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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
Q

What hormone controls urine concentration?

A

Antidiuretic hormone

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26
Q

Nope

A

Nope

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27
Q

What is a central stimulus for ADH release? What organ senses?

A

Increased plasma osmolarity.

Sensed by osmoreceptor cells in anterior hypothalamus

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28
Q

What cardiac reflexes stimulate ADH release?

A

Arterial varoreceptor reflex

Cardiopulmonary reflex

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29
Q

True or false: Aldosterone also stimulates potassium uptake into the cell.

A

True

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30
Q

Hydrogen ion secretion and HCO3- reabsorption occur where in the nephron?

A

All parts of the tubules except the descending and ascending thin limbs of the loop of Henle.

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31
Q

What is the most potent stimulus for H+ secretion by the kidney?

A

Elevated blood CO2

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32
Q

What is the 60% 40% 20% rule?

A

Total body water is 60% of body weight

Intracellular fluid is 40% of the body weight

Extracellular fluid is 20% of the body weight

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33
Q

What is the extracellular fluid compartment composed of? What is the fraction of each?

A

Plasma - 1/4 of ECF

Interstitial 3/4 of ECF

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34
Q

What happens in SIADH?

A

Increased ADH release - gain of water (hyponatremia)

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35
Q

What hormones cause vasodilation of renal arteriole?

A

Prostaglandins (PGE2; PGI2)
Bradykinin
Nitric oxide
Dopamine

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36
Q

What is atrial natriuretic peptide’s effect on renal arterioles?

A

Vasodilation of afferent arterioles

Vasoconstriction of efferent arterioles

= increases RBF and GFR

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37
Q

How much of the sodium that is filtered is reabsorbed in the nephron?

A

99%

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38
Q

How much of the sodium is reabsorbed in the proximal tubule?

A

67%

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39
Q

Where does acetazolamide work?

A

In the early proximal tubule by inhibiting reabsorption of the filtered HCO3-

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40
Q

Where are glucose, amino acids, phosphate and lactate reabsorbed?

A

Early proximal tubule, cotransported with Na+

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41
Q

How much sodium does the ascending thick limb of the loop of Henle reabsorb?

A

25%

Contains Na-K-2Cl cotransporter - Blocked by furosemide

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42
Q

Is the thick ascending limb of the loop of Henle permeable to water?

A

NO - As a result, the ultrafiltrate becomes diluted. Called the diluting segment.

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43
Q

What are some intracellular buffers?

A
  1. Organic phosphates
  2. Proteins
  3. Hemoglobins (major intracellular buffer)
44
Q

What is the most important site of Mg++ reabsorption in the nephron?

A

Ascending thick loop of Henle - Reabsorbs 65% of the magnesium

(all other things are mostly reabsorbed in proximal tubule)

45
Q

What is the mechanism for hyponatremia in DKA?

A

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
Q

What is the mechanism for hypokalemia in DKA?

A

Osmotic diuresis from hyperglycemia and glucosuria promotes increased renal loss of potassium

Vomiting/anorexia causes K loss through the GI tract
47
Q

What are some causes for acquired Fanconi syndrome (3)?

A
  1. Gentamicin
  2. Ethylene glycol toxicity
  3. Primary hypoparathyroidism
48
Q

What is the pathophysiology in Fanconi syndrome?

A
  1. Defective glucose resorption - Glucosuria and osmotic diuresis
  2. Defective amino acid resorption
  3. Defective absorption of bicarb, Na, K and urate
49
Q

What is the treatment for Fanconi syndrome?

A
  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
Q

How much of the bicarbonate is reabsorbed in the proximal tubule?

A

85%

51
Q

What is renal tubular acidosis?

A

Rare tubular disorders that lead to hyperchloremic metabolic acidosis (non-AG)

52
Q

What is a proximal tubular acidosis (Type II)

A

Inability of the proximal tubules to prevent loss of bicarbonate.

(Can occur alone or as part of Fanconi syndrome)

53
Q

What is a distal tubular acidosis? (AKA type I, classic)

A

Inability of the distal tubules to secrete H+

54
Q

What is the most common type of glomerulonephritis in dogs?

A

Membranoproliferative GN

55
Q

What is the most common type of glomerulonephritis in cats?

A

Membranous GN

56
Q

Where does amyloid deposition occur in renal amyloidosis?

A

Usually glomerular

Sharpeis and Abyssinian cats - Medullary/interstitial

57
Q

What stain is used to identify amyloid deposition?

A

Congo Red stain

58
Q

What is the treatment for renal amyloidosis? (Two medications)

A

Colchicine to PREVENT further deposition. Also helps with proteinuria.

DMSO - reduces interstitial fibrosis and inflammation

59
Q

Cutaneous and Renal Glomerulopathy of Greyhounds (AKA Alabama rot)

(Clinical signs and cause)

A

Skin ulceration (primarily limbs), pitting edema, and renal dysfunction

Caused by E. coli toxin - similar to hemolytic-uremic syndrome in children

60
Q

Cutaneous and Renal Glomerulopathy of Greyhounds (AKA Alabama rot)

Treatment

A

(i) supportive care for skin
(ii) most dogs without azotemia survive
(iii) supportive care/regular treatment for renal failure

61
Q

What % of cats with CKD develop renal secondary hyperparathyroidism?

A

84%

62
Q

What is the pathophysiology behind renal secondary hyperparathyroidism?

A

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
Q

Where is calcitriol formed? (Vitamin D)

A

Kidney - Formed by 1 alpha hydroxylation of 25-hydroxycholecalciferol in the PROXIMAL renal tubular cells

64
Q

What are the effects of calcitriol? (4)

A
  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
Q

What are the effects of PTH?

A
  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
Q

What is the role of treating renal secondary hyperparathyroidism with calcitriol?

A

Decreases PTH by negative feedback and by increasing calcium

67
Q

What are the two main mechanisms for aldosterone secretion?

A

Increased K+

Increased angiotensin II

68
Q

What hormones suppress aldosterone?

A

ANP
Dopamine
Heparin

69
Q

What hormone contributes to urea reabsorption via the urea transporters (UT-AI)?

A

ADH - helps create a medullary gradient

70
Q

What is nephrotic syndrome?

4 clinical findings

A

Glomerular disease resulting in peripheral edema, proteinuria, hypoalbuminemia and hypercholesterolemia

71
Q

Why does glomerular disease result in hypercholesteronemia?

A
  1. Loss of albumin stimulates the liver to produce lipoproteins
  2. Decreased orosomucoid - co-factor for normal lipoprotein lipase production
72
Q

Glucose transporters in the kidney? Which one is apical (luminal)? Which one is basolateral?

SGLT
GLUT

A

SGLT - Apical

GLUT - Basolateral

73
Q

What are the lower limits for creatinine of each IRIS stage, in dogs?

A

Stage 1 - no lower limit
Stage 2 - 1.4
Stage 3 - 2.9
Stage 4 - 5.0

74
Q

What are the lower limits for creatinine of each IRIS stage, in cats?

A

Stage 1 - no lower limit
Stage 2 - 1.6
Stage 3 - 2.9
Stage 4 - 5.0

75
Q

What is considered borderline proteinuria in dogs? Cats?

A

Dogs - 0.2 - 0.5

Cats - 0.2 - 0.4

76
Q

Acute NSAID is associated with:

A

Acute CORTICAL NEPHROtoxicity

77
Q

Chronic NSAID toxicity causes:

A

Chronic MEDULLARY CYTOtoxicity

78
Q

Asipirin is a (selective/non-selective) COX inhibitor?

A

Non-selective (binds both COX 1 and COX 2)

79
Q

Aspirin binds (reversibly/non-reversibly) to COX receptors?

A

irreversible

80
Q

How does hypercalcemia cause PU/PD

A

It causes nephrogenic diabetes insipidus by inhibiting V2 receptors

81
Q

A decrease in glomerular oncotic pressure results in (increased/decreased) GFR?

A

Increased

82
Q

What is a normal UPC based on the IRIS guidelines?

A

<0.2 for both dogs and cats

83
Q

What is the mechanism of PU/PD in CKD?

A

Increased solute load resulting in osmotic diuresis.

84
Q

Dog has USG of 1.005. Fails to respond to water deprivation test or vasopressin. What is the diagnosis?

A

Nephrogenic DI

85
Q

What is the most potent simulator for aldosterone secretion?

A

Elevated K+

86
Q

Determine the disturbance:

Low pH; Low bicarb; High CO2

A

Mixed metabolic/respiratory acidosis

87
Q

Which nerve innervates skeletal muscle at the external urethral sphincter?

A

Pudendal nerve

88
Q

How does acid base affect iCa?

A

Alkalosis - More iCa binds to albumin (leads to ionized hypocalcemia)

Acidosis - more Calcium ionizes (becomes free - ionized hypercalcemia)

89
Q

What are some chemistry changes with aflacotoxicosis?

A

Increased ALT»ALP
Hypoalbuminemia
Elevated T.bili
Normal BUN/Creat

90
Q

Given an elevated iCa and normal PTH - What is the diagnosis?

A

Hyperparathyroidism

91
Q

What is considered proteinuria in a dog? Cat?

A

Dog > 0.5

Cats >0.4

92
Q

Epinephrine (increases/decreases) GFR

A

Decreases

93
Q

What carries parasympathetic innervation to the bladder?

A

Pelvic nerve

94
Q

What causes false positive in a protein dipstick?

A

pH >8

95
Q

What will cause a false negative on a urine dipstick?

A

Bence jones proteinuria

SSA will pick it up and be positive

96
Q

What is the formula for anion gap?

A

(Na+ + K+) – (Cl- + HCO3-)

97
Q

What would you expect in a patient with increased bicarb and decreased K?

A

Paradoxical aciduria

98
Q

Where does carbonic anhidrase work in the equation?

A

Converting CO2 (and water) to carbonic acid

99
Q

How is serum osmolarity calculated?

A

2 (Na + K) + (BUN/2.8) + (Glu/18)

100
Q

What is Henry’s law?

A

The amount of dissolved O2 is proportional to the partial pressure

101
Q

How does acidosis affect potassium levels? What about ionized calcium?

A

Both of them increase

102
Q

Does aldosterone cause acidosis or alkalosis?

A

Alkalosis (stimulates H+-ATPase pump on intercalated cells)

103
Q

What is the Donnan effect?

A

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
Q

What is renal tubular acidosis?

A

rare tubular disorders that lead to hyperchloremic metabolic acidosis (non-AG)

105
Q

Where is the defect in proximal tubular acidosis (type II)?

A

In basolateral membrane Na-HCO3 cotrasnporter

106
Q

Bence jones proteinuria can cause a false (positive/negative) on a urine dipstick protein check?

A

False negative (SSA will detect bence jones)

ACVIM General Boards - 2022 (16 decks)

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