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Therapeutics P2 > Exam 1 lecture 3 > Flashcards

Exam 1 lecture 3 Flashcards

1
Q

Name 6 physiological functions of kidney

A

Endocrine function
control of solutes and fluids
BP control
Acid/base balance
Drug metabolism and excretion
Metabolic waste excretion

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2
Q

What are the two big components of nephrons

A

Tubules
blood vessels

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3
Q

What is the relationship between tubules and blood vessels in kidney

A

There is reabsorption and excretion between tubules and blood vessels

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4
Q

What happens in glomerulus

A

Filtration (100% filtrate produced)

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5
Q

What structure is present after filtration in glomerulus

A

PCT

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6
Q

What happens in PCT

A

Major reabsorption site (both active and passive).
Glucose and aa reabsorbed.
Lots of blood vessels present for reabsorption

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7
Q

What structure is present after PCT

A

loop of henle

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8
Q

What are the two parts of loop of henle and what are their functions

A

descending (thin) limb- primary site for H2O absorption
Ascending (thick) limb- permeable to ions (salts reabsorption)

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9
Q

What is after loop of henle

A

DIstal tubule

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10
Q

Percent of filtrate reabsorbed at distal tubule

A

9%

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11
Q

What structure comes after distal tubule

A

collecting duct

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12
Q

Percent of filtrate reabsorbed at collecting tubule

A

4%

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13
Q

percent of filtrate reabsorbed from loop of henle

A

6%

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14
Q

Percent of filtrate reabsorbed from proximal tubule

A

80%

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15
Q

average kidney has how many nephrons

A

1 million

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16
Q

afferent vs efferent arteriole

A

afferent- brings blood to glomerulus
efferent- carries blood away from glomerulus

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17
Q

difference between PCT and proximal tubule

A

proximal tubule- secretions and reabsorption of organic acids and bases, uric acid and most diuretics

PCT- reabsorption of 65% of ions, 100 % of aa and glucose

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18
Q

function of thick ascending loop

A

active reabsorption of 15-25% of filtered NA/K/Cl.
secondary reabsorption of Ca and Mg

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19
Q

function of distal convoluted tubule

A

PTH control

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20
Q

Function of medullary collecting duct

A

Water reabsorption under vasopressin control

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21
Q

Water permeability of
Proximal tubule
Thick ascending loop
DCT

A

proximal- very high
thick ascending loop- very low
DCT- very low

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22
Q

What are some different ways of measuring kidney function

A

serum creatinine
blood urea nitrogen (BUN)
creatinine clearence
Glomerular filtration rate (GFR)

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23
Q

What does serum creatinine measure? How would an increase or decrease affect our body?

A

measures how well kidneys filter waste from blood.
Increase in this is bad

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24
Q

What does Blood urea nitrogen measure (BUN), how would change affect it?

A

Measures waste from liver breakdown of AA
increase is bad

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25
What does creatinine clearence measure
Useful for predicting secretion and drug clearence
26
What are some markers for damage for kidney
Urinary abnormalities- protein, RBC in urine suggest membrane malfunction Imaging abnormalities (MRI/CTI scans)
27
Kidney functions decline with age due to
Decline in kidney mass (nephrons)
28
How does renal injury lead to decrease in number of nephrons
Decrease in number of nephrons lead to compensatory rise in size and function of remaining nephrons Increase in size and function of nephrons lead to glomerular and tubular lesions lesions lead to loss of nephrons, leading to decline in GFR decrease in GFR leads to azotemia and uremic syndrome (death)
29
Criteria to determine acute kidney failure (AKF)
1.Increase in Scr of 0.3 or more 2. Increase in Scr by 50% (1.5x) baseline, which is known to have occured within the prior 7 days 3. A reduction in urine output of less than 0.5 ml/kh/h for 6 H
30
How is normal GFR maintained under decreased perfusion pressure and reduction of GFR by drugs
The kidney has an internal mechanism for autoregulation.
31
how does the kidneys internal autoregulation of perfusion pressure work
Normal GFR is maintained by afferent vasodilation and efferent vasoconstriction
32
How is afferent vasodilation maintained
Increased vasodilatory prostaglandins- dilation
33
how is efferent vasoconstriction maintained
Increased angiotensin II
34
How would taking NSADIs affect autoregulation of kidney
NSAIDs affect prostaglandin. This will affet vasodilation of efferent arterioles leading to low GFR
35
We can use NSAIDs with renal injury t/f
False
36
What drugs could affect angiotensin II levels
ACE inhibitors
37
Major causes of intrinsic acute kidney injury
sepsis, ischemia, nephrotoxicity
38
What are some causes of obstruction leading to post renal AKI (acute kidney injury)
Kidney- kidney stones, blood clots, tumor Bladder- Prostate enlargement, blood clots, cancer Urethra- obstructed foley catheter
39
What are some common key elements of progressive nephropathies?
Increased glomerular capillary pressure Proteinuria Glomerulosclerosis
40
2 main abnormalities that give rise to CKD-MBD (chronic kidney disease- mineral bone disease)
1. impaired phsophate excretion 2. decreased production of 1,25 dihydroxy vitamin D3
41
why cant patients with CKD produce active vit-D3
Vitamin D3 becomes active invivo. goes through liver and then kidney to become activated. CKD patients can not undergo kidney portion. That is why CKD patients require Ca homeostasis checks
42
What is uremia
Uremic illness due to buildup of organic waste products
43
signs and symptoms of uremia
Endocrine and metabolic neural and muscular
44
nephropathy meaning
Damage or disease of kidney
45
Name 5 nephropathies
Nephritic syndromes nephrotic syndromes Cystic disease of kidney nephrolithiasis contrast induced nephropathy
46
differentiate nephritic and nephrotic syndromes
Nephritic- INFLAMMATION distrupting glomerular basement membrane (hematuria, cola colored urine) Nephrotic- pOdocyte damage leading to glomerular charge barrier disruption (massive proteinuria)
47
Which has more proteinuria nephritic or nephrotic
Nephrotic
48
How does proteinuria affect serum albumin?
lowers serum albumin
49
How does low albumin affect the body?
Edema proteinuria-->low albumin-->edema
50
What is generally observed with nephritic syndrome
Hematuria
51
What is glomerulonephritis? two forms?
inflammation of glomerulus. Can have chronic or acute. Presents with both proteinuria and hematouria
52
cause of glomerulonephritis
Primary- genetics secondary- infection, drugs etc
53
pathogenesis of glomerular disease
antibody associated immune rxn cell mediated immune rxn
54
what is pyelonephritis
Inflammation of kidney caused by bacteria from blood or UTI
55
clinical presentation of pyelonephritis?
Painful urination, white cells in urine
56
What is the major cause of pyelonephritis
Bacteria from UTI go against the floe of urine using flagella and go into the kidney.
57
What is interstitial nephritis? what is AIN (acute interstitial nephritis caused by?)
Interstitial nephritis is the primary injury to renal tubules and interstitium. It has several different causes. 70-75% Drugs- penicillin and diuretics 4-10% Infections 10-20% autoimmune infections
58
What is the most common form of cystic renal disease
cystic disease of kidney
59
2 forms of cystic disease
APKD- autosomal dominant polycystic kidney disease (adult) autosomal recessive polycystic kidney disease (childhood)
60
What is the difference between autosomal dominant polycystic kidney disease and autosomal recessive polycystic kidney disease
autosomal dominant affects adults autosomal recessive affects children autosomal dominant is characterized by multiple expanding cysts of both kidneys that ultimately destroy the parenchyma. autosomal recessive is ultimately fatal, those who survive will have liver disease
61
what is nephrothiasis
Kidney stones
62
what percent of men and women are affected by nephrothiasis
10% of men, 5% of women
63
how does nephrothiasis occur?
supersaturation of calcium (kidney stones are predominantly calcium phosphate)

Therapeutics P2 (41 decks)

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