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Renal > Physiology > Flashcards

Physiology Flashcards

1
Q

What are the 2 stimuli for ADH release

A

hypothalamic osmoreceptors

left atrial stretch receptors

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2
Q

when is aldosterone secreted?

A

in response to increased potassium and decreased sodium in the blood
activation of RAAS

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3
Q

what does atrial natriuretic peptide promote?

A

excretion of sodium

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4
Q

what cells release renin?

A

granular cells

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5
Q

tracer used to measure
total body water (TBW)?
ECF?
plasma?

A

TBW - 3H2O
ECF - inulin
plasma - labelled albumin

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6
Q

is there always more Na and Cl outside or inside the cell?

A

always more Na and Cl outside the cell

always more K inside the cell

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7
Q

what is the osmotic conc of ECF? ICF?

A

both the same - 300mosmol/l

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8
Q

what is the most common type of nephron in the human body? what type of urine do they produce?
capillary feature?

A

cortical
they produce dilute urine
peritubular network of capillaries

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9
Q

juxtamedullary nephrons
short or long loop of henle?
capillary feature?

A

long loop of hence

single capillary called the vasorectum

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10
Q

how is GFR calculated?

A

filtration coefficient (how ‘holey’ the membrane is) x net filtration pressure

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11
Q

what are the 2 types of auto-regulation in the kidney?

A

myogenic - if vascular smooth muscle is stretched, it contracts
tubuloglomerular feedback - if more NaCl is flowing through the tubule it is sensed and constriction of the afferent arterioles occurs

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12
Q

what is used to measure renal plasma flow?

A

para amino hippuric acid

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13
Q

what is filtration fraction?

A

the fraction of plasma flowing through the glomeruli that is filtered into the tubules

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14
Q

equation for plasma clearance

A

rate of excretion of x / plasma conc of x

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15
Q

is clearance of reabsorbed/secreted substance constant once transport maximum has been reached?

A

no

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16
Q

does blood osmolality of the vast recta rise or fall as it dips into the medulla?

A

blood osmolality rises as it dips into the medulla and falls again as it rises back up

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17
Q

what are the three sources of H+ ions

A
  1. the largest is carbonic acid formation
  2. inorganic acids produced during breakdown of nutrients
  3. organic acids resulting from metabolism i.e. lactic acid
18
Q

when bicarbonate is low, what do secreted hydrogen ions combine with? what is the max amount that can be secreted per day?

A

phosphate - the next most plentiful buffer

max amount secreted per day = 40 mmol

19
Q

what happens if acidosis persists and all filtered phosphate has combined

A

the kidneys use ammonia to create new bicarb

20
Q

what is the normal plasma pH, bicarb and arterial PCO2

A

plasma pH - about 7.4
bicarb - about 25
arterial PCO2 - about 40

21
Q

what is the pH proportional to ?

A

conc of bicarb / conc of CO2

22
Q

what is used if its essential to get accurate assessment of GFR?

A

51Cr-EDTA clearance

23
Q

where is the sodium chloride co transporter? what is it blocked by?

A

in the distal tubule

blocked by thiazide diuretics

24
Q

where is the sodium potassium exchanger? what blocks it?

A

in the collecting duct

blocked by K sparing diuretics e.g. spironolactone

25
Q

how do anions enter at the basolateral membrane?

A

either by diffusion or exchange for alpha-KG via OATs

26
Q

at the apical membrane, how do anions enter the lumen?

A

via MRP2 or OAT4

27
Q

how do cations enter the lumen at the apical membrane?

A

via either MRP1 or oc+/H+ anti porters

28
Q

what is the indirect result of loop diuretics? what is this beneficial in?

A

venodilation

beneficial in acute pulmonary oedema

29
Q

how do loop diuretics enter the nephron?

A

by OAT

30
Q

what do loop diuretics cause loss of?

A

potassium

31
Q

side effects of loop diuretics

A

hypomagnesia and hypocalcaemia
increased toxicity of digoxin and class 3 antidysarrhythmic drugs e.g. amiodarone
metabolic alkalosis
hyperuricaemia

32
Q

Do thiazides cause hypocalcaemia?

A

no they increase reabsorption of Ca2+

33
Q

adverse effects of thiazide diuretics

A 
hypokalaemia
hypomagnesia
metabolic alkalosis
hyperuricaemia
male sexual dysfunction if used at high dose
impaired glucose tolerance
34
Q

how do potassium sparing diuretics work?

A

they block the apical sodium potassium channel causing decreased sodium reabsorption and decreased potassium secretion
» sodium loss, potassium gain

35
Q 
Osmotic diuretics
example
how are they given 
what part of the nephron do they act on
effect 
when are they used
A

mannitol
given IV bc they’re extremely polar
act on proximal tubule
they hold onto water and cause decreased sodium reabsorption
used in prevention of acute hypovolaemic renal failure and acutely raised IOP and ICP

36
Q

what channel does aldosterone activate? where?

A

ENAC at the apical membrane

37
Q

what receptors does ADH act on ? where?

what does this cause

A

vasopressin receptors at the basolateral membrane

causes aquaporins to be inserted onto the apical membrane which water diffuses in across

38
Q

diabetes insipidus
difference between neurogenic and nephrogenic?
treatment of each?

A 
neurogenic = lack of vasopressin secretion from the posterior pituitary. treated with desmopressin 
nephrogenic = inability of nephron to respond to vasopressin. usually x linked recessive mutation in the v2 receptor gene. no current treatment
39
Q

what drugs cause water loss without accompanying sodium?

A

aquaretics “vaptans”

40
Q

when are aquaretics of value?

A

in hypervolaemic hyponatraemia

41
Q

example of a SGLT2 inhibitor

A

canagliflozin

42
Q

where to SGLT2 inhibitors work?

A

proximal tubule

Renal (9 decks)

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