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D&T test 5 - Renal, Urogential > Class: Renal Sodium balance > Flashcards

Class: Renal Sodium balance Flashcards

1
Q

normal urine osmolality

A

285-295

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2
Q

intracellular volume is controlled by what

A

osmolality

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3
Q

extracellular volume is controlled by what

A

sodium

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4
Q

major intracellular ion

A

K+

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5
Q

major extracellular cation

A

Na+

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6
Q

hyponatremia water moves where?

A

to ICF

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7
Q

hyperglycemia/natremia water moves where

A

to ECF

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8
Q

What does the kideny regulate (volume-wise)

A

ECF volume and osmolality

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9
Q

ECF osmolality is regulated by what

A

renal ADH = water handling

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10
Q

ECF volume is regulated by what

A

renal Na+ handling = RAAS system

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11
Q

Which is tightly regulated and which varies all day- ECF volume or osmolality

A

osmolality is tightly regulated

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12
Q

min and max urine osmolality

A 
min = 50
max = 1200
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13
Q

desert islnad no water = what type of state

A

hyperosmolar

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14
Q

in hyperosmolar state, what occurs

A

ADH released

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15
Q

sweating a lot and drinking water with no salt leads to what state

A

hyposmolar state

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16
Q

what 3 things will promote renin secretion:

A

Decreased NaCl to macula densa
Low BP in Afferent arteriole
Increased SNS activity

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17
Q

Decreased NaCl to macula densa –> what 2 things

A

dilation of AA

Prostaglandin release –> JG cells release renin

18
Q

What do JG cells do in low BP independent of macula densa

A

release renin

19
Q

SNS activity increased by what

A

low BP

20
Q

SNS effects on kidney (3) and one systemic effect

A

i. Vasoconstriction (systemic)
ii. Renin release
iii. Decreased RBF, GFR (dt constriction of AA, EA)
iv. Increased reabsorption of NaCl (PCT, TAL, DT/CD)

21
Q

Hypothalamus is activated by what 4 things

A

i. Hyperosmolarity
ii. decreased atrial receptor firing
iii. SNS
Angiotensin II

22
Q

V1 receptor activation –> increased MAP via what MOA?

A

V1 is present on blood vessels–> increased SVR (vasoconstriction)

23
Q

V2 receptor activation –> increased MAP via what MOA?

A

ADH receptor in tubule –> kidney water reabsorption–> increased BV

24
Q

define hypern natremia

A

Sodium >145

25
Q

4 causes of Diabetes insipidus

A

Neurosurgery
Head trauma
Neoplasms
Sarcoidosis

26
Q

4 causes of hypernatermia

A

Inadequate water intake
Insensible water losses
Inability to concentrate urine (central or nephrogenic diabetes insipidus)
Salt toxicity

27
Q

Diabetes insipidus 4 sx

A

Polyuria/polydipsia
Lethargy/weakness
Irritability
Seizures/coma

28
Q

3 causes of Nephrogenic diabetes indipidus

A

Pregnancy
Lithium use
genetic mutations

29
Q

Give ADH:

no response = what dx

A

no response = nephrogenic DI

30
Q

Tx for Central DI:

A

Desmopressin (synthetic DDAVP)

31
Q

Tx for Nephrogenic DI- 2 drugs and MOA

A

amiloride- competes with lithium

HCTZ - MOA unknown

32
Q

Tx for Nephrogenic DI: (non-pharmacological) and MOA

A

reduce Na and protein in diet –> reduced urine volume

33
Q

define hyponatremia

A

Sodium <135

34
Q

presentation of hyponatremia (4)

A

Headache
Nausea/vomiting
Disorientation
Gait abnormality

35
Q

3 reasons for Urine Osmolality <100 mOsm/kg in hyponatremia

A

primary polydypsia
beer potomania = decreased ADH secretion
tea/toast diet = urine has no osmotic pull

36
Q

3 reasons for Urine osmolality >100 mOsm/kg in hyponatremia

A

impaired water excretion (RF, thiazides)
exccess ADH
ADH receptor dysfunction

37
Q

urine sodium and urine osmolailty in both:
hypovolemic hyponatremia
hypervolemic hyponatremia

A

Both will have low urine sodium and high urine osmolality

38
Q

SIADH urine sodium and urine osmolality

A

SIADH will have high urine sodium (<40) and high urine osmolality (>300),

39
Q

What is a major cause for euvolemic hyponatremia

A

SIADH = medications

40
Q

TX for Any patient with gait abnormality/disorientation/obtunded (mental status changes due to hyponatremia)-

A

give hypertonic saline

41
Q

What can you give to treat acute hyponatremia that you can’t give in Chronic hyponatremia? Why?

A

can’t give hypertonic saline
bc: the brain cells have adjusted to the new normal by pumping out osmoles which keeps them from being filled with water too. (since in hyponatremia they have higher osmolarity than the ECF). If you give hypertonic saline in chronic, the cells will lose all their water and become demyelinated

D&T test 5 - Renal, Urogential (27 decks)

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