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Kidney + Liver + Endocrine > Quick Hits - Kidney COPY > Flashcards

Quick Hits - Kidney COPY Flashcards

1
Q

What 4 things does the kidney produce?

A

Renin

Erythropoietin (Secreted in response to hypoxia)

Calcitriol (converts inactive Vitamin D to active)

Prostaglandins - vasodilate renal arteries, Thromboxane A2 constricts the renal arteries

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2
Q

What is the function of aldosterone?

A

Controls extracellular volume
(Na and water are reabsorbed together)

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3
Q

What is antidiuretic hormone?

A

Produced in the hypothalamus and stored in the posterior pituitary

Water is reabsorbed but Na is not

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4
Q

How is long, intermediate, and short term BP controlled?

A

Long - thirst and sodium/water excretion

Intermediate - Renin, aldosterone, angiotensin system

Short- Baroreceptor reflex

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5
Q

Which two organs maintain pH balance?

A

Kidneys - titrating non volatile acids (Hydrogen)

Lungs- volatile acids (CO2)

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6
Q

How can the kidneys regulate glucose homeostasis?

A

The kidneys can synthesize glucose from amino acids

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7
Q

How much of the Cardiac output do the kidneys receive ?

A

25% or 1250 mL

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8
Q

What are the parameters of autoregulation?

A

MAP 50-180
Sys - 80-180

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9
Q

Which area of the kidney is more sensitive to hypotension?

A

Medulla because it only receives 10% of the renal blood flow why the cortex receives 90%

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10
Q

Blood pathway through the kidneys?

A
  1. Renal artery
  2. Renal segmental artery
  3. Interlobar artery
  4. Arcuate Artery
  5. Interlobar artery
  6. Afferent arterioles
  7. Glomeular bed
  8. Efferent arterioles
  9. Peritubular bed
  10. Venules
  11. Interlobar vein
  12. Arcuate vein
  13. Interlobar vein
  14. Renal segmental vein
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11
Q

How does the kidney respond if they perfusion is too low? Too high?

A

Too low -increases flow by reducing renal vascular resistance

Too high - decreases flow by increasing renal vascular resistance

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12
Q

Is urine autoregulated?

A

NO, it’s lineraly related to MAP

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13
Q

What are the most important mechanisms to renal autoregulation?

A

Myogenic Mechanism - Constriction or dilation of afferent arteriole

Tubuloglomerular feedback- juxtaglomerular negative feedback of chloride and sodium

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14
Q

What renal structures receive sympathetic innervation? Which levels?

A

Afferent and efferent arterioles

T8 - L1

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15
Q

How does ischemia, sepsis, and surgical stress affect the kidneys?

A

Vasoconstricts and retains sodium

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16
Q

How does vasoconstrtion and sodium retention affect renal blood flow, GFR, Urine output, and sodium excretion?

A

Decreases all of them

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17
Q

How does prostaglandins, ANP, and Kinins affect the kidneys?

A

Causes vasodilation and sodium excretion

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18
Q

How does vasodilation and sodium excretion affect the RBF, GFR, Urine output, and sodium excretion?

A

Increases them

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19
Q

Which three things increase renin release?

A

1, Decreased renal perfusion
2. Beta 1 stimulation (SNS activation)
3. Decreased Na and Cl delivery to the distal tubule (Tubuloglomerular feedback)

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20
Q

Where is aldosterone synthesized?

A

Zona Glomerulosa of the adrenal gland

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21
Q

How does ADH affect the aquaporin-2 channels?

A

It upregulates them

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22
Q

Which two mechanisms control the release of ADH?

A
  • Increased osmolarity
  • Decreased blood volume
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23
Q

How does ADH restore blood pressure?

A
  1. Stimulates V1 receptor which causes vasoconstriction (IP3, DAG, CA)
  2. Stimulates V2 receptor in the collecting ducts (Increased cAMP) which upregulates aquaporin 2 channels
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24
Q

Which three pathways promote renal vasodilation?

A
  1. Prostaglandins
  2. Natriuretic peptides
  3. Dopamine receptors
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25
Q

How can NSAIDS affect the kidneys?

A

Harm them through inhibition of COX. (this prevents renal arteries from vasodilating)

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26
Q

What is the response from the kidneys with increased ANP?

A

Inhibit renin release

Promote Na and water excretion

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27
Q

What is fenoldopam?

A

Selective DA1 receptor agonist that increases renal blood flow

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28
Q

What is a normal GFR? What substances are freely filtered?

A

125mL/min

Water, electrolytes, and glucose are filtered

Plasma protein are not

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29
Q

What is the most important determinant of GFR?

A

Glomerular hydrostatic pressure which determined by arterial BP, afferent arteriole resistance, and efferent arteriole resistance

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30
Q

nephron photo

A
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31
Q

photo

A
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32
Q

**What is reabsorption?

A

Substance is transferred from the tubule to the peritubular capillaries

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33
Q

**What is secretion?

A

Substance is transferred from the peritubular capillaries to the tubule

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34
Q

What is excretion?

A

Substance is removed from the body to urine

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35
Q

What is an example of maximum transport?

A

Glucose - only so much can be transported so the excess is eliminated through the urine

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36
Q

Where does the bulk of reabsorption of solutes and water occur?

A

Proximal convoluted tubule

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37
Q

What occurs in the descending loop of Henle?

A

Forms concentrated urine

Permeable to water and solutes

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38
Q

What occurs in the ascending loop of Henle?

A

Not permeable to water

Reabsorbs 20% of sodium

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39
Q

What occurs in the distal convoluted tubule?

A

Fine Tunes solute concentration

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40
Q

What occurs in the collecting duct?

A

regulation of final concentration of water

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41
Q

Where does aldosterone and ADH act on the nephron?

A

Collecting ducts

Distal tubule

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42
Q

What is ADH’s effect on water and solutes?

A

Retains water but not solutes

43
Q

What is aldosterone’s effect on water and solutes?

A

Retains both water and solutes

Increases K and H secretion

44
Q

Where does the parathyroid hormone promote Calcium reabsorption?

A

Distal tubule

45
Q

Which part of the nephron is impermeable to water?

A

Ascending loop of Henle

46
Q

Examples of carbonic anhydrase inhibitors? Where do they work? When are they used?

A

Acetazolamide

Proximal tubule

Binds to carbonic anhydrase which reduces the reabsorption of Bicarb, Na, and water

Causes metabolic acidosis
Causes urine to be alkaline

Useful in high altitude, glaucoma, and sleep apnea

47
Q

Examples of osmotic diuretics? Where do they work? When are they used?

A

Mannitol, Glycerin, Isosorbide

Undergoes filtration but not reabsorption in the proximal tubule. Increases Plasma osmolarity

Mannitol is a free range scavenger

Can cause cerebral edema if the BBB is disrupted

48
Q

Examples of loop diuretics? Where do they work? When are they used?

A

Lasix, Bumex, Ethacrynic acid

Ascending loop of Henle

They disrupt the Na-K-Cl transport which forces solutes to stay in the tubule

Can cause ototoxicity, low electrolytes, muscle weakness, reduced lithium clearance

49
Q

Examples of thiazide diuretics? Where do they work? When are they used?

A

Hydrochlorothiazide, Chlorthalidone

Inhibits Na-Cl in the distal tubule

***causes hyperglycemia

50
Q

Examples of potassium sparing? Where do they work? When are they used?

A

Spironolactone (aldosterone antagonists), amiloride

Collecting ducts

Side effects, Hyperkalemia, metabolic acidosis, gynecomastia, libido changes, nephrolithiasis

51
Q

Which three drug classes increase the risk of hyperkalemia in a patient who is taking a K sparing diuretic ?

A

NSAIDs, Beta blockers, Ace inhibitors

52
Q

What are the best tests of tubular function?

A

Urine osmolality

Fractional excretion of sodium

53
Q

What are the best tests of GFR?

A

BUN and creatinine clearance

54
Q

A BUN < 8 indicates?

A

-Overhydration
-Decreased Urea production (malnutrition or liver disease)

55
Q

A BUN of 20-40 indicates?

A

-Dehydration
-Increased protein input
-Decreased GFR

56
Q

A BUN > 50 indicates?

A

Decreased GFR

57
Q

Why is serum creatinine a useful indicator of GFR?

A

Creatinine undergoes renal filtration but not reabsorption

58
Q

A 100% increase in creatinine indicates?

A

a 50% reduction in GFR

59
Q

Normal BUN: Creatinine ratio?

A

10:1

60
Q

A BUN:Cr ration of >20:1 indicates?

A

Prerenal azotemia

61
Q

What is the fractional excretion of sodium?

A

Relates to sodium clearance to creatinine clearance

62
Q

If the fractional excretion of sodium is less than 1%, what does this indicate?

A

More sodium is conserved to the amount creatinine is cleared

Suggestive of pre renal azotemia

63
Q

If the fractional excretion of sodium is greater than 3%, what does this indicate?

A

More sodium is excreted relative to the amount of creatinine cleared

Suggestive of impaired tubular function

64
Q

What amount of protein in the urine indicates glomerular injury?

A

> 750mg/day

65
Q

Urinary sodium less than 20 indicates?

A

Prerenal oliguria

66
Q

Urinary sodium greater than 20 indicates?

A

Acute tubular necrosis

67
Q

Urine osmolality > 500 indicates?

A

Pre renal oliguria

68
Q

Urine osmolality < 400 indicates?

A

Acute tubular necrosis

69
Q

Most common cause of perioperative kidney injury?

A

Ischemia - reperfusion injury

70
Q

Normal BUN, Creatinine, and Creatinine clearance? What does this indicate?

A

Best to assess GFR

BUN 10-20
Creatinine .7-1.5
Creatinine Clearance 110-150

71
Q

What is creatinine ?

A

Breakdown of muscle

72
Q

What is the most useful indicator of GFR?

A

Creatinine Clearance

73
Q

Kidney function

A
74
Q

Absolute contraindications to lithotripsy?

A

Pregnancy
Risk of bleeding

75
Q

What is a risk of percutaneous nephrolithotripsy

A

Pneumothorax

76
Q

Most common anesthetic for a TURP? What level?

A

Neuraxial T10

77
Q

CKD stages? What lab value?

A
78
Q

What are the most common causes of CKD?

A
  1. Diabetes
  2. HTN
79
Q

What is the most common event during dialysis ?

A

Hypotension

80
Q

Ways to prevent kidney injury related to contrast?

A

-Lowest volume of contrast
-Iso or low osmolar contrast
- Hydrate with 0.9%
-Use sodium bicarb
- N acetylcysteine is a free radical scavenger

81
Q

How can sevo harm the kidneys?

A

Compound A

Free fluoride ions

82
Q

Nephrotoxic antibiotics?

A

‘mycin

and

amphotericin B

83
Q

Which paralytic should be avoided with low kidney function?

A

Pancuronium

84
Q

Which kidney injury is associated with hypoalbuminemia?

A

Nephrotic syndrome because they lose the protein in the urine

85
Q

Which irrigation fluid presents the greatest risk for microshock during a TURP?

A

LR or .9 because they are highly ionized and good conductors

86
Q

Which diuretic is the most likely to increase preload?

A

Mannitol, glycine, isosorbide

87
Q

Which hormone controls plasma osmolarity ?

A

ADH

88
Q

Which hormone controls ECF?

A

Aldosterone

89
Q

Which 6 mechanisms regulate the renal blood flow

A
  1. Myogenic
  2. Tubuloglomerular feedback
  3. Renin-angiotensin-aldosterone
  4. Prostaglandins
  5. ANP
  6. SNS
90
Q

What are the 3 determinants of glomerular hydrostatic pressure?

A

Arterial blood pressure

Afferent arteriole resistance

Efferent arteriole resistance

91
Q

What is the most accurate predictor of bleeding risk?

A

Bleeding time

92
Q

List the S&S of uremic syndrome?

A

Anemia
Fatigue
N/V
Anorexia
Coagulopathy

93
Q

Why does anemia occur in patients with chronic renal failure?

A

Decreased production of erythropoietin

94
Q

What is the most common cause of death in chronic renal failure patients?

A

CAD

95
Q

What leads to gap metabolic acidosis in chronic renal failure patients?

A

Decreased excretion of non-volatile acids (hydrogen)

96
Q

At what potassium level is dialysis recommended?

A

> 6

97
Q

Which opioids are best in renal failure?

A

Any of the Fent’s

98
Q

Which paralytics are best in renal failure?

A

Benzylisoquinolines

  1. Cisatracurium
99
Q

What are the three signs of TURP syndrome?

A

HTN
Bradycardia
Mental status change

100
Q

What sodium level will seizures occur?

A

<110

101
Q

Rough estimate of blood loss per minute during TURP?

A

2-5 ml of blood per resection time

102
Q

With a neuraxial block, how does a bladder perforation present?

A

Abdominal and shoulder pain

103
Q

What is increased with a patient who has renal osteodystrophy?

A

Phosphate and parathyroid hormone

2 P’s

104
Q

Does the dose of anticholinesterase inhibitors need to be changed with renal injury?

A

No

Kidney + Liver + Endocrine (6 decks)

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