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Renal Exam > CC of renal phys and disease > Flashcards

CC of renal phys and disease Flashcards

1
Q

What is the value of Na+ in the ECW normally?

A

140 mEq/L (range 135-145meq/L is okay)

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2
Q

Osmolarity =

A

total solute/ECF volume

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3
Q

What is the normal expected urine output for a day?

A

1- 1.5 L/day (get about ~.5 L in total insensible loses) *this is apx = to intake of water/day)

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4
Q

The goal is to maintain isotonicity. In the case of hypertonicity– what happens?

A

Stimulate hypothalmic Rs–> INCREASE thirst to increse H20 intake INCREASE ADH release to increase renal water retention

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5
Q

The goal is to maintain isotoniity. In the event of hypOtonicity, what is the body’s response?

A

Inhibit Hypothalmic Rs Decrease thirst to decrease H20 intake Decrease ADH release –> renal water excreation

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6
Q

ADH is stimulated when plasma osmolarity is in the range of: when % blood volume loss is:

A

At plasma osmolarity of 290 Osm start to see sharp increase in ADH release At % blood loss of 7-10% start to see sharp increase in release of ADH

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7
Q

ADH levels are ____ in dilute urine and ______ in concentrated urine

A

Low High

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8
Q

Pt that drank tons of water in water contest had headache, found dead in apt later with serum Na at 114 meq/L. What happened?

A

Body failed to maintain isotonicity She would be HYPOtonic that should cause decreased thrist, decreased release of ADH and increased urine output.. she didn’t stop drinking

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9
Q

What are signs and symptoms of Hyponatremia and when are they most common

A

when change in Na happens rapidly Nausea, Vomiting, Weakness, Headache, Lethargy, Seizures, Respiratory, Depression, Death

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10
Q

Example of appropriately elevated ADH: Inappropriate ADH elevation:

A

app: volume depletion inapp: • Cancer (eg small cell lung), CNS disease, Pulmonary disease, Drugs, Narcotics, Antiemetic, SSRIs, HIV

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11
Q

What can the following lead to: Excessive water intake • Hypotonic fluids • Other irrigants Aletered renal water hanling • Chronic kidney disease

A

altered water balance

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12
Q

______ is the primary determinant of ECF osmolarity

A

• Serum Na

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13
Q

ECF osmolarity is tightly regulated by

A

changes in thirst and ADH secretion

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14
Q

Excretion of a dilute urine (osm < 100 mOsm/kg) is required to prevent _______ due to increased water intake

A

hypoosomalarity

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15
Q

• Inappropriately elevated ADH can precipitate hyponatremia and hypoosmolarity because:

A

urinary dilution is impaired (osm > 300 mOsm/kg)

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16
Q

Define GFR and it’s normal value

A

GFR: amount of plasma filtered through glomeruli per unit time (~90-125 mL/min)

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17
Q

• Nitrogenous waste product of protein metabolism • Less accurate indicator of GFR than creatinine

A

Blood Urea Nitrogen

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18
Q

Why is BUN less accurate then creatine as an indicator of GFR?

A

due to variation in: – protein intake – catabolic rate – tubular reabsorption • Useful in conjunction with creatinine in the differential diagnosis of renal disease

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19
Q

• Breakdown product of skeletal muscle • Production remains constant over time • Filtered at the glomerulus (like inulin) and can be used to estimate GFR

A

Serum Creatinine

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20
Q

Serum levels are______ proportionate to GFR

A

inversely (GFR~100/Cr)

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21
Q

Limitation of using creatine for estimate in GFR

A

creatinine is also secreted in the nephron and creatinine clearance overestimates GFR

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22
Q

Describe the releationship of GFR to serum creatine

A

serum creatine from 1 to 2 we see change in GFR = 50 ml/min

from 2 to 3; change in GFR = 25 ml/min

as serum creatine increase and kidney funx decrease, GFR decrease exponentially

23
Q

What is the best way to measure GFR?

A

Renal clearance of inulin

GFR = Uinulin x V/ Pinulin

24
Q

Assuming the following values, what is our GFR?

Pinulin = 1mg/ml

V = 1ml/min

Uinulin= 125mg/ml

A

Equation for GFR:

[Uinulin x V] / Pinulin

125mg/ml x 1ml/mg / 1mg/ml = 125ml/min

25
Q

What is the equaiton for measuring Creatine clearance

A

Creatine clearance = Ucreat x Uvol/ Pcreat

26
Q

A pts primary care doc asks you to start pt on dialysis bc his GFR is 5 ml/min. You decide that you will IF his GFR is truly tht low. You collect a 24 hr urine sample (1440 mins) to calc Creatine clearance. Uvol = 2.1 L with Ucreat = 95mg/dl. The serum creatinine is 7.0 mg/dl and BUN is 44mg/dl

What is the pts Creatine clearance?

A

Creatine Clearance = Ucreat x Uvol/ Pcreat

** you need to take into account the collection was over 24 hours or 1440 mins–>

Ucreat x Uvol/ Pcreat x 1440 mins

95mg/dl x 2100 ml

7 mg/dl x 1440min

= 19.8 ml/min

27
Q

When is dialysis indicated?

A

When pts GFR is less then 10

28
Q

What is the Cockcroft-Gault Equation?

A

Creatine clearance = (140-age) x weight (kg)/ Serum Cr x 72

*if female, multiply answer by 0.85

29
Q

Serum creatinine can be used to estimate_____:
• GFR is ~ ______

A

GFR

100/serum creatinine

30
Q
  • CrCl can be calculated by
  • CrCl can be estimated by
A

U●V/P

Cockcroft-Gault

31
Q

Serum creatinine based GFR estimates can be
inaccurate due to extremes of

A

age, BMI, or muscle mass

32
Q

If ECF is contracted, we will cause barareceptor ______ which then cauases _____ sympathetic tone

A

activation

increased

33
Q

Increased sympathetic tone d/t ECF contraction leads to:

A

increased renin secreation–> causes increase of Ang II–> increased aldosterone –> increased Na reabsorption to increase effective circulating volume

+

increased sympathetic tone directly increase tubular Na+ reabosorption.

34
Q

Control of tubular Na Reabsorption is controlled by a number of inputs. These will effect tubular Na channels and transporters

A

– Renal sympathetic tone
– Hormonal
– Blood pressure

35
Q

What are the 2 Direct Tubular Effects to increase Na reabsorption

A

• Renal sympathetic nerves:Multiple tubular receptors stimulate Na reabsorption
• Angiotensin II: Tubular receptors and increases activity of proximal tubule Na/H
countertransporter

36
Q

Actions of Ang II in the Proixmal tubule

A

Increases Na reabsorption:

  1. Increases Na+ in/H+ out on the lumen side
  2. Increases Na+ in/K+ out on the renal IF side
  3. Increases Na+/HCO3- in to the renal IF
37
Q

Aldosterone stimulates Na reabsorption in :
– ___of filtered load of Na has its excretion
dependent on aldosterone action

A

cortical collecting duct principal cells

~2%

38
Q

How does Aldosterone increase Na reabsorption?

A

– increases number of luminal Na channels and BL Na/K-ATPases

39
Q

– Most important stimulus for aldosterone secretion relating to Na balance

-dependent upon renin secretion and therefore baroreceptors, macula densa, and
renal sympathetic tone

A

Angiotensin II

40
Q

What is the MOA of ADH on late distal tubules, CDs and collecting tubules

A

increases produciton and distribtuion of AQP-2 on the tubular lumen side to increaes H20 reabsorption

41
Q

The systemic response to decreased ECF volume involves:

A
  • Baroreceptor and sympathetic nerve activation
  • Activation of Renin-AngII-Aldo system
  • Increased ADH
42
Q

These factors lead to enhanced renal tubular Na and water reabsorption

A

• Clinically reflected by low urine Na, low FENa, and elevated urine osmolarity

43
Q

– secreted by juxtaglomerular cells
– converts angiotensinogen –> angiotensin
– angiotensin regulates BP and salt balance

A

Renin

44
Q

Erythropoetin (epo)
– produced by _________
– stimulates erythrocyte production in ____

A

renal cortical tubular cells

marrow

45
Q

formed in proximal tubule cells
– regulates calcium and phosphate balance

A

• 1,25 dihydroxyvitamin D production

46
Q

Increased reabsorption of Na proximal tubule, increased ADH secreation and Activation of baroreceptors are all activated when:

A

they sense ECF depletion

47
Q

Increased serum _____ will contribute to hyperparathyroidism

A

increased serum phosphorus

48
Q

Low Ca++ leads to increase in _____

A

Increased PTH

49
Q

All of these things will be increased in response to increased PTH thats stimulated by low Ca++

A

Increased vit D2 activtion–> increased intestinal Ca++ reabsorption

increased renal Ca++ reabsorption

Increased Ca++ released from bones

50
Q

Kidney disease results in _____ 1,25 Vit D prodcution and _____ serum P04

A

DECREASED 1,25 Vit D production

Increaed serum PO4

51
Q

Increased serum PO4 and decreased 1,25 Vd prodution lead to what three things

A

decreased serum Ca++

decreased CaR

Decreased VDR

–> all leads to increased PTH

52
Q

Chronic kidney disease:
•Decreased_______ production leading decreased calcium absorption, hypocalcemia, and 2° hyperparathyroidism

A

calcitriol

53
Q

Chronic kidney disease:

Leads to________ retention leading to 2°hyperparathyroidism

A

phosphorus

54
Q

Secondary hyperparathyroidism leads to :

A

increased bone turnover and extraosseus calcification

Renal Exam (22 decks)

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