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Pharm Y2S2 > Renal > Flashcards

Renal Flashcards

1
Q

What proportion of sodium ions are reabsorbed in the proximal tubule?

A

Approximately 70%

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2
Q

How do sodium ions pass through the tubule epithelia?

A

Co-transported with organic molecules

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3
Q

What is the main cause of water reabsorption?

A

Sodium ion movement results in the reabsorption via passive diffusion

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4
Q

How do kidneys regulate acid-base balance?

A

Controlled secretion of protons and carbonic anhydrase

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5
Q

How do kidneys correct alkalosis?

A

Secretion of protons from the plasma reduces the pH, leading to a build up of carbon dioxide which is removed via the lungs

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6
Q

How is sodium regulated in the kidneys?

A

Aldosterone is released increasing the number of sodium channels in the apical membrane and sodium-potassium ATPase channels in the basolateral membrane

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7
Q

Briefly describe the effect of low sodium on the RAAS?

A

Low sodium causes juxtaglomerular cells to release renin allowing conversion of angiotensin to angiotensin I.
Kidney and lung capillaries secrete ACE allowing conversion of angiotensin I to the active form of angiotensin II.
Angiotensin II stimulates release of aldosterone from the adrenal cortex.

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8
Q

What is the outer region of the kidney?

A

Cortex

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9
Q

What is the inner region of the kidney?

A

Medullar

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10
Q

Where are the kidneys found in the body?

A

Lie against the back of the abdominal wall, not found in the peritoneal cavity

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11
Q

What are the three major functions of the kidney?

A

Homeostasis
Excretion
Endocrine

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12
Q

Describe the journey of the blood/plasma through the kidney. (4 main points)

A

Enters glomerulus via afferent arteriole
Filtration occurs into the Bowman’s capsule before entry into the lumen of the nephron
Follows proximal and straight convoluted tubules into the Loop of Henle
Travels to bladder via cortical and medullar collecting ducts

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13
Q

What allows glomerular filtration to occur at a reasonable rate?

A

Efferent arteriole is narrower than the afferent arteriole, increasing blood pressure in the glomerulus

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14
Q

Where do molecules travel to if they are not filtered into the Bowman’s capsule?

A

Through efferent arteriole to vasa recta

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15
Q

What are the three layers that plasma travels through to enter Bowman’s capsule?

A 
Capillary endothelium
Basement membrane
Capsule cells (podocytes)
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16
Q

How are molecules filtered into Bowman’s capsule?

A

Pores of 30kDa diameter act as a molecular sieve

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17
Q

Why is albuminuria common in reduced GFR?

A

Filtration becomes less efficient, allowing larger molecules such as albumin to filter into the nephron and be excreted in urine

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18
Q

What is secretion?

A

Movement of molecules from the vasa recta peritubular capillary into tubules

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19
Q

What is reabsorption?

A

Movement of molecules from tubules back into peritubular capillaries. Generally small molecules such as glucose and amino acids

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20
Q

Under what circumstances can molecules not be filtered?

A

If they are bound to plasma proteins

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21
Q

What are diuretics?

A

Compounds that increase excretion of sodium and water

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22
Q

Why are diuretics used in cardiac failure?

A

Increase in interstitial fluid volume with reduced cardiac output, increases venous pressure. By reducing fluid volume, blood pressure is reduced, reducing cardiac workload.

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23
Q

Why are diuretics used in hyperaldosteronism?

A

Increased sodium retention causes increase in plasma volume raising blood pressure. Diuretics promote excretion of excess sodium

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24
Q

What is the action of loop diuretics?

A

Inhibit the Na/K/Cl carrier in the ascending loop of henle

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25
Q

Give examples of loop diuretics.

A

Furosemide

Bumetanide

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26
Q

Why is there a risk of alkalosis with loop diuretics?

A

Carbonic acid excretion is not affected, increasing the plasma concentration thus raising pH

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27
Q

What effects do loop diuretics have on small molecule concentrations?

A

Increased excretion of magnesium and calcium

Reduced secretion of uric acid

28
Q

What is the effect of loop and thiazide diuretics on proton concentrations?

A

Na/H exchanger is not affected thus entry of sodium drives the excretion of protons

29
Q

Why is hypokalaemia a common side effect of diuretics?

A

The K/Cl transporter is blocked, reducing uptake of these ions from the tubule

30
Q

What is the mechanism of action of thiazide like diuretics?

A

Inhibit the Na/Cl co-transporter in the distal tubule

31
Q

Give examples of thiazide like diuretics?

A

Bendroflumethiazide
Indapamide
Metolazone

32
Q

Why is indapamide preferred to other thiazide diuretics?

A

Lowers blood pressure at subdiuretic doses

Does not have as many metabolic effects

33
Q

What effects do thiazide like diuretics have on small molecule concentrations?

A

Increase magnesium excretion

Reduce secretion of calcium and uric acid

34
Q

What is the mechanism of action of potassium sparing diuretics?

A

Aldosterone antagonists, blocking the reabsorption of sodium and Na/K exchange in the collecting tubule

35
Q

Give examples of potassium sparing diuretics.

A

Spironolactone

Eplerenone

36
Q

What is the mechanism of action of amiloride?

A

Inhibits reabsorption of sodium in collecting tubules by blocking luminal sodium channels

37
Q

What is the mechanism of action of osmotic diuretics?

A

Increase osmolarity of filtrate, increasing sodium and water excretion, mainly in the proximal convoluted tubule, ascending loop of henle and collecting ducts

38
Q

Give an example of an osmotic diuretic.

A

Mannitol

39
Q

What are the two main methods of measuring kidney function?

A

1- creatinine produced by muscles and freely filtered by kidneys, increase in serum creatinine is suggestive of reduced kidney function
2- inulin administered IV is a fructose polymer that is freely filtered by kidneys, if concentration does not reduce quickly then likely to be kidney issues

40
Q

What is renal clearance?

A

The volume of plasma from which a substance is completely removed over unit time

41
Q

How does glucose reabsorption occur?

A

Uptake via active transport from tubular fluid to vasa recta via transporters requires sodium

42
Q

What is dapagliflozin used for? How does it work?

A

Treatment of diabetes mellitus aiming to reduce plasma levels of glucose. Blocks SGLT2 glucose transporter to reduce reabsorption from tubules

43
Q

Name 3 efflux transporters found in the cells of the kidney. Which membrane do they lie on?

A

Multidrug resistance associated polypeptide
Breast cancer resistance protein
P-glycoprotein.
Found on basolateral membrane

44
Q

What is chronic kidney disease?

A 
Damage for over 3 months as evidenced by structural or functional abnormalities
Abnormal GFR (may not be present) <60mL/min/1.73m
45
Q

What is the main quantitative marker of kidney disease?

A

Albumin-creatinine-ratio >3mg/mmol

46
Q

Why is serum creatinine not always accurate?

A

Proportional to muscle mass

47
Q

Under what circumstances is a correction factor applied to GFR values? What is this correction factor?

A

African and Afro-Caribbean patients

Correction factor of x1.159

48
Q

What test can be used where an improved assessment of risk is required?

A

Cystatin C based GFR

49
Q

Give complications of reduced renal function.

A

Anaemia
CVD
Disordered bone mineral metabolism
Calcification of blood vessels

50
Q

Give risk factors of chronic kidney disease.

A 
Diabetes
Hypertension
Acute kidney injury
CVD
Family history
Structural disease
Systemic Lupus
Haematuria
51
Q

What are the standard management aims/treatments for chronic kidney disease?

A

BP <140/90mmHg or below 130/80mmHg with proteinuria
Good glycaemic control
Statin therapy
Avoid nephrotoxic drugs
ACE/ARB not to be used together
Three or more antihypertensive agents
Anticoagulants for secondary prevention of CVD

52
Q

What are the risk factors for acute kidney injury?

A 
Over 65
Acute illness/sepsis
Hypovalaemia
Hypotensive
CKD
Heart failure
Diabetes
Liver failure
53
Q

How is acute kidney injury detected?

A

Rise in serum creatinine of >26umols/L in 48 hours
50% or more rise in creatinine over 7 days
Urine output <0.5mL/kg/hr over 6 hours (8 hours in children)
25% or more reduction in eGFR in young people over 7 days

54
Q

What is the main benefit of haemodialysis?

A

Good/efficient removal of electrolytes

55
Q

What are the disadvantages of haemodialysis?

A 
Anaemia
Hypotension
Air embolism
Infection
Pruritis
56
Q

What are the disadvantages of peritoneal dialysis?

A

Constipation
Pleural effusion
Sclerosing peritonitis

57
Q

What is the standard protocol for immunosuppressant therapy post kidney transplant?

A

Ciclosporin/tacrolimus

With or without prednisone and mycophenolate/azothioprine

58
Q

What is the treatment for rejection of transplantation in hospital?

A

Sirolimus
Methylprednisolone
Plasma exchange
Rituximab

59
Q

What is the treatment for renal anaemia?

A

Serum ferritin 200-500mcg/L

Iron and erythropoietin replacement

60
Q

What is mineral bone disease?

A

Osteoporosis etc

Deranged calcium, raised phosphate and increased levels of parathyroid hormone

61
Q

When does acidosis generally occur? How is it treated?

A

With a GFR <30mL/min/1.73m

Corrected with oral sodium bicarbonate

62
Q

What are the common side effects of haemodialysis? How can they be managed?

A

Hypotension due to rapid fluid removal, counteracted with bolus NaCl 0.9%
Cramps due to hypotension can be improved with quinine tablets
Chest and back pain due to complement activation can occur, a more biocompatible dialysed would be preferred

63
Q

Give examples of drugs can can increase levels of cyclosporin/tacrolimus.

A 
Amiodarone
Erythromycin
Ketoconazole
Diltiazem
Nifedipine
Progestogens
64
Q

Give examples of drugs can can decrease levels of cyclosporin/tacrolimus.

A 
Rifampicin
Carbamazepine
Phenytoin
Phenobarbitone
St John's Wort
65
Q

What are the nephrotoxic drugs?

A 
Contrast agents
Aminoglycosides
NSAIDs
Amphotericin
Diuretics
ACE inhibitors/ARBs

Pharm Y2S2 (26 decks)

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