Kidney Regulation Flashcards
2.4 mmEq/L
Serum Calcium
TIGHTLY regulated by PTH in the distal tubule
1200 mOsm/L
MAX urine Osmolarity
Maximum concentrating ability
Osmotic Diuretics
Mannitol, Urea, Glucose, Sucrose
Proximal Tubule - Inhibit 1st half Na+ transporters by saturating Tm
Na+ Channel Antagonists
Directly block ENaC channels in late distal tubule and cortical collecting duct
Amiloride, Triamterene
500-600 mOsm/day
Obligatory solute loss
Generally the quantity we consume each day. Except holy crap Americans eat 4x that amount…
Exercise
Hyperkalemia
Acetazolamide
Carbonic Anhydrase Inhibitor
Proximal Tubule - inhibits reabsorption of HCO3- and H+ secretion
Pre-Renal Failure
Generally secreting LESS sodium
BUN/Cr >20
Urine Osmolarity >500
Urinary Na < 20
BUN increases in pre-renal failure because urea gets reabsorbed with the Na+ retention
10 mmHg
A good value for Peritubular capillaries
Cell Lysis
Hyperkalemia
Write GFR equation (2 of them)
GFR = Cr Clearance
GFR = Kf * Capillary Equation
Hypoaldosteronism
Addison’s
Decreased K+ Secretion
i.e. Hyperkalemia, also decreased BP
ADH Inhibitors
Alcohol, Clonidine, Haloperidol
Lose Water
Insulin Deficiency
Hyperkalemia
K+ can’t move into cells along with glucose
ADH Agonists
Morphine, Nicotine, Cyclophosphamide
Nausea, Hypoxia
Retain Water
Iso-Osmotic Volume Expansion
Drinking isotonic NaCl
Increase ECF volume, no other changes
200 mg/dL
When you begin seeing glucose in the urine
Transport max is usually higher, like 380 mg/dL
Hyperaldosteronism
Conn’s Syndrome
Increased K+ Secretion
i.e. Hypokalemia, also increased BP
Hyperosmotic Volume Contraction
Loss of ECF water volume
Sweating, Fever, Diabetes
Sympathetic Agonists
Hypokalemia
Insulin
Hypokalemia
K+ moves into cells with Glucose
180 L
Amount kidneys filter each day
Hypo-Osmotic Volume Contraction
Adrenal Insufficiency - Decreased Aldosterone
Loss of NaCl
Kidneys excrete more NaCl than H2O
Decreased ECF volume
Increased ICF volume
Hematocrit increases because it occupies a greater % now that plasma has gone down
Inhibitors of Na/K ATPase
Hyperkalemia
Digitalis - results in reduced intracellular K+ and allows it to move out of the cells
Thiazide Diuretics
Na/Cl Cotransporter
Early Distal Tubule
Can be used to aid in the passage of kidney stones because promotes Ca2+ reabsorption and removes it from urinary tract
Loop Diuretics
NKCC2 transporter
Thick Ascending Limb - inhibit reabsorption of cations
Furosemide, Bumetanide
50 mOsm/L
Minimum urine Osmolarity
The most dilute your urine can get
Alkalosis
HYPOkalemia
Exchange of intracellular H+ (to compensate for alkalosis) for extracellular K+
Acetazolamide - prevents alkalosis by inhibiting reabsorption of HCO3 and secretion of H+
Aldosterone Antagonists
Late Distal Tubule + Cortical Collecting Duct
Spironolaction, Eplerenone
Lead to HYPERkalemia
HYPOosmolarity
Hypokalemia
H2O flows into the cell and K+ follows
B-Adrenergic ANTAGONISTS (sympathetic)
Hyperkalemia
60 mmHg
A good marker for GFR
Above = increased GFR Below = decreased GFR
Aldosterone Antagonists
Hyperkalemia
Acidosis
Hyperkalemia
- Exchange of extracellular H+ (which is high) for intracellular K+ on the basolateral membrane
Specific Gravity
- 01 = LOW, Hydrated
1. 03 = HIGH, Dehydrated
Hyperosmotic Volume Expansion
HIGH NaCl intake into ECF
Increased ECF Volume
Edema (swollen salt hands)
Hypo-Osmotic Volume Expansion
SIADH
Inappropriate retention of water in ECF
ICF Volume goes up
High Plasma Creatinine
Tells me there is kidney damage because Cr isn’t being cleared properly
Hypoaldosteronism
Decreased K+ Secretion
i.e. hyperkalemia
Iso-Osmotic Volume Contraction
Diarrhea
Decreased ECF volume, no other changes
Hyperosmolarity
Hyperkalemia
H2O flows out of the cell and K+ follows
500-600 mOsm/day
Obligatory solute loss
Generally the quantity we consume each day. Except holy crap Americans eat 4x that amount…
Intrinsic Renal Failure
Acute Tubular Necrosis
Generally secreting MORE sodium
BUN/Cr 10-15
Urine Osmolarity < 350
Urinary Na > 40
Cells in the urine
- These values can sometimes be seen if someone is using diuretics
0.5 L/day
Minimum urine volume
If you’re not excreting 0.5 L per day, you may go into electrolyte imbalance
Metabolic Alkalosis effect on Ca2+
Retention of Ca2+
Metabolic Acidosis effect on Ca2+
Increased excretion of Ca2+
Increased Plasma Phosphate on Ca2+
Retention of Ca2+
Decreased Plasma Phosphate on Ca2+
Increased excretion of Ca2+
Renal Tubular Osteomalacia
Consequence of acidosis and hypercalciuria
Increased excretion of Ca2+
