Chapter 6. Renal System Flashcards
- The filtration in the kidney occurs at?
- It is the measure of glomerular filtration rate (eGFR). Give the normal range.
- Transportation of ions or drugs back into blood from nephron is referred as?
- Secretion of ions or small molecular drugs into nephron from nephron walls.
- glomerular or bowman capsules
- Creatinine clearance: Normal is 80 to 120 mL/min.
- Reabsorption
ARF is rapid decline in the renal ability to clear the blood of toxic substances, causing accumulation of metabolic waste products, like blood urea nitrogen.
Prerenal ARF (probs in organs
liver, heart and blood circulations).
Intrinsic ARF (probs in kidney).
Drugs such as aminoglycoside, NSAIDs. Sepsis.
Post-renal ARF (probs in organs aft kidney like ureter or bladder).
Causes of prerenal ARF: Inadequate blood perfusion, CHF, hemorrhagic, hypovolemia, severe blood loss, dehydration, sepsis.
Give symptoms.
Symptoms of prerenal ARF include the following: Dizziness, dry mouth, Low blood pressure (hypotension), rapid heart rate, slack skin, thirst, weight loss.
Urine output is usually low in people with prerenal ARF. The patient also may have symptoms of heart or liver disease.
This is the slow progressive decline in kidney function can cause accumulation of metabolic waste like BUN. (CrCl >30 and <60 ml/min)
Risk Factors:
Chronic kidney diseases CKD: • High BO (uncontrolled) • Atherosclerosis • Blood loss • Chronic liver disease • ♥️ disease • Blood sugar (diabetes) • Autoimmune disease like SLE
How Chronic kidney disease affects blood:
- ↑ urea (azotemia or uremia) and creatinine concentration
- Anemia (↓ erythropoetins)
- ↑ blood acidity (acid-balance)
- ↓ absorption Ca and vitamin D3 concentration
- ↑ Para thyroid hormone (PTH)
- Normal or slightly ↑ K concentration
- CKD will lead to what deficiencies?
- Syndrome severe prolonged loss of protein into urine decrease blood proteins like albumin.
- Glomeruli are damaged and kidney function degenerates over a period of time. Symptoms are vomiting, nausea, edema, high blood pressure, difficulty in breathing, itchy and fatigue.
CKD can cause azotemia, anemia, vitamin D3 deficiency, decrease Ca concentration, and increased blood activity (acidosis).
CKD can cause decrease drug (metabolite) clearance and drug half-life (T1/2) increase.
-Nephrotic syndrome
-Chronic nephritis syndrome
- Electrolytes present in blood:
- Extracellular (interstitial and plasma)
- Intracellular
- Na, K, Ca, Mg, Cl,and CO3
- Ex: Na , Cl , Ca
- In: K, Mg, PO4
- This hormone helps to dissolve Ca ion from bones to blood. Helps in calcium reabsorption in kidney.
- This hormone is secreted from thyroid gland. Ca from the blood to bone formation.
-Parathyroid hormone (PTH):
hypercalcemia
-Calcitonin: Thereby hypercalcemia stimulates secretion of calcitonin from thyroid gland.
How is Ca absorbed?
Active form of Vit. D?
- Calcium is primarily absorbed by carrier-mediated diffusion at small intestine (jejunum, and duodenum)
- 1, 25-dihydroxy vitamin D3 (chole-calciferol)
-Causes of Hypercalcemia and what drugs causes this?
-Malignancy or metastatic bone disease.
Drugs: Hydrochlorothiazide, Chlorothiazide, Metolazone
Tx: calcitonin, bisphosphonates,
zolindranoic acid, corticosteroids, and prednisone
- Excessive parathyroid hormone secretion.
- PTH Increase Ca2+ reabsorption by activating ________ in the distal tubule.
- Hyperparathyroidism
- adenyl cyclase
- Due to deficiency of vitamin D and drugs that can cause this.
- due to decrease in PTH secre.
-Hypocalcemia
Drugs: corticosteroids counteract the effects of vitamin D. Loop diuretics increase Ca2+ excretion therefore cause hypocalcemia (furosemide, ethacrinic acid). Excess of phosphate in total parenteral nutrition.
-Hypoparathyroidism
- An intracellular ion. Found primarily in bone (85%) and soft tissues (14%)
- Exacerbates ______ by increasing renal synthesis of 1, 25- DHD cholecalciferol, red. bone forma. and inc. bone resorp.
- hypoparathyroidism (low PTH)
-Phosphorus
↑Ca= ↑PTH = hypophosphatemia
↓PTH = hyperphosphatemia = ↓ bone resorption
Drugs that prevent bone resorption (death) are and examples.
Antiresorptive agents: bisphosphonates, clodronate disodium, pamidronate disodium and
zoledronic acid.
Distri. prim. in intracell. 98%) and extracell. (2%) in muscle tissues.
• Major cation in intracell. space.
• Maintenance of proper electrical conduction in cardiac and skeletal muscles (muscle and nerve
excitability).
• Plays a role in acid base equilibrium acidosis.
Give normal range and what functions does this regulate?
Potassium
• Range of normal value 3.5 to 5 mEq/L.
• Kidneys (renal funcx), Aldosterone, Arterial pH, Insulin(insulin decrease K in blood by shifting K into cell), K+ supplement intake, Sodium delivery to distal tubule
*drugs that inh. Aldosterone = hyperkalemia
Renal insufficiency and drugs
• K sparing diuretics: Spironolactone,Triamterene,and
Amiloride, ACEi, and ARBs etc.
• Adrenal insufficiency (aldosterone hormones)
• During vigorous exercise
• Cellular breakdown (tissue damage, hemolysis, burns, infections)
• Metabolic acidosis, and cardiac arrest.
Hypokalemia Symptoms: Malaise (feeling NOT well), Confusion, Dizziness, ECG changes, Muscle weakness and Pain
Give causes.
Causes:
• Excessive mineral corticoid activity, Vomiting, and Diarrhea
Drugs: Diuretics, Thiazide, loop diuretics, and acetazolamide increase K secre. Corticosteroids, penicillin (piparicillin, ticaracillin), beta2 agonist, and amphotericin.
• Glucosuria • Alkalemia • Admin of insulin and glucose
-The most abundant extracellular anion is
-The most abundant extracellular cation, essential in establishing osmotic pressure relation between intracellular and extra
cellular fluid.
-Major cation in intracellular space
Cl-
Na+: Normal levels (135 to 147 mEq/L or mmol/L)
K (3.5-5mEq/L)
Hyperchloremia causes:
• Renal insufficiency when Cl intake exceeds excretion
• Dehydration
• Excessive salt intake
Hypernatremia causes: • Loss of free water (not body fluid) • Loss of hypotonic fluid • Excessive sodium intake • Drugs that contain (beta lactam, ticaracillin, antacids such as sodium carbonate
Hyponatremia
• Caused by cirrhosis, CHF, nephrosis or the administration of osmotic active solutes such as albumin
or mannitol (osmotic diuretic).
Hypochloremia caused by: • Excess loss of GI fluids • Diuretic therapy: Thiazide, and loop diuretics. Hypochloremic alkalosis is caused by: thiazides. • Fasting • Adrenal insufficiency
Body produces two types of acids;
Give the body’s normal pH
volatile (CO2) and non-volatile or fixed acids (HCl. phosphoric acid, sulfuric acid
Normal pH 7.35 – 7.45
↓ Bicarbonates (HCO -) in blood and ↑CO in blood
pH of blood is reduced (↓) pH of urine is increased (alkaline)
- This is present in most cells, catalyzes the reversible reaction between CO2 and HO➡️HCO
-Give drugs that causes this and tx.
Metabolic acidosis
Carbonic anhydrase
Drugs: acetazolamide, amiloride, triamterene, spironolactone (potassium sparing), and OD of ASA.
Tx: Sodium bicarbonate (NaHCO3)
↑ Bicarbonates (HCO -) in blood and ↓ CO in blood. 32
Drugs and disease that causes this and tx.
Metabolic alkalosis
Drugs: Thiazide and loop diuretics, hypercalcemia, high concentration of alkali administration, and vomiting.
Tx: Ammonium chloride (NH4Cl) or ascorbic acid
This occurs due to inadequate ventilation of CO2 by lungs. Predisposing factor for this such as?
Respiratory Acidosis:
asthma, beta-blockers, sleep apnea, CNS depressants, pulmonary edema or embolism, and cardiac arrest.
Due to increase secretion of CO2 Not very common
Example:
Respiratory Alkalosis
Overdose of ASA
CO2, HCO3, pH, ventilation M. Ac ↑ ↓ ↓ normal M. Alk ↓ ↑ ↑ normal Resp. Ac ↑ normal ↓ hypoventilation Resp. Alk ↓ normal ↑ hyperventilation
Hypoventilation: Resp. Ac. ↑CO2, ↓O2
Hyperventilation: Resp. Alk. ↓CO2, ↑O2
Apnea: No spontaneous breathing
Reabsorption of elements:
- Early proximal convoluted tubule
- Early distal convoluted tubule
- Thin descending loop of Henle
- Thick ascending loop of Henle
- both for early: Reabsorbs Na , Cl , Ca + -Reabsorbs H2O
- Reabsorbs: Na , K , Cl , Mg ,Ca
Collecting tubule reabsorption by what hormone?
Reabsorbs Na+ in exchange of K+ or H+ (regulated by aldosterone)
Reabsorbtion of H2O is regulated by ADH (vasopressin)
Overview of HCO3 in metabolism
Bicarbonate, byproduct of your body’s metabolism. Your blood brings bicarbonate to your lungs, and then it is exhaled as carbon dioxide. Your kidneys also help regulate bicarbonate. Bicarbonate is excreted and reabsorbed by your kidneys. This regulates your body’s pH, or acid balance.
