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A1 > Kidney APEX > Flashcards

Kidney APEX Flashcards

1
Q

Body fluid compartments

A

ECF-14L (vascular 3L, interstitial 11L)
ICF- 24L

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2
Q

What compartments are in the cortex of the kidney?

A

Glomerulus/ bowmans capsule
PCT
DCT

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3
Q

What compartments are in the medulla

A

Loop of Henle (ascending and descending)
Collecting duct

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4
Q

The kidney produces ___

A

Renin (JG cells)
Calcitrol (active vitamin D3)
EPO stimulates stem cells in the bone marrow
Prostaglandins control blood flow
Glucose from amino acids (gluconeogensis)

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5
Q

The kidneys receive _____% of cardiac output, ____ L/min

A

25
1

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6
Q

Renal blood flow formula

A

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

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7
Q

Blood flow thru the kidney

A

Renal artery
Afferent arterioles
Glomerular capillary bed
Efferent arterioles
Peritubular capillary bed
Renal segmental vein

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7
Q

At what map mmHg can RBF autoregulate?

A

50-180

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8
Q

Renal autoregulation is carried out by what processes?

A

Myogenic mechanism- constricts or dilates afferent arterioles
Tubuloglomerular feedback/ JG apparatus-
PGs, ANP, SNS, RAAS

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9
Q

What states can decrease RBF?

A

Sepsis
Surgical stress
Ischemia

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10
Q

After 50 years old, RBF decreases by _____

A

1% per year

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11
Q

What increases renin release?

A

PEEP reduces renal blood flow
Beta 1 stimulation from circulating or exogenous catecholamines
Hemorrhage
CGF
Liver failure w ascites
Sepsis
Diuresis
Decreased sodium and chloride delivery to the DCT (Tubuloglomerular feedback
Hypovolemia
Hyponatremia

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12
Q

BP is regulated by what 3 systems?

A

SNS
RAAS
Vasopressin

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13
Q

Beta 1 ____ renin

A

STIMULATES

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14
Q

Plasma osmolarity formula

A

(2Na) + (glu/18) + (BUN/2.8)

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15
Q

What is the normal plasma osmolarity?

A

280-290

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16
Q

What pathways promote renal vasodilation?

A

PGs
Natriuretic peptide
Dopamine receptors

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17
Q

D1 vs D2

A

D1- vasodilation, increased RBF
D2- decreases norepi release

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18
Q

How can NSAIDs affect RBF?

A

Inhibit PGs- prevent vasodilation- decrease RBF

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19
Q

The plasma is slightly ____ charged

A

positively because it has more cations such as sodium and potassium

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20
Q

What term refers to the pressure that prevents osmosis?

A

Osmotic

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21
Q

If an isotonic solution is added to ECF, the effect will be ____

A

An increase in ECF only

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22
Q

A rapid correction in ______ can cause permanent brain damage

A

Hyponatremia from 3% hypertonic saline

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23
Q

Intracellular edema can lead to ____

A

Lack of nutrients to the cells
Depression of metabolic function
Reduced blood flow, oxygen, and nutrients
Inflammation increases cell permeability

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24
Q

What can cause increased capillary pressure?

A

1- increased capillary pressure (Kidney retention of salt and water, high venous pressure, low arteriolar pressure)
2- Decreased plasma proteins (nephrotic syndrome, wounds, liver disease)
3- Increased cap permeability (toxins, immune reactions, infections, burns)
4- Lymph blockage (cancer, surgery)

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25
Q

In heart failure, blood flow to the kidneys is _____, which stimulates _____, causing _______

A

Decreased
Renin
AT2 & aldosterone which will cause additional salt and water retention by the kidneys

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26
Q

What 3 factors prevent edema?

A

Low interstitial compliance (-3mmHg)
Drainage (lymphatic) (7mmHg)
Wash down of IF proteins as lymph is washed away (7mHg)
Thus, capillary pressure could rise to 17 (double the normal value) before edema would occur

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27
Q

Plasma filtration occurs in the ____

A

glomerulus

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28
Q

The kidneys receive ____ % of CO

A

20

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29
Q

What are the two types of nephrons?

A

Cortical- short loops of henle
Juxtamedullary- Long loops of henle, concentrate urine, higher GFR, larger glomeruli

30
Q

How fast do we lose nephrons?

A

10% every 10 years after 40 (apex says 50)

31
Q

Each nephron contains what?

A

A glomerulus
A renal tubule- where filtered fluid become urine

32
Q

The bowmans capsule and glomerulus form the ___

A

Renal corpuscle- where GFR begins

33
Q

____ % of RBF is filtered by the glomerulus, the remaining ___% is delivered to the _____

A

20%
80% goes to the peritubular capillaries

34
Q

The normal GFR is ____

A

125ml/min

35
Q

Where does most sodium get reabsorbed?

A

PCT- 65%

36
Q

Reabsorption of what requires ATP?

A

Electrolytes
NOT water- water occurs via osmosis

37
Q

What is the primary function of the Loop of Henle?

A

Forming dilute or concentrated urine- separating the handling of sodium and water

38
Q

What are the vasa recta?

A

Peritubular capillaries that run parallel to the Loop of Henle

39
Q

Which part of the Loop of Henle is permeabile to water?

A

Descending IS permeable
Ascending is NOT permeable

40
Q

Target location of Loops, osmotics, CA inhibitors, and Thiazides, K sparing

A

Loop diuretics- loop of henle
CA Inhibitors- PCT
Osmotics- PCT
Thiazides- DCT
K sparing- Collecting ducts

41
Q

Spironalactone MOA

A

Aldosterone antagonist
Blocks K secretion and Na reabsorption

42
Q

Side effects of K sparing diuretics

A

Hyperkalemia (especially if taking with nsaids, BBs, ACEis)
Gyno

43
Q

Side effects of loop diuretics

A

Hypokalemic hypochloremic met alkalosis
Hypokalemia can increase risk of digoxin, and potentiate NMBs
Ototoxicity

44
Q

Side effects of Osmotics

A

If BBB is disrupted, mannitol will enter brain and cause edema

45
Q

Side effects of CA inhibitors

A

Met acidosis (reabsoprtion of H ions while excretion of CA and HCO3)
May exacerbate COPD depression from hypercarbia because of the loss of bicarb buffer

46
Q

What is the best test of tubular function?

A

Urine osmolality
Fractional excretion of sodium

47
Q

What are to best tests of GFR?

A

BUN (although this is a better indicator of uremic symptoms from the metabolism of protein)
Creatinine clearance

48
Q

Normal urine sodium

A

130-260mEq/day

49
Q

Urine specific gravity

A

1.003-1.030

50
Q

What could be some causes of low BUN (<8)

A

Overhydration
Decrease urea production (malnutrition, liver disease)

51
Q

What could cause high BUN (>20)

A

Dehydration
Increased protein input (high protein diet, GI bleed, hematoma breakdown)
Catabolism (trauma, sepsis)
Decreased GFR

52
Q

Creatinine is produced by ___, and is directly proportional to ___

A

skeletal muscle, it is a breakdown of creatine
muscle mass (lower in women and elderly)

53
Q

A 100% increase in creatinine indicates a ___ reduction in GFR, why so?

A

50% reduction
Creatinine only undergoes renal filtration, no reabsorption (half the process)

54
Q

BUN undergoes ____, Creatinine undergoes ___

A

filtration and reabsoprtion
filtration only

55
Q

The normal BUN: Cr ratio is ___, and is useful for evaluating ___

A

10:1
Hydration status

56
Q

____ is the4 most useful tool for GFR

A

creatinine clearance

57
Q

GFR formula

A

[(140-age) x BW] / (72 x serum Cr)
x .85 for women to account for smaller muscle mass

58
Q

Failing kidney __ sodium

A

waste

59
Q

Pre renal vs ATN urinary sodium

A

Pre renal- urinary sodium <20,
ATN- urinary sodium >20,

60
Q

What are intrinsic causes of ATN?

A

Ischemia
Nephrotoxic drugs- nsaids, abx, contrast dye

61
Q

____ maintain GFR and UOP better than levo or phenyl

A

Vaso!
d/t constriction of the EFFERENT arterole

62
Q

What is the most important pump of the ascending LOH?

A

Na K 2 Cl
Site of acrtion for Loop Diuretics

63
Q

ADH and aldosterone are counteracted by ____

A

ANP in the collecting ducts

64
Q

What are the stages of CKD

A

Measured by GFR
1- normal >90ml/min
2- 60-89
3- 30-59
4- 15-29
5- Kidney failure, requires dialysis <15

65
Q

Most common cause CKD is ___, and the second most common cause is ___

A

Diabetes mellitus
Hypertension

66
Q

What are the symptoms of uremic syndrome?

A

Anemia
Fatigue
N/V
Anorexia
Coagulopathy

67
Q

Decreased EPO leads to ____ ____ anemia

A

Normochromic normocytic

68
Q

Acidosis shifts the oxyhemoglobin dissociation curve to the ___

A

right

69
Q

Dialysis is indicated when K exceeds ___

A

6 mEq/L

70
Q

Treatments to reduce serum K are ____

A

Glucose 50g + insulin 10 units
Hyperventilation- for every 10mmHg decrease in paco2, K will decrese by 0.5
HCO3 100mEq
Calcium chloride 1g

71
Q

Most common cause of death in dialysis/ chronic renal failure patients

A

CAD
Then Infection d/t impaired WBC, low protein diet

72
Q

What is the most accurate predictor of bleeding risk in kidney patients?

A

Bleeding time

73
Q
A

A1 (125 decks)

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