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Flashcards in Renal system Deck (103)
1

what hormone controls Na+?

 

aldosterone

 

2

what hormone controls amount of water?

ADH

3

the kidneys have a major influence on what hemodynamic

blood pressure

 

4

what is the functional unit if the kidney

Nephron

5

metabolic end-prodeucts are excreted how?

filtration

(they are filtered into, and then trapped within, the renal tubule)

6

Renal Functions:

what are the main electrolytes the kidney balances?(5)

Na+

K+

Ca++

Mg++

Cl-

7

Renal Functions:

what 2 things does it control for acid base balance?

H+ 

HCO3-

8

Renal Functions: regulation of osmolality

________ are 90% of total osmolality of the ECF

sodium salts

9

Renal Functions: regulation of osmolality

when we talk about regulating osmolality, we are talking about regulating what?

Sodium concentration

(b/c sodium salts represent 90% of total osmolality)

10

Renal Functions: regulation of osmolality

what is normal osmolality? give normal and range!

normal 300 mOsm/kg

range 270-310 mOsm/kg

11

Renal Functions: 

what are 6 non-volatile end products of metobolism excreted

HP04 --

SO4 --

urea

Creatinine

uric acid

lactic acid

12

Maintenance of ECF volume is acheived by controlling what 2 things

 

salt NaCl

and 

water excretion

13

the kidneys are considered endocrine why?

they produce hormones

14

What 3 hormones to the kidneys produces

Erythropoietin

Renin

Vitamin D

15

Endorince functions:

what does erythropoietin do?

acts on bone marrow and stimulates RBC production

16

Endorince functions:

whay is a pt with chronic renal failue anemic

decreased production of erythropoietin

17

Endorince functions:

what is the purpose of renin

enzyme that participates in blood pressure regulation, potassium ecretion, and sodium reabsorption

18

Endorince functions:

function of vitamin D

the kidney w/ help of the liver convert Vit D into its active form Vit D3

19

Endorince functions:

why does a chronic renal pt become hypocalcemic

b/c absorption from the intestine is impaired when there is a vit d if difficient

20

Renal Blood flow:

the kidney receives what % of CO

25%

1.25 L/min

21

how do the kidneys autoregulate

they have 2 sets of capillaries, the dual function allows for control of flow and pressure

22

Label

  1. Efferent Arteriole
  2. proximal convoluted tubule
  3. Loop of henle
  4. Afferent Arteriole
  5. Distsal convoluted tubule
  6. Collecting duct

23

Point or explain where each diuretic works

CAI

Loop

Thiazides

K+ sparing

CAI- proximal tubule

Loop- thick Ascending loop oh henle

Thiazide- distal tubule

K-sparing- collecting duct

24

point to the bowmen's capsul

 

25

point to the glomerulus

 

26

three functions of the kidney

filtration

reabsorption

secretion

27

what is the function of the proximal tubule

reabsorbs the bulk of the filtered fluid and it's dissovled contents

28

what is the function of the Loop of Henle

establishes and maintains an osmotic gradient in the medulla. 

29

what is the function of the distal tubule and collecting ducts?

make final adjustments on urine pH, osmolality, and ionic composition

30

the LOH is a COUNTERCURRENT MULTIPLIER which does what

creats the osmotic gradient

31

the vasa recta is a COUNTERCURRENT EXCHANGER whch does what?

Maintains the osmotic gradient of the LOH

32

the Thick acending LOH is impearmeable to what?

water

33

explain the osmolality of the cortical and medullary tissue from cortex to inner medulla

 

in the cortex osmolality 300

in the outer medulla increases from 400 - 600

in the inner medulla increass from 800 to 1200

 

The osmolality increases as it travels throught the nephron

 

34

picture to expain osmolality of cortical and medullary tissue

 

 

 

35

deposition of Na+ into the medullary interstitium by the TAL of henle can increase the interstitial osmolality to 600 mOsm/kg. where does the additional 600 come from- for a total of 1200 at the tip of the medullary pyramid?

urea

36

the bullk of the glomerular filtrate (67%) is reabsorbed by what?

proximal tubule

37

Renal control of glucose:

what part of the nephron has the maximum capacity for reabsorbing glucose

proximal tubule

38

Renal control of glucose:

just to read and understand

the proximal tubule has the maximum capacity for reabsorbing glucose; this maximum reabsorption capacity is referred to as the transport maximum (Tm). all of the filtered glucose is normally completly reabsorbed from the the proximal tubule y active transport mechanisms. the amount of filterd glucose normally does not exceed the transfer (transport) maximum. in untreated DM, the amount of glucose filtered exceeds the transfer (transport) maximum of the proximal tubule. glucose that escapes reabsorption from the proximal tubule is excreted. all segments of the renal tubule beyond the proximal tubule are impermeable to glucose.

39

picture to explaint the renal control of glucose

 

40

what happens to urine output in the untreated pt w/ DM? why?

UOP increases, bc unfiltered glucose load exceeds the transport maximum; glucose the remains in the tubular fluid after PCT causes osmotic diuresis

41

renal control of water excretion:

the rate of ADH released into the bloodstream is directly related to the what of the ECF?

osmolality

42

renal control of water excretion:

besides osmolality, what other 2 things can trigger release of ADH

decreases in ECF volume

stressors (pain)

43

renal control of water excretion:

an INCREASE in ECF osmolality is corrected how 

ingesting water and adding to the ECF

44

renal control of water excretion:

a decrease in ECF osmolality is corrected how

by excreting water and removing it from ECF

45

renal control of water excretion:

ECF osmolality (hence sodium concentration) is regulated by what?

ADH 

also called AVP (arginine vasopressin)

46

AVP/ADH:

synthesized where?

hypothalamus (paravetricular and Supraoptic nucleus)

47

AVP/ADH:

stored where

post pituitary

neurohypophysis

48

AVP/ADH:

secreted into what

blood

49

AVP/ADH:

stimulus for release

increased Na+

Increased osmolality

50

AVP/ADH:

site of action

collecting ducts

51

2 hormones the neurohypophysis releases

ADH

Oxytocin

52

6 hormones the andenohypophysis releass

GH

ACTH

FSH

Prolactin

LH

TSH

53

how do you tell the orientation of the pituitary gland in a picture

CN II the optic chiasm (anterior)

54

in response to an increase in ECF osmolality what occurs 

paraventricular and supraoptic nuclei shrink and nerve axons fire action potential, which cause AVP/ADH release from the neurohypophysis

55

what is the most powerful stimulus for triggering the release of AVP/ADH

increase in ECF osmolality

56

when AVP/ADH reaches the collecting duct what occurs

reabsorption of water increases

57

in response to a decreas in ECF osmolality what occurs in the hypothalamus

cells of the paraventricular and supraoptic nucli swell and nerve action potentials are inhibited so AVP/ADH release is depressed.

58

in the absence of AVP/ADH what happens in the collecting ducts 

they are impeameable to water and a large volume of dilute urine if formed

59

any stress (hypovolemia, hypotension, pain, emotional) will cause what regarding the release of AVP/ADH

lead to an increase in the release

60

extracellular fluid volume:

what is the major determinant of ECF volume

amount of Na+ in the body

61

extracellular fluid volume:

what is the most important hormone in regulating ECF volume

aldosterone

62

aldosterone is produced where?

zona glomerulosa of the adrenal cortex

63

where does aldosterone work

distal convoluted tubule

64

what does aldosterone do?

increases the rate of Na+ REABSORPTION, therby decreases the rate of Na+ elimination

65

what does aldosterone do to K+

increases the rate of K+ secretion into the late DCT and collecting duct therby increasing the rate of K+ excretion

66

when sodium intake is high, the body Na+ content increases, and the body fluids become concentrated. ADH/AVP output increases to conserve water, and thirst causes water ingestion, which stores osmolality but expands fluid volume

 

67

what is the majar consequence of sodium retention

ECF volume expansion (hypervolemia)

and arterial bp to increase

68

a picture of body's response to increased sodium

 

69

when the bodies sodium intake is low, the body sodium content decreases, and the body fluids become dilute. AVP/ADH output decreases, and a dilute high volume urine is formed. osmolality is restored, but fluid volume is contracted

 

70

what is the major consequence of Na+ loss?

fluid volume contraction (hypovolemia) 

decreased arterial bp

71

picture showing body's response to low Na+

 

72

Diuretics:

name some loop diuretics

Furosemide (lasix)

Bumetanide (Bumex)

Torsemide (demadex)

73

Diuretics: Loop

where do they work

Acending LOH

74

Diuretics:​ Loop

how do they work?

  • the LOH simultaneously transports Na+, K+, and 2Cl- in the same direction (termed Na+, K+, 2Cl- symporter)
  • Loop diuretics bind to the Na+, K+, 2Cl- symported and inhibit the reabsorption of these ions from the ascending LOH
  • the amount of H20 reabsobed is reduced and watyer excretion increases

75

Diuretics:​ Loop

Side effects of Loop diuretics

  • Hypokalemia
  • Fluid volume deficit
  • Orthostatic hypotension
  • reversibel deafness

76

Diuretics:​ Loop

why can bp fall even before UOP increases

bc they trigger the release of prostaglandins that cause venodilation, the decreased prelad causes a decrease in bp

77

picture of Loop diuretics

 

78

diuretics that work on the DCT an dColecting duct work to inhibit what

Na+ reabsorption

79

thiazides inhibit Na+ reabsorption where 

early DCT

80

where does spiralactone work

late DCT, early collecting duct (go with collecting duct)

81

spironolactone competively inhibits what?

aldosterone

82

give an ex on a Carbonic Anhydrase Inhibitor

Acetazolamide (diamox)

83

Carbonic Anhydrase Inhibitor inhibits what

the enzyme Carbonic Anhydrase 

84

Carbonic Anhydrase Inhibitor works where

PCT

85

Carbonic Anhydrase Inhibitor does what to Intraoccular pressure and how

decreases the formation of aques humor, this decreaseing intraocular pressure.

86

Acute Kidney Injury:

formally called what

acute renal failure

87

Acute Kidney Injury:

periop renal failure accounts for ____ of all pts requiring acute dialysis

half

88

Acute Kidney Injury:

3 types

prerenal

intrarenal

postrenal

89

Acute Kidney Injury:

3 causes of prerenal

decreased renal blood flow

Hypovolemia

Decreased CO

(anything that occurs befor blood gets to kidney)

90

Acute Kidney Injury:

4 causes of Intrarenal failure

  • renal tubular damage (tubular necrosis)
  • Renal ischemia d/t prerenal causes
  • Nephrotoxic drugs
  • release of hemoglobin or myoglobin

 

(anything that occurs inside the kidney)

91

Acute Kidney Injury:

3 causes of postrenal failure

  • Obstruction of urine flow
  • Bilat ureteral obstrution
  • extravasation d/t bladder rupture

(anything that occurs after the kidney)

92

Acute Kidney Injury:

what is a syndrome triggered by hypoperfusion of the kidneys resulting in te rapid deterioration of renal function and accumulation of nitrogenous wastes (azotemia)

ischemic Acute renal failure

93

Chronic Kidney disease:

normal GFR

125 ml/min

94

Chronic Kidney disease:

GFR for decreased renal reserve

50-80 mL/min

95

Chronic Kidney disease:

GFR for renal insufficiency

12-50 mL/min

96

Chronic Kidney disease:

GFR for uremia

97

Chronic Kidney disease:

what is the best test to show renal reserve

creatinine clearance (measures GFR)

98

Chronic Kidney disease:

3 main complications 

Anemia

Pruitus

Coagulopathies

99

Chronic Kidney disease:

common electrolyte disturbances?

Hyperkalemia

Hypocalcemia

Hypermagnesemia

Hyperphosphatemia

100

Chronic Kidney disease:

what is the most serious electrolyte disturbance

Hyperkalemia

101

Chronic Kidney disease:

what fluid would u wanna avoid and why

LR

contains 4 mEq of k+

102

Chronic Kidney disease:

avoid elective sx unless K+ is less than what?

5.5

103

Chronic Kidney disease:

ways to treat hyperkalemia

Iv calcium

Hyperventilation

IV Insulin and glucose

IV Beta 2 agonist

IV loop diuretics

kayexalate

Dialysis

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