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COM - Renal > McCormick lectures > Flashcards

McCormick lectures Flashcards

1
Q

hypoxia results in what compared to normal?

A

INcreased ICF Na

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2
Q

ICF osmolarity is due to what?

A

K+

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3
Q

The cell membrane between ECF and ICF is permeable to what?

A

water

NO IONS

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4
Q

the capillary membrane between ECF compartments is permeable to what?

A

small ions

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5
Q

how is fluid distribution between plasma and interstitial fluid maintained?

A

balance of hydrostatic and osmotic forces across capillaries

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6
Q

how is fluid distribution between ECF and ICF determined?

A

osmotic effect of small solutes across cell membrane (highly permeable to water)

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7
Q

what fluids stay in the ECF only?

whole body?

A

crystalloid fluids

saline

lactated Ringer’s Solution

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8
Q

what kind of fluids contain large proteins and molecules which stay within the vascular space?

A

colloid fluids

dextran, albumin, mannitol

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9
Q

what is non-pitting edema?

A

swollen cells due to increased ICF volume

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10
Q

what is pitting edema

A

increased interstitial fluid volume

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11
Q

what are the 3 anatomical urinary tract divisions?

A

upper
bladder
urethra

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12
Q

what composes the upper urinary tract?

A

CPU
calyces
pelvis
ureters

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13
Q

what controls voiding of the urethra?

A

2 sphincters

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14
Q

internal sphincter:

smooth or skeletal m.?

Symp or PS?

voluntary/involuntary?

A

smooth

PS

involuntray

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15
Q

what is the afferent pathway for bladder fullness?

A

pelvic splanchnic nerve or hypogastric plexus

POSTERIOR column

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16
Q

afferent pathway for bladder pain?

A

pelvic splanchnic n. / hypogastric plexus in the

ANTEROLATERAL column

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17
Q

reflex arc from the bladder?

A

bladder –> sacral detrusor nucleus –> bladder

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18
Q

reflex arc from urethra?

A

urethra –> sacral pudendal nucleus/sacral micturition center –> voluntary sphincter

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19
Q

where do the reflex arcs occur?

A

S2-S4

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20
Q

what nt does Symp fiber use?

where does it originate?

what does it pass through?

function?

A

NE
intermediolateral spinal gray horn T10-L2
hypogastric plexus
inhibits voiding

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21
Q

what nt does PS use?

origin?

what does it pass through?

function?

A

Ach

sacral detrusor/micturition center S2-S4

pelvic splanchnic nerve

contracts detrusor, relaxes sphincter

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22
Q

somatic fiber origin?

passes through what?

function?

A

sacral pudendal nucleus, S2-S4

hypogastric plexus and pelvic splanchnic nerve

contracts external urethral sphincter (rhabdomyosphincters)

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23
Q

what overrides the urge to void?

how?

A

Pontine micturition center (barrington’s center) located at the pons

control of sacral micturition center and thoracolumbar sympathetic outflow

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24
Q

what does Barrington’s Center coordinate?

A

activity of bladder and urinary sphincters

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25
Q

Tension = ?

A

(P x r) / 2

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26
Q

where do bladder stretch receptors send sensory info to?

A

sacral micturition center –> activate PS

higher centers in brainstem, cerebral cortex –> inhibit PS

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27
Q

what is the cause of an atonic/flaccid bladder?

what happens to the bladder?

A

destruction of afferent inputs via injury, Diabetes, syphilis, MS

stretch info not transmitted, no contractions, bladder fills to capacity and overflows, walls get thin and distended

AA

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28
Q

what causes denervated (hypertrophic areflexic) bladder?

what is the result?

A

destruction of afferent and efferent

detrusor contractions cease, bladder becomes flaccid and distended

later the detrusor has spontaneous activity and bladder shrinks due to hypertrophy of wall

DD

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29
Q

what causes automatic (spastic) bladder?

result?

A

injury/severed spinal cord above sacral region cuts off brain communication

spinal shock suppresses micturition reflex makes flaccid bladder

control by brain is lost, spastic bladder

A.I.

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30
Q

what causes uninhibited neurogenic bladder (dysreflexia)?

A

destruction of somatic tracts for inhibition

micturition is activated by small amounts of urine (constantly stimulated)

detrusor hypertrophies, bladder capacity reduced

UTI

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31
Q

what causes UTI?

result?

A

E. coli

uninhibited contraction of detrusor m. w/micturition reflex

urinary freq and leakage

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32
Q

what is isosmotic volume contraction?

expansion?

A

vomiting, diarrhea, hemorrhage

infusion of 0.9 NaCl

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33
Q

what is hyperosmotic volume contraction?

A

loss of water

dehydration
diabetes insipidus

34
Q

what is hyperosmotic volume expansion?

A

gain NaCl

excess NaCl intake
mannitol infusion

35
Q

what is hyposmotic volume expansion?

A

gain water

SIADH
psychogenic polydipsia

36
Q

hyposmotic volume contraction?

A

lose NaCl

hypoaldosteronism
adrenal insufficiency
diuretics

37
Q

what is ECF osmolarity due to?

bc of what?

A

Na and Cl

Na-K ATPase pump

38
Q

Do the glomerular capillaries have a high or low hydrostatic pressure?

net result?

A

HIGH

filtration into Bowman’s capsule

39
Q

what kind of pressure do the peritubular capillaries have?

net result?

A

low hydrostatic pressure

water and solute reabsorbed

40
Q

where do sympathetic neurons synapse to cause renin secretion?

A

granular cells

41
Q

what are the effects of sympathetic discharge on the kidney?

A

DEC GFR
inc reabsorption of Na and water from PCT and DCT
thirst via AgII production

42
Q

Filtration rate equation

A

filtration rate = GFR x plasma [ ] of substance

43
Q

urinary excretion rate equation

A

= urine flow rate x [ ] of substance

44
Q

clearance of substance X = ?

A

(Ux x V) / Px

[ ] of X in urine x urine volume / [ ] of X in plasma

45
Q

what does inulin clearance equal?

A

GFR

46
Q

what are some advantages of using Cystatin C for measuring GFR?

A

levels not affected by muscle mass, age, or gender

47
Q

when do PAH estimations for RPF become less useful?

A

at higher plasma [ ]’s of PAH

48
Q

what is filtration fraction equation?

A

FF = GFR/RPF

49
Q

increased FF means what?

A

increased oncotic pressure of efferent arteriole, more reabsorption

50
Q

RBF equation?

A

RBF = RPF / (1-Hematocrit)

51
Q

what is main function of ADH?

A

makes the collecting ducts permeable to water

52
Q

when is ADH released?

A

increased blood osmolarity

decreased blood volume

53
Q

what is the main function of aldosterone?

A

reabsorb Na+ from DCT

secrete K+ into urine

54
Q

what effects does aldosterone have on volume and osmolarity?

A

Increases volume

no change in osmolarity

55
Q

what effects does ADH have on osmolarity and volume?

A

Decreases osmolarity

Increases volume

56
Q

where are osmoreceptors located?

A

anterior hypothalamus

57
Q

where are volume receptors located?

A

Right Atrium

58
Q

what are the physiological causes of proteinuria?

A

orthostasis (esp. in children)

strenuous physical activity like running a marathon

59
Q

what are the 4 pathological causes of proteinuria?

A

loss of charge barrier
loss of size barrier
failure of PCT to reabsorb protein
overload proteinura, inc. plasma [ ]’s of low mw, filterable proteins

60
Q

what is RBF equation?

A

RBF = change in pressure / Resistance

61
Q

what can change the Kf?

A

surface area

permeability (Lp)

62
Q

what do mesangial cells do to GFR?

A

decrease it bc they decreases the s.a.

63
Q

Puf equation?

A

Puf = Pgc - Pbc - pigc

64
Q

what does a kidney stone or blockage do to GFR?

A

DECREASE it

65
Q

how is GFR primarily regulated?

A

Pgc

66
Q

what BPs is GFR regulated over?

A

80-170

67
Q

what does sympathetic stimulation do?

A

constrict afferent and a little efferent

Dec GFR, DEC RBF

activate RAAS to raise BP and INC Na and water reabsorption

68
Q

what is PG release enhanced by?

A

ADH and NO

69
Q

what hormones decrease GFR?

A

NE
Epi
Endothelin

70
Q

what hormones increase GFR?

A

NO

PG

71
Q

what is the myogenic response of autoregulation in response to?

A

INC. systemic arterial pressure

72
Q

what happens in myogenic response?

A

resistance of blood vessels stretch
vascular smooth m. contraction in response via INC Ca2+ movement into cells

Result is prevents INC RBF and GFR when BP INC.

73
Q

what is the TGF response to INC renal perfusion pressure?

A

constriction of afferent arteriole (Decreases GFR) via Adenosine

74
Q

what is the TGF response to decreased renal perfusion?

A

INC sympathetic discharge
activate RAAS to Inc efferent arteriole constriction
will reabsorb Na and water

75
Q

what is the criteria for diagnosing a UTI?

A

if urine collected by clean catch need both pyuria and at least 50,000 colonies

if by catheter: pyuria and 50,000 or 10-50,000 cpm confirmed by repeat

76
Q

if urine collected via suprapubic aspiration, what meets the criteria for diagnosis of uti?

A

pyuria and ANY growth on culture

77
Q

what enzyme will present with a positive uti?

A

leukocyte esterase

78
Q

gram negative bacteria?

gram positive?

A

PECK

SEnterococcusS

79
Q

what is renal scarring?

A

loss of renal parenchyma between the calyces and renal capsule

80
Q

what antibiotic do you use to treat uti?

A

cephalosporin or fluoroquinolones

81
Q

when do you image with VCUG?

A

after 2nd uti
OR
after 1st uti with abnormal RBUS and temp > 39 C

82
Q

what are the 2 major tests for detecting proteins and what are their major characteristics?

A

Dipstick test - color rxn to protein more sensitive to albumin

Sulfosalicylic acid test - detects all proteins, the more turbid, the higher the protein [ ]

COM - Renal (5 decks)

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