All of Kidney Phys + Pharm Flashcards
Functions of Kidneys
Acid base balance
Water balance
Electroyte balance
Toxin removal
Blood pressure control
Erythropoietin prod
Vitamin D activation
What drives filtration at level of glomerulus?
Pressure gradient
Causes of Oedema?
high hydrostatic pressure
sodium retention
inflammation
plasma osmotic pressure
What measures the functional capacity of the nephrons?
GFR
GFR Clearance Curve
Creatinine:
- marker of kidney function
- 50% of renal function needs to be lost before serum creatinine increases
RAAS System leads to what
- increased symp activity
- tubular Na+ and water retention
- Aldosterone secretion
- Vasoconstriction and increased BP
- ADH secretion from pituitary -> water reabsorption
Acute Renal Failure - prerenal, intrarenal, postrenal causes
Chronic Kidney Disease summarised
Proximal Convoluted Tubules - transporters and what PCT does
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
Loop of Henle Diagram
What transporters in Thick ascending limb and functions
Transporters:
- NKCC2 (Na+/K+/2Cl-)
- Na+/K+ antiporter
- K+ channels
- K+/Cl- symporter
Function:
- allows for solutes to be pumped into interstitium
DCT transporters and functions
Transportes:
- Na+/Cl- cotransporter
- Ca2+/Na+ cotransporter
Function:
- help regulate parathyroid hormone bc important for blood calcium levels
Collecting Duct transporters and functions
- 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+
How to approach and interpret arterial blood gas analysis -> for acidosis/alkalosis
- look at pH (acidosis vs alkalosis)
- Look at pCO2 & HCO3- (resp or metabolic)
- Look for compensation
How to determine acidosis/alkalosis and what type
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
pH buffers
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%
Boston Bedside Rules
Nerves involved with peeing
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
Micturition pathway?
2 Causes of Incontinence
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)
Non-Neurogenic types
- Stress incontinence
- Urge incontinence
- Mixed incontinence (stress and urge)
Neurogenic Bladder - De-afferentation
- sensory nerve fibres are damaged
- Hypotonic bladder
- results in overflow incontinence
Eg Syphilis
Neurogenic Bladder - Denervation
- damage to both afferent and efferent arterioles
- upper motor neuron spastic bladder (hyper reflexive)
- Lower motor neuron flaccid bladder
Neurogenic Bladder - Spinal cord transection
- initially causes autonomic bladder + overflow incontinence due to spinal shock
- micturition reflex returns later but no voluntary control
Eg spinal cord injury
What is the primary hypertension ladder -> order of drugs used to treat hypertension
- Thiazide diuretics
- DHP Ca2+ channel blockers
- ACEi + ARBs
What are anti-hypertensives for Pregnancy?
- Hydalazine
- Labetalol (beta blockers)
- Methyl-dopa + Clonidine (alpha 2 agonist
- Nifedipine
(He Likes My Neonate)
What do Loop Diuretics do? where do they act? example? AE?
Function:
- Inhibits Na+/K+/2Cl- symporter
Where:
- Thick ascending loop of Henle
Example:
- Furosemide
AE:
- Causes hypokalemia
What do Thiazide Diuretics do? where do they act? example? AE?
Function:
- Inhibits Na+/Cl- symporter
Where:
- Distal Convoluted Tubules (DCT)
Examples:
- Hydrochlorothiazide
- Indapamide
AEs:
- Hypercalcaemia
- Hypokalemia
What do Potassium-Sparing Diuretics do? where do they act? example? AE?
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
What do Osmotic Diuretics do? where do they act? example? AE?
Function:
- Block water by decreasing osmotic gradient -> used for local oedema
Where:
- PCT and LOH
Example:
- Mannitol
Should Loops and Thiazide Diuretics be used together?
No bc they both increase Digoxin toxicity
Summary of Diuretics
What do SGLT2 inhibitors do? MOA? AE?
Function:
- inhibit SGLT2 in PCT
- used to lower plasma glucose -> decreases weight, decreases BP
Where:
- PCT
Examples: (-gliflozin)
- Dapagliflozin
- Empagliflozin
What do ACE Inhibitors do? where do they act? example? AE?
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
What do Angiotensin do? example? AE?
Function:
- AT1 receptor antagonist
Example: (-sartan)
- Candesartan
- Valsartan
AEs:
- Hyperkalemia
- Hypotension
What do Beta Blockers do? Examples? AEs?
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
What do Alpha Antagonists do? Examples? AEs?
Function:
- Alpha receptor antagonist (inhibits vasoconstriction)
- for Hypertension
Examples: (-osin)
- Prazosin
- Tamsulosin
- Phentolamine (non selective)
AEs:
- urinary urgency
- reflex tachycardia
What do Alpha 2 Agonists do? Examples? AEs?
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
What is a combination of drugs to avoid?
RASi + NSAID + Diuretic
They all lead to reduced GFR = bad
NSAIDS dilate afferent arteriole
ACEi constricts efferent arteriole
Resistant HTN Agents summary
Pulmonary HTN Agents summary
