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Apex > Kidney > Flashcards

Kidney Flashcards

1
Q

There are three pathways that promote renal vasodilation:

A

Prostaglandins
Natriuretic Peptide
Dopamine Receptors

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2
Q

How do prostaglandins influence renal artery dilation?

A

The IEDs won’t kill your kidneys

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3
Q

What do natriuretic peptides do?

A

Released from the atria with distention

Inhibit renin release and promote sodium and water excretion

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4
Q

What dopamine receptors are present in the kidney?

A

D1

Increase cAMP, leading to vasodilation

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5
Q

What is fenoldopam?

A

It’s a D1 agonist that increases renal artery dilation without causing systemic dilation. Very useful in cardiac patients during aortic surgery

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6
Q

Trace the nephron from beginning to end

A

Afferent arteriole
Glomerulus
Proximal Tubule
Loop of Henle
Distal Tubule
Collecting Duct

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7
Q

Which nephron components are located in the cortex?

A
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8
Q

Which nephron features are contained in the medulla?

A

Everything that involves concentrating is in the medulla:
loop of henle
Collecting duct

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9
Q

What triggers erythropoietin release from the kidneys?

A

Hypoxia, from high altitude, heart failure, anemia etc)

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10
Q

Which prostaglandins vasoDILATE the renal artery?

A

PGI2 and PGE2

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11
Q

Which prostaglandins vasoCONSTRICT the renal artery?

A

Thromboxane A2

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12
Q

How does the kidney impact calcium levels?

A

In response to PTH stimulation, it produces calcitriol, which stimulates bone breakdown, decreases Ca renal excretion, and increases Ca reabsorption from GI tract

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13
Q

Which two organs can perform gluconeogenesis?

A

The kidneys can too! they rival the liver in producing glucose in fasting states!

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14
Q

The kidneys receive _____% of the cardiac output

A

20-25

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15
Q

What percentage of RBF is filtered in the glomerulus?

A

20%

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16
Q

What percent of filtrate is excreted as urine?

A

Only 1%!!

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17
Q

Renal blood flow decreases ____% each decade after ______

A

10% each decade after 50

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18
Q

Which region of the kidney is most sensitive to ischemia?

A

The medulla. It has a much lower PaO2 at baseline and much less blood flow

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19
Q

When do infants achieve normal RBF levels?

A

about 2 years

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20
Q

How quickly does RBF change in the newborn?

A

Doubles in the first two weeks!

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21
Q

What are the two most important methods of autoregulation in the kidney?

A

Myogenic
Tubuloglomerular Feedback

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22
Q

Describe the myogenic mechanism

A

When blood pressure in the afferent arteriole increases, it constricts to prevent the glomerulus from being overloaded

When pressure is low, it dilates

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23
Q

The juxtaglomerular apparatus is located in the:

A

distal tubule

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24
Q

Innervation of the kidneys occurs at what spinal level?

A

T8-L1

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25
Q

What is the generalized effect of SNS stimulation on the kidneys?

A

Decreased GFR
Increased Na/H2O retention
Decreased UO

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26
Q

What renal structures are innervated by the SNS?

A

Afferent and Efferent arterioles

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27
Q

What does the Juxtaglomerular device measure?

A

Na and Cl concentration

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28
Q

Angiotensin causes constriction of the _______

A

EFFERENT arteriole

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29
Q

How is urine output autoregulated?

A

IT ISN’T!

It has a linear relationship with MAP above 50mmHG

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30
Q

Where is aldosterone released from?

A

zona glomerulosa of The adrenal gland

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31
Q

There are three things that trigger renin release:

A

Afferent Autoregulation: Decreased renal perfusion pressure

Sympathetic Stimulation: Beta 1

Tubuloglomerular Feedback

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32
Q

What is the MOA of aldosterone?

A

Stimulates the Na/K ATPase pump in the distal tubule AND collecting duct

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33
Q

What effect does aldosterone have on serum osmolarity?

A

NONE! it effects sodium and water reabsorption equally

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34
Q

In addition to RAAS activation, Aldosterone is stimulated by:

A

Hyponatremia
Hyperkalemia

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35
Q

Conn’s disease is:

A

excess aldosterone

Exhibits all the “cons” of aldosterone

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36
Q

Addison’s disease is:

A

Inadequate cortisol and aldosterone

Need to “add” aldosterone

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37
Q

What is osmolality?

A

Osmoles per Kg

38
Q

What is osmolarity?

A

Osmoles per Liter

L is NOT FOR LITER

39
Q

Where is ADH produced?

A

Nuclei of the HYPOTHALAMUS

40
Q

What is the calculation for Serum Os?

A

You can’t get a sugar daddy until you’re 18

41
Q

Where is ADH stored and released?

A

The posterior pituitary

42
Q

There are two things that control ADH release:

A
  1. Increased osmolarity
  2. Decreased blood volume
43
Q

ADH stimulates _______ receptors

A

V1 and V2

44
Q

What does V1 stimulation cause?

A

Vasoconstriction in the PERIPHERY

45
Q

What does V2 stimulation cause?

A

Activates aquaporin channels in the collecting ducts, leading to water reabsorption

46
Q

What is a normal serum os?

A

280-290

47
Q

What is a normal GFR?

A

125 ml/min

48
Q

Destruction of ______ leads to proteinuria

A

The basement membrane of the glomerulus

49
Q

Where is MOST sodium reabsorbed?

A

65% of sodium and water is reabsorbed in the proximal tubule

50
Q

Where are acids, bases, and hydrogen ions secreted?

A

The proximal tubule

51
Q

What occurs in the descending loop of henle?

A

HIGHLY PERMEABLE TO WATER
but not ions, and passes through counter-current, resulting in concentration of the filtrate
20% of water is reabsorbed here

52
Q

What occurs in the ascending loop of henle?

A

IMPERMEABLE TO WATER
20% of sodium is reabsorbed here and pumped into the tubular interstitium, creating the countercurrent!

53
Q

Is the distal tubule permeable to water?

A

It is impermeable EXCEPT in the presence of aldosterone or ADH

54
Q

What three substances impact the collecting duct?

A

Aldosterone
ADH
Atrial Natriuretic peptides

55
Q

What impact does aldosterone have on K and H secretion?

A

It INCREASES secretion of K and H

56
Q

Where does calcium reabsorption occur?

A

Distal tubule

57
Q

What is the MOA of carbonic anhydrase inhibitors?

A

Noncompetitively inhibit carbonic anhydrase in the PROXIMAL TUBULE

This leads to excretion of bicarb and mild metabolic acidosis

58
Q

What are the clinical uses for acetazolamide?

A

Open angle glaucoma (reduces aqueous humor production)

Altitude sickness (acidosis increases RR)

OSA (Increases RR)

59
Q

What are the complications of acetazolamide?

A

HYPOkalemia
Metabolic acidosis

60
Q

which patients should not receive mannitol?

A

Patients who can’t tolerate brief fluid overload

Patients whose BBB is NOT intact (glucose can cross and cause seizures)

61
Q

What is the MOA of loop diuretics?

A

Inhibits the Na-K-2CL pump transporter in the ASCENDING loop of henle

62
Q

What is the MOA of thiazide diuretics?

A

Inhibit Na-Cl cotransporter in the DISTAL TUBULE

63
Q

What is a unique feature of thiazide diuretics?

A

They cause hyperglycemia and increases calcium reabsorption

64
Q

Name four thiazide diuretics

A

HCTZ
Chlorthalidone
Metolazone
Indapamide

65
Q

Name three potassium sparing diuretics

A

“SALT”
Spironolactone
Amiloride
Triamterene

66
Q

Where do potassium sparing diuretics exert their effects?

A

The COLLECTING DUCT

67
Q

List five side effects of potassium sparing diuretics

A

Hyperkalemia
Metabolic acidosis
Gynecomastia
Libido changes
Nephrolithiasis

68
Q

List three drug classes that increase the risk of hyperkalemia in a patient taking a potassium sparing diuretic

A

Beta blockers
NSAIDS
ACE-Is

69
Q

Which blood tests assess GFR?

A

BUN and CR

70
Q

Which blood tests assess tubular function?

A

Fractional excretion of sodium

Urine Os

71
Q

Creatinine undergoes renal _____ but not ______

A

filtration but not reabsorption

72
Q

What is a normal BUN:Cr ratio?

A

10:1

73
Q

A BUN:Cr ration greater than ________ indicates prerenal azotemia

A

> 20%

74
Q

What is urea?

A

Primary metabolite of protein breakdown in the liver

75
Q

Why is Cr a better indicator of GFR than BUN?

A

BUN undergoes filtration AND reabsorption

76
Q

Who is at the highest risk for a perioperative AKI?

A

CHF
Sepsis
Renal Dx (duh)
Advanced age

77
Q

The risk of prerenal azotemia is reduced by:

A

Keeping the MAP > 65
providing adequate hydration

78
Q

How does CKD impact coagulation?

A

Inhibits platelet function. This means bleeding time will be elevated, but PT/PTT/INR will be normal

79
Q

What is a side effect of exogenous Epo administration?

A

HTN

80
Q

You should assume that all patients with CKD also have _____

A

Coronary Artery Disease

This is usually what kills them

81
Q

What cardiac abnormality is associated with uremia?

A

Pericarditis

82
Q

What pH abnormalities occur with CKD?

A

Anion gap acidosis from all the uremic acid built up

83
Q

How does uremia impact the neurological system?

A

It impairs nerve conduction, leading to sensory AND motor neuropathy

84
Q

Why are CKD patients at an increased risk for infection?

A

Impaired WBC function and the need for a low protein diet

85
Q

What are the best NMBAs for patients with CKD?

A

Cis and Atracurium

86
Q

Will patients with CKD need more or less propofol?

A

Maybe more, because they have hyperdynamic circulation and an impaired BBB

87
Q

What can be done to avoid an AKI from contrast?

A

IV fluid bolus
Bicarb
Low-osmolar contrast

88
Q

Which class of antibiotics is the worst for the kidneys?

A

Aminoglycosides (gentamycin etc)

89
Q

What is the classic TURP syndrome triad?

A

HTN
Bradycardia
Decreased LOC

90
Q

Correcting serum Na too quickly increases the risk of

A

central pontine demyelination

91
Q

What are absolute contraindication to ESWL?

A

Pregnancy and anticoagulation

92
Q
A

Apex (46 decks)

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