renal 9

Question 1

why is it important to assses renal function?

Answer 1

due to its central role in homeostasis

Question 2

what two clinical situations is the ability to measure GFR important?

Answer 2

in patients with renal disease, progression of underlying disease results in nephorn distruction and decreased function

many drugs and anitbiotics removed from body by exretion/filtration when gfr falls excretion fallls so drug in plasma may rise causing toxicity may need to adjust dose in decreased renal function

Question 3

what is total gfr?

Answer 3

sum of all filtration by functioning nephrons so progression of disease would be incadicated by reduction in gfr

Question 4

how is gfr measured?

Answer 4

plasma clearance tests - measure ability of the kidney to clear the plasms of various substances

Question 5

what does clearance relate to?

Answer 5

the volume of plasma cleared not a quantity of substance removed from plasma

Question 6

what is the gold standard for measurement of gfr?

Answer 6

insulin clearnce, polyfructose, loading iv dose insulin allow time to equilibrate then sample simultaneously plasma and urine

Question 7

how is insulin filtered?

Answer 7

Question 8

Answer 8

Question 9

why is inuslin no longer used in clinical practice what is used instead?

Answer 9

Question 10

what is routinely used to estimate gfr?

Answer 10

Question 11

what are factors affecting serum creatine?

Answer 11

muscle mass - athletes vs malnutrition

dietary intake - creatine suppliments vs vegetarians

drugs - some lead to spurios increases as does ketoacidosis

Question 12

what is normal gfr usually?

Answer 12

100mls/min/1.73m2

Question 13

what is the clearance of glucose?

Answer 13

Question 14

what is the clearance of urea?

Answer 14

Question 15

what is the clearance of PAH?

Answer 15

Question 16

what is the clearance of penicillin?

Answer 16

Question 17

what is the bladder?

Answer 17

big bag of smooth muscle arranged in spiral longitudinal and circular bundles - detrusor muscle

contractio of this muscle is mainly responsible for empything the bladder durig micturation

Question 18

what is the internal urethral sphincter?

Answer 18

not a true sphincter but where the smooth muscle at the start of the urethra acts as a sphincter when the smooth muscle is relaxed

Question 19

what is the external urethra; sphincter?

Answer 19

true sphincter made up of skeletal muscle under voluntary somatic control

Question 20

how does urine flow from kidneys to the ureters?

Answer 20

via peristaltic contraction of the smooth muscle of the ureters they enter the bladder at an obliwue angle preventing reflux of urea

Question 21

describe the anatomy of the bladder?

Answer 21

Question 22

what do urethral obstructions lead to?

Answer 22

bilateral renal problems

Question 23

what do ueter obstruction lead to?

Answer 23

unilateral renal problems

Question 24

what does normal daily urine production vary between?

Answer 24

750-2500mls in temperate climates

Question 25

describe the mechanism of control for motor innervation of micturation?

Answer 25

Question 26

describe the mechanism of control for sensory innervation of micturation?

Answer 26

Question 27

descirbe the operation of the local spinal reflex of micturation?

Answer 27

Question 28

how is delay of micturation accomplished?

Answer 28

Question 29

what is one of the initial events in voluntary urination?

Answer 29

Question 30

what can be abnormalities of micturation?

Answer 30

Question 31

how can paraplegic patients train them selves?

Answer 31