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MHD V: Renal > 10.30: Renal Review > Flashcards

10.30: Renal Review Flashcards

1
Q

What is special about flow of blood in kidney?

A

Only place in body where blood goes from artery, to capillary and back to artery

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2
Q

Where does filtrate go after it leaves glomerulus?

A

Bowmans capsule

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3
Q

Is there much protein in healthy urine?

A
  • No, nearly none is filtered
  • Most that is filtered is reabsorbed
  • Protein in urine sign of pathology
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4
Q

What is Tamm horsfall protein?

A
  • Makes up majority of protein seen in healthy urine

- Serves to prevent clot formation

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5
Q

Main factor impacting glomerular filtration?

A

Hydrostatic pressure in the capillary

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6
Q

How is RPF estimated?

A
  • PAH clearance
  • Nearly all that enters renal circulation is excreted
    RPF = clearance PAH
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7
Q

RBF equation?

A

RBF = RPF / (1-hematocrit)

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8
Q

What is the filtration fraction?

A

FF = GFR./ RPF

*Normally 125/625 ml /min ~20%

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9
Q

What happens in decreased RPF?

A
  • RAS system constricts efferent arteriole
  • Increase hydrostatic pressure in capillary
  • Maintains GFR increase FF
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10
Q

What do prostaglandins do to afferent?

A

Dilate increasing RPG and GFR

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11
Q

What do NSAIDs do to afferent arterial?

A
  • Constrict it

- Can cause renal failure

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12
Q

What does angiotensin do to efferent arterial?

A

Constricts

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13
Q

How does kidney autoregulate in increased systemic BP?

A
  • Constricts afferent
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14
Q

RAS steps?

A
  1. Renin converts angiotensinogen to angiotensin I

2. ACE converts I to II

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15
Q

How do ACE inhibitors work?

A
  • Prevent angiotensin from constricting efferent arteriole

- Decreases GC pressure to protect kidney

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16
Q

What do dihydropyridine Ca antagonist drugs do?

A
  • Very effective at lowering BP

- But abolish autoregulation of kidney so renal hypertension can occur

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17
Q

Best way to measure GFR? How is it normally measured?

A
  • Inulin
  • Freely filtered and neither reabsorbed or secreted
  • ***However, measured creatinine clearance is most often used
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18
Q

Creatinine clearance calculation?

A

Clearance = (urine [] * urine flow rate) / plasma []

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19
Q

Why is creatinine good measure?

A
  • Byproduct of muscle breakdown

- In steady state, production = excretion

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20
Q

What is eGFR?

A

Estimated GFR

21
Q

What is required for eGFR?

A
  • Steady state level of plasma creatinine

- Cannot be used if renal function is rapidly changing

22
Q

What is relationship between creatinine clearance and plasma creatinine?

A
  • Inversely proportional (C= UV/P)
  • If clearance is 100 and plasma is 1
  • If plasma 2, clearance would be 50
  • If 4, then 25
23
Q

What is creatinine clearance good example of?

A

GFR

24
Q

Cockroft Gault equation?

A

(140 - age * weight kg) / 72 * plasma Cr

  • ***Multiply by .85 if female
  • Gives us creatinine clearance
25
Q

When is eGFR applicable?

A

Only if serum creatinine is stable

26
Q

What happens in CDK to creatinine?

A
  • Exponential increase in plasma Cr with time
27
Q

What happens in AKI to creatinine?

A
  • Linear increase

- Drops back to normal if function restored

28
Q

What does amount of Cr in a healthy person depend on?

A

Directly proportional to muscle mass

29
Q

What is fractional excretion?

A
  • Amount of substance excreted in urine related to amount filtered by kidney
  • FE = Amount excreted / amount filtered
30
Q

What is FENa equation?

A

FENa = (UNa/PNa) * (PCr/Ucr) * 100

31
Q

What is FENa in healthy person?

A

1%

32
Q

What happens to FENa in decreased GFR?

A
  • Increases

- As long as there is not edema present

33
Q

Where are bulk of solutes reabsorbed?

A

Prox tubule

34
Q

What happens in loop of henle?

A

Water goes out diluting filtrate

35
Q

What does ADH do?

A

Water resorption in collecting ducts

36
Q

What does tubular [] > plasma [] mean?

A

Item is being secreted

37
Q

What is proximal tubule dysfunction called?

A

Fanconi syndrome

38
Q

What is fanconi Syndrome?

A
  • Prox tubule disorder with decreased resorption
  • Glycosuria
  • Hypo P, K
  • Metabolic acidosis: Bicarb is buffer
  • Proteinuria
39
Q

What is loop dysfunction called?

A
  • Bartter’s syndrome
  • Salt wasting
  • Hypokalemia
  • Metabolic acidosis
40
Q

What is bartter’s syndrome?

A
  • Loop dysfunction
  • Salt wasting
  • Hypokalemia
  • Metabolic acidosis
  • **Loop diuretics cause same problems
41
Q

What does distal dysfunction cause?

A

Gitelman’s syndrome

42
Q

What is Gitelman’s syndrome?

A
  • Distal disfunction
  • Hypokalemia, Mg, Ca
  • Thiazides case the same
43
Q

Where is angiotensinogen made?

A

Liver

44
Q

Where is ACE present?

A

Mostly lung but kidney too

45
Q

What does angiotensin II do?

A
  • Vasoconstric

- Activate aldosterone

46
Q

Where is EPO made?

A

Kidney

47
Q

Where is Vitamin D activated?

A

Kidney

48
Q

What is orthostatic hypertension indicative of?

A

Volume depletion

49
Q

What should FENa be if volume depleted?

A

Low

MHD V: Renal (28 decks)

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