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Renal Step 1 > Physiology Part 2 > Flashcards

Physiology Part 2 Flashcards

1
Q

What stimulates Renin?

A

Decreased BP (JGC)
Decreased Na Delivery (MDC)
Increased sympathetic tone (B1R)

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2
Q

What are all the 6 effects of AngII?

A
  1. Acts at AT1 receptors of vascular SM
  2. Constricts efferent arteriole of glomerulus
  3. Aldosterone Secretion from Adrenal Gland
  4. ADH secretion from Post. Pituitary
  5. Increased PT Na/H activity
  6. Simulates Hypothalamus
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3
Q

What happens when AngII binds AT1 receptors?

A

Vasoconstriction–>

Increased BP

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4
Q

What happens when AngII constricts eff. afteriole?

A

Increased FF to preserve GFR in low-volume states and RBF is low

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5
Q

Aldosterone enhances ______ and ________ excretion, and creates a favorable gradient for ____ and ____ reabsorption

A

K, H, Na, H2O

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6
Q

ADH does what? This leads to what?

A

Increases H2O channel insertion in principal cells leading to water reabsorption

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7
Q

Increased PT Na/H activity increases _________ reabsorption

A

Na, HCO3, and H2O

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8
Q

Increased PT Na/H activity permits

A

Contraction alkalosis

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9
Q

AngII stimulation hypothalamus does what?

A

Increased thirst

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10
Q

AngII affects _____, which limits ________

A

Baroreceptor function

Bradycardia

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11
Q

AngII maintains what?

A

Blood volume and Blood Pressure

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12
Q

Where is ANP released from?

A

Atria

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13
Q

What is ANP released in response to?

A

Increased atrial volume

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14
Q

What does ANP act as?

A

Check on RAA system

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15
Q

ANP _____ vasc. SMC via ______

A

relaxes, cGMP

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16
Q

ANP causes _____ GFR and ____ Renin

A

Increased, decreased

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17
Q

What are the 2 things ADH regulates?

A

Osmolarity

low blood volume level

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18
Q

Which of ADH’s 2 regulating things takes precedent?

A

Low Blood Volume

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19
Q

What is Aldosterones primary job?

A

Regulates blood volume

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20
Q

In low volume states _____ and ______ protect Blood Volume.

A

ADH, Aldosterone

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21
Q

JGA consists of ______ and ______

A

JGC and MDC

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22
Q

what are JGC?

A

Modified smooth muscle of afferent arteriole

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23
Q

What are MDC?

A

NaCl sensor part of the distal convoluted tubule

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24
Q

JGC secrete ______

A

Renin

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25
Q

JGC secrete renin in response to what?

A

Decreased Renal BP
Decreased NaCl delivery to DT
Increased SNS tone (B1R)

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26
Q

JGA defends GFR via what system?

A

RAA

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27
Q

B-Blockers have what effect on JGA

A

Decrease BP by inhibiting B1R of the JGA causing decreased renin release

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28
Q

What is Epo released from?

A

Interstitial cells in the peritubular capillary bed

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29
Q

What is Epo released in response to?

A

Hypoxia

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30
Q

PT cells convert ________ to _________ via 1-alpha hydroxylase.

A

25-OH Vit. D, 1,25-(OH)2 Vit. D

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31
Q

What stimulates 1 alpha hydroxylase?

A

PTH

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32
Q

Paracrine secretion of Prostaglandins does what?

A

Vasodilates afferent arterioles to maintain GFR

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33
Q

How do NSAIDS negatively effect the kidney?

A

Inhibit renal production of prostaglandins

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34
Q

ANP causes ______ GFR and ______ Sodium filtration WITH NO compensatory Na reabsorption at the distal nephron.

A

Increased, increased

35
Q

What is the net effect of ANP?

A

Na and volume loss

36
Q

PTH is secreted in response to…

A

Decreased plasma Ca
Increased plasma Phosphate
Decreased plasma Vit. D

37
Q

PTH causes…

A

Increased Ca reabsorption (DCT)
Decreased Phosphate reabsorption (PCT)
Increased Vitamin D production (PCT)

38
Q

What additional extrarenal effect does PTH have?

A

Increased calcium and phosphate absorption from the gut

39
Q

ATII is synthesized in response to ____ BP

A

Decreased

40
Q

When it causes efferent arteriole constriction, it ____GFR and ____ FF WITH compensatory Na reabsorption in the proximal and distal Nephron

A

Increase, increase

41
Q

Net effect of ATII is…

A
  1. Preserve renal function in low volume states (Increased FF)
  2. Simultaneous Na resorption (P and D)

both to decrease volume loss

42
Q

Aldosterone is secreted in response to _______ (via ATII) and _________.

A

Decreased Blood Volume

Increased plasma K

43
Q

Aldosterone causes what?

A

Increased Na reabsorption
Increased K secretion
Increased H secretion

44
Q

ADH is secreted in response to ______ plasma osmolarity and ________ Blood volume

A

Increased, Decreased

45
Q

ADH binds to receptors on principal cells and _______ water channels and increases _______.

A

Increase number of

H2O reabsorption

46
Q

What causes hyperkalemia?

A

DO Insulin LAB:

Digitalis
HyperOsmolarity
Insulin deficiency
Lysis of cells
Acidosis
Beta antagonists
47
Q

What causes hypokalemia?

A

Hypo-osmolarity
Insulin (increases Na/K ATPase)
Alkalosis
Beta agonist

48
Q

Low serum Na concentration leads to…

A

Nausea
Malaise
Stupor
Coma

49
Q

High serum Na concentration leads to…

A

Irritability
Stupor
Coma

50
Q

Low serum K concentration leads to what on an ECG?

A

U waves

Flattened T waves

51
Q

Low serum K concentration leads to…

A

Arrhythmias

Muscle weakness

52
Q

High serum K concentration leads to what on an ECG?

A

Wide QRS

Peaked T waves

53
Q

High serum K concentration leads to…

A

Arrhythmias

Muscle weakness

54
Q

Low serum Ca concentration leads to…

A

Tetany

Seizures

55
Q

High serum Ca concentration leads to…

A

Stones (renal)
Bones (pain)
Groans (ab pain)
psychiatric Overtones (anxiety, altered mental status)

56
Q

Low serum Mg concentration leads to…

A

Tetany

Arrhythmias

57
Q

High serum Mg concentration leads to…

A 
Decreased DTR
Lethargy
Bradycardia
Hypotension
Cardiac Arrest
hypocalcemia
58
Q

Low serum Phosphate leads to…

A

Bone loss

Osteomalacia

59
Q

High serum Phosphate leads to…

A

Renal stones
Metastatic calcifications
hypocalcemia

60
Q

Metabolic acidosis (pH, Pco2, Hco3)

A

decreased, decreased, decreased

61
Q

Metabolic alkalosis (pH, Pco2, Hco3)

A

increased, increased, increased

62
Q

Respiratory acidosis (pH, Pco2, Hco3)

A

Decreased, Increased, increased

63
Q

Respiratory alkalosis (pH, Pco2, Hco3)

A

Increased, decreased, decreased

64
Q

What is the compensation for metabolic acidosis?

A

Hyperventilation (immediate)

65
Q

What is the compensation for metabolic alkalosis?

A

Hypoventilation (immediate)

66
Q

What is the compensation for respiratory acidosis?

A

Increased renal HCO3 reabsorption (delayed)

67
Q

What is the compensation for respiratory alkalosis?

A

Decreased renal HCO3 reabsorption (delayed)

68
Q

What is the henderson-Hasselbach equation?

A

pH=6.1+log(HCO3 conc.)/0.03PCO2

69
Q

If the measured PCo2 differs significantly from the predicted PCo2, then ________ is likely present

A

Mixed acid-based disorder

70
Q

What causes hypoventilation?

A

Airway obstruction
Acute/chronic lung disease
Opioids/sedatives
Weakening of respiratory muscles

71
Q

What causes an increased anion gap?

A 
MUDPILES
Methanol (formate)
Uremia
Diabetic Ketoacidosis
Propylene glycol
Iron tables or INH
Lactic Acidosis
Ethylene glycol (oxalate)
Salicylates (late)
72
Q

What causes a normal anion gap?

A 
HARD ASS
Hyperalimentation
Addison's disease
Renal tubular acidosis
Diarrhea
Acetozolamide
Spironolactone
Saline infusion
73
Q

What causes respiratory alkalosis?

A

Hyperventilation (eg. early high altitude exposure)

Salicylates (early)

74
Q

What causes metabolic alkalosis?

A

Loop diuretics
Vomitting
Antacid use
hyperaldosteronism

75
Q

What is type 1 distal RTA?

A

Defect in CT ability to excrete H

76
Q

Untreated patients with type 1 distal RTA have a urine pH of _______

A

> 5.5

77
Q

Patients with type 1 distal RTA have a ________ risk for _________ as a result of ________ urine pH and ________.

A

increased
calcium phosphate kidney stones
increased
bone resorption

78
Q

Type I distal RTA is associated with ________

A

hypokalemia

79
Q

What is type 2 proximal RTA?

A

Defect in PT HCO3 resorption

80
Q

type 2 proximal RTA can be seen with _______ syndrome

A

Fanconi’s

81
Q

Untreated patients with type 2 proximal RTA typically have a urine pH of _________

A

<5.5

82
Q

Type 2 proximal RTA is associated with ________, and patients with this are at increased risk for _______

A

hypokalemia

hypophosphatemic rickets

83
Q

What is type 4 hyperkalemic RTA?

A

Hypoaldosteronism or lack of CT response to aldosterone

84
Q

In type 4 hyperkalemic RTA, the hyperkalemia impairs _____ in the ________, leading to ______ and ______urine pH.

A

ammoniagenesis
proximal tubule
decreased buffering capacity
decreased

Renal Step 1 (6 decks)

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