Renal 1 Flashcards by Paige Hamay

the kidney is located outside what cavity? what is the purpose of this location? between what vertebral levels are the kidneys found at?

outside peritoneal/retroperitoneal; purpose is for protection (spinal column, ribs, and muscles protect them); T12-L3

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which kidney is positioned lower?

right

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where do kidney stones usually get stuck?

in flattened angle of the ureter close to the bladder entrance (“ureterovesicle”)

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what three things does the renal cortex contain?

nephrons, glomeruli, and tubular structures

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what two things does the renal medulla contain?

pyramids and pelvis

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what does the renal artery branch from?

aorta

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what’s the function of the major and minor calyx?

drainage

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how many lobes are in each kidney? what two things make up a kidney lobe?

18- cortex and pyramid

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each glomerulus has its own what?

afferent arteriole

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where does the renal vein drain to?

IVC

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what’s the functional unit of the kidney? what two things does it contain?

nephron: glomerulus and tubular structures

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what are the four tubular structures of the kidney?

proximal convoluted tubule, loop pf henle, distal convoluted tubule, collecting tube

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what are the two vascular components of the nephron?

glomerulus and peritubular capillaries

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how many nephrons are in each kidney? what is reabsorbed here?

1 million; sodium and water (how urine is made and concentrated)

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what are the five components of the juxtamedullary nephron? what components are in the medulla vs the cortex?

renal corpuscle, proximal tubule, nephron loop, distal tubule, and collecting duct; renal corpuscle, prox tubule, distal tub, some upper part of nephron loop, and upper part of collecting duct

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what are the 5 vascular components of the renal corpuscle?

arcuate artery, interlobular artery, afferent arteriole, glomerulus, efferent arteriole

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what three things make up excretion?

filtration - reabsorption + secretion

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_____________ is important for filtration. ____________ ____________ are important for reabsorption.

glomerulus; peritubular capillaries

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what three things does the renal corpuscle contain?

glomerulus, bowman capsule, mesangial cells

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what is ultrafiltration used for? where does it occur? what type of pressure is needed for it?

used to filter out waste; glomerulus; very high pressure

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what are the two functions of the glomerular basement membrane?

1) . determines permeability of the glomerulus capillary membrane
2) . keeps RBCs and plasma proteins from passing into urine

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what three things are in the filtration apparatus that together perform glomerular ultrafiltration?

glomerular capillary endothelium, GBM, and visceral layer of Bowman capsule

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six basic functions of the kidney

1) . filters/reabsorbs substances (K, Na, PO4)
2) . filters waste (1.5 L/day)
3) . regulates volume and composition body fluids (Na/K balance)
4) . blood pressure (renin-angiotensin system)
5) . Ca metabolism
6) . RBC production (erythropoietin)

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how is urine formed?

via filtration of blood by the glomerulus, tubular reabsorption of electrolytes/nutrients, and eliminating waste

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what is GFR? what is the average rate?

rate of blood filtered by the glomerulus; 125 mL/min

when a patient has uncontrolled DM, what sometimes happens to filtration?

amount of substances filtered exceeds the transport max (which is 320 mg/min)

what is the average urine output?

60 mL/hr

what part of the nephron is where 65% of reabsorption and secretory processes occur?

proximal convoluted tubule

what two things does active sodium transport mechanisms facilitate?

sodium reabsorption and cotransport of electrolytes

where is the majority of the glomerular ultrafiltrate reabsorbed?

proximal convoluted tubule

what part of the nephron controls the concentration of urine? how does it do this?

loop of henle; reabsorbs water so that we have more waste

what part of the nephron reabsorbs NaCl?

distal convoluted tubule

what part of the nephron reabsorbs water?

collecting duct

what is the hormone that is regulating urine concentration?

ADH

what does ADH do for the kidney? (increases 3 things)

increases the water permeability of the principal cells, activity of NaK-2Cl cotransporter, and urea permeability

what happens if there are low levels of ADH? what two parts of the nephron are most affected by this?

you get hypo-osmotic urine (dilute); distal tubule and collecting ducts are impacted because they become impermeable to water

what is SIADH? what happens with this syndrome?

syndrome of inappropriate antidiuretic hormone; secretes inappropriately high levels of ADH which promotes high levels of water reabsorption in the collecting ducts

what two things are the result of SIADH?

hyperosmotic urine (concentrated) and dilutes plasma osmolarity

what is tx for SIADH? (5 things)

basically diet and normal saline titrated slowly: fluid restriction, replacement of Na (be careful of central pontine myelinolysis), demeclocycline (inhibits ADH action on renal principal cells) not bolded options: mannitol and loop diuretics

what percent is hypertonic saline?

what is the arterial renal circulation starting from the aorta?

aorta, renal artery, segmental artery, interlobar artery, arcuate artery, cortical radiate artery, afferent arteriole to glomerulus

what is the venous renal circulation starting after the peritubular capillaries?

PT caps, cortical radiate vein, arcuate vein, interlobar vein, renal vein, inferior vena cava

6 things that can regulate renal blood flow

sympathetic activity, angiotensin II, ANP, Dopamine, Prostaglandins, autoregulation by juxtamedullary complex

increasing sympathetic activity has what impact on renal blood flow?

increasing activity constricts afferent and efferent arterioles, which decreases renal flow

angiotensin II has what impact on renal blood flow?

it vasoconstricts renal vessels, which decreases renal blood flow

ANP has what impact on renal blood flow?

it vasodilates afferent arterioles and vasoconstricts efferent arterioles (more vasodilator properties); mostly decreases vascular resistance and increases GFR

dopamine has what impact on renal blood flow?

vasodilates and increases flow

prostaglandins have what impact on renal blood flow? what two prostaglandins are mentioned in this ppt?

vasodilates and protective renal blood flow; PGE2 and PGI2

what impact does NSAID use have on prostaglandins?

NSAIDS inhibit prostaglandins, which decreased renal blood flow and GFR

what is GFR? what is the normal rate?

the amount of filtrate formed each minute; normally greater than 90 mL/min

what is the ideal glomerular marker? what is the easiest marker to assess though?

inulin; creatinine

definition of renal clearance

volume of plasma that's completely cleared of a substance by the kidneys per unit time

the ______ the renal clearance, the _______ plasma that is __________ of that substance

higher; more; cleared

high renal clearance = what? low renal clearance = ?

high: removed on a single pass through the kidney low: may not be removed at all

what two things regulate sodium and potassium elimination?

1) . GFR | 2) . humoral agents (aldosterone and ANP)

how does aldosterone affect sodium/potassium elimination?

causes sodium to be reabsorbed and potassium to be excreted into tubular fluid

what does ANP (atrial natriuretic peptide) do to aldosterone, sodium, and ADH?

inhibits aldosterone secretion and sodium reabsorption; inhibits ADH release which then increases excretion of water by the kidneys

what are the 3 main urine buffers?

bicarbonate, phosphate, and ammonia

what are four steps of uric acid elimination?

1) . uric acid is filtered in the glomerulus 2) . secreted in proximal tubules 3) . reabsorbed in medullary collecting ducts 4) . uric acid is then excreted in the urine

urea elimination: 2 steps

1) . kidneys filter urea in the glomeruli | 2) . reabsorption in the tubules

what does urea elimination maintain?

BUN levels

what is uric acid a product of? the kidney eliminates what % of the body's uric acid?

purine metabolism; 70%

what two things are decreased in the elderly (drug elimination wise)?

glomerular filtration and tubular secretion

ionized drugs are _____-_____; nonionized drugs are ______-________

water-soluble; lipid-soluble

glomerular filtration decreases _____% from age 25 to age 65 and ____% by age 90

30%; 48%

tubular secretion decreases _____% from age 25 to age 65 and ____% by age 90

38%; 62%

kidneys produce _______ _________ that travel through the _______ to ______ sites where they exert different actions

chemical mediators; blood; distant

kidneys maintain BP control through what system?

RAAS

kidneys maintain Ca++ metabolism by what?

activating vitamin D

kidneys regulate RBC production by what? RBCs form where?

secretion of erythropoietin; bone marrow

anemia secondary to decreased production of RBCs could result from what two things?

1) . problem with EPO secretion OR | 2) . problem with bone marrow

in renal failure, the kidneys ability to secrete ____ is diminished, which can result in ______.

EPO; anemia

if renal failure is the cause of anemia, one would also see ____________ ____________ and elevated _____ and __________.

electrolyte abnormalities; BUN, creatinine

on a UA, you examine the _________, _____________, and __________ of urine. you evaluate for ____________, ____________, and ____________.

appearance, concentration, and content; evaluate for infection, disorders, diseases

what two things in a UA are signs of infection?

nitrite and leukocytes

how long might it take for nitrites to show up in a lab test?

24 hrs

GFR is the preferred gauge of evaluating what?

renal function

as the GFR increases, BUN and creatinine _________

decreases

if you don't have inulin values or a BMP, you can also use _________ ____________ to figure out GFR

creatinine clearance

what two values on a BMP are most useful in terms of looking at renal function?

BUN and Creatinine

Fractional excretion of sodium = ______________ divided by ______________

clearance of sodium; glomerular filtration rate

what is FENa?

fractional excretion of sodium

if FENa is below 1%, what category of kidney disease is it?

prerenal (inc in sodium reabsorption caused by volume depletion or low output heart failure)

if FENa is above 2%, what category of kidney disease is it?

acute tubular necrosis OR other kidney damage (excess sodium is lost to tubular damage or hypervolemia causes normal sodium wasting)

if FENa is intermediate (between 1 and 2), what category of kidney disease is it?

either disorder (renal tract obstruction- lower # in early dz and higher # in later dz)

what is normal adult urine output?

0.5-1 ml/kg/hr

what is oliguria rate? (low urine output)

<400 cc in 24 hrs

what is anuria rate? what patients does this usually occur in?

<50 ml in 24 hrs; dialysis pt

most common cause of prerenal failure?

dehydration

what is prerenal failure characterized by?

marked decrease in blood flow

when blood flow falls below ___%, then __________ changes occur, which lead to morbidity and mortality

25%, ischemic

what % of kidney probs are prerenal, intra renal, and post renal

prerenal: 40-70% intra renal: 20-50% post renal: 10-20%

high doses of dopamine can ________ perfusion to the kidney

decrease

prerenal failure presents with what?

acute reduction in amount of urine output

what is maintenance phase of ATN marked by?

a decrease in GFR