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APEX: Flashcards > Kidney > Flashcards

Kidney Flashcards

1
Q
A
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2
Q

Nephron

A
  • functional unit of kidney
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3
Q

Renal cortex

A
  • outer section
  • contains:
    1. glomerulus
    2. bowman’s capsule
    3. proximal tubules
    4. distal tubules
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4
Q

Renal medulla

A
  • inner section
  • contains:
    1. LOH
    2. collecting ducts
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5
Q

Identify structures of nephron

A
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6
Q

Identify structures of kidney

A
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7
Q

6 functions of kidney

A
  1. Maintain ECF & composition
    - aldosterone (Na+/H2O reabsorption)
    - ADH (H2O reabsorbed but not Na+)
    - K+, Cl-, Phos, Mg, H+, HCO3, glucose, urea
  2. BP regulation
    - RAAS
  3. Excretion of toxins/metabolites
  4. Maintain acid-base balance
  5. Hormone production
  6. Blood glucose homeostasis
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8
Q

Hormones produced by kidney

A
  1. erythropoietin
    - triggers for release: anemia, reduced IV vol, hypoxia
    - stimulates bone marrow to produce erythrocytes
  2. prostaglandins
  3. calictriol
    - 25-hydroxycholecalciferol converted to calcitriol (active vit D)
    - stimulates intestinal absorption Ca+
    - tells kidney to reduce Ca+ & phos excretion
    - increases deposition of Ca+ into bone
  4. renin
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9
Q

hormone that controls plasma osmolarity

A

ADH

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10
Q

hormone that control ECF volume

A

aldosterone

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11
Q

2 organs responsible for acid-base balance

A
  1. kidney
  2. lung
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12
Q

Pathway of blood flow through kidney

A

afferent arteriole > glomerular capillary bed > efferent arteriole > peritubular capillary bed

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13
Q

Kidneys receive _______ % of CO

A

20-25%

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14
Q

Renal blood flow formula

A

RBF = (MAP - Renal venous pressure) / Renal vascular resistance

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15
Q

Renal cortex receives ____% of RBF

A
  • 90%
  • PO2 50 mmHg
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16
Q

Renal medulla receives ____% of RBF

A
  • 10%
  • PO2 10 mmHg
  • more sensitive to ischemia
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17
Q

Pathway of blood through kidney

A

ARTERIAL
Renal a. > renal segment a. > interlobar a.> arcuate a. > interlobular a. > afferent arteriole > glomerular capillary bed > efferent arteriole > peritubular capillary bed

VENOUS
venules > interlobular vein > arcuate vein > interlobar vein > renal segmental vein > renal vein

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18
Q

RBF Autoregulation

A
  • low renal perfusion > autoregulation increases RBF by decreasing renal vascular resistance > RBF increases
  • too high renal perfusion > autoregulation decreases RBF by increasing renal vascular resistance > RBF decreases

RBF limits ~ 50-180 mmHg

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19
Q

6 mechanisms that autoregulate RBF

A
  1. myogenic
  2. JG apparatus + tubuloglomerular feedback
  3. RAAS
  4. prostaglandins
  5. ANP
  6. SNS
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20
Q

Most important contributors to renal autoregulation

A
  1. myogenic mechanism
    - contricts/dilates afferent arteriole if renal artery pressure high/low
  2. tubuloglomerular feedback
    - JG apparatus in distal tubule b/t afferent & efferent arteriole detects Na+/Cl- composition in DCT & affects arteriolar tone
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21
Q

Kidney response to ischemia/sepsis/surgical stress

A

Vasoconstriction & Na+ retention
- SNS, RAAS, ADH
- decreased RBF, GFR UOP, Na+ excretion

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22
Q

RBF decreases by ____% per decade after the age 50

A

10%

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23
Q

JG apparatus

A
  • located in distal tubule
  • decreased RBF > decreased Na+/Cl= delivery to JG app (sensed by macula densa) > afferent arterioles dilate > GFR increases
  • low Cl- delivery > renin released from juxtaglomerular cells > RAAS activates > AG2 constricts efferent arteriole > GFR increases
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24
Q

RAAS

A
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25
Conditions that increase renin release
26
Aldosterone
- produced in zona glomerulosa of adrenal gland - stimulates Na/K ATPase in principal cells of distal tubules & collecting ducts - facilitates Na+ & H2O reabsorption & K+ & H+ excretion - release is increased by high K+ & low Na+ - Conn's dz = excess aldosterone (Na+ retention & K+ loss)
27
ADH (vasopressin)
- produced in the supraoptic & paraventriular nuclei of hypothalamus - released from posterior pituitary gland - 2 mechanisms that control release: increased osmolarity, decreased blood volume - stimulates V1 in peripheral vasculature (vasoconstriction) - stimulates V2 in collecting ducts- aquaporins reabsorption of H2O
28
Prostaglandins
- produced in afferent arteriole - promote RBF - arachidonic acid is liberated from cells in r/t ischemia, hypotension, NE, & AG2. - NSAIDs inhibit cyclooxygenase & can reduce RBF by inhibiting production of vasodilating prostaglandins
29
natriuretic peptide
- atrial distension > ANP & BNP release - inhibit renin release - promote Na+/H2O excretion
30
dopamine receptors
- DA1 (kidney, splanchnic circ) - DA2 (presynaptic adrenergic n. terminal) - DA1: increase cAMP > vasodilation, increased RBF & GFR, diuresis, Na+ excretion
31
Fenoldopam
- selective DA1 agonist - increases RBF - renal vasodilator - facilitates Na+ excretion
32
normal GFR
125 ml/min
33
glomerular filtration
- H2O, electrolytes, glucose freely filtered - plasma proteins not filtered - kidney disease destroys basement membrane which allows proteins to enter tubules
34
Net filtration pressure
NFP = glomerular hydrostatic P - Bowman's capsule hydrostatic P - Glomerular oncotic P
35
Most important determinant of GFR
glomerular hydrostatic pressure
36
BP
- increased MAP increases GFR - decreased MAP decreases GFR
37
Constriction of afferent arteriole _____GFR
reduces
38
Dilation of afferent arteriole ______ GFR
increases
39
Constriction of efferent arteriole
- mild reduces flow toward peritubular capillaries & increases GFR - excessive reduces RBF & GFR
40
Dilation of efferent arteriole
increases flow towards peritubular capillaries & reduces GFR
41
reabsorption
substance transferred from tubule to peritubular capillaries
42
secretion
substance transferred from peritubular capillaries to tubule
43
excretion
substance removed from body in urine
44
urine excretion rate
= filtration - reabsorption + secretion
45
proximal convoluted tubule
- 65% Na+ reabsorption - 65% H2O reabsorption - 65% K+, Cl-, HCO3 reabsorption Diuretics: - acetazolamide, dorzolamide (carbonic anyhdrase inhibitors) - osmotic diuretics: mannitol (also LOH)
46
descending LOH
- highly permeable to H2O (20% reabsorbed) - more concentrated w/ Na+ - LOH = countercurrent multiplier - creates osmotic gradient - vasa recta = countercurrent exchanger = maintains medullary osmotic gradient
47
ascending LOH
- NOT permeable to H2O - Na/2K/Cl co transporter - Na+ reabsorption - more dilute Diuretics: - Loop diuretics (furosemide, bumetanide)
48
DCT
- 5% Na+ reabsorbed - K, Cl, HCO3 reabsorbed - late DCT impermeable to H2O except in presence of ADH or aldosterone - JGA lives here - PTH promotes Ca+ reabsorption Diuretics: - thiazide (HCTZ, chlorthalidone, metalazone, indapamide)
49
Collecting duct
- 5% Na+ reabsorbed - aldosterone & ADH act here Diuretics: K+ sparing (spironolactone, amiloride, triamterene)
50
carbonic anhydrase inhibitors
- inhibit carbonic anhydrase in proximal tubule - reduces HCO3, Na+, H2O reabsorption - ex: acetazolamide, dorzolamide
51
osmotic diuretics
- inhibit H2O reabsorption in proximal tubule (primary) & LOH - pull ECF volume into intravascular space - ex: 1. Mannitol 0.25-1 gram/kg 2. glycerin 3. isosorbide
52
Loop diuretics
- inhibit Na/K/2Cl transporter in ascending LOH - ex: furosemide, bumetanide, ethacrynic acid
53
thiazide diuretics
- inhibit Na/Cl co-transporter in DCT - activates Na-Ca antiporter (increases Ca+ reabsorption) - hyperglycemia - HCTZ, chlorthalidone, metolazone, indapamide
54
K sparing diuretics
- inhibit K secretion & Na reabsorption in collecting ducts - spironolactone subclass - inhibit aldosterone > inhibit K secretion/Na reabsorption in collecting ducts - amiloride, triamterene
55
Best indicator of GFR
Creatinine clearance
56
Best test of tubular function
urine osmolality
57
prerenal AKI
- cause = hypoperfusion - Tx: IVF, HD support, PRBCs - avoid NSAIDs
58
intrinsic AKI
- cause = parenchymal dysfunction 1. normally ATN -ischemia, drugs 2. contrast, abx, NSAIDs - Tx: restore perfusion, supportive
59
postrenal AKI
- cause = obstruction 1. clogged foley, ureteral stone, neurogenic bladder - Tx: relieve obstruction
60
most common cause CKD
DM
61
second most common cause CKD
HTN
62
stages of kidney disease
63
uremic syndrome
-s/s = anemia, fatigue, n/v, anorexia, coagulopathy
64
uremic bleeding
- at risk for increased bleeding - elevated bleeding time - PT/PTT/PLT normal - 1st line tx = desmopressin - dialysis w/i 24 hours of surgery (improves bleeding time)
65
Other s/s CKD
- anemia - HTN - CAD - CHF - gap metabolic acidosis - hyperkalemia - renal osteodystrophy - ANS dysfunction - CNS s/s - infection
66
indications for dialysis
1. volume overload 2. hyperkalemia > 6 3. severe metabolic acidosis 4. symptomatic uremia 5. OD w/ a drug that is cleared by dialysis
67
Impaired renal function: anesthetic drug considerations
- sevo Compound A - sux ok w/ normal K+ - cisatracurium > atracurium (benzyliso's) - roc, vec, pancuronium prolonged DOA - sugammadex not recommended - morphine = resp depression - meperidine = sz - hydromorphone = sz - fentanyl, sufentanil, remi better choices - precedex safe
68
prevention of contrast-induced nephropathy
- nonionic/low osmolar contrast - lowest volume of contrast possible - no other nephrotoxic drugs - NS IVF before contrast dye - HCO3 - n-acetylcysteine
69
Compound A
- produced when sevo is exposed to soda lime - FGF of 1 L/min safe for up to 2 MAC hours
70
nephrotoxic agents
- amnioglycosides (gent, tobramycin, amikacin) - amphotericin B - vanc - sulfonamide - tetracylcines - cephalosporins - NSAIDs - caclineurin inhbitors - IVP dye - sevo - myoglobin
71
TURP
- spinal preferred (T10 level) - height of solution bag no more than 60 cm above OR table - limit surgery to 1 hour - irrigation solution complications 1. distilled water = TURP syndrome (low Na+, hemolysis, hemoglobinuria) 2. glycine = blindness 3. sorbitol = hyperglycemia 4. LR/NaCL = electrocution (monopolar) - complications 1. TURP 2. bladder perforation (abd/shoulder pain) - supportive, H/H, transfusion, suprapubic cysto, ex lap 3. bleeding 4. hypothermia
72
TURP syndrome
- absorption of hypo-osmolar irrigation solution - S/S: HTN, bradycardia, AMS - circulatory overload - Na < 110 = SZ - Tx: 1. O2 & CV support 2. tell surgeon to stop 3. electrolytes, Hct, Creat, gluc, EKG 4. Na > 120 = restrict fluids, give lasix 5. Na < 120 = 3% NaCl at 10 ml/hr 6. versed for sz 7. intubate if pt has difficult w/ oxygenation
73
extracorporeal shock wave lithotripsy
- delivers shocks in rapid succession to break up stone - absolute contraindications: 1. pregnancy 2. risk of bleeding - relative contraindications: 1. PM/AICD 2. UTI 3. obesity 4. calcified aneurysm or aorta or renal artery - complications: R on T phenomenon, bruising, hematuria
74
percutaneous nephrolithotripsy
- nephrostomy tube to access stone& ureteral stents placed - prone - GETA - irrigation fluid used - pneumo complication
75
laser lithotripsy
- uses laser to break up stone - laser precautions - irrigation fluids used - lithotomy
76

APEX: Flashcards (13 decks)

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