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Y2 S1 Physiology > All of Kidney Phys + Pharm > Flashcards

All of Kidney Phys + Pharm Flashcards

1
Q

Functions of Kidneys

A

Acid base balance
Water balance
Electroyte balance
Toxin removal
Blood pressure control
Erythropoietin prod
Vitamin D activation

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2
Q

What drives filtration at level of glomerulus?

A

Pressure gradient

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3
Q

Causes of Oedema?

A

high hydrostatic pressure
sodium retention
inflammation
plasma osmotic pressure

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4
Q

What measures the functional capacity of the nephrons?

A

GFR

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5
Q

GFR Clearance Curve

A

Creatinine:
- marker of kidney function
- 50% of renal function needs to be lost before serum creatinine increases

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6
Q

RAAS System leads to what

A
  • increased symp activity
  • tubular Na+ and water retention
  • Aldosterone secretion
  • Vasoconstriction and increased BP
  • ADH secretion from pituitary -> water reabsorption
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7
Q

Acute Renal Failure - prerenal, intrarenal, postrenal causes

A
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8
Q

Chronic Kidney Disease summarised

A
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9
Q

Proximal Convoluted Tubules - transporters and what PCT does

A

Transporters:
- Na+/K+ ATPase
- Cl-/Base- cotransporter
- SGLT2 (Sodium glucose transporter) Na+/Glucose symporter
Function:
- Majority of stuff reabsorbed here -> important for maintaining acid/base balance

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10
Q

Loop of Henle Diagram

A
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11
Q

What transporters in Thick ascending limb and functions

A

Transporters:
- NKCC2 (Na+/K+/2Cl-)
- Na+/K+ antiporter
- K+ channels
- K+/Cl- symporter
Function:
- allows for solutes to be pumped into interstitium

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12
Q

DCT transporters and functions

A

Transportes:
- Na+/Cl- cotransporter
- Ca2+/Na+ cotransporter
Function:
- help regulate parathyroid hormone bc important for blood calcium levels

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13
Q

Collecting Duct transporters and functions

A
  • no transporters
    Function:
  • ADH increases number of aquaporins -> help water get in to collecting ducts
  • Aldosterone acts here as well to reabsorb Na+ and secrete K+
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14
Q

How to approach and interpret arterial blood gas analysis -> for acidosis/alkalosis

A
  1. look at pH (acidosis vs alkalosis)
  2. Look at pCO2 & HCO3- (resp or metabolic)
  3. Look for compensation
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15
Q

How to determine acidosis/alkalosis and what type

A

normal pH = 7.35-7.45
normal CO2 = 36-44
normal HCO3- = 22-26

  • Also revise the causes before the exams cos im kinda ceebs remembering that now
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16
Q

pH buffers

A

1st Line:
Buffers in ICF and ECF
2nd Line:
Excretion of CO2 and rapid-acting and compensates for 75%
3rd Line:
Slow acting (48 hours) and compensates for 25%

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17
Q

Boston Bedside Rules

A
18
Q

Nerves involved with peeing

A

Pelvic Nerves:
- Afferent nerves detecting streth and send impulses to spinal cord
Pons: (storage/mictruition):
- Higher centre activity to either stim or inhibit pathways of continence
Pelvic splanchnic (mictruition):
- excites bladder and relaxes internal urethral sphincter
Sympathetic system (storage):
- inhibits bladder body -> contracts internal urethral sphincter
Pudendal nerve (somatic nerves):
- constricts external urethral sphincter

19
Q

Micturition pathway?

A
20
Q

2 Causes of Incontinence

A

Neurogenic Bladder:
- due to neurological dysfunction
- impaired urine storage (due to detrusor overactivity) and emptying
- significant morbidity if left untreated
Non-Neurogenic Bladder:
- unknown causes -> need to rule out other causes first\
- Lifestyle modifications
- Treatment w anticholinergics (decrease parasymp activity)

21
Q

Non-Neurogenic types

A
  • Stress incontinence
  • Urge incontinence
  • Mixed incontinence (stress and urge)
22
Q

Neurogenic Bladder - De-afferentation

A
  • sensory nerve fibres are damaged
  • Hypotonic bladder
  • results in overflow incontinence

Eg Syphilis

23
Q

Neurogenic Bladder - Denervation

A
  • damage to both afferent and efferent arterioles
  • upper motor neuron spastic bladder (hyper reflexive)
  • Lower motor neuron flaccid bladder
24
Q

Neurogenic Bladder - Spinal cord transection

A
  • initially causes autonomic bladder + overflow incontinence due to spinal shock
  • micturition reflex returns later but no voluntary control

Eg spinal cord injury

25
Q

What is the primary hypertension ladder -> order of drugs used to treat hypertension

A
  1. Thiazide diuretics
  2. DHP Ca2+ channel blockers
  3. ACEi + ARBs
26
Q

What are anti-hypertensives for Pregnancy?

A
  • Hydalazine
  • Labetalol (beta blockers)
  • Methyl-dopa + Clonidine (alpha 2 agonist
  • Nifedipine

(He Likes My Neonate)

27
Q

What do Loop Diuretics do? where do they act? example? AE?

A

Function:
- Inhibits Na+/K+/2Cl- symporter
Where:
- Thick ascending loop of Henle
Example:
- Furosemide
AE:
- Causes hypokalemia

28
Q

What do Thiazide Diuretics do? where do they act? example? AE?

A

Function:
- Inhibits Na+/Cl- symporter
Where:
- Distal Convoluted Tubules (DCT)
Examples:
- Hydrochlorothiazide
- Indapamide
AEs:
- Hypercalcaemia
- Hypokalemia

29
Q

What do Potassium-Sparing Diuretics do? where do they act? example? AE?

A

Function:
- Aldosterone antagonist
- Na+ channel blocker
Where:
- Distal tubule and Collecting ducts -> principal cells
Examples:
- Spironolactone & Eplernone = Aldosterone Antagonists
- Amiloride = Na+ channel blocker
AE:
- causes Hyperkalemia

30
Q

What do Osmotic Diuretics do? where do they act? example? AE?

A

Function:
- Block water by decreasing osmotic gradient -> used for local oedema
Where:
- PCT and LOH
Example:
- Mannitol

31
Q

Should Loops and Thiazide Diuretics be used together?

A

No bc they both increase Digoxin toxicity

32
Q

Summary of Diuretics

A
33
Q

What do SGLT2 inhibitors do? MOA? AE?

A

Function:
- inhibit SGLT2 in PCT
- used to lower plasma glucose -> decreases weight, decreases BP
Where:
- PCT
Examples: (-gliflozin)
- Dapagliflozin
- Empagliflozin

34
Q

What do ACE Inhibitors do? where do they act? example? AE?

A

Function:
- Block conversion of Ang I to Ang II -> leads to reduced Na+/H20 retention, vasodilation, decreased symp drive
Where:
Afferent and Efferent arteriole
Example: (-pril)
- Captopril
- Enalapril
- Perindopril
AEs:
- Dry cough
- Headache
- Hypotension

DONT use in pregancy

35
Q

What do Angiotensin do? example? AE?

A

Function:
- AT1 receptor antagonist
Example: (-sartan)
- Candesartan
- Valsartan
AEs:
- Hyperkalemia
- Hypotension

36
Q

What do Beta Blockers do? Examples? AEs?

A

Function:
- Selectively inhibits beta 1 receptors (in heart and kidneys)
- Used for HTN, Heart failure, Arrythmias
Examples: (-olol)
- Atenolol
- Metoprolol
- Bisoprolol
AEs:
- Hypotension
- bradycardia
- worsening renal function
- worsening heart failure

37
Q

What do Alpha Antagonists do? Examples? AEs?

A

Function:
- Alpha receptor antagonist (inhibits vasoconstriction)
- for Hypertension
Examples: (-osin)
- Prazosin
- Tamsulosin
- Phentolamine (non selective)
AEs:
- urinary urgency
- reflex tachycardia

38
Q

What do Alpha 2 Agonists do? Examples? AEs?

A

Function:
- Centrally acting alpha 2 agonists
- Decrease CNS sympathetic outflow
- For hypertension and safe in pregnancy
Examples:
- Methyl-dopa
- Clonidine
AEs:
- Sedation
- Fatigue
- Rebound HTN

39
Q

What is a combination of drugs to avoid?

A

RASi + NSAID + Diuretic

They all lead to reduced GFR = bad

NSAIDS dilate afferent arteriole
ACEi constricts efferent arteriole

40
Q

Resistant HTN Agents summary

A
41
Q

Pulmonary HTN Agents summary

A

Y2 S1 Physiology (13 decks)

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