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Nick's MD1 > Renal > Flashcards

Renal Flashcards

1
Q

What is the main prostaglandin secreted by the kidneys?

A

Prostacyclin

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2
Q

What is the maximum possible concentration of urine?

A

1200 m.osmol/L

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3
Q

What percentage of glomeruli are superficial cortical glomeruli?

A

85%

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4
Q

What percentage of glomeruli are juxtamedullary glomeruli?

A

10%

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5
Q

Where do juxtamedullary glomeruli have their Bowman’s capsules?

A

In the cortex, near the junction with the medulla

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6
Q

How many afferent arterioles are there per nephron?

A

1

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7
Q

What percentage of cardiac output goes to the kidneys?

A

20%

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8
Q

Where is the macula densa?

A

At beginning of distal convoluted tubule

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9
Q

What do macula densa cells detect?

A

NaCl concentration

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10
Q

What do macula densa cells release to cause constriction of the afferent arteriole?

A

Adenosine

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11
Q

Where does creatinine come from?

A

Turnover of muscle cells and protein degradation

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12
Q

What percentage of renal plasma flow is filtered by the glomerulus?

A

20%

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13
Q

What is the hydrostatic pressure in the glomerular capillary?

A

50mmHg

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14
Q

What is the net filtration pressure across the glomerulus?

A

10mmHg

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15
Q

What happens to GFR when afferent arteriole constricts?

A

Decreases

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16
Q

What happens to GFR when efferent arteriole constricts?

A

Increases

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17
Q

What does angiotensin II do?

A

Constriction of efferent arteriole to cause increase in GFR

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18
Q

What happens to GFR when MAP increases from 80 to 180?

A

Nothing

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19
Q

Where does autoregulation in the kidney occur?

A

Afferent arteriole

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20
Q

Which cells of the kidney release renin?

A

Granular cells

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21
Q

Where are granular cells in the kidney?

A

In the wall of the afferent arteriole where it enters the glomerulus

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22
Q

What does renin do?

A

Catalyses angiotensinogen –> angiotensin 1

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23
Q

What causes granular cells to release renin?

A

Decreased NaCl, sympathetic drive and pressure.

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24
Q

The clearance of substance X is…..

A

The volume of plasma cleared of X per time

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25
Q

What do we call infection of the bladder and lower UT?

A

Cystitis

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26
Q

What do we call infection of kidney and renal pelvis?

A

Pyelonephritis

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27
Q

How far along the urinary tract should be sterile?

A

Everything above bladder sphincter

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28
Q

What’s the most common pathogen in UTI?

A

E. coli

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29
Q

How do must bacteria get into the urinary tract to cause infection?

A

Ascend up the urethra

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30
Q

What is the major innate immune mechanism in the urinary tract?

A

Constant flushing effects of urine and regular emptying of bladder

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31
Q

What is the most important thing to remember when taking a urine sample from a catheter bag?

A

Never collect it from the bag itself; collect freshly passed urine from the catheter itself

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32
Q

Why must a urinalysis be performed promptly?

A

More time would allow the bacteria to replicate and quantitative analysis is important in urine samples

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33
Q

What do we call pus in the urine?

A

Pyuria

34
Q

What is sterile pyuria?

A

Pus in urine, but without bacterial growth

35
Q

What antibiotics should be used for a UTI?

A

Cephalexin OR co-amoxyclav OR trimethoprim

36
Q

What antibiotics should be used for pyelonephritis?

A

Cephalexin OR co-amoxyclav OR trimethoprim

37
Q

What is the definition of recurrent UTI in women?

A

>2 UTIs in 6 months

38
Q

What percentage of water is reabsorbed by the kidneys after it has been filtered?

A

99%

39
Q

Where is water reabsorption in the kidney regulated?

A

Collecting ducts

40
Q

Where is calcium mainly reabsorbed in the nephron?

A

Proximal convoluted tubule

41
Q

What percentage of creatinine is reabsorbed in the kidney?

A

None

42
Q

How is Na reabsorbed in the thick ascending limb of the nephron?

A

Na/K/2Cl co-trasnporter

43
Q

What percentage of nephrons are juxta-medullary?

A

15%

44
Q

What size are the fenestrations in glomerular capillaries?

A

70-100nm

45
Q

What size are the podocyte interdigitating slits in the glomerulus?

A

3-5nm

46
Q

What type of epithelium lines the proximal convoluted tubule?

A

Simple cuboidal

47
Q

What type of epithelium lines the thin descending loop of Henle?

A

Simple squamous

48
Q

What type of epithelium lines the ureters?

A

Transitional epithelium

49
Q

Which substance is responsible for constriciton of the efferent arteriole in the kidney?

A

Angiotensin II

50
Q

Where is reasborption greatest along the nephron?

A

Proximal convoluted tubule

51
Q

What is the most important solute to be reabsorbed in the nephron?

A

Sodium

52
Q

What measure is the most important for defining renal failure in clinical practice?

A

GFR

53
Q

Urine output of less than 500ml per day indicates what?

A

Renal failure

54
Q

Define acute renal failure

A

A sudden fall in GFR over hours to days

55
Q

When does kidney function begin to decline?

A

40 years of age

56
Q

What is the most accurate measure of daily fluid balance?

A

Daily weight measurement

57
Q

What is the most common cause of acute renal failure?

A

Acute tubular necrosis

58
Q

Define oliguria

A
59
Q

In which 2 ways can the kidney regulate HCO3- levels?

A

Can reabsorb HCO3- in PCT. Can synthesise HCO3- in DCT

60
Q

What is a normal pH in the body?

A

7.35-7.45

61
Q

How do you calculate the anion gap?

A

Na + K - Cl - HCO3

62
Q

What makes up most of the unmeasured ions in the anion gap?

A

Albumin

63
Q

Name 3 types of acidosis with a large anion gap

A

Renal failure. Diabetic ketoacidosis. Lactic acidosis

64
Q

What is a normal HCO3- level?

A

21-28 mmol/L

65
Q

What happens to bicarbonate levels in metabolic alkalosis?

A

Increased

66
Q

What happens to bicarbonate levels in metabolic acidosis?

A

Decreased

67
Q

What happens to bicarbonate levels in respiratory alkalosis?

A

Decreased

68
Q

What happens to bicarbonate levels in respiratory acidosis?

A

Increased

69
Q

What effect does metabolic acidosis have on potassium levels?

A

K+ levels increase in metabolic acidosis

70
Q

Define Grave’s disease

A

Type II hypersensitivity in which host generates Ig to TSH receptor on thyroid gland, which stimulates thyroid hormone release. Leads to hyperthyroidism.

71
Q

Define myasthenia gravis

A

Type II hypersensitivity in which host generates Ig to muscle nicotinic ACh receptors. When bound, this stops ACh from activating muslce, leading to weakness.

72
Q

Define vasculitis

A

Type III hypersensitivity in which immune complexes are deposited in vessel walls

73
Q

What are the 4 features of nephrotic syndrome?

A

Proteinuria. Hypoalbuminaemia. Oedema. Hyperlipidaemia

74
Q

Which part of the nephron is impaired with proteinuria?

A

Glomerular filter

75
Q

Define glomerulonephritis

A

Injury to the glomerulus that is almost always immune mediated

76
Q

What is focal vs diffuse glomerulonephritis?

A

Every glomerulus is abnormal vs no all

77
Q

What is segmental vs global glomerulonephritis?

A

All or most part of each glomerulus is involved with not

78
Q

What is the leading cause of end stage renal failure in Australia?

A

Diabetic nephropathy

79
Q

What is suggested by cresents in the urinary space outside the glomerular tuft?

A

Severe acute injury to the glomerulus

80
Q

What is the “triple whammy”?

A

Combination of ACE inhibitor, diuretic and NSAID

81
Q

How do NSAIDs impair renal function?

A

By interfering with vasodilation from PGI2

82
Q

What is the mechanism of action of potassium-sparing diuretics?

A

Block Na transporter in collecting tubules and ducts

Plus or minus:

Inhibit synthesis of Na/K cotransporter in collecting tubules and ducts

Nick's MD1 (28 decks)

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