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renal > disorders of sodium balance > Flashcards

disorders of sodium balance Flashcards

1
Q

volume status is dictated by the _____ in the body

A

content of sodium

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2
Q

volume contraction is a disorder of

A

sodium depletion

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3
Q

volume expansion is a disorder of

A

sodium overload

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4
Q

kidneys modify sodium handing according to the

A

perceived volume status- effective circulating volume

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5
Q

sodium retention occurs under circumstancces of

A

volume depletion

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6
Q

sodium excretion occurs under circumstances of

A

volume overload

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7
Q

sodium balance affects

A

volume status

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8
Q

water balance affects

A

plasma osmolality and sodium concentration

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9
Q

sensors that assess volume status

A
  1. afferent arteriole
  2. macula densa
  3. carotid/ aortic bodies
  4. cardiac chambers
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10
Q

blood pressure fall leads to the activation of

A

RAAS system

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11
Q

factors that stimulate renin secretion from JG

A
  1. decreased chl- delivery to macula densa
  2. decreased perfusion of JGA
  3. B1 sympathetic stimulationof JGA
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12
Q

actions of angiotensin II

A
  1. vasoconstriction of the systemic arterioles and efferent arterioles
  2. aldosterone release
  3. renal sodium retention through direct stimulation of sodium reabsorption in the PCT and enhancing sodium reabs. in CT mediated by aldosterone
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13
Q

factos stimulating aldosterone synthesis

A
  1. Angiotensin II

2. hyperkalemia

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14
Q

actions of aldosterone at the renal cortical collecting tubule

A
  1. increased sodium reabs
  2. enhanced potassium secretion
  3. increased hydrogen secretion
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15
Q

factors that stimulate SNS

A

decreased pressure at nerve plexi bodies in carotid arteries and aortic arch

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16
Q

actions of SNS

A
  1. sympathetic vasoconstriction
  2. renal sodium retention- direct stimulation pf PCT Na reabs
  3. efferent arteriolar vasoconstriction
  4. stimulation of renin release
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17
Q

factos that stimulate ANP from atria

A

increased atrial stretch

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18
Q

actions of ANP

A
  1. increased renal Na excretion- direct on CT

2. at higher doses is a vasodilator and can increase RPF and GFR

19
Q

blood pressure is associated with which pressure

A

Pgc

20
Q

in volume overload, where there is a higher GFR and thus a faster tubular flow rate what happens?

A

there is a shorter tubular transit time thus reabs of Na decreases and there is more loss of it in the urine

the whole purpose it to correct volume overload

21
Q

volume depletion is diagnosed by

A

clinical symptoms!!!!!!!!

  • decreased BP
  • tachy
  • decreased skin turgor
  • orthostasis
  • decresed JVP
22
Q

characteristic lab and urine tests in volume depletion

A
  • reduced GFR
  • low urine Na
  • increased BUN/Cr ration
  • low Fractional Excretion of Na (FENa)
23
Q

what is FENa?

A

excreted load of Na / filtered load of sodium

24
Q

when do we expect to see a low FENa?

A

at times of volume depletion and there is an activation

25
Q

true or false:

host response to ineffective perfusion is the same as the response to volume depletion

A

yep

26
Q

true or false:

we can measure the effective circulating volume

A

nope

27
Q

volume overload diagnosis made by

A

clinical symptoms!!!!!

  • pulmonary edema
  • peripheral edema
28
Q

characteristics we see with volume overload

A
  • elevated BNP
  • high urine Na+
  • high FENa
29
Q

which diseases are associated with volume overload but there is still stimulus for sodium retention

A
  1. heart failure
  2. cirrhosis
  3. Nephrotic syndrome
30
Q

underfill hypothesis 1

A

movement of fluid into intersittium triggers retention (via RAAS and SNS) in attempt to expand extracellular volume and restore tissue perfusion

31
Q

overflow hypothesis 2

A

sodium retention by the kidney leads to expanded extracellular volume and results in fluid movement out of capillaries and into interstitium

32
Q

edema formation is from 4 mechanisms

A
  1. increased capillary pressure due to increased venous pressure either by venous obstruction or expanded venous blood volume
  2. decreased plasma oncotic pressure such as in hypoalbuminemia
  3. increased capillary permeability
  4. lymphatic obstruction
33
Q

how do we treat cirrhosis

A

treating the hemodynamic dysregulation and splanchnic vasodilation adn reducing extracellular volume

34
Q

nephrotic syndrome

A

poorly characterized impairment of sodium excretion precedes the underfilled state due to heavy albumin loss in the urine

35
Q

treatment of nephrotic syndrome

A

decreased Pgc with ACEi and AII blockers

36
Q

ineffective circulating volume leads to inadequate renal perfusion which causes sodium rentetion by the kidney leading to an overall volume overload

this is the common pathway where these four diseases/states converge

A
  1. Heart failure- low cardiac output
  2. marathon- true volume depletion
  3. cirrhosis- Drop in SVR
  4. Nephrotic syndrome- hypoalbunemia resulting in extra-vascular pooling
37
Q

treatment of volume disorders require

A

managing sodium balance and renal perfusion

38
Q

FeNa is often a good indicator of the ______ as the kidney retains Na when it is underperfused and released Na when it is well perfused

A

effective circulating volume

39
Q

HF results in volume overload by

A

reducing cardiac output, lowering renal perfusion, and stimulating Na retention.

40
Q

Cirrhosis results in volume overload by

A

dropping plasma oncotic pressure (through impaired albumin synthesis).

41
Q

Arteriovenous malformations in cirrhosis also drop SVR and BP, leading to

A

renal underperfusion and Na retention.

42
Q

In nephrotic syndrome, protein loss in the urine lowers plasma oncotic pressure and intravascular volume, stimulating .

A

renal Na retention

43
Q

Volume overload is sensed by the cardiac chambers which release atrial __________ to block sodium reabsorption in the CT.

A

natriuretic peptide (ANP)

renal (21 decks)

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