Nephrology Flashcards
Site of erythropoietin (EPO) production
Interstitial cells of the peritubular capillaries
Active form of Vitamin D
1,25-dihydroxycholecalciferol (calcitriol)
Contains vasa recta and has longer loops of Henle
Juxtamedullary nephrons (less common than cortical nephrons)
Components of the juxtaglomerular apparatus
Macula densa (walls of the dital tubule; detects changes in BP)
Physiologic function of renin
None (merely converts angiotensinogen from the liver to angiotensin I)
Physiologic function of angiotensin I
None (merely converted to angiotensin II due to ACE in the lungs)
Physiologic functions of angiotensin II
Vasoconstricts afferent and efferent arteriole (efferent > afferent)
Site of aldosterone production
Zona glomerulosa of the adrenal cortex
Aldosterone actions
Increases Na+ reabsorption, K+ secretion, H+ secretion
ADH actions
Insertion of aquaporins (AQP-2) in the collecting ducts
Triggers for ADH secretion
Increased plasma osmolarity
Increases GFR
Afferent arteriolar vasodilation
Decreases GFR
Afferent arteriolar vasoconstriction
Principal cells
Absorb Na+ and H20 and secrete K+
Intercalated cells
Absorb K+ and secrete H+
Tubuloglomerular feedback
Macula densa feedback
Glomerulotubular balanca
“Percentage of solute reabsorbed is held constant”
Substances with no transport maximum and renal threshold
Sodium and all passively transported solutes
Ascending limb of the Loop of Henle is permeable to
Solutes (Mnemonic: asin-ding limb is permeable to solutes)
Descending limb of the Loop of Henle is permeable to
Water
Normal pH in various fluid sites
Arterial blood: 7.4
Acid-base abnormalities caused by diuretics
Metabolic acidosis: acetazolamide (Mnemonic: acid-azolamide)
Intact Nephron Hypothesis by Neil Bricker
Decreases in the number of functioning nephrons causes remaining nephrons to carry a larger burden of transport, synthetic function and regulatory function
Bricker’s Trade-Off Hypothesis
Some physiologic adaptations to nephron loss also produce unintended clinical consequences
Hyperfiltration Hypothesis by Barry Brenner
Some adaptations accelerate the deterioration of residual nephrons
Standard test for measurement of albuminuria
Accurate 24-hour urine collection
Most useful renal imaging study
Renal ultrasound
The only test to establish etiology in early-stage CKD in the absence of a clinical diagnosis
Renal biopsy
Most sensitive test for renal vein thrombosis (RVT)
CT angiography
Imaging test for diagnosis of nephrolithiasis
Helical computed tomography (CT) scanning without radiocontrast enhancement
Most common form of renal replacement therapy for AKI
Hemodialysis
Clear indications for initiation of renal replacement therapy in patients with CKD
- Uremic pericarditis
Best potential for complete renal rehabilitation
Kidney transplantation
Educational programs should be commenced
No later than stage 4 CKD
Most common therapeutic modality for end-stage renal disease (ESRD)
Hemodialysis
Leading cause of ESRD
Diabetes mellitus
Dialysis access with highest long-term patency rate
Fistula
Most important complication of arteriovenous grafts
Thrombosis of the graft and graft failure
Most common acute complication of hemodialysis, particularly among DM patients
Hypotension
Preferred buffer in peritoneal dialysis solutions
Lactate