Renal

Question 1

Afferent constriction of RBF mediated by …

And dilatation mediated by …

Answer 1

SNS, AT ll, mesangial cell constriction, and endothelin.

PGs, NO, ANP, dopamine, bradykinin.

Question 2

Explain decrease GFR in blood loss

Answer 2

It appears higher alpha receptors in the afferent RBF, therefore in high levels of stimulation (such as blood loss), GFR will decrease not only from loss of blood volume but an attempt to decrease urine production and keep blood more centrally

Question 3

The majority of Na reabsorbed in … nephrons.

Only …% excreted in urine

Answer 3

Proximal tubules 75%

Only 5% normally dumped in urine

Question 4

Which part of nephron impermeable to water

Answer 4

Ascending loop of henle where furosemide works.

Question 5

ANP effect on kidney

Answer 5

Fluid overload -> atrial stretch -> ANP released -> dilates afferent with efferent constriction-> increases GFR

Question 6

What’s the number of BUN/Cr indicates prerenal vs renal injury

Answer 6

If BUN/Cr > 20 (pre-renal)

Also FENa < 1% (pre-renal cause)

Question 7

Transfusion trigger in CKD patient’s?

Answer 7

Based on symptoms not Hb level. Anemia in CKD is secondary to decreased erythropoietin

Question 8

MoA Acetazolamide

Answer 8

Indirectly inhibits the uptake of HCO3 at the proximal tubule though inhibiting carbonic anhydrase

Question 9

MoA furosemide vs Thiazides

Answer 9

(-) the Na-K-Cl in THICK Ascending loop of henle

Thiazides -> (-) Na-Cl in DCT

Question 10

Volume effect and plasma osmolality in Aldo deficiency

Answer 10

Decreased extracellular volume due to loss of Na but will shift the volume to intracellular (because intracellular osmolality won’t change)

Plasma osmolality decreases

Question 11

Which Diuretics if administered with digoxin can lead to digoxin toxicity

Answer 11

The one causes hypokalemia, the less potassium makes digoxin binds to receptors more so furosemide (causes hypokalemia).

Question 12

Reason behind the acute hypotension during dialysis is …

Answer 12

The countercurrent exchange where large volumes of blood are rapidly driven through the dialysis circuit while dialysis fluid is driven at twice the rate in the opposite direction. Furthermore, fluid is removed from the patient but not returned, so this rapid process leaves a decreased intravascular volume

Question 13

HD vs CRRT dialysis

Answer 13

CRRT is pressure driven (no volume removed) so less blood removed from the patient. And also the fluid removed from patient can be given back with the circuit, end result that the patient tolerates it better than HD.

But CRRT is less effective and done continuously throughout the day.

Question 14

Corrected Na in hyperglycemia state, calculated by

Answer 14

For every 100 mg/dL increase in glucose, the Na falls by 1.6 mEq/dL

Question 15

Hyper/hypo Mg and Po4 causes prolonged muscle relaxation and RS failure

Answer 15

HypoPo4

HyperMg

Question 16

Decrease Strong Ion Gap demonstrates…

Answer 16

Metabolic acidosis

Where increase SIG -> metabolic alkalosis

(Increase AG -> retaining acid)