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Board Study > Kidney > Flashcards

Kidney Flashcards

1
Q

Controls extracellular fluid volume (Na+ and water are reabsorbed)

A

Aldosterone

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2
Q

Controls plasma osmolarity (water is reabsorbed, but Na+ is not)

A

ADH (vasopression)

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3
Q

What are the hormones produced in the kidney?

A
  • erythropoietin
  • calcitrol
  • prostaglandins
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4
Q

What causes the kidney to release erythropoietin?

A
  • inadequate O2 delivery to the kidney (anemia, reduced intravascular volume, hypoxia)
  • severe kidney dz reduces EPO production and leads to chronic anemia
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5
Q

How is Calcitrol synthesized in the kidneys?

A
  • calciferol is synthesized by injested vit D or light exposure
  • in the liver calciferol is converted to 25 [OH] Vit D3 (inactive Vit D3)
  • in the kidney (under control of the parathyroid hormone) 25 [OH] Vit D3 is converted to calcitrol (1, 25 [OH]2 Vit D3 (active form)
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6
Q

What are the 2 functions of calcitrol?

A
  • stimulate intestine to absorb Ca+2 from food
  • stimulate bone to store Ca+2
    stimulate kidney to reabsorb Ca+2 and phosphate
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7
Q

What are the renal prostaglandin hormones and what do they do?

A
  • PGE2 and PGI2 vasodilate renal arteries

- thromboxane A2 constricts the renal arteries

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8
Q

What is urine output related to?

A
  • linearly r/t MAP > 50mmHg

- NOT autoregulated

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9
Q

What are the two most important processes that carry out autoregulation?

A
  • myogenic mechanism

- tubuloglomerular

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10
Q

What are conditions that increase renin release?

A
  • Dec. renal perfusion pressure (hemorrhage, PEEP,CHF, liver failure w/ascites, sepsis, diuresis)
  • SNS activation - Beta 1 (circulating catecholamines, exogenous catecholamines)
  • tubuloglomerular feedback (dec Na+ & Cl in distal tubule)
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11
Q

What is Conn’s disease?

A
  • excess aldosterone production

- Na+ retention and K+ loss

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12
Q

What is the principle determinant of osmolarity?

A

Na+ concentration

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13
Q

What are the two mechanisms that control ADH release?

A
  • increased osmolarity in the ECF

- decreased blood volume

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14
Q

ADH stimulates which receptor in the collecting ducts and does what to cAMP?

A
  • V2 receptor

- increases cAMP

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15
Q

What receptor does ADH stimulate to cause vasoconstriction in the peripheral vasculature? (inc IP3, DAG, Ca+2)

A
  • V1

- net result is inc SVR

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16
Q

GFR is how many mL/min or L/day?

A
  • 125 mL/min

- 180 L/day

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17
Q

What is the glomerular filtration fraction?

A
  • 20% of RBF is filtered by glomerulus

- 80% is delivered to peritubular capillaries

18
Q

What determines GFR?

A

hydrostatic pressure across the glomerulus

19
Q

What is freely filtered by the glomerulus?

A

water, electrolytes, and glucose

20
Q

What are the 3 determinants of hydrostatic pressure across the glomerulus?

A
  • arterial blood pressure
  • afferent arteriole resistance
  • efferent arteriole resistance
21
Q

Where is the region of the nephron where the MOST of the filtered Na+ is reabsorbed?

A
  • Proximal tubule 65%
  • Loop of Henle (thick ascending) 20%
  • Distal tubule 5%
  • Collecting duct 5%
  • Urine 5%
22
Q

What is reabsorbed in the proximal tubule?

A
  • potassium
  • chloride
  • bicarb
  • sodium
  • water
23
Q

What is secreted into the proximal tubule?

A
  • organic bases and acids (bile salts, uric acid, catecholamines, toxins)
  • H+ ions
24
Q

What is reabsorbed in the Loop of Henle (descending)?

A
  • water (20%)
25
Q

What is reabsorbed in the Loop of Henle (ascending)?

A
  • Na+ (20%)
  • potassium
  • chloride
  • region is impermeable to water
  • Hydrogen is EXCRETED via sodium countercurrent mechanism
26
Q

What is reabsorbed in the Distal Tuble?

A
  • Na+
  • potassium, chloride, and bicarb (via sodium co-transport mechanism)
  • late distal tubule is impermeable to water except in presence of aldosterone or ADH
  • parathyroid hormone inc’s Ca+ reabsorption
27
Q

What is reabsorbed in the Collecting Duct?

A
  • Sodium (5%)
  • ADH inc’s water reabsorption only
  • Atrial natriuretic peptide inhibits water & Na+ reabsorption
  • aldosterone works here
  • adjusts H+ concentration
28
Q

What is the most useful indicator of GFR?

A
  • creatinine clearance
29
Q

What is the most common cause of perioperative kidney injury?

A

ischemia-reperfusion injury

30
Q

What is the standard monitor for urine production?

A

foley catheter

31
Q

What medication should you avoid in pts at risk for kidney injury?

A
  • NSAIDS

- NSAIDs dec. prostaglandin synthesis causing constriction of renal vasculature

32
Q

What is the most common and second most common cause of CKD?

A
  • DM

- HTN

33
Q

What is the most common cause of death in CDK pts?

A

CAD

34
Q

What are the 5 indications for use of dialysis?

A
  • volume overload
  • hyperkalemia
  • severe metabolic acidosis
  • symptomatic uremia
  • overdose w/drug that is cleared by dialysis
35
Q

What are anesthetic options for dialysis graft placement?

A
  • brachial plexus block
  • local infiltration
  • general
36
Q

What is the leading cause of death in dialysis pts?

A

infection

37
Q

What are the best opioids to give a pt with renal failure?

A
  • fentanyl
  • sufentanil
  • alfentanil
  • remifentanil
38
Q

What is the estimated absorbed volume while doing a TURP?

A
  • 10-30 mL/min of resection time
39
Q

What is the classic triad of TURP Syndrome?

A
  • HTN (w/ inc. pulse pressure)
  • Bradycardia (reflex)
  • Change in mental status
40
Q

How to estimate bleeding during TRUP?

A

2-5 mL of resection time

41
Q

What are absolute contraindications to Extracorporeal Shock Wave Lithotripsy?

A
  • Pregnancy

- risk of bleeding (bleeding disorder or anticoagulation)

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