All of Kidney Phys + Pharm

Question 1

Functions of Kidneys

Answer 1

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

Question 2

What drives filtration at level of glomerulus?

Answer 2

Pressure gradient

Question 3

Causes of Oedema?

Answer 3

high hydrostatic pressure
sodium retention
inflammation
plasma osmotic pressure

Question 4

What measures the functional capacity of the nephrons?

Answer 4

GFR

Question 5

GFR Clearance Curve

Answer 5

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

Question 6

RAAS System leads to what

Answer 6

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

Question 7

Acute Renal Failure - prerenal, intrarenal, postrenal causes

Answer 7

Question 8

Chronic Kidney Disease summarised

Answer 8

Question 9

Proximal Convoluted Tubules - transporters and what PCT does

Answer 9

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

Question 10

Loop of Henle Diagram

Answer 10

Question 11

What transporters in Thick ascending limb and functions

Answer 11

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

Question 12

DCT transporters and functions

Answer 12

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

Question 13

Collecting Duct transporters and functions

Answer 13

• 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+

Question 14

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

Answer 14

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

Question 15

How to determine acidosis/alkalosis and what type

Answer 15

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

Question 16

pH buffers

Answer 16

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%

Question 17

Boston Bedside Rules

Answer 17

Question 18

Nerves involved with peeing

Answer 18

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

Question 19

Micturition pathway?

Answer 19

Question 20

2 Causes of Incontinence

Answer 20

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)

Question 21

Non-Neurogenic types

Answer 21

• Stress incontinence
• Urge incontinence
• Mixed incontinence (stress and urge)

Question 22

Neurogenic Bladder - De-afferentation

Answer 22

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

Eg Syphilis

Question 23

Neurogenic Bladder - Denervation

Answer 23

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

Question 24

Neurogenic Bladder - Spinal cord transection

Answer 24

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

Eg spinal cord injury

Question 25

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

Answer 25

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

Question 26

What are anti-hypertensives for Pregnancy?

Answer 26

- Hydalazine - Labetalol (beta blockers) - Methyl-dopa + Clonidine (alpha 2 agonist - Nifedipine (He Likes My Neonate)

Question 27

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

Answer 27

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

Question 28

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

Answer 28

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

Question 29

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

Answer 29

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

Question 30

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

Answer 30

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

Question 31

Should Loops and Thiazide Diuretics be used together?

Answer 31

No bc they both increase Digoxin toxicity

Question 32

Summary of Diuretics

Answer 32

Question 33

What do SGLT2 inhibitors do? MOA? AE?

Answer 33

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

Question 34

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

Answer 34

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

Question 35

What do Angiotensin do? example? AE?

Answer 35

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

Question 36

What do Beta Blockers do? Examples? AEs?

Answer 36

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

Question 37

What do Alpha Antagonists do? Examples? AEs?

Answer 37

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

Question 38

What do Alpha 2 Agonists do? Examples? AEs?

Answer 38

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

Question 39

What is a combination of drugs to avoid?

Answer 39

RASi + NSAID + Diuretic They all lead to reduced GFR = bad NSAIDS dilate afferent arteriole ACEi constricts efferent arteriole

Question 40

Resistant HTN Agents summary

Answer 40

Question 41

Pulmonary HTN Agents summary

Answer 41