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BRS Physio > Renal and Acid-Base Physiology > Flashcards

Renal and Acid-Base Physiology Flashcards

1
Q

2/3 of TBW

A

intracellular fluid

K, Mg, protein and organic phosphates

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2
Q

1/3 of TBW

A

extracellular fluid
1/4 is plasma
3/4 is interstitial fluid

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3
Q

Marker for TBW

A

tritiated H2O, D2O

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4
Q

Marker for ECF

A

Sulfate, inulin, mannitol

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5
Q

Marker for Plasma

A

Radioiodinated serum albumin (RISA), Evans Blue

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6
Q

Interstitial Fluid marker

A

measured indirectly

ECF-plasma volume

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7
Q

Marker for ICF

A

measured indirectly

TBW-ECF

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8
Q

Infusion of isotonic NaCl - addition of isotonic fluid

A

isosmotic volume expansion

ECF volume increases but no change in osmolarity

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9
Q

Diarrhea - loss of isotonic fluid

A

isosmotic volume contraction

ECF volume decreases no change in osmolaritiy

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10
Q

Excessive NaCl intake - addition of NaCl

A

Hyperosmotic volume expansion
osmolarity of ECF increases and water shifts from ICF to ECF
ICF osmolarity increases until it equals that of ECF

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11
Q

sweating, fever, diabetes insipidus

A

hyperosmotic volume contraction

decrease in ECF, ICF volume and increase ECF osmolarity

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12
Q

SIADH

A

hyposmotic volume expansion

increase in ECF & ICF volume and decrease in ECF osmolarity

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13
Q

Adrenal Insufficiency

A

hyposomotic volume contraction

decrease in ECF volume, increase in ICF volume, ECF osmolarity is decreased

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14
Q

Clearance Equation

A

CL = (UV)/P
U is urine conc
V is urine vol/time
P is plasma conc

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15
Q

Vasoconstriction of renal arterioles on RBF

A

RBF will decrease

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16
Q

Low conc of Ang II

A

preferentially constricts efferent arterioles and increase GFR

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17
Q

ACE-inhibitors on GFR

A

dilate efferent arterioles thus decreasing GFR

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18
Q

Vasodilation of renal arterioles on RBF

A

increase in RBF, is produced by PGE2 and PGI2, bradykinin, NO and dopamine

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19
Q

Macula Densa

A

increases renal artery pressure leads to increased delivery of fluid to macula densa
increased load causes constriction of nearby afferent arteriole, increasing resistance to maintain constant blood flow

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20
Q

Measurement of renal plasma flow

A

clearance of PAH, it is filtered and secreted by renal tubules

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21
Q

RPF equation

A

Cpah = (Upah*V)/Ppah

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22
Q

Measurement of RBF

A

RBF = RPF/(1-Hb)

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23
Q

Measurement of GFR

A

clearance of inulin

Cin = (Uin*V)/Pin

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24
Q

BUN and serum [creatinine] increase

A

when GFR decreases

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25
Q

Filtration Fraction

A

FF = GFR/RPF

normal is ~0.20

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26
Q

increases in FF causes

A

increase in protein conc of peritubular capillary blood

increased reabsorption in proximal tubule

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27
Q

decreases in FF causes

A

decreases in protein conc of peritubular capillary blood

decreased reabsorption in proximal tubule

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28
Q

GFR Starling eqtn

A

GFR = Kf[(Pgc-Pbs)-(OSMgc-OSMbs)

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29
Q

Constriction of Afferent Arteriole (sympathetic)

A

decrease GFR, decrease RPF, no change in FF

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30
Q

Constriction of Efferent Arteriole (angII)

A

increase GFR, decrease RPF, increase FF

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31
Q

increased plasma [protein]

A

decrease GFR, no change in RPF, decrease FF

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32
Q

Kidney Stone

A

decrease GFR, no change in RPF, decrease FF

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33
Q

Filtered Load

A

GFR * [plasma]

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34
Q

Excretion rate

A

V * [urine]

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35
Q

Reabsorption rate

A

Filtered Load - Excretion Rate

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36
Q

Secretion Rate

A

Excretion Rate - Filtered Load

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37
Q

Splay (on Tm for glucose)

A

excretion of glucose before glucose is fully saturated

ususllay between 250 and 350

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38
Q

HA form predominates in which type of urine?

A

acidic urine

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39
Q

A- form predominates in which type of urine?

A

alkaline

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40
Q

How to excrete salicylate acid

A

increase excretion by alkalinizing the urine

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41
Q

compares the concentration of a substance in tubular fluid at any point along the nephron with the conc in plasma

A

Tubular Fluid/Plasma ratio

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42
Q

TF/P = 1

A

no reabsorption of substance or reabsorption of the substance is exactly proportional to the reabsorption of water

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43
Q

TF/P < 1

A

reabsorption of substance

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44
Q

TF/P > 1

A

secretion of substance

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45
Q

Reabsorbs 2/3 of 67% of filtered Na and H2O in nephron

A

Proximal Tubule

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46
Q

Isosmotic process in the renal tubules

A

in Proximal Tubules

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47
Q

Carbonic anhydrase inhibitor

A

diuretic that act in early PT by inhibiting the reabsorption of filtered HCO3-

48
Q

Late Proximal tubules reabsorbs what

A

Sodium and Chloride

49
Q

Reabsorbs 25% of filtered Na+

A

Thick Ascending Limb of Henle

50
Q

inhibits Na-K-2Cl in TAL

A

loop diuretics like furosimide, ethacrynic acid and bumetanide

51
Q

impermeable to water

A

Thick ascending limb of henle, early distal tubule

52
Q

diluting segment

A

TAL, TF/P is <1

53
Q

site of action of thiazide diuretics

A

Distal Convoluted tubules

54
Q

Principal Cells

A

in late distal tubule and collecting duct
Aldosterone - reabsorb Na and H2O & secrete K
ADH - increases H2O permeability

55
Q

K-sparing diuretics

A

spironolactone, triamterene, amiloride

56
Q

alpha-intercalated cells

A

secrete H+ by H-ATPase, stimulated by aldosterone

reabsorbs potasium by H/K-ATPase

57
Q

Causes of Hyperkalemia

A

insulin deficiency, acidosis
digitalis
exercise
cell lysis

58
Q

Causes of Hypokalemia

A

insulin, beta-agonists, alkalosis, hypo-osmolarity

59
Q

Hyperaldosteronism

A

increases K secretion and causes hypokalemia

60
Q

Hypoaldosteronism

A

decreases K secretion and causes hyperkalemia

61
Q

Increases the urea permeability of the inner medullary collecting ducts

62
Q

Low urine flow rate

A

greater urea reabsorption

63
Q

high urine flow rate

A

greater urea excretion

64
Q

Phosphate reabsorbed in the PT

A

85% via Na-Phos Cotransport

65
Q

PTH

A

inhibits phsophate reabsorption in PT by activating adenylate cyclase
increased Calcium reabsorption by activating AC in distal tubule

66
Q

Treatment of idiopathic hypercalciuria

A

Thiazide diuretics

67
Q

TAL competition

A

Mg and Ca compete for reabsorption, hypercalcemia causes an increase in Mg excretion
hypermagnesemia causes an increase in Ca excretion

68
Q

hyperosmotic urine

A

when ADH levels are high, water deprivation, hemorrhage, SIADH

69
Q

maintenance of the corticopapillary osmotic gradient

A

Countercurrent exchange in the vasa recta
countercurrent mulitplication in the loop of Henle
ADH has a big part in reabsorption of NaCl and Urea to make the gradient

70
Q

Impermeable to water

A

TAL, therefore NaCl will be reabsorbed making the urine dilute therefore TF/P <1.0
Early distal convoluted tubule as well

71
Q

Late Distal Tubules and high ADH

A

ADH increases the H2O permeability of principal cells

TF/P = 1.0

72
Q

Collecting Ducts and high ADH

A

ADH increases the H2O permeability of principal cells

TF/P >1.0

73
Q

Renal Tubules without ADH

A

PT: TF/P = 1.0 (isosmotic)

TAL, early DT, late DT, and CT: TF/P <1.0

74
Q

Used to estimate the ability to concentrate or dilute urine

A

Free water Clearance

  • no ADH: Ch2o is (+)
  • yes ADH: Ch2o is (-)
75
Q

Primary Polydipsia

A

decreased ADH, decreased serum Na, hyposmotic urine, High urine flow rate, positive free water clearance

76
Q

Central Diabetes Insipidus

A

decreased ADH, increased serum Na, hyposmotic urine, High urine flow rate, positive free water clearance

77
Q

Nephrogenic diabetes insipidus

A

increased ADH, increased serum Na, hypoosmotic urine, high urine flow rate, positive free water clearnace

78
Q

Water Deprivation

A

increase ADH, high/normal serum Na, hyperosmotic urine, low uring flow, negative free water clearance

79
Q

SIADH

A

really increased ADH, decreased Na because too much water reabsorption, hyperosmotic urine, low urine flow rate, negative free water clearance

80
Q

Stimulates 1alpha-hydroxylase

81
Q

secreted when hyperosmotic plasma and decreased blood volume

A

ADH

increases H2O permeability in LDT and CD principal cells

82
Q

released when there is a decreased in blood volume and an icnrease in plasma [K]

A

Aldosterone

83
Q

Actions of Aldosterone

A

increase sodium reabsorption in DT principal cells
increase K secretion in DT principal cells
increase H+ secretion in DT alpha-intercalated cells

84
Q

what is release with an increase in atrial pressure and its MoA

A

ANP, cGMP

used to increase GFR, decrease Na reabsorption

85
Q

MoA of AngII

A

increases Na/H-exchange and HCO3- reabsorption in proximal tubule

86
Q

Volatile Acid

87
Q

When are buffers most effective?

A

within 1pH unit of the pK of buffer

88
Q

Most important extracellular buffer

89
Q

Most important urinary buffer

90
Q

Intracellular Buffers

A

Organic Phosphates & Proteins like Imidazole and alpha-amino groups and Hb
deoxyHb is better buffer than oxyHb

91
Q

Henderson-Hasselbalch Eqtn

A

pH = pK + loh ([A-]/[HA])

92
Q

Buffer is most effective in what part of a titration curve?

A

Linear portion

93
Q

Primary reabsorption site for HCO3-

A

proximal tubule

94
Q

pCO2 and HCO3-

A

increased pCO2 => increased rates of HCO3- reabsorption, basis for renal compensation for respiratory acidosis
decreased pCO2 => decreased rates of HCO3- reabsorption, renal compensation for respiratory alkalosis

95
Q

ECF volume and HCO3-

A

ECF volume expansion results in decreased HCO3- reabsorption

ECF volume contraction results in increased HCO3 reabsorption

96
Q

Diffusion Trapping

A

H+ is secreted into lumen via H-ATPase and combines with NH3 to form NH4

97
Q

NH3 and acidosis

A

in acidosis, adaptive increase in NH3 synthesis occurs thus increasing gradient for NH3 diffusion

98
Q

Inhibits NH3 synthesis

A

Hyperkalemia

99
Q

Kussmaul Breathing

A

respiratory compensation for metabolic acidosis

100
Q

Serum Anion Gap

A

For metabolic Acidosis
[Na]-([Cl]+[HCO3])
normal is 12mEq/L

101
Q

Hypoventilation

A

respiratory compensation for metabolic alkalosis

102
Q

Decerase in respiratory rate and retention of CO2

A

Respiratory Acidosis

increase in both H+ and HCO3-

103
Q

Winter Formula

A

PCO2 = (1.5 x HCO3) + 8 ± 2
• If Measured < Expected = Respiratory Alkalosis
• If Measured > Expected = Respiratory Acidosis

104
Q

Anion Gap with K+

A

= ([Na] + [K]) − ([Cl] + [HCO3])

105
Q

Metabolic Acidosis increase anion gap

A 
Increase Anion ( >12 ): MUDPILES
	Methanol
	Uremia
	Diabetic Ketoacidosis
	Paraldehyde
	Iron, Isoniazide
	Lactate
	Ethylene Glycol
	Salicylates, Starvation
106
Q

Metabolic Acidosis non-gap

A

normal is between 5-12: Hypercholemic
GI Loss: diarhhea, Sx drain, Fistula, Cholestryamine
Renal Loss: Renal tubular acidosis
• Proximal RTA – Acetazolamide (Diuretic)
• Distal RTA – Inpaired H+ Secretion, Cannot Acidify Urine

107
Q

Nasogastric suction

A

causes metabolic alkalosis

108
Q

medical procedures that cayse metabolic alkalosis with chloride sensitivity

A

vomiting, NG suction, diuretics, LR, TPN, Blood

109
Q

Metabolic Acidosis - pH, primary disturbance, compensatory response

A

decreased pH, decreased HCO3

compen - decrease pCO2

110
Q

Metabolic Alkalosis - pH, primary disturbance, compensatory response

A

increased pH, increased HCO3

compen - increase pCO2

111
Q

Respiratory Acidosis - pH, primary disturbance, compensatory response

A

decreased pH, increased pCO2

compen - increase HCO3

112
Q

Respiratory Alkalosis - pH, primary disturbance, compensatory response

A

increased pH, decreased pCO2

Compen - decrease HCO3

113
Q

Furosimide, ALbuterol, Na Polysterene Sulfonate

A

Cause Hypo-K

114
Q

Spironolactone, ACEi, Ibuprofen

A

Cause Hyper-K

115
Q

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BRS Physio (7 decks)

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