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Valley Boards Review > Renal System > Flashcards

Renal System Flashcards

(53 cards)

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1
Q

Regulator of extracellular volume

A

Aldosterone

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2
Q

Regulator of extracellular osmolality

A

ADH or vasopressin

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3
Q

concentration

A

Amount/volume

Solute/solvent

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4
Q

Osmolality

A

Na concentration

Na salts are 90% of total osmolality

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5
Q

Normal osmolality number

A

300 mOsm/kg

Range: 270-310

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6
Q

Kidney functions

A
  1. Maintenance of extracellular fluid composition
  2. Maintenance of extracellular fluid volume
  3. Regulation of arterial blood pressure
  4. Endocrine functions
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7
Q

Endocrine functions of kidney

A
  1. Erythropoietin
  2. RAS
  3. Vitamin D- conversion to active form Vitamin D3
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8
Q

Vit D life

A
  1. Born in skin
  2. Liver (adolescence)- adds OH group
  3. Kidney- another OH group makes it Vit D3
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9
Q

Endocrine implications of CKD

A
  1. Anemic because of lack of erythropoietin

2. Hypocalcemia because Ca absorption from intestine is impaired with decreased vitamin D

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10
Q

Renal blood flow

A

20-25% of blood pumped by heart

1-1.2 L/min

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11
Q

GFR

A

125 mL/min

180 L filtered per day

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12
Q

Nephron functions

A
  1. Filtration
  2. Reabsorption
  3. Secretion

Excretion- NOT a kidney process but is a result of 1-3

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13
Q

Blood flow in glomerulus

A

Enters via afferent arteriole

Exists via efferent arteriole

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14
Q

Reabsorption

A

2/3 of what is filtered is reabsorbed in proximal tubule

Any ? Asking where something is reabsorbed should choose proximal tubule

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15
Q

Parts of nephron in cortex

A

Glomeruli
Proximal tubule
Distal tubule

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16
Q

Parts of nephron in medulla

A

Loops of Henle

Collecting duct

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17
Q

Most vulnerable part to ischemia

A

Inner stripe of outer medulla

Secondary to hypotension

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18
Q

Glomerular filtration

A

From glomerular capillary into Bowman’s capsule

Pressure for this created by beat of heart causing glomerular capillary hydrostatic pressure

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19
Q

Tubular reabsorption

A

Out of the lumen of renal tubule

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20
Q

Tubular secretion

A

Into the lumen of the renal tubule

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21
Q

Loop of Henle

A

Establishes and maintains an osmotic gradient in medulla of kidney
Countercurrent multiplier

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22
Q

Distal tubule and collecting duct

Study These Flashcards
A

Make final adjustments on urine pH, osmolality, and ionic compositions

23
Q

Thick ascending limb of Henle

Study These Flashcards
A

Countercurrent multiplier
Creates the osmotic gradient
Impermeable to water
Sodium is reabsorbed into medullary interstitium, water can’t follow

24
Q

Vasa recta

Study These Flashcards
A

Countercurrent exchanger

Maintains osmotic gradient created by loop of Henle

25
Interstitial osmolality created by deposition of sodium
600 mOsm/kg
26
Total osmolality at tip of medullary pyramid
1200 mOsm/kg | Additional 600 from urea
27
Urea
Partially reabsorbed in proximal tubules Secreted into tubules in TAL- increases concentration in tubules High concentration drives reabsorption at collecting ducts Urea is recycled
28
Renal control of glucose
Proximal tubule has maximum capacity for reabsorbing | All filtered glucose is usual completely reabsorbed by active transport here
29
Renal transport of glucose in DM
Amount of glucose filtered exceeds transport maximum All segment beyond proximal tubule impermeable to glucose=glucose excreted Glucose appears in urine Causes osmotic diuresis
30
Life of vasopressin (aVP, ADH)
1. Synthesized in hypothalamus cell bodies- paraventricular nucleus, supraoptic nucleus 2. Stored before release in posterior pituitary (neurohypophysis) 3. Secreted into blood 4. Stimulus for release is increase in extracellular osmolality 5. Site of action is collecting duct
31
Absence of ADH/AVP/vasopressin
Collecting duct and distal tubule impermeable to water | Causes large volume (up to 25 mL/min) of dilute urine (50-100 mOsm) to be formed
32
ADH/AVP/vasopressin in circulation
``` Causes reabsorption of H2O in collecting duct Small amount (0.5 mL/min or 0.5mL/kg/hr) of concentrated urine (1200-1500 mOsm) is formed ```
33
Ascending loop of Henle
Impermeable to H2O | Reabsorbed NaCl
34
DI
Failure of vaso synthesis or release | Insensitivity of DT and CD to vaso
35
SIADH
Inappropriate secretion of vaso From intracranial tumors, hypothyroid, porphyria, and small cell carcinoma of lung Diagnosed by increased urine sodium concentration and osmolality in the presence of hyponatremia and decreased plasma osmolality
36
Actions of aldosterone
Increases Na reabsorption from late installments tubule and collecting duct (decreases Na excretion) Increase rate of K secretion into late signal tubule and collecting cute (increases rate of K excretion)
37
Production of aldosterone
In Zona glomerulus a of adrenal cortex
38
Atrial natriuretic peptide
Released from R atria | Acts on kidney to increase sodium excretion
39
Determinants of K excretion
1. Aldosterone- increases rate of K secretion in distal tubule and collecting duct 2. Distal tubular flow rate- excretion is increased when flow through distal tubule is increased and vice versa 3. Bicarbonate ion concentration - increased bicarb concentration in distal tubule increased (alkaline urine)= K secretion increase
40
Loop diuretics example
Furosemide Bumetanide Ethacrynic acid Torsemide
41
Loop diuretics
Site of action- thick ascending limb Bind to Na K 2Cl symporter and inhibiting reabsorption of these ions Osmolality of medulla decreases causing water excretion SE-hypokalemia, fluid volume deficit, orthostatic hypotension, reversible deafness
42
Thiazides examples
Chlorothiazide Hydrochlorothizide Chlortahidone Metolazone
43
Thiazides
Work in early distal tubule Inhibit sodium reabsorption SE-hypokalemia
44
K sparing examples
Spironolactone Traiamterene Amiloride
45
K sparing
Spironolactone-competitive aldosterone antagonist, works in late distal tubule and collective duct (mostly) Others- decrease Na reabsorption from late distal tubule and collecting duct SE- hyperkalemia
46
Carbonic anhydrase inhibitor example
Acetazolamide
47
Carbonic anhydrase inhibitor
Works in proximal tubule Inhibits carbonic anhydrase inhibits bicarb reabsorption Diminishes Na reabsorption SE- hyerchloremic metabolic acidosis, decreased intraocular pressure by decreased rate of aqueous humor formation
48
Osmotic diuretics
Loop of henle or Bowman’s capsule- controversial Exerts osmotic force and hinders reabsorption of water SE- hypokalemia
49
Intraoperative acute renal failure stats
Accounts for 50% of patients requiring acute dialysis | Associated with mortality of 40-90%
50
Prerenal vs renal failure sodium
Prerenal (prerenal oliguria)- FENa <0.01 (1%) Extensive Na reabsorption due to slow flow through tubule ``` Renal failure (acute tubular necrosis)- FENA >0.03 (3%) Reabsorbed sodium poorly so there is a large amount in the urine ```
51
Best test of renal reserve
Creatinine clearance | Measures GFR
52
Electrolyte abnormalities in CKD
Hyperkalmia Hypocalcemia Hypermagnesemia Hyperphosphatemia
53
Decrease of K with hyperventilation
0.5 mEq/L for each 10 mmHg decrease in PaCO2

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