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ACVECC 2024 > Renal > Flashcards

Renal Flashcards

1
Q

Which part of the kidney is more prone to ischemic and toxic injury?

A

Medulla as it only received 3-10% of the overall blood flow to the kidneys.

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2
Q

Factors that determine the filtration of molecules at the glomerular capillaries:

A
  • Size (< 4 nm) selectivity - lamina densa
  • Charge selectivity - favour positively charged molecules - sialoglycoproteins and peptidoglycans at the capillary endothelium, lamina RI, lamina RE, podocytes all negatively charged
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3
Q

What are the 7 functions of the kidneys?

A
  1. Regulation of water and electrolyte balance
  2. Regulation of systemic blood pressure and extracellular fluid volume
    a. Determine blood volume: salt and water balance
    b. Production of vasoactive hormones: RAAS
  3. Excretion of metabolic waste and foreign substances (uremic retention solutes)
  4. Regulation of red blood cell production: erythropoietin (synthesised by interstitial cells)
    a- Stimulus: reduction in partial pressure of oxygen
  5. Regulation of acid-base balance
  6. Regulation of Vit D production and calcium + phosphate balance
    - Production of calcitriol (active Vit D)
  7. Gluconeogenesis
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4
Q

What is the GFR of a dog?

A

3-5mL/kg/min

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5
Q

What is the GFR of a cat?

A

2.5-3.5mL/kg/min

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6
Q

What is the macula densa?

A

Specialised tubular epithelial cells that line the thick ascending loop of Henle at its junction with the distal tubules and sits in close contact with the afferent arterioles

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7
Q

What is the autoregulation range of the kidneys?

A

MAP 80-180mmHg

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8
Q

What is autoregulation

A

Intrinsic ability of kidneys to maintain RBF and GFR for varying BPs between 80-180mmHg

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9
Q

Name the 3 main ways Angiotensin II stimulates Na reabsorption:

A
  1. aldosterone secretion
  2. vasoconstriction of efferent arterioles
  3. direct stimulation of pumps in PT, LOH, DT and collecting tubules (Na-K ATPase, Na-bicarb cotransporter, Na/H+ antiporter luminal)
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10
Q

Where is aldosterone’s site of action?

A

principal cells of cortical collecting tubules

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11
Q

What does aldosterone do?

A

Na reabsorption (Na-K-ATPase basolateral, ENaC at luminal)
K+ secretion (ROMK in luminal)

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12
Q

Where does ADH act to increase water reabsorption?

A

V2 receptor in the late distal tubule and collecting ducts

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13
Q

How does ADH reabsorb water?

A

Synthesis + insertion of aquaporin 2 to luminal membrane

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14
Q

Where does ANP act?

A
  • collecting ducts to inhibit Na and water reabsorption
  • inhibits renin secretion
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15
Q

Which 2 mechanisms create the hyperosmotic medullary interstitium?

A
  • loop of Henle’s countercurrent mechanism
  • urea recycling
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16
Q

Which 2 mechanisms maintain the hyperosmotic medullary interstitium?

A
  • distal tubule and collecting duct
  • vasa recta
17
Q

Function of the pelvic nerve (S2-3):

A

Sensory: detect stretch, micturition reflexes for bladder emptying
Motor: parasymathetic -> contraction of detrusor muscle

18
Q

Function of the pudendal nerve (S2-S4):

A

External bladder sphincter (skeletal muscle)
Inhibiting it -> mictrurition

19
Q

Which enzyme is the rate limiting factor in the metabolism of ethylene glycol?

A

Alcohol dehydrogenase

20
Q

2 most important factors to promote urethral healing:

A

Good mucosal continuity
Prevention of urine extravasation

21
Q

Why are high chloride containing fluids harmful to the kidneys?

A

High conc. of Cl delivered to the macula densa which would induce afferent arteriole vasoconstriction and lower GFR, RBF

22
Q

What is the main causative agenet for pyeloneprhitis?

A

Enterobacteriaceae

23
Q

What is a reasonable first choise for pyeloneprhitis while awaiting C/S?

A

Fluoroquinolones or cefpodoxime

24
Q

What antibiotic characteristics are best for crossing the prostatic blood barrier?

A
  • lipid soluble
  • weakly alkaline
  • high pKa
25
Q

What defines recurrent urinary tract infection?

A

3 or more episodes of clinical bacterial cystitis in prev 12 months OR
2 or more episodes in preceding 6 months

26
Q

Main method of solute removal for intermittent hemodialysis, continuous venovenous haemodialysis (CVVHD)

A

diffusion

27
Q

Main method of solute removal for slow continuous ultrafiltration (SCUF) and continuous venovenous haemofiltation (CVVH):

A

convection

28
Q

Difference between SCUF and CVVH:

A

in CVVH once the ultrafiltrate is removed, it is replaced with a sterile balanced electrolyte solution

29
Q

Which condition is SCUF good for?

A

CHF - as ultrafiltate is not replaced by anything

30
Q

What method of solute removal does continuous venovenous hemodiafiltration rely on:

A

Combines diffusion and convection

31
Q

What is convection?

A

when solutes are dragged with plasma water across the dialysis membrane due to osmotic pressure gradient or hydrostatic pressure (solvent drag)

32
Q

How does diffusion work?

A

Countercurrent movement of the blood and dialysate across the dialyser semipermeable membrane allows for efficient bidirectional movement of solutes from high -> low concentration

33
Q

what is ultrafiltration?

A

Process of plasma water removal from the intravascular compartment (and ultimately from the interstitial and intracellular spaces)

In IHD and CRRT application of a negative transmembrane pressure to the dialyser will allow plasma water to shift across the membrane into the dialysate and out of the patient

34
Q

what is dialysis?

A

Dialysis is the movement of solutes between 2 aqueous solutions separated by a semipermeable membrane

35
Q

Toxin factors to consider for extracorporeal removal:

A
  • Vd (<2L/kg)
  • MW
  • Degree of protein binding
  • Water solubility
36
Q

List 10 complications that have been reported with PD in small animals

A
  1. Catheter flow problems – obstruction with omentum, catheter kinking, fibrin clots
  2. Catheter exit site leaks – into subcutaneous tissue
  3. Catheter exit site and tunnel infection
  4. Electrolyte disorders
  5. Hypoalbuminemia (most commonly reported)
  6. Peritonitis
  7. Dyspnoea caused by ↑abdominal pressure or pleural effusion
  8. Changes in hydration status (overhydration)
  9. Dialysis disequilibrium
  10. Hyperglycemia
    Peritoneal fibrosis
37
Q

Why is urine osmolality better than USG?

A

Provides more information on renal concentrating ability than USG

38
Q

Difference between urine osmollality and USG

A

USG = density per unit volume of solution (no. of particles and MW)
Osmolality = no. of particles per unit volume of solution

ACVECC 2024 (14 decks)

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