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ACVIM General Boards - 2022 > Renal/Acid-base > Flashcards

Renal/Acid-base Flashcards

1
Q

What percentage of total body weight is the extracellular fluid compartment?

A

20% of body weight

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2
Q

What percentage of total body weight is the intracellular fluid?

A

40%

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3
Q

What two compartments make up the extracellular fluid?

A

Interstitial fluid - 3/4

Plasma - 1/4

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4
Q

Strong sympathetic activation (increases/decreases) GFR

A

Decreases - e.g. during hemorrhage want to keep blood volume

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5
Q

What are the effects of prostaglandins on renal blood flow?

A

Dampen the vasoconstrictive effects of SNS or angiotensin => Vasodilation

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6
Q

What does the juxtaglomerular complex consist of?

A
  1. Macula densa - Initial portion of the distal tubular cells
  2. Juxtaglomerular cells - at wall of efferent and afferent arterioles
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7
Q

How is a decrease in blood pressure sensed by the kidney?

A

Decreased sodium chloride delivery to the macula densa (through distal tubule)

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8
Q

What is the effect of decreased sodium chloride delivery to the macula densa? (tubuloglomerular feedback)

A
  1. Decreased resistance of to afferent and efferent arterioles => increased GFR
  2. Increase in renin release from JUXTAGLOMERULAR cells
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9
Q

What is the myogenic mechanism of blood vessels?

A

Vascular contraction in response to high blood pressure => protects kidneys when blood pressure rises

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10
Q

How much of the water, sodium, potassium and other electrolytes is resorbed by the proximal tubule?

A

65%

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11
Q

Which part of the loop of Henle does furosemide work in?

A

Ascending Thick loop of Henle at the 1-sodium 2-chloride 1-potassium co-transporeter

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12
Q

Where do thiazide diuretics work?

A

Early distal tubule - sodium chloride contransporter

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13
Q

What does the early distal tubule do? Is it permeable to water?

A

Ion resorption and is not permeable to water - Dilutes tubular fluid

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14
Q

The late distal tubule and cortical collecting ducts are similar. What are the two cells that compose them?

A

Principal cells

Intercalated cells

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15
Q

What do the principal cells of the late distal tubule and cortical collecting ducts do?

A

Principal cells - Resorb sodium and water/secrete potassium

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16
Q

What do the intercalated cells of the late distal tubule and cortical collecting duct do?

A

Intercalated cells - Reabsorb potassium and secrete hydrogen ions (control acid-base)

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17
Q

What hormone controls the principal cells?

A

Aldosterone

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18
Q

What are the two types of intercalated cells? What do they do?

A

Type A intercalated cells - Secrete hydrogen ions, reabsorb bicarbonate => help with acidosis

Type B intercalated cells - Opposite of type A; secrete bicarbonate and reabsorb hydrogen ions

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19
Q

Where is urea reabsorbed in the kidney?

A

In the medullary collecting duct - helps raise the osmolality of renal medula

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20
Q

What influences the peritubular capillary hydrostatic pressure?

A
  1. Arterial pressure

2. Resistant of afferent and efferent arterioles

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21
Q

What influences the peritubular capillary colloid osmotic pressure?

A
  1. Systemic plasma colloid osmotic pressure

2. Filtration fraction (GFR/plasma flow ratio) - higher the filtration fraction = more concentrated protein

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22
Q

What is the effect of angiotensin II on the renal arterioles?

A

Constrict efferent&raquo_space;> afferent

Constrict efferent arteriole = Decrease in peritubular capillary hydrostatic pressure > increased filtration fraction

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23
Q

Angiotensin II preferentially constricts the (afferent/efferent) arteriole of the kidney

A

Efferent

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24
Q

What are the effects of parathyroid hormone on the kidney?

A

Calcium reabsorption in the distal tubule

Inhibition of phosphate reabsorption in the proximal tubule

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25
What hormone controls urine concentration?
Antidiuretic hormone
26
Nope
Nope
27
What is a central stimulus for ADH release? What organ senses?
Increased plasma osmolarity. Sensed by osmoreceptor cells in anterior hypothalamus
28
What cardiac reflexes stimulate ADH release?
Arterial varoreceptor reflex Cardiopulmonary reflex
29
True or false: Aldosterone also stimulates potassium uptake into the cell.
True
30
Hydrogen ion secretion and HCO3- reabsorption occur where in the nephron?
All parts of the tubules except the descending and ascending thin limbs of the loop of Henle.
31
What is the most potent stimulus for H+ secretion by the kidney?
Elevated blood CO2
32
What is the 60% 40% 20% rule?
Total body water is 60% of body weight Intracellular fluid is 40% of the body weight Extracellular fluid is 20% of the body weight
33
What is the extracellular fluid compartment composed of? What is the fraction of each?
Plasma - 1/4 of ECF | Interstitial 3/4 of ECF
34
What happens in SIADH?
Increased ADH release - gain of water (hyponatremia)
35
What hormones cause vasodilation of renal arteriole?
Prostaglandins (PGE2; PGI2) Bradykinin Nitric oxide Dopamine
36
What is atrial natriuretic peptide's effect on renal arterioles?
Vasodilation of afferent arterioles Vasoconstriction of efferent arterioles = increases RBF and GFR
37
How much of the sodium that is filtered is reabsorbed in the nephron?
99%
38
How much of the sodium is reabsorbed in the proximal tubule?
67%
39
Where does acetazolamide work?
In the early proximal tubule by inhibiting reabsorption of the filtered HCO3-
40
Where are glucose, amino acids, phosphate and lactate reabsorbed?
Early proximal tubule, cotransported with Na+
41
How much sodium does the ascending thick limb of the loop of Henle reabsorb?
25% | Contains Na-K-2Cl cotransporter - Blocked by furosemide
42
Is the thick ascending limb of the loop of Henle permeable to water?
NO - As a result, the ultrafiltrate becomes diluted. Called the diluting segment.
43
What are some intracellular buffers?
1. Organic phosphates 2. Proteins 3. Hemoglobins (major intracellular buffer)
44
What is the most important site of Mg++ reabsorption in the nephron?
Ascending thick loop of Henle - Reabsorbs 65% of the magnesium (all other things are mostly reabsorbed in proximal tubule)
45
What is the mechanism for hyponatremia in DKA?
i) osmotic diuresis causes by glycosuria and ketonuria = loss of Na, Mg, potassium, and Phosphorous ii) Na should decrease by 1.6 for every 100 mg/dl rise in glucose
46
What is the mechanism for hypokalemia in DKA?
Osmotic diuresis from hyperglycemia and glucosuria promotes increased renal loss of potassium Vomiting/anorexia causes K loss through the GI tract
47
What are some causes for acquired Fanconi syndrome (3)?
1. Gentamicin 2. Ethylene glycol toxicity 3. Primary hypoparathyroidism
48
What is the pathophysiology in Fanconi syndrome?
1. Defective glucose resorption - Glucosuria and osmotic diuresis 2. Defective amino acid resorption 3. Defective absorption of bicarb, Na, K and urate
49
What is the treatment for Fanconi syndrome?
1. Supportive 2. DO NOT GIVE ORAL SODIUM BICARB (will exacerbate bicarburia 3. Potassium citrate - Treat acidosis. Will alkalinize the urine without contributing to bicarburia. 4. Manage renal failure
50
How much of the bicarbonate is reabsorbed in the proximal tubule?
85%
51
What is renal tubular acidosis?
Rare tubular disorders that lead to hyperchloremic metabolic acidosis (non-AG)
52
What is a proximal tubular acidosis (Type II)
Inability of the proximal tubules to prevent loss of bicarbonate. (Can occur alone or as part of Fanconi syndrome)
53
What is a distal tubular acidosis? (AKA type I, classic)
Inability of the distal tubules to secrete H+
54
What is the most common type of glomerulonephritis in dogs?
Membranoproliferative GN
55
What is the most common type of glomerulonephritis in cats?
Membranous GN
56
Where does amyloid deposition occur in renal amyloidosis?
Usually glomerular Sharpeis and Abyssinian cats - Medullary/interstitial
57
What stain is used to identify amyloid deposition?
Congo Red stain
58
What is the treatment for renal amyloidosis? (Two medications)
Colchicine to PREVENT further deposition. Also helps with proteinuria. DMSO - reduces interstitial fibrosis and inflammation
59
Cutaneous and Renal Glomerulopathy of Greyhounds (AKA Alabama rot) (Clinical signs and cause)
Skin ulceration (primarily limbs), pitting edema, and renal dysfunction Caused by E. coli toxin - similar to hemolytic-uremic syndrome in children
60
Cutaneous and Renal Glomerulopathy of Greyhounds (AKA Alabama rot) Treatment
(i) supportive care for skin (ii) most dogs without azotemia survive (iii) supportive care/regular treatment for renal failure
61
What % of cats with CKD develop renal secondary hyperparathyroidism?
84%
62
What is the pathophysiology behind renal secondary hyperparathyroidism?
Increased PTH due to hypoCa, hyperP, and decreased calcitriol formation in the kidney (CKD). Detailed: Phosphorous retention AND decreased renal mass inhibits 1 alpha hydroxylase > dec calcitriol synthesis > decreased negative feedback > increased PTH synthesis
63
Where is calcitriol formed? (Vitamin D)
Kidney - Formed by 1 alpha hydroxylation of 25-hydroxycholecalciferol in the PROXIMAL renal tubular cells
64
What are the effects of calcitriol? (4)
1. Induces calcium-binding proteins to increase absorption in the intestines (and phosphorus) 2. Resorption of bone 3. increases renal tubular resoprtion of Ca and Phosphorous 4. Decreases PTH synthesis
65
What are the effects of PTH?
1. Stimulates formation of calcitriol 2. Stimulates osteoblasts to resorb bone 3. Decreases phosphorus reabsorption (proximal tubule) 4. Increases Ca resorption in collecting ducts
66
What is the role of treating renal secondary hyperparathyroidism with calcitriol?
Decreases PTH by negative feedback and by increasing calcium
67
What are the two main mechanisms for aldosterone secretion?
Increased K+ Increased angiotensin II
68
What hormones suppress aldosterone?
ANP Dopamine Heparin
69
What hormone contributes to urea reabsorption via the urea transporters (UT-AI)?
ADH - helps create a medullary gradient
70
What is nephrotic syndrome? | 4 clinical findings
Glomerular disease resulting in peripheral edema, proteinuria, hypoalbuminemia and hypercholesterolemia
71
Why does glomerular disease result in hypercholesteronemia?
1. Loss of albumin stimulates the liver to produce lipoproteins 2. Decreased orosomucoid - co-factor for normal lipoprotein lipase production
72
Glucose transporters in the kidney? Which one is apical (luminal)? Which one is basolateral? SGLT GLUT
SGLT - Apical | GLUT - Basolateral
73
What are the lower limits for creatinine of each IRIS stage, in dogs?
Stage 1 - no lower limit Stage 2 - 1.4 Stage 3 - 2.9 Stage 4 - 5.0
74
What are the lower limits for creatinine of each IRIS stage, in cats?
Stage 1 - no lower limit Stage 2 - 1.6 Stage 3 - 2.9 Stage 4 - 5.0
75
What is considered borderline proteinuria in dogs? Cats?
Dogs - 0.2 - 0.5 | Cats - 0.2 - 0.4
76
Acute NSAID is associated with:
Acute CORTICAL NEPHROtoxicity
77
Chronic NSAID toxicity causes:
Chronic MEDULLARY CYTOtoxicity
78
Asipirin is a (selective/non-selective) COX inhibitor?
Non-selective (binds both COX 1 and COX 2)
79
Aspirin binds (reversibly/non-reversibly) to COX receptors?
irreversible
80
How does hypercalcemia cause PU/PD
It causes nephrogenic diabetes insipidus by inhibiting V2 receptors
81
A decrease in glomerular oncotic pressure results in (increased/decreased) GFR?
Increased
82
What is a normal UPC based on the IRIS guidelines?
<0.2 for both dogs and cats
83
What is the mechanism of PU/PD in CKD?
Increased solute load resulting in osmotic diuresis.
84
Dog has USG of 1.005. Fails to respond to water deprivation test or vasopressin. What is the diagnosis?
Nephrogenic DI
85
What is the most potent simulator for aldosterone secretion?
Elevated K+
86
Determine the disturbance: Low pH; Low bicarb; High CO2
Mixed metabolic/respiratory acidosis
87
Which nerve innervates skeletal muscle at the external urethral sphincter?
Pudendal nerve
88
How does acid base affect iCa?
Alkalosis - More iCa binds to albumin (leads to ionized hypocalcemia) Acidosis - more Calcium ionizes (becomes free - ionized hypercalcemia)
89
What are some chemistry changes with aflacotoxicosis?
Increased ALT>>ALP Hypoalbuminemia Elevated T.bili Normal BUN/Creat
90
Given an elevated iCa and normal PTH - What is the diagnosis?
Hyperparathyroidism
91
What is considered proteinuria in a dog? Cat?
Dog > 0.5 Cats >0.4
92
Epinephrine (increases/decreases) GFR
Decreases
93
What carries parasympathetic innervation to the bladder?
Pelvic nerve
94
What causes false positive in a protein dipstick?
pH >8
95
What will cause a false negative on a urine dipstick?
Bence jones proteinuria SSA will pick it up and be positive
96
What is the formula for anion gap?
(Na+ + K+) – (Cl- + HCO3-)
97
What would you expect in a patient with increased bicarb and decreased K?
Paradoxical aciduria
98
Where does carbonic anhidrase work in the equation?
Converting CO2 (and water) to carbonic acid
99
How is serum osmolarity calculated?
2 (Na + K) + (BUN/2.8) + (Glu/18)
100
What is Henry's law?
The amount of dissolved O2 is proportional to the partial pressure
101
How does acidosis affect potassium levels? What about ionized calcium?
Both of them increase
102
Does aldosterone cause acidosis or alkalosis?
Alkalosis (stimulates H+-ATPase pump on intercalated cells)
103
What is the Donnan effect?
The oncotic pressure of albumin is mediated by its negative charge (attracts cations like Na and K+ and thus more H2O than it would by itself)
104
What is renal tubular acidosis?
rare tubular disorders that lead to hyperchloremic metabolic acidosis (non-AG)
105
Where is the defect in proximal tubular acidosis (type II)?
In basolateral membrane Na-HCO3 cotrasnporter
106
Bence jones proteinuria can cause a false (positive/negative) on a urine dipstick protein check?
False negative (SSA will detect bence jones)

ACVIM General Boards - 2022 (16 decks)

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