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A/P > Lecture 11/22: Renal Physiology Cont'd > Flashcards

Lecture 11/22: Renal Physiology Cont'd Flashcards

Final- Hopefully end smh

1
Q

Where can we reabsorb water in the nephron?

A

PCT
TAL
DCT
Collecting duct

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2
Q

What is the osmolarity of the diluting segment

A

100 mOsm/L

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3
Q

Osmo in the PCT should be ______ to the plasma filtered

A

about equal

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4
Q

What is the pathology for hyponatremia?

A

This is decreased plasma Na+ osmo

Decreased ADH levels –> decrease urea reabsorption at the collecting duct –> dilute renal ISF & decreased AQP2 channels in the apical cell wall –> ions still being reabsorbed but not water –> increased water excretion

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5
Q

Where would you see a decrease in plasma osmo of Na+, K+, & Cl+?

A

End of the TAL in the loop of henle

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6
Q

PAH is increased in the nephron _____x

A

528

just know that its freely filtered & heavily secreted

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7
Q

Where would you see a dip in plasma osmo of creatinine/inulin?

A

last part of the loop on henle

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8
Q

What does diuresis mean?

A

Di = 2

Taking out ions & water

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9
Q

Where is the fluid excreted from diuretics coming from? How is it divided?

A

Extracellular fluid

Plasma 20%

ISF 80%

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10
Q

Explain the breakdown of excretion of 1L from a diuretic

A

1L of ECF

ECF: Plasma = 1/5
ISF = 4/5

Therefore: 200cc of Plasma was excreted
800 cc of ISF was excreted

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11
Q

T/F: Diuretics increase the amount of fluids we lose each day

A

F

It maintains the initial amount that we first took the drug

If we want to take off more fluid we have to increase the dose

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12
Q

Why are diuretics better for long term BP management than vasodilators?

A

With long term vasodilation, the body will find a way to work around that

Ex) with the nervous system: If it cant get the job done with Epi/NE –> releases ADH/ANGII to go around vasodilator

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13
Q

How much is total body water?

A

TBW is 60% of body mass

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14
Q

How do you find the the amount of ICF?

A

2/3 of TBW

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15
Q

How do you find the amount of ECF?

A

1/3 of TBW

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16
Q

What is considered ECF?

A

ISF and plasma

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17
Q

How do you find the amount of plasma?

A

ECF x (1/4) - ECF (1/5)

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18
Q

How do you find the amount of ISF?

A

ECF minus plasma

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19
Q

What are the values for TBW, ICF, ECF, Plasma, and ISF in a 70kg person?

A

TBW = 42 LITERS
ICF = 28 L
ECF = 14 L
Plasma = 2.8 - 3.5 L (Going to use 3L)
ISF = 11 L

20
Q

Describe the pathology for chronically high ANGII. What is the treatment for this?

A

If salt intake increase = BP increases & increased filtration in kidneys

Cant suppress ANGII system
Increased salt will also increase water & raise BP
THIS IS A SYSTEMIC PROBLEM

Tx: decrease salt & water intake

21
Q

Describe the pathology for Angiotensin II blockade. What is the temporary treatment for this?

A

Difficulty reabsorping Na to keep BP normal –> decreases Aldo as well –> Decreases BP

Temporary Tx: Increase salt intake

22
Q

What is the pathology for 1 kidney becoming stenotic? What is the Tx for this?

A

Bad Kidney: ↓RBF –> ↓Pressure at GC –> ↓GFR –> ↓Na/Cl at MD –> ↑Renin/ANGII release –> Increase GFR

Good Kidney: ↑Renin/ANGII release effects this kidney too
-↑Pressure at GC –> ↑GFR
-AA will try to constrict to combat but wont be able to fully compensate so pressure still high

Tx: ACE inhibitor (-pril)
ARBs (-sartan)

23
Q

What are surgical options available for the treatment of Renal artery stenosis?

A

Renal stent

Nephrectomy

24
Q

T/F: A taste bud is an electrically excitable cell

A

T

25
Q

What channels are on a taste bud?

A

Na+
K+

Remember you have some K+ channels on cells than Na

26
Q

Why does adding salt to food makes things taste better?

A

It makes the taste bud cell more excitable

Na+ binds to its receptor on the taste bud → ↑ its membrane permeability allowing Na+ to come into the cell increasing its mV → ↑ taste

27
Q

What is salt substitute?

A

K+

28
Q

What is the difference between Essential hypertension & salt-sensitive hypertension?

A

They’re both forms of essential HTN

-essential HTN: idiopathic
-Salt intake does not increase the BP

-salt-sensitive hypertension: overexpression of RAAS
-salt intake will increase the BP
Low Renin production <– hallmark sign

29
Q

______ HTN is seen more commonly in African Americans and NOT African Africans

A

Salt-sensitive hypertension

30
Q

What are predisposers of essential HTN?

A

-Genes <– primary
-diet

31
Q

What is the Tx for salt-sensitive hypertension?

A

ACE inhibitors (-prils)

Maybe ARBs? (-sartans)

32
Q

What are some renal antihypertensive drugs?

A

-Mannitol
-ARBs (-sartans)
-ACE inhibitors (-pril)
-K+ sparing

33
Q

What compounds can act like an osmotic diuretic?

A

Excess glucose
Excess Vitamin C

34
Q

What are some Tx for renal failure?

A

Na+ restriction (lots of Na+ pumps in nephron)

K+ restriction (K+ secreted alot)

Protein restrictions (broken down to amino acids)

All these things increase the work of nephrons
**There are way more but these were highlighted **

35
Q

What are some problems you’ll see with kidney failure?

A

Think, why did my pt need dialysis?

Hypernatremia
hypervolemia
hyperkalemia
hypertension
acidosis

36
Q

What is the effects on giving isotonic fluids on fluid compartments?

A

ECF: add volume

ICF: No change

37
Q

What is the effects on giving hypotonic fluids on fluid compartments?

A

EFC: Adds volume; decreases osmo –> water goes into cell

ICF: Adds volume; decreases osmo –> water goes into cell

38
Q

What is the effects on giving hypertonic fluids on fluid compartments?

A

EFC: Adds volume; increases osmo –> water pulled out of cell

ICF: decreases volume; increases osmo –> water pulled out of cell

39
Q

What is normal plasma creatinine?

A

1mg/dL

40
Q

How much creatinine is normally secreted?

A

0.15mg/min

41
Q

What is the normal excretion rate of creatinine?

A

1.40mg/min

42
Q

With creatinine, Excretion rate has to equal ________

A

production rate

43
Q

Creatinine is a byproduct of _______

A

skeletal muscle metabolism

44
Q

What is normal filtered load of creatinine?

A

1.25mg/min

45
Q

What happens to creatinine production when we have a nephrectomy? Why does this happen?

A

Everytime we lose half our nephrons, plasma creatinine has to double

We are still producing the same amount of creatinine = 1.4mg/min.
-We lost 1/2 nephrons: We are now only excreting 0.7mg/min now
-The excess that we are producing is BUILDING UP IN THE PLASMA!!!!
-Once the normal plasma creatinine doubles, it will now equal the production rate (The old excretion rate)

Plasma concentration would have to continue to rise until excretion rate equals production rate

46
Q

What is physiology hypertrophy of the kidney?

A

About a year after a nephrectomy your kidney will get big/stronger –> able to do more work –> increases GFR by 50%

This is only if the remaining kidney is healthy

A/P (33 decks)

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