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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?

24
Q

Cockroft Gault equation?

A

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

  • ***Multiply by .85 if female
  • Gives us creatinine clearance
25
When is eGFR applicable?
Only if serum creatinine is stable
26
What happens in CDK to creatinine?
- Exponential increase in plasma Cr with time
27
What happens in AKI to creatinine?
- Linear increase | - Drops back to normal if function restored
28
What does amount of Cr in a healthy person depend on?
Directly proportional to muscle mass
29
What is fractional excretion?
- Amount of substance excreted in urine related to amount filtered by kidney - FE = Amount excreted / amount filtered
30
What is FENa equation?
FENa = (UNa/PNa) * (PCr/Ucr) * 100
31
What is FENa in healthy person?
1%
32
What happens to FENa in decreased GFR?
- Increases | - As long as there is not edema present
33
Where are bulk of solutes reabsorbed?
Prox tubule
34
What happens in loop of henle?
Water goes out diluting filtrate
35
What does ADH do?
Water resorption in collecting ducts
36
What does tubular [] > plasma [] mean?
Item is being secreted
37
What is proximal tubule dysfunction called?
Fanconi syndrome
38
What is fanconi Syndrome?
- Prox tubule disorder with decreased resorption - Glycosuria - Hypo P, K - Metabolic acidosis: Bicarb is buffer - Proteinuria
39
What is loop dysfunction called?
- Bartter's syndrome - Salt wasting - Hypokalemia - Metabolic acidosis
40
What is bartter's syndrome?
- Loop dysfunction - Salt wasting - Hypokalemia - Metabolic acidosis * **Loop diuretics cause same problems
41
What does distal dysfunction cause?
Gitelman's syndrome
42
What is Gitelman's syndrome?
- Distal disfunction - Hypokalemia, Mg, Ca - Thiazides case the same
43
Where is angiotensinogen made?
Liver
44
Where is ACE present?
Mostly lung but kidney too
45
What does angiotensin II do?
- Vasoconstric | - Activate aldosterone
46
Where is EPO made?
Kidney
47
Where is Vitamin D activated?
Kidney
48
What is orthostatic hypertension indicative of?
Volume depletion
49
What should FENa be if volume depleted?
Low

MHD V: Renal (28 decks)

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