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Phys exam 5 > Renal 8 > Flashcards

Renal 8 Flashcards

1
Q

ECF K+ tightly regulated at ____ meq/L.

A

4.2

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2
Q

Increase of only ____to____ mEq/L of K can cause cardiac arrhythmias, cardiac arrest, or fibrillation.

A

3 to 4

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3
Q

What are the 2 mechs controlling K+ homeostasis?

A
  1. Control of K+ distribution between the ECF and ICF

2. To keep [K+]ECF constant; rate of K+ excretion must equal rate of K+ input.

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4
Q

High [K+]ECF

A

: Hyperkalemia

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5
Q

Low [K+]ECF

A

: Hypokalemia

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6
Q

Factors that shift K+ ____ cells:

  • Insulin
  • Aldosterone
  • B2 Adrenergic stimulation (Epi and NE)
  • Alkalosis
  • Decreased Osm
A

into cells (Decreases [K}ECF)

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7
Q

What is the mechanism for how the following factors shift K into cells?

  • Insulin
  • Aldosterone
  • B2 Adrenergic stimulation (Epi and NE)
  • Alkalosis
A

Increased Na-K ATPase activity

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8
Q

What is the mechanism for how the following factors shift K into cells?
- Decreased ECF Osm

A

Dilute ICF, Decreased ΔEC for diffusion out of K+ cell

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9
Q

Factors that shift K+ ____ cells:

  • Increased Insulin deficiency
  • Aldosterone insufficiency (Addison’s disease)
  • B2 Adrenergic antagonists
  • Acidosis
  • Increased ECF Osm
  • Strenuous exercise
  • Cell lysis
A

Out of cells (Increases [K}ECF)

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10
Q

What is the mechanism for how the following factors shift K out of cells?

  • Increased Insulin deficiency
  • Aldosterone insufficiency (Addison’s disease)
  • B2 Adrenergic antagonists
  • Acidosis
A

Decreased Na-K ATPase activity

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11
Q

What is the mechanism for how the following factors shift K out of cells?
- Increased ECF Osm

A

Concentrate ICF, Increased ΔEC for diffusion out of K+ cell

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12
Q

Where does the majority of the regulation of K+ occur?

A

Secretion in collecting duct

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13
Q

Day to Day regulation of [K+]ECF is function of what portion of nephron?

A

late Distal Tubule/Collecting Duct

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14
Q

High K+ intake leads to Increased K+ _________

A

secretion (principal cells)

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15
Q

Low K+ intake leads to increased K+ _______

A

reabsorption (alpha intercalated cells)

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16
Q

What are the 3 factors that determine the rate of K secretion by principal cells?

A
  1. Na+/K+ ATPase Activity
  2. Transepithelial potential difference (TEPD) between blood and lumen
  3. Permeability of apical membrane for K+
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17
Q

____ in [K]ECF results in increased K+ secretion

A

Increased [K]ECF

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18
Q

_____ in aldosterone results in increased K+ secretion

A

INcreased Aldo

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19
Q

____ in distal tubule flow rate results in increased K+ secretion

A

Increase in distal tubule flow rate

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20
Q

Does alkalosis increase or decrease K+ secretion?

A

Increases K+ secretion

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21
Q

Does acidosis increase or decrease K+ secretion?

A

Decreases K+ secretion

22
Q

The mechanisms for ____ K+ secretion are :

  1. Increased Na+/K+ ATPase activity
  2. TEPD is more lumen negative (due to increased Na+ reabsorption) which favors K+ secretion
  3. Increased # K+ channels in apical membrane
  4. Stimulates aldosterone secretion.
A

↑[K+]ECF

23
Q

Does aldosterone increase or decrease K+ secretion?

A

Increase K secretion

24
Q

Causes of ____ that increases K+ secretion:
Increased ECF volume
Na+ loading
Some Diuretics

A

INcreased distal tubule flow rate

25
Q

How does increased ECF volume lead to increased distal tubule flow rate?

A

Increased ECF volume -> Increased ANP release -> Increased GFR -> Decreased Na and K reabsorption -> Increased distal tubule flow rate

26
Q

The mechanisms for _____ that causes increased K+ secretion include:

  1. Increased tubule flow rate keeps luminal K+ lower, maintaining ΔC for secretion
  2. Increases #BK channels in apical membrane
A

INcreased distal tubule flow rate

27
Q

Causes of _____ include:
Renal failure
 Decreased distal nephron flow (heart failure, severe volume depletion, NSAID, etc.)
 Decreased aldosterone or decreased effect of aldosterone
- adrenal insufficiency
- resistance to aldosterone
- K+ sparing diuretics (spironolactone)
 Metabolic acidosis (hyperkalemia is mild)
Diabetes (kidney disease, acidosis, insulin)

A

Hyperkalemia

28
Q 
Causes of \_\_\_\_\_ include:
Very low intake of K +
GI loss of K+ - diarrhea
Metabolic alkalosis
Excess insulin
Increased distal tubular flow
  -salt wasting nephropathies
  -osmotic diuretics
  - loop diuretics
Excess aldosterone
A

Hypokalemia

29
Q

_____ is a drug that increases urine volume output.

A

Diuretic

30
Q

Most diuretics act by _____ Na+ reabsorption from some part of the nephron

A

decreasing

31
Q

_______ causes diuresis by an osmotic mechanism.

A

Natriuresis

32
Q

Most common reason for use of diuretics is to ______

A

reduce ECFV

33
Q

Reducing ECFV via diuretics _____ edema and _____ MAP

A

Reduces edema; reduces MAP

34
Q

______ Increase Solute and H2O Excretion until Compensatory Mechanisms Re-establishes Balance

A

Diuretics

35
Q

____ Transport is a Target for many Diuretics

A

Na+ transport

36
Q

_____ diuretics:
Nonabsorbable substance is filtered (ex. mannitol, sucrose).
Osmols in tubular fluid require water.
Similar to effects of endogenous substances (glucose,
urea).
-Diuresis caused by hyperglycemia.
May increase excretion of other solutes.

A

Osmotic diuretics

37
Q

______ (diuretics):
Acetazolamide.
More than 80% of HCO3- reabsorption and H+secretion occurs in proximal tubule.
block Na+reabsorption (and H+secretion) indirectly.

A

Carbonic Anhydrase Inhibitors

38
Q

At what part of the nephron do carbonic anhydrase inhibitors act?

A

Proximal tubule

39
Q

At what part of the nephron do loop diuretics act?

A

Thick ascending limb

40
Q

Furosemide, ethacrynic acid, bumetanide
Inhibit Na+-K+-2Cl- - cotransport pump on luminal membrane of TAL of Henle.
Most powerful diuretics available (30% of GFR may appear in urine!).
Overwhelm downstream absorptive capacity.
Disrupt countercurrent multiplier.

A

Loop diuretics

41
Q

At what part of the nephron do thiazide diuretics act?

A

Early distal tubule

42
Q

_____ diuretics increase osmolarity of tubular fluid in the proximal tubule

A

Osmotic

43
Q

_____ diuretics decrease Na-K-2Cl cotransport in the TAL of loop of henle

A

Loop diuretics

44
Q

_____ diuretics decrease Na-Cl cotransport in the early distal tubule

A

Thiazide diuretics

45
Q

______ diuretics decrease H secretion, HCO3 absorption (decreases Na-H exchange) in the proximal tubule

A

Carbonic anhydrase inhibitor

46
Q

_____ diuretics decrease Na absorption and K secretion in the late distal tubule and collecting duct

A

Aldosterone antagonists

47
Q

_____ diuretics block ENaC and decrease K secretion in the late distal tubule and collecting duct

A

Na channel blocker

48
Q

Which 2 classes of diuretics are K sparing diuretics?

A

Aldosterone antagonists and Na channel blocker

49
Q

_____ diuretics: cause K+ loss
Increasing flow rate of filtrate through distal nephron increases K+ secretion.
Keeps luminal K+ concentration low supporting secretion
Hypokalemia may result.

A

K sparing diuretics

50
Q

_____ diuretics reduce levels of Na+/K+ ATPase, ENaC, K+ channel.

A

Aldosterone antagonists

51
Q

____ diuretics reduce Na+ uptake, Na+/K+activity, K+secretion

A

ENaC blockers

Phys exam 5 (9 decks)

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