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Physiology Flashcards

1
Q

What is the gold standard for calculating GFR

A

Inulin clearance

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2
Q

Does Creatinine clearance over or under estimate GFR? why?

A

Overestimates b/c it is freely filtered by glomerulus but also secreted by proximal tubule

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3
Q

Where does most electrolyte re-absorption occur?

A

proximal tubule

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4
Q

Where do loop diuretics act?

A

Thick ascending loop of Henle

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5
Q

Where do thiazides act

A

Distal tubule

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6
Q

What are the features of SIADH?

A
  1. Hyponatremia
  2. low serum osmolality, high urine osmolality
  3. normal BUN/Cr
  4. low serum uric acid
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7
Q

What happens if you correct low sodium too quickly?

A

Central Pontine Myelinolysis

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8
Q

How is renin mediated? What does it do

A

1) macula densa senses decreased Na in blood,
2) hypo perfusion of kidney,
3) afferent arteriole resistance (decrease GFR)
4) sympathetic stimulation

Converts Angiotensinogen to Angiotensin I

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9
Q

What does Angiotensin Converting Enzyme do?

A

Converts Angiotensin I to Angiotensin II

Degrades bradykinin leading to vasoconstriction

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10
Q

Where does Aldosterone come from? How is it released? What does it do?

A
  1. Adrenal gland - Glomerulus
  2. Stimulated by ATII
  3. Increases re-absorption of Na-Cl in collecting duct, acidifies urine, excretes K in distal tubule
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11
Q

What happens in RTA II

A

Defect in reabsorption of bicarb in proximal tubule leading to hyperchloremic metabolic acidosis (acidosis self limiting)

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12
Q

What happens in RTA I

A
  • Distal tubule unable to secrete H ions

- hypercloremic metabolic acidosis leads to increase in increased urinary calcium -> nephrocalcinosis

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13
Q

What is the calculation for anion gap? What is normal range?

A

Na - (Cl + HCO3)

8 - 14

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14
Q

What are some examples of causes of anion gap acidosis?

A

MUDPILES

Methanol
Uremia
Diabetic/starvation ketoacidosis
Paraldehyde
Isoniazid/iron
Lactic acid
Ethylene glycol
Salicylates
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15
Q

What are some examples of causes of non anion gap acidosis?

A

HARDUP

Hyperalimentation
Acetazolimide
RTA/Renal insufficiency
Diarrhea
Ureteroenterostomy
Pancreatic fistula
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16
Q

Why does secondary hyperparathyroidism occur in ESRD? What is treatment?

A

Impaired calcium re-absorption in distal tubule, Increased phosphatemia, lack of conversion to active form of Vital D (1-25) leading to decrease small bowel absorption of calcium;

Treatment is calcitonin

17
Q

What can occur if gadolinium is administered to an ESRD patient?

A

nephrogenic systemic fibrosis

18
Q

What are some signs of IgA nephropathy?

A
  1. recurrent acute gross hematuria after URI or exercise,
  2. young adults(2nd-3rd decade),
  3. mesangial deposits IgA
19
Q

What are some signs of post streptococcal Acute glomerulonephritis

A
  1. latent hematuria
  2. previous strep
  3. pyoderma.
  4. anti-streptolysin O positive
  5. low serum complement C3/C4
20
Q

What regulates erythropoietin

A

hypoxia -> up regulation of hypoxia inducible factor 1 alpha (HIFa)

21
Q

where does PTH act?

A

distal tubule

22
Q

What is the first to be impacted in unilateral urinary obstruction?

A

Water absorption d/t defect in aquaporin channels

23
Q

What scenarios impact sex hormone binding globulin?

A

liver dysfunction
obesity (decrease)
nephrotic syndrome

24
Q

what impact does glucose have on sodium?

A

pseudohyponatremia: for every 100 drops by 1.6

25
Q

What is the urinary sodium in intrinsic renal failure?

A

High due to lack of re-absorption

26
Q

What is the urinary osmolarity in intrinsic renal failure?

A

low due to lack of water absorption, unable to concentrate urine

27
Q

wolffian structure development is under the most influence of?

A

Testosterone

28
Q

what impairment is preserved in unilateral obstructed kidney?

A

dilution

29
Q

What is the mechanism of action of sleep apnea induced eneuresis?

A

hypoxia -> increased RA pressure -> increased ANP -> decreased ADH -> diuresis

30
Q

What is a normal Whitaker test cut off?

A

< 14 cm of H20

31
Q

What are the indications for vascular intervention in setting of hypertension?

A

Occlusion bilaterally or in solitary kidney
Stenosis > 75%
2 > Cr < 4
Failed 3 anti-hypertensives

32
Q

What does Protein C and S do?

A

Inactivate Factor Va and VIIIa -> regulates blood clotting

33
Q

What factors are affected by Vitamin K?

A

synthesizes II, VII, IX, X (extrinsic coagulation pathway) and
Protein C and S

34
Q

What factors are affected by Antithrombin?

A

inhibits IXa, Xa, XIa, XIIa (intrinsic coagulation pathway)

35
Q

What does PT measure?

A

extrinsic pathway

36
Q

What does PTT measure?

A

intrinsic pathway

37
Q

what is the definition of global pyuria?

A

> 40ml/kg in a 24hr period

38
Q

what is the definition of nocturnal pyuria?

A

> 1/3 of total urine voided

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