes final adjustment to urine pH and osmolality?


Distal tubule

42


what does aldosterone reabsorb? and secrete?


reabsorbs- Na+

Secretes K+

43


What is excreted in the proximal tubule?


Na+

H2O

44


What is excreted in the descending loop of henle


H2O

45


What is excreted in the ascending loop of Henle


Na+

Cl-

46


What is excreted in the Distal Tubule

Na+

H2O

47


what is excreted in the collecting ducts?


H20

48


What is the basic equaltion for Acid Base balance?


Carbonic Anhydrase

CO2 + H2O H2CO3 HCO3_ + H+

49


refere to acid base disturbances on own I am not going over that


Know your different ranges and how to determine them

50


Mind the Gap:

what is the anion gap used for?


to differentiate b/t metabolic acidosis

51


Anion Gap:

Is the difference b/t the primary measured what?

 

  • cations (Na+ and K+) and the primary measured Anions (Cl- and HCO3) in serum

52


Anion Gap:

what is the equation?


Normal: (Na+ + K+) - (Cl- + HCO3)

or ususally done w/o K+ as

(Na+) - (Cl- + HCO3)

 

53


Mind the Gap:

What is te normal Anion Gap

 

8-12mM

54


Mind the Gap:

what does high Anion Gap Indicate?

  • increased non-chloride acids (H+) uses more HCO3- therby Increaseing Anion Gap
  • Normachloremia
  • Lactic Acidosis
  • DKA

55


Mind the Gap:

what does normal Anion Gap Mean?

 

  • Decreased HCO3- from loss of body fluids (emesis/diarrhea), is replaced by Cl- resulting in no change to anion GAp
  • Hyperchloremia

56


Diuretics:

what is a peptide hormone synthesized, stored, and secreted by teh cardiac atria

Atrial Natriuretic Factor

57


Diuretics:

what is teh stimulis for ANF release?


atrial stretch, distention, or pressure

58


Diuretics:

what is one of the most potent diuretics known?


ANF

59


Diuretics:

ANF acs on the kidneys to increase urine flow and Na+ excretion, it antagonizes both the release and end organ effects of ______, ______, and ____.

 

  • renin
  • Aldosterone
  • ADH

60


Loop Diuretics:

what are 2 examples of them

 


lasix

bumex

61


Loop Diuretics:

how do they basically work?


stop reabsortion of Ions in ascending loop thus decreasing osmolality.

Increass water excretion

62


Diuretics:

What are ex of thiazide diuretics work?

HCTZ

Zaroxoyln

63



Diuretics:

what are examples of K+ sparing diuretics?


spironlactone

64



Diuretics:

whare to thiazides work?


distal convoluted tubule

65



Diuretics:

how do Thiazides work


Inhibit Na+ reabsorbtion thus decreasing water reabsortion

66



Diuretics:

Where do K+ sparing diuretics work


i think in the collecting ducts

67



Diuretics:

how do K+ sparing diuretics (spironlactone work?

competitively inhibits aldosterone increasing sodium excretion and promoting sodium retention

68


Diuretics:

where do Carbonic-anhydrase inhibitors work?


Proximal tubule

69


Diuretics:

what type of diuretic is impermeable to teh renal tubule and exerts osmotic force dereasing the reabsorption of water

Osmotic diuretics Mannitol

70


Describe the RAAS! (basic don't need to say that renin is released from the juxta.... blah blah blah)

  • Kidney releases renin into blood
  • Liver releases angiotensinogen
  • they meet and convert into ATI
  • ACE from the lungs then cahnges ATI into ATII
  • ATII stimulates aldonsterone secretion by the adrenal cortex
  • aldosterone stimulates Na+ and H2O reabsorption in the nephrons

(ATII also works on the neurohypophysis to release ADH and such, but the basics is above)

remember from previous slides ADH works in collecting ducts, and ALdosterone works in the distal tubule

71


Blocking the actions of what can cause refractory Hypotension how?

Blocks the release of both aldosterone and ADH

72


what are the pros of Colloid?

 

  • increased plasma volume
  • Less peripheral edema
  • Smaller volumes for resuscitation
  • Intravascular half-life 3-6 hrs

73


What are the advantages of Crystalloids?

 

  • Inexpensive
  • Unse for maintenance fluid and inital resuscitation
  • restore 3rd space loss
  • Intravascular half-life 20-30 minutes

74


K+ controls what with the membrane potential


resting membrane potential

75


Ca++ controls what w/ the membrane potential


threshold

76


Treatment of Hyperkalemia:

why give Ca++

 

 

move threshold away from resting membrane potential

77


Treatment of Hyperkalemia:

whay give HCO3 and hyperventilate the pt?


decrease Concentration of H+ in the plasma (H+ from ICF to ECF, K+ back inside the cell)

78


Treatment of Hyperkalemia:

why give a Beta-2 agonist (albuterol) and insulin?


to stimulate Na-K pump,  drives K back into cells

79


Treatment of Hyperkalemia:

why give dextrose?


to prevent hypoglycemia

80


thats it for for that next is Renal patho!!!!!


whooooo hoooooo