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Kidney + Liver + Endocrine > Kidney > Flashcards

Kidney Flashcards

1
Q

What is the outer part of the kidney? What does it contain?

A

Renal Cortex

-Most parts of the nephron

-Glomerulus
-Bowmans Capsule
-Proximal Tubules
-Distal Tubules

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2
Q

What is the inner part of the kidney?

A

Renal Medulla

Contains loops of Henle and collecting ducts

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3
Q

What is the functional unit of the Kidney? How does it work?

A

Nephron

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4
Q

Photo of Nephron

A
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5
Q

What are the two key hormones that govern how the kidney regulates ECF and composition?

A

Aldosterone - Controls ECF through the absorption of water and Na

Antidiuretic Hormone - Controls plasma osmolarity through the absorption of water and not Na

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6
Q

How do the kidneys control long term blood pressure?

A

Through the thirst mechanism

Intake of Na
Output of water

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7
Q

How do the kidneys control short term blood pressure?

A

Baroreceptor

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8
Q

How do the kidneys control intermediate term blood pressure?

A

Renin-angiotensin-aldosterone system

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9
Q

Are Kidneys capable of phase 1 and 2 biotransformation?

A

Yes

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10
Q

How do kidneys eliminate toxins and metabolites?

A

Glomerular filtration and tubular secretion

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11
Q

What two systems regulate the acid-base balance in the body?

A

Lungs - CO2 (volatile acids)

Kidneys - titrates nitrogen (Non-volatile acids)

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12
Q

What stimulates the kidney to release erythropoietin?

A

It is released in the response to inadequate O2 to the kidney

-Anemia
-Reduced intravascular volume
-Hypoxia
-High altitude
-CV/Resp failure

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13
Q

What does EPO do??

A

Stimulates cells in the bone marrow to produce erythrocytes

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14
Q

What is Calcitriol and what does it do?

A

Stimulates the

-intestine to absorb calcium from food
-bone to store Ca
-Kidney to reabsorb Ca and Phosphate

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15
Q

How much blood flow do the Kidneys receive?

A

20-25% of the CO

1000ml/Min

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16
Q

Kidney blood flow photo

A
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17
Q

Where does kidney filtration occur?

A

Glomerular capillary bed

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18
Q

Where does reabsorption and secretion occur?

A

Peritubular bed

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19
Q

When does glomerular filtration become pressure dependent?

A

When MAP is outside the range of autoregulation (50-180)

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20
Q

What happens when renal perfusion is too high or too low?

A

Too low- renal blood flow is increased by reducing renal vascular resistance

Too high- renal blood flow is increased by increasing renal vascular resistance

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21
Q

What is the myogenic mechanism of renal autoregulation>

A

When pressure is too high the afferent arteriole constricts to protect

When pressure is too low the afferent arteriole dilates to allow more blood in

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22
Q

What does the juxtaglomerular apparatus do?

A

Regulates tubuloglomerular feedback about sodium and chloride in the distal tone

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23
Q

How does surgical stress affect the kidney?

A

Vasoconstriction and sodium retention which results in decreased

RBF
GFR
UO
Sodium excretion

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24
Q

What does Renin release do?

A

Converts Angiotensinogen to Ang 1

which gets converted by the lungs to Ang 2

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25
Q

What three conditions increase renin release?

A

Decreased renal perfusion

SNS activation through beta 1

Tubuloglomerular feedback (decreased NA and Chloride

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26
Q

Increased Renin leads to increased Ang 2, What is seen in the body as a response?

A
  1. Peripheral vasoconstriction
  2. Efferent vasoconstriction
  3. Increased aldosterone which retains Na and secretes K
  4. Increased ADH from the posterior pituitary
  5. Increased thirst
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27
Q

Where is aldosterone produced and what is it’s function?

A

A steroid produced in the zona glomerulosa of the adrenal gland

Na reabsorption
H2O reabsorption
K excretion
H+ excretion

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28
Q

Where is ADH produced and stored? Function?

A

Produced - hypothalamus

Stored - Posterior pituitary due to increased osmolarity of the ECF and decreased blood volume

29
Q

How does ADH increase blood pressure?

A

V2 stimulation in the collecting ducts (Increased cAMP)

V1 stimulation in the peripheral vasculature (Alpha 1 stim)

30
Q

What clinical situations will increase ADH?

A

-PEEP
-Positive pressure ventilation
-Hypotension
-Hemorrhage

31
Q

What 3 mechanisms promote renal vasodilation?

A
  1. Prostaglandins
  2. ANP
  3. Dopamine 1 stimulation
32
Q

Dopamine 1 receptor?

A

DA1 - present in the kidney and splanchnic circulation

2nd messenger cAMP

Vasodilation, increased renal blood flow, increased GFR, Diuresis, Na excretion

33
Q

Dopamine 2 receptor?

A

Presynaptic SNS nerve terminal

Decreased cAMP

Decreases norepi release

34
Q

How does fenoldapam use?

A

Selective DA1 agonist which increases renal blood flow

May offer renal protection

35
Q

What is a normal GFR?

A

125mL/min

36
Q

What are the 3 determinants of glomerular hydrostatic pressure?

A
  1. Arterial BP
  2. Afferent arteriole resistance
  3. Efferent arteriole resistance
37
Q

When the afferent arteriole is constricted, what happens to the RBF, GFR, and filtration fraction?

A

Decreased Renal Blood flow

Decreased GFR

No change in filtration

38
Q

When the efferent arteriole is constricted, what happens to the RBF, GFR, and filtration fraction?

A

Decreased renal blood flow

Increased GFR

Increased filtration

39
Q

What happens with an increased in plasma protein to the RBF, GFR, and filtration fraction?

A

No change in RBF

Decreased GFR

Decreased filtration

40
Q

What happens with a decrease in plasma protein to the RBF, GFR, and filtration fraction?

A

No change in RBF

Increased GFR

Increased filtration

41
Q

What is reabsorption?

A

Substance is transferred from the tubule to the peritubular capillaries

42
Q

What is secretion?

A

Substance is transferred from the peritubular capillaries to the tubule

43
Q

What is excretion?

A

Substance is removed from the body to the urine

44
Q

What part of the nephron is most sodium reabsorbed?

A

Proximal tubule

45
Q

What occurs in the proximal tubule?

A

Bulk of solutes and water are reabsorbed

46
Q

What happens in the descending loop of Henle?

A

High permeability of H2O

tubular fluid is concentrated

47
Q

What happens in the ascending loop of Henle?

A

No permeability of H2O

Tubular fluid is diluted

48
Q

What happens in the collecting duct?

A

Regulates the final concentration of urine (Aldosterone and ADH)

49
Q

What happens in the distal tubule?

A

Fine tunes solute concentration (Aldosterone and ADH)

50
Q

What are carbonic anhydrase inhibitors and how do they work?

A

Acetazolamide, Dorzolamide

Works in the proximal tubule with a loss of bicarb and sodium

51
Q

Uses for carbonic anhydrase inhibitors. Side effects?

A

Glaucoma
Altitude sickness
Central sleep apnea syndrome

Hypokalemia
Metabolic acidosis

52
Q

What is the MOA of osmotic diuretics? Examples

A

Mannitol
Glycerin
Isosorbide

They are sugars that undergo filtration but not reabsorption (Stops water from being reabsorbed in the loop of Henle)

53
Q

Key notes for osmotic diuretics?

A

Used for free radicals and intracranial HTN

Can cause pulmonary edema, volume overload, and cerebral edema if the BBB is disrupted

54
Q

Examples of loop diuretics and how they work?

A

Lasix, Bumex, Ethacrynic acid

They poison the Na-K-2Cl transporter in the ascending loop of Henle

55
Q

Clinical uses of loop diuretics? Side effects?

A

HTN
CHF
Acute pulmonary edema
Hypercalcemia

Reduced electrolytes
Ototoxicity
Reduced lithium clearance

56
Q

Examples of thiazide diuretics? MOA?

A

Hydrochlorothiazide
Metolazone
Indapamide

Inhibits Na-Cl transported in the distal tube

57
Q

Clinical uses of thiazide diuretics? Side effects?

A

HTN
CHF
Osteoporosis
DI

Hyperglycemia
Hypercalcemia
Hyperuricemia
Hypokalemia
Hypovolemia

58
Q

MOA and examples of potassium sparing diuretics?

A

Spironolactone, Amiloride, Triamterene

Collecting ducts

59
Q

Clinical uses and side effects of K sparing diuretics?

A

Reduce potassium loss
Secondary hyperaldosteronism

Libido changes
Hyperkalemia
Metabolic acidosis
Nephrolithiasis

60
Q

List three tests of GFR and normal values for each?

A

BUN (10-20)
Creatine (0.7-1.5)
Creatine Clearance (110-150)

61
Q

List four tests of tubular function and give the normal values for each

A

Fractional excretion of NA (1-3%)

Urine osmolality (65-1400)

Urine sodium (130-260)

Urine specific gravity (1.003 - 1.030)

62
Q

What does a BUN of less than 8 signify ?

A

Overhydration

Decreased Urea Production
-malnutrition
-Severe liver disease

63
Q

What does a BUN of 20-40 signify?

A

Dehydration

Increased protein

Catabolism

64
Q

What does a BUN > 50 signify?

A

Decreased GFR

65
Q

What is the BUN: Creatine ratio?

A

Helps evaluate the state of hydration

Normal is 10:1

Greater than 20:1 indicates prerenal azotemia

66
Q

What does BUN undergo; filtration, reabsorption or both

A

Filtration and Reabsorption

67
Q

What does creatine undergo; filtration, reabsorption or both

A

Filtration NOT reabsorption

68
Q

**What is the best indicator if GFR?

A

Creatine clearance

Kidney + Liver + Endocrine (6 decks)

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