Renal Flashcards by Emily Brayne

Blood vessel into glomerulus

Afferent Arteriole

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

Glomerulus and Bowmans Capsule

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Three layers of kidney

Renal cortex- contains corpuscules and convoluted tubules

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

Renal pelvis-

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Blood flow to kidney

Abdominal aorta
Renal artery
Afferent arteriole

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Blood flow from kidney

Efferent arterole
Renal vein
Inferior vena cava

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Bowmans capsule

Contains glomerulus

Arterioles enter bowman

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Cluster of blood vessels in bowmans capsule

Glomerulus

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Proximal convoluted tubule

Reabsorption of water, ions, nutrients

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Loop of Henle

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

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Distal convoluted tubule

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

Diuretics/antidiuretics work here

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Collecting System

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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Hydrostatic Pressure

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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Hydrostatic Pressure is affected by:

Systemic Blood pressure

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AKI Definition

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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AKI Characteristics

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

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Pre-renal

Decreased blood supply to kidneys

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

Intra-renal

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

Post renal

Resulting from obstruction below renal pelvis

Kidney stones, prostate, cancer, fibroids

Acute Vs Chronic

Acute- sudden, rapid, reversible

Chronic- progressive, non reversible, nephron less

Management of AKI

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

RASS System

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

Part of nephron which chiefly regulated reabsorption of potassium

Distal convoluted tubule

Kidneys produce the following substances

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

Aldosterone

AG2 causes release of aldosterone

increases sodium retention and water reabsorption

Anti-diuretic hormone

-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

Antidiuretic hormone- negative feedback loop

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

Atrial Natriuretic Peptide (ANP)

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

Hyperkalaemia treatment

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

Renal replacement therapy- processes

``` Filtration Convection Adsorption Diffusion Osmosis ```

Indications for RRT

``` Acidosis Electrolyte disturbance Toxins/Drugs Fluid overload Uraemia Temperature Control ```

Filtration

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

Convection

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

Adsorption

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

Diffusion

Movement of solutes from high to low concentration | Passive process

OSMOSIS

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

CVVHD

Diffusion and ultrafiltration to remove waste products | Dialysate rate determines rate of clearance

Anticoagulation

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

Fluid Management

Insensible losses: 800ml | Therapeutic window to treat AKI-conceptual framework