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Physio Topnotch 2020 > RENAL > Flashcards

RENAL Flashcards

1
Q

body fluid “60-40-20” RULE

A

60% of BW: Water
40% of BW: ICF
20% of BW: ECF (INTERSTITAL FLUID 15%, PLASMA 5%)

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2
Q

Marker for Total Body Water

A
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3
Q

MArker for ECF

A
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4
Q

Marker for plasma

A
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5
Q

Marker for IF

A
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6
Q

MArker for Intercellular fluid

A
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7
Q

Explain thr volume and concentration changes across compartments during LOss of Isotonic fluid ie Diarrhea

A

ECF volume: decrease

ECF osmolarity : no change

ICF volume: no change

ICF osmolarity: no change

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8
Q

Explain the volume and concentration changes across compartments during excess fluid ie Infusion of isotonic fluid

A

ECF volume: increase

ECF osmolarity : no change

ICF volume: no change

ICF osmolarity: no change

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9
Q

Explain the volume and concentration changes across compartments during volume contraction ie Loss in dessert

A

ECF volume: decrease

ECF osmolarity : no change

ICF volume: no change

ICF osmolarity: no change

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10
Q

Explain the volume and concentration changes across compartments during Volume expansion ie Excessive NaCl intake

A
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11
Q

Explain the volume and concentration changes across compartments during Adrenal sufficiency ie decrease Aldosterone secretion

A

Aldosterone: inc Na reabsorption along with water.

Decrease aldosterone levels would reselt in salt and water wasting

ECF volume: decrease

ECF osmolarity : no change

ICF volume: no change

ICF osmolarity: no change

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12
Q

Explain the volume and concentration changes across compartments during SIADH

A

ECF volume: increase

ECF osmolarity : decrease

ICF volume: increase

ICF osmolarity: decrease

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by excessive unsuppressible release of antidiuretic hormone (ADH). Unsuppressed ADH causes an unrelenting increase in solute-free water being returned by the tubules of the kidney to the venous circulation

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13
Q

Workhorse of the Nephron

A

PCT

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14
Q

Reabsorption in the PCT

A

66% of filtered Na, K, H20

100% of filtered glucose and amino acids

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15
Q

most susceptible to hypoxia and toxins

A

PCT

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16
Q

Loop of HEnle

Descending Limb

A

permeable to water

Impermeable to solutes

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17
Q

loop of henle

Ascending limb

A
  • permeable to solutes
  • impermeable to water
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18
Q

where does NA K 2Cl transport located

A

Thick ascending limb of henle also called Diluting segment

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19
Q

Also called Cortical diluting segment and the site for macula densa

A

Early Distal tubule

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20
Q

Site of action of Aldosterone

A

Late distal tubule

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21
Q

Cells contain in the LAte Distal TUbule

A

Principal cells and Intercalated cells

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22
Q

Pricipal cells REABSORB AND SECRETE?

A

reabsorb : Na

Secrete: K

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23
Q

Intercalated cells reabsorb and secrete?

A

reabsorb : K

Secrete: H

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24
Q

Role of ADH

A

↑ ADH → ↑ AQP-2 channels → ↑water reabsorption

  • Results in ↑ intravascular volume → ↑VR, CO, BP
  • Results in ↓ urine volume, ↑ urine concentration
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25
Q

Movement from Glomerular Capillaries to Bowman’s Space

A

GLomerular filtration

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26
Q

Movement from Tubules to Interstitium to Peritubular
Capillaries

A

(Tubular) Reabsorption

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27
Q

Movement from Peritubular Capillaries to Interstitium to
Tubules

A

(Tubular) Secretion

28
Q

Define Excretion

A

Excretion = (Amount Filtered) – (Amount Reabsorbed) +

(Amount Secreted)

29
Q

Point were Substance start to appear in the urine and
nephrons exhibit saturation

A

Renal Threshold

30
Q

All excess substance appear in the urine
and All nephrons exhibit saturation

A

Renal Transport Maximum

31
Q

Management for overdose with acidic drug

A

overdose with an ACIDIC
drug (e.g. ASA), ALKALINIZE the urine so that the weak acid will be in its water-soluble (charged) form.

WEAK ACIDS:

HA Form (lipidsoluble)
and A- Form (water-soluble)
  • A- Formpredominates: less back diffusion,ncreased excretion of weak acids (e.g., ASA excretion increased by alkalinizing urine)
32
Q

Management overdose with basic drug

A

If you overdose with an ALKALINE/BASIC
drug (e.g., morphine), ACIDIFY the urine so that the weak base will once again be in its water-soluble (charged) form).

WEAK BASES:

BH+ Form (watersoluble)
and B Form (lipid-soluble)

• B form predominates, more
“back-diffusion”,decreased excretion
of weak bases

33
Q

Volume of plasma cleared of a substance per unit of time (in mL/min or mL/24 hour)

A

Clearance

34
Q

principle behind tubular processing

A

involves two parameters: renal threshold and renal transport maximum.. for examlpe, glucose is 100% and reabsorbed. suposed na madami kang intake ng glucose( 200mg/dl) , some of your nephrons will eventualy be saturated over time. when renal transport maximum is achieve (>375mg/dl), at this point glucose will start to appear in urine. In english: the higher the plasma conc, the higher the glucose filtered and excreted in the urine :)

As for the case ng PAH, filtered, secreted not reabsorb. never sya magkakaroon ng renal threshold or transport maximum kasi never masasaturate yung nephron kasi naeexcrete nga kasi sya all the time

35
Q

TRUE OR FALSE: If substance has high clearance: most will be found in the urine

A

true

36
Q

If substance has low clearance: most will be found in the blood

A

true

37
Q

Reason why PAH hs the highest clearance

A

Reason: Filtered and Secreted, not reabsorbed

38
Q

Used to estimate for Renal Blood Flow (RBF) and Renal Plasma Flow (RPF)

A

PAH

39
Q

Relative clearances in order

A

PAH > K > inulin > urea > Na > glucose, amino acids and HCO3-

40
Q

Substance with low clearances

A

Lowest Clearance: Protein, Na, Glucose, amino Acids, HCO3- and Cl

  • Reason: Not filtered (protein), or filtered but mostly reabsorbed

(everything else listed above)
o Normally not found or found in small amounts in the urine

41
Q

Substances were clearance is equal to gfr

A

inulin, creatinine

filtered but not secreted not reabsorbed

42
Q

substance that is more concentrated at the end of PCT that at the start of PCT:

A

Creatinine

Crea Clearance = Crea excreted/plasma crea concentration

43
Q

Marker for Kidney function (glomerular marker)

A

Creatinine

44
Q

Directly proportional to pressure difference between renal artery and renal vein; inversely proportional to resistance of renal vasculature?

and 25% of cardiac output

A

renal blood flow

45
Q

True or false: vasodilation of renal arterioles increses RBF

A

TRUE

46
Q

Substance that cause Vasodilation of Renal Arterioles:

A

PGE2, PGI2, bradykinin, NO, dopamine

47
Q

True or false: Vasoconstriction of Renal Arterioles:Increases

A

false: decreases

48
Q

True or false : ANP vasoconstrict Afferent Arterioles and to a lesser extent vasodilates Efferent Arterioles.

Net effect: increases RBF

A

false

ANP: vasodilates Afferent Arterioles and to a lesser extent vasoconstricts Efferent Arterioles.

Net effect: increases RBF

49
Q

Estimated by PAH Clearance

A

Renal Plasma Flow (RPF)

50
Q

True or false : PAH Clearance underestimates true RPF by 10% due to RPF to
kidney regions that do not filter and secrete PAH

A

TRUE

51
Q

A patient is infused with para-aminohippuric acid (PAH) to measure renal blood flow (RBF). She has a urine flow rate of 1 mL/min, a plasma [PAH] of 1 mg/mL, a urine [PAH] of 600 mg/mL, and a hematocrit of 45%. What is her “effective” RBF?
(A) 600 mL/min
(B) 660 mL/min
(C) 1091 mL/min
(D) 1333 mL/min

A 
CPAH = UPAH × V/PPAH = 600 mL/min
CPAH = RPF since clearance of PAH is used to estimate RPF
RBF = RPF/ (1 – hematocrit)
RBF = (6000mL/min)/ (1-0.45)
RBF = 600mL/min/0.55
RBF = 1091 mL/min
52
Q

renal blood flow formula

A

RBF= RPF/ 1- hematocrit

53
Q

Amount filtered in the glomerular capillaries per unit time

A

GFR

Normal Value: 125mL/min or 180L/day

54
Q

T/F : GFR Determined by Starling Forces at the level of the glomerular
capillary (glomerulus)

A

TRUE

55
Q

T/F : BUN and Creatinine increase when GFR increases
o

A

FALSE: DECREASES

56
Q

T/F In pre-renal azotemia (e.g. Hypovolemia), CREATININE increases more than BUN and Crea/BUN ratio > 20:1

A

FALSE

In pre-renal azotemia (e.g. Hypovolemia), BUN increases
more than creatinine and BUN/Crea ratio > 20:1

57
Q

T/F GFR decreases with age, but Creatinine remains constant due to decreased muscle mass

A

TRUE

58
Q

• ” Water pressure” at the GC.
• Promotes GFR.
• Increased by vasodilation of afferent
arteriole or moderate vasoconstriction of
efferent arteriole

A

GC Hydrostatic
Pressure

59
Q

• “Water pressure” at the BS that opposes GC
hydrostatic Pressure and GFR.
• Increased by ureteral obstruction

A

BS Hydrostatic
Pressure

60
Q
  • “Proteins attracting water” at the GC.
  • Opposes GFR.
  • Increased by plasma protein concentration.
A

GC Oncotic
Pressure

61
Q

“Usually ignored”.
• Normal value: 0 (no protein is normally
filtered to BS

A

BS Oncotic
Pressure

62
Q

• Not a Starling Force.
• Hydraulic conductance/filtration
coefficient describes capillary permeability.
• Promotes GFR. Increased by histamine
• (e.g. in burns)

A

Kf

63
Q

Fraction of renal plasma flow that is filtered

A

FILTRATION FRACTION (FF)

• Normal Filtration Fraction: 20%

64
Q

T/F ↑ Filtration Fraction → ↑ peritubular capillary protein
concentration → ↑ reabsorption in the tubules

A

true

65
Q
A

Physio Topnotch 2020 (1 decks)

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