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My Patho Cards > Renal > Flashcards

Renal Flashcards

1
Q

Do you want to be hypertonic or hypotonic in the medulla?

A

Hypertonic

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2
Q

Do you want to be hypertonic or hypotonic in the Cortex?

A

Hypotonic

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3
Q

What occurs in the PCT

A

Reabsorption of Salts, Water, Glucose, AA

Secretion of Organic Wastes, Metabolites, Drugs/Toxins

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4
Q

Where in the kidneys is urine concentrated?

A

Collecting Ducts (Hypertonic interstitium/vasa recta)
Loop of Henle (Na/water balance)
Juxtamedullary Nephrons (think loop)

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5
Q

Where is the best place for urine concentration?

A

Loop of Henle

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6
Q

What is permeable in the DESCENDING loop?

A

Water (it is moving out)

It is impermeable to NaCL (stays in)

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7
Q

What is permeable in the ASCENDING loop?

A

NaCl (moving out)

Impermeable to water (staying in)

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8
Q

What 2 places in the kidneys are responsible for blood pressure and blood volume?

A

DCT
Juxtamedullary Nephrons

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9
Q

What is the MOA of the DCT?

A

Maintanance of blood pressure and blood volume.
Triggers Renin from the JGA.
Aldosterone works here
Hypotonic

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10
Q

What is the purpose of the glomerulus?

A

Filtering

Losing proteins, glucose, blood cells into the urine

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11
Q

Urea is secreted by what in the kidneys?

A

Collecting Ducts

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12
Q

Where is there bulk water movement and what hormone is involved?

A

Collecting Ducts
ADH inserts aquaporins

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13
Q

Where is the hypertonic interstitium located?

A

Collecting Ducts

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14
Q

What does the hypertonic interstitium do?

A

Concentration of urine in the vasa recta

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15
Q

In DI the kidneys are not responding to ____________, therefore they are not absorbing water

A

ADH

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16
Q

What is located in the Cortex?

A

-Afferent/Efferent Arterioles
-Glomerulus
-PCT/DCT
-Proximal portions of the Collecting Duct & Interstitium

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17
Q

What occurs in the Minor and Major Calyx?

A

Precipitation of urine into renal pelvis

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18
Q

What is the primary blood supply to kidney and it’s importance?

A

Renal Artery-> Leads to GFR

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19
Q

What is located in the Nephron?

A

Afferent/Efferent arterioles
Glomerulus

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20
Q

What lab work monitors Glomerulus fxn?

A

GFR, BUN/Crt

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21
Q

What is used for the Na/K to Cl transport?

A

Loop Diuretics

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22
Q

Where does Spironolactone works?

A

DCT

23
Q

Where is the main place for Na reabsorption->water reabsorption?

A

PCT

24
Q

What does the (Loop) Medullary Interstitium regulate?

A

Regulates interstitium Na concentration

25
Q

The tubules are all about __________ & ___________.

A

Absorption; Secretion

26
Q

What happens to diseases of the tubules?

A

Na/Water imbalances
Acid/base imbalances
Loss of cells into the urine (cast formation)

27
Q

What labs should be monitored during tubular disease?

A

FENa (overall volume in the urine, urine concentration)
Look for casts (proteins or cells)

28
Q

What are the 2 types of glomerular diseases?

A

Nephrotic & Nephritic Syndromes
Glomerulus vs Tubular Interstitium

29
Q

What are the problems that affect GFR?

A

Glomerular dx
AKI/ATN
Infection/Obstruction downstream

30
Q

What is azotemia?

A

Elevated BUN/Creatine related to dec GFR

31
Q

What are the 3 types of Azotemia?

A

Pre-renal
Renal
Post-renal

32
Q

What causes pre-renal azotemia

A

Dec blood flow to the kidneys

33
Q

Examples of Pre-renal causes

A

**Renal artery stenosis
Hemorrhage
Shock
Coagulation d/o
CHF
Volume depletion

34
Q

What causes renal azotemia?

A

Diseases of glomerulus, tubules, or interstitium

35
Q

Examples of renal azotemia

A

Vasculitis
Glomerular injury (DM, autoimmune)
Ischemia to the nephron (renal vascular disease)
Toxic injury (mercury, methemoglobin)
Drugs (NSAIDs, Efferent Arteriole dilating ACE inhibitors)

36
Q

S/Sx of renal azotemia

A

**Casts, protein in urine, oliguria, edema, HTN

37
Q

What causes post-renal azotemia?

A

Obstruction/infections downstream of the kidneys causing backup and changes in pressure profiles.

Can damage kidneys

38
Q

Examples of post-renal azotemia?

A

Urethral reflex, reduced blood flow, pylenonephritis, Nephrolithiasis, UTI (WBC/RBC)

Ureter or urethra compression (neoplasm)

39
Q

What is azotemia+clinical signs?

A

Uremia

40
Q

What is a common sign of Uremia?

A

Ammonia

41
Q

Why is FENa important?

A

Na is filtered freely in glomerulus and about 99% is reabsorbed in the tubules.

Value should be <1%

If elevated, indicates tubule damage (AKI/ATN and maybe even CKD

42
Q

What is the normal GFR?

A

> 60mL/minute

43
Q

What is the normal UOP with normal GFR?

A

1ml/kg/hour

44
Q

What determines GFR or filtration/Net filtration Pressure?

A

Hydrostatic pressure of the capillaries
Interstitial Hydrostatic Pressure (In Bowman’s capsule)
Plasma/Capillary Oncotic Pressure (Colloid/Osmotic Pressure)
Bowman’s Oncotic Pressure

45
Q

What is the normal NFP?

A

10-12

46
Q

What are the 2 mechanisms of maintaining GFR?

A

Intrinsic and Extrinsic

47
Q

What primarily occurs during the Intrinsic pathway (Autoregulation)?

A

Myogenic tone

AA vs EA (constriction & dilation)
-Inc in pressure=inc in resistance to drop flow
-Dec in pressure= dec resistance to increase flow

Both are maintaining GFR

48
Q

Which pathways does Tubuloglomerular Feedback (TBF) occur?

A

Intrinsic

49
Q

What happens if the TBF senses a drop in the RBF?

A

Causes the granular mesangial cells to release renin->dilation of AA->increases RBF

(However this is not the primary effect of renin)

50
Q

What does Nitric Oxide and Prostaglandins do to the AA?

A

Dilate them to inc RBF

51
Q

Process of RAAS system

A

Renin->Angiotensin cascade->Angiotensin 2-> constriction of the efferent arteriole->dropping RBF->inc GFR (as long as AA stays dilated)

52
Q

Angiotensin does alot, what all can it do?

A

-Increases in PVR/SVR and redistributes blood
-Inc in reabsorption of Na in PCT & DCT->inc vol->in BP
-Releases aldosterone from Cortex of the Adrenal Glands

53
Q

What triggers the release of ADH?

A

Drop in volume->drop in AA pressure->drop in RBF->high osmolarity->Osmo receptors sense in the hypothalamus of the brain->releasing ADH (Vasopressin)

My Patho Cards (6 decks)

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