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Critical Care Course > Renal > Flashcards

Renal Flashcards

1
Q

Blood vessel into glomerulus

A

Afferent Arteriole

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2
Q

Which of thevnephron is actively involved in the process of filtration?

A

Glomerulus and Bowmans Capsule

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3
Q

Three layers of kidney

A

Renal cortex- contains corpuscules and convoluted tubules

Renal medulla- loops of Henley and collecting tubules and renal pyramids

Renal pelvis-

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4
Q

Blood flow to kidney

A

Abdominal aorta
Renal artery
Afferent arteriole

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5
Q

Blood flow from kidney

A

Efferent arterole
Renal vein
Inferior vena cava

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6
Q

Bowmans capsule

A

Contains glomerulus

Arterioles enter bowman

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7
Q

Cluster of blood vessels in bowmans capsule

A

Glomerulus

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8
Q

Proximal convoluted tubule

A

Reabsorption of water, ions, nutrients

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9
Q

Loop of Henle

A

Further reabsorption water (descending limb) and both sodium and chloride ions (ascending limb)

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10
Q

Distal convoluted tubule

A

Secretion of ions, acids, drugs, toxins.
Variable reabsorption of water sodium and calcium (hormone controlled)

Diuretics/antidiuretics work here

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11
Q

Collecting System

A

Collecting Duct -variable reabsorption of water and reabsorption/secretion of sodium, hydrogen and bicarb ions

Papillary duct- delivery of urine to minor calyx

ureter

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12
Q

Hydrostatic Pressure

A

pressure exerted by any fluid in a space

Consists of 3:
Glomerular hydrostatic pressure (55mm hg)
Blood osmotic pressure (30mmhg)
Capsular hydrostatic pressure (15mmhg)

overall net outward pressure = 10mmhg

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13
Q

Hydrostatic Pressure is affected by:

A

Systemic Blood pressure

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14
Q

AKI Definition

A

Acute kidney injury is an abrupt decline in glomerular filtration
failure of kidneys to excrete waste products of metabolism
inability to maintained electrolyte and acid base homeostasis

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15
Q

AKI Characteristics

A 
Reduction in GFR
High urea/ creatine
Reduce urine output
electrolyte imbalance
drowsiness
Labile BP
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16
Q

Pre-renal

A

Decreased blood supply to kidneys

ie: Dehydration, renal artery thrombosis, low bp, medications

17
Q

Intra-renal

A

Abnormalities within kidney
Ie: Infection, rabdomyolysis, medications NSAIDS for example, cancer, tumorlysis, vasculitis, acute tubular necrosis, contrast, ischeamia, toxins.

18
Q

Post renal

A

Resulting from obstruction below renal pelvis

Kidney stones, prostate, cancer, fibroids

19
Q

Acute Vs Chronic

A

Acute- sudden, rapid, reversible

Chronic- progressive, non reversible, nephron less

20
Q

Management of AKI

A
  • Haemodynamic monitoring and support
  • control sugars
  • fluid management isotonic crystalloids
  • nutritional support
  • diuretics (fluid overload)
  • Low use contrast
  • Initiate RRT in life threatening electrolyte/fluid changes
21
Q

RASS System

A 
Drop In BP
Macula densa cells (stimulated)
Constriction of afferent arteriole
reduction in filtration rate (GFR)
renin released by the JGA
renin to liver = AG1
AG1 to lungs changed to AG2 with ACE
AG1 causes vasoconstriction
This increases vascular resistance and maintains hydrostatic pressure
22
Q

Part of nephron which chiefly regulated reabsorption of potassium

A

Distal convoluted tubule

23
Q

Kidneys produce the following substances

A

Renin- JGA
Calcitrol- cells in proximal convoluted tubule
Erythropoetin- kidneys- bone marrow to produce red blood cells

24
Q

Aldosterone

A

AG2 causes release of aldosterone

increases sodium retention and water reabsorption

25
Q

Anti-diuretic hormone

A

-Secreted by posterior pituitary
-Increases water permeability in the tubule increased reabsorption of water= reduced urine output
A lack of ADH leads to excessive urine output (diabetes insipidus)
-Negative feedback

26
Q

Antidiuretic hormone- negative feedback loop

A

Osmoreceptors in hypothalamus detect rise in plasma osmolarity
ADH secreted by posterior pituitary gland
Binds to collecting duct
Causing water channels to open therefore water is reabsorbed into blood.
Stimulation of osmoreceptors decreases

27
Q

Atrial Natriuretic Peptide (ANP)

A

Opposite of ADH
Atrial wall cell receptors- stretch
Releases ANP
Down regulated renin and AG2 and Aldosterone
Causes increased GFR
Diureses
Reduction in blood volume and blood pressure

ANP also causes vasodilation and reduction in BP

28
Q

Hyperkalaemia treatment

A 
IV Calcium chloride or gluconate- protects cardiac muscle
Insulin-Glucose infusion
Salbutamol
Sodium Ziconium
Consider Dialysis
29
Q

Renal replacement therapy- processes

A 
Filtration
Convection
Adsorption
Diffusion
Osmosis
30
Q

Indications for RRT

A 
Acidosis
Electrolyte disturbance
Toxins/Drugs
Fluid overload
Uraemia
Temperature Control
31
Q

Filtration

A

Ultrafiltration
Movement of fluid through semi-permeable membrane caused by a pressure gradient
High to low
Positive, negative and osmotic pressure from non-permeable solutes
Ie in Glomerulus

32
Q

Convection

A

Water pushed across dialysis filter and carries solute from blood stream
known as solvent drag
Hydrostatic pressure involved
Pressure gradient

33
Q

Adsorption

A

Filter attracts solute, molecules and attach to filter
Rapid onset
size of molecules affects

34
Q

Diffusion

A

Movement of solutes from high to low concentration

Passive process

35
Q

OSMOSIS

A

Movement of water across semipermeable membrane
from and area of high to low concentration to produce equilibrium
passive
based on solute concentration

36
Q

CVVHD

A

Diffusion and ultrafiltration to remove waste products

Dialysate rate determines rate of clearance

37
Q

Anticoagulation

A

Citrate:
Decreases ionised calcium- prevents clotting
Prolongs circuit life
Heparin

38
Q

Fluid Management

A

Insensible losses: 800ml

Therapeutic window to treat AKI-conceptual framework

Critical Care Course (6 decks)

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