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CC 2 lecture > kidneys, water balance, electrolytes > Flashcards

kidneys, water balance, electrolytes Flashcards

1
Q

water is filtered and reabsorbed by…

A

osmosis

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2
Q

4th most abundant cation in the body

A

magnesium

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3
Q

what is the major site of water reabsorption

A

proximal tubule

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4
Q

what is reabsorbed in loop of henle

A

ions

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5
Q

this hormone controls the isertion of aquaporin water channels necessary for water reabsorption in the collecting duct

A

ADH

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6
Q

other names of ADH

A

argipressin
vasopressin
arginine vasopressin

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7
Q

these are looped blood vessels which maintain the concentrated nature of the medullary interstitium

A

vasa recta

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8
Q

this is best to use in kidney function test because it is a 100% waste product

A

creatinine

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9
Q

what are the things to consider when doing creatinine clearance test to ensure accurate results

A

start collection with empty bladder
urinate in 24 hour period

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10
Q

this is the most ideal substance for GFR

A

inulin or lothalamate (lo)

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11
Q

___ is a polymer of fructose which is obtained from plants (dahlias, onions, garlic)

A

inulin

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12
Q

the problem of this test is that it requires IV infusions and are more laborous and expensive

A

inulin or lotholamate clearance test

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13
Q

clearance of this substance is the most accurate for GFR determination

A

inulin

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14
Q

the reference method for GFR determination

A

inulin or lotholamate clearance test

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15
Q

this measures the effective renal plasma flow (ERPF) in the absence of a tubular functional impairment

A

PAH clearance

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16
Q

this substance is the most commonly used to assess secretory function of renal tubules

A

PAH clearance

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17
Q

PAH clearance is dependent on the…

A

volume of blood perfusing the kidney (total renal blood flow)

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18
Q

this is the reference method for ERPF determination

A

PAH clearance

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19
Q

what are the two important properties of the ECF

A

volume and osmolality

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20
Q

ECF volume is directly dependent on what substance

A

sodium

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21
Q

ECF volume is maintaned by (2)

A

regulation of renal excretion of sodium or GFR, and aldosterone via the RAA system

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22
Q

percentage of filtered sodium reabsorbed by the earlier parts of the renal tubules

A

70%

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23
Q

what is the role of aldosterone in maintaining ECF volume

A

Sodium reabsorption
Release of potassium and hydrogen ions
because it is a vasoconstrictor

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24
Q

what situations/conditions stimulates the juxtaglomerular cells of the kidneys to release renin

A

Hyponatremia
Hyperkalemia
Hypotension

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25
Q

what kind of dehydration causes increased ECF osmolality

A

Pure water loss or deficit

26
Q

this type of dehydration have a normal sodium levels

A

pure water loss or deficit

27
Q

this type of dehydration have a less effect on plasma or ECF volume because the body easily compensates for the fluid loss by recruiting water from the ICF

A

pure water loss or deficit

28
Q

this type of dehydration have a greater effect on ECF or plasma volume

A

water and sodium loss

29
Q

what readily takes place in water and sodium loss especially in isotonic fluid loss

A

hypovolemia

30
Q

what are the different types of water and sodium loss and what causes them

A

Hypernatremic dehydration: water and food deprivation, excessive sweating, osmotic diuresis

Normonatremic dehydration: vomiting, diarrhea

Hyponatremic dehydration: diuretic therapy, salt-wasting renal disease, adrenocortical insufficiency

31
Q

this is the measure of solute/water ration (amount of dissolved particles)

A

osmolality

32
Q

what causes overhydration

A

Excessive intake of water (polydipsia)
Excessive water reabsorption: SIADH and ectopic ADH secretion

33
Q

ECF osmolality is regulated by these substances

A

Na
Cl
HCO3
Glucose
Urea
Proteins

34
Q

what provides colloid osmotic pressure or oncotic pressure at te tissue interstitial fluid

A

proteins (globulin)

35
Q

what increases in pure water loss? And what does it trigger

A

ECF osmolality increases, which triggers release of ADH (released by posterior pituitary) or vasopressin via hypothalamic osmoreceptors, stimulation of the hypothaamic thirst center, and redistribution of water from the ICF

36
Q

where can serum hyperosmolality found and serum hypoosmolality

A

hyper- excessive water loss
hypo- polydipsia

37
Q

this refres to the difference between the calculated osmolality using the equation (lower) and the measured osmolality using any of the above direct methods (higher)

A

delta osmolality

38
Q

this is used to evaluate acutely ill or comatose patients

A

delta osmolality

39
Q

what value suggests poor prognosis in delta osmolality

A

> 40 mOsmol/kg H2O

40
Q

delta osmolality is increased in what situations

A

Ingestion of poison
Ethanol overdose
Azotemia

41
Q

this causes a large osmolar gap but does not cause an anion gap metabolic acidosis

A

isopropyl alcohol

42
Q

an osmolal gap of >10 is caused by…

A

Toxic alcohols
Mannitol
Lorazepam infusions

43
Q

they are used ot differentiate between pre-renal and renal causes of acute renal failure

A

RFI and FeNa

44
Q
A
45
Q

this evaluates the concentration and diluting ability of the kidneys

A

osmol clearance

46
Q

it measures the amount of water cleared from the plasma resulting in urine that has the same osmolality as the plasma

A

osmol clearance

47
Q

this is used for the concentration and dilution ability of the kidneys

A

free water clearance

48
Q

this is calculated as the difference between the total urine volume and the osmol clearance

A

free water clearance

49
Q

if the free water clearance is positive….

A

the urine is dltuted compared to serum

50
Q

if free water clearance is negative…

A

the urine is more concentrated than serum

51
Q

enumerate situations where plasma osmolality is increased

A

dehydration
alcohol intoxication
hypercalcemia
diabetes insipidus
osmoticaly active drugs (mannitol)

52
Q

when is plasma osmolality decreased

A

water intoxication (polydipsia)
inappropriate wtaer retention in kidneys (SIADH in asthma and pneumonia; ectopic secretion of ADH)
bronchogenic cancer
lymphosarcoma

53
Q
A
54
Q

this is an indirect measure of ADH content

A

overnight water department test

55
Q

in overnight water department test, water is withheld from the patient for ___ hours

A

8

56
Q

in overnight water department test, patients with ADH deficiency have ___ serum osmolality and ___ urine osmolality over time

A

increasing, decreasing

57
Q

most abundant cation in the body

A

calcium

58
Q

major extracellular fluid anion

A

chloride

59
Q

most abundant cation in extracellular fluid

A

sodium

60
Q

major intracellular cation

A

potassium

CC 2 lecture (3 decks)

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