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Renal ERIN > Renal cards II > Flashcards

Renal cards II Flashcards

1
Q

where does renin come from?

A

JG cells

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2
Q

What triggers renin release from JG cells?

A

decreased renal perfusion (detected via renal barorecepotrs in afferent arteriole), increased renal sympathetic discharge (B1 effect), and decreased NaCl delivery to macula densa

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3
Q

What is the function of ANP/BNP?

A

inhibits renin-angiotensin-aldosterone symstem; relax SM via increased cGMP -> Increased GFR
Dilates afferent arteriole and promotes diuresis

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4
Q

Name 5 functions of ATII

A

Adrenal cortex ->increased aldosterone section
Pituitary -> increased ADH
PCT - > increased Na/H activity
Glomerulus ->constricts efferent arteriole
Blood vessels -> vasoconstriction

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5
Q

What does the macula densa sense?

A

decreased NaCl delivery to DCT

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6
Q

Where is the macula densa?

A

DCT

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7
Q

What are the components of the JGA?

A

mesangial cells, JG cells, and macula densa

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8
Q

Where does erythropoietin come from?

A

interstitial cells in peritubular capillary beds of kidney

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9
Q

What is the PCTs role in vitamin D?

A

converts 25-OH vitamin D3 to 1,25 vitamin D3 (calcitriol)

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10
Q

what is the enzyme involve in the version of 25,OH bit D to 1,25 OH vitamin D?

A

1-alpha hydroxylase

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11
Q

How do prostaglandins effect the glomerulus ?

A

paracrine secretion vasodilates the afferent arterioles to increase RBF

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12
Q

what effect can NSAIDs have on the kidneys?

A

they inhibit prostaglandin synthesis so lead to constriction of thee afferent arterile and decreased GFR; may result in AKI

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13
Q

which cells in the glomerulus may secrete dopamine?

A

PCT

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14
Q

What effect does dopamine have at low doses, and at high doses?

A

low doses - increased RBF

high doses - vasoconstrictor

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15
Q

What is the ‘capillary effect’ ?

A

constriction of the efferent arteriole leads to a decrease in hyrostatic pressure in the peritubular capillaries and thus an increased reabsorption of Na/H2O

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16
Q

List things that cause an intracellular K shift

A

Hypo-osmolarity
Alkalosis
B-adrenergic agonists (increase Na/K atpase)
Insulin (Na/K atpase)

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17
Q

List things that cause an extracellular K shift?

A 
Digitalis (blocks Na/K atpase)
Hyperosmolarily
Lysis of cells
Acidosis
B-blocker
High blood sugar
Succinocholine
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18
Q

What substances will be elevated in Rhabdomyolysis?

A

CK, aldolase, lactate dehydrogenase, AST/ALT
Hyperkalemia and hyperphosphatema are common
Hyperuricemia
Myoglobin

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19
Q

What effect does elevated myoglobin have on the kidneys in rhabdomyolysis?

A

Obstructs the tubules and is toxic to the PCT.
It leads to vasoconstriction and hypoxia
(made worse by dehydration)

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20
Q

how to diagnose rhabdomyolysis

A

CK >1000 IU/L
Urine dipstick for heme +
No RBCs on microscopy

21
Q

Why does hypocalcemia initially occur with rhabdomyolysis?

A

Calcium deposits in damaged myocytes (note that it may become elevated during recovery)

22
Q

Symptoms of low Na

A

nausea, malaise, stupor, coma, seizures

23
Q

Symptoms of high serum Na

A

irritability, stupor, coma

24
Q

Symptoms of low potassium in serum

A

U waves and flattended T waves on ECG, arythmias, muscle cramps, spasms and weakness

25
Q

Symptoms of high potassium in serum

A

wide QRS, peaked T waves on ECG, arythmias and muscle weakness, sinus arrest, AV block

26
Q

Symptoms of low calcium

A

tetany, seizures, QT prolongation, twiching (Chvostek), spasm (trousseaux)

27
Q

Symptoms of high calcium

A

renal stones, bone aches, psychiatric disturances, abdominal pain, urinary freqency

28
Q

Symptoms of low Mg

A

tetany, torsades de pointes, hypokalemia, hypocalcemia (when mg is severely decreased)

29
Q

Symptoms of high Mg

A

Decreased DTRs, lethargy, bradycardia, hyptotension, cardiac arrest, hypocalcemia

30
Q

Symptoms of low phosphate

A

bone loss, osteomalacia or rickets

31
Q

Symptoms of high phosphate

A

renal stones, metastatic calcifications, hypocalcemia (it precipitates calcium)

32
Q

What effect does an aspirin overdose have on breathing?

A

Causes a respiratory alkalosis because salicylates stimulate the medulla to cause hyperventilation

33
Q

What effect will aspirin have on the oxidative phosphorylation?

A

Inhibits ox phosph ->metabolic acidosis

34
Q

What will the blood pH be in someone with aspirin overdose?

A

variable

35
Q

What will Winters formula predict in an aspirin overdose?

A

it will predict a CO2 higher than what the patient has because the patient has concomitant respiratory alkalosis

36
Q

What effects does acidosis have on the heart and brain?

A

myocardial depression from decreased contractility

Increased CO2 leads to cerebral vasodilation

37
Q

What effects does alkalosis have on the brain?

A

Cerebral vasoconstriction - > decreased cerebral blood flow

38
Q

What does winters formula predict?

A

predicts the appropraite respiratory compensation (pCO2) for a simple metabolic acidosis

39
Q

What is winters formula?

A

pCO2 = 1.5(bicarb) + 8 plus or minus 2

40
Q

Causes of respiratory alkalosis

A 
Anxiety/panic attack
Hypoxemia (high altitude)
Salicylates)
Tumour
PE
41
Q

Casues of respiratory acidosis?

A 
airway obstruction
acute lung disease
chronic lung disease
opioids, sedatives
Weak resp muscles
42
Q

Causes of metabolic alkalosis

A

loop diuretics/thiazides
vomiting
antacid use
hyperaldosteronism

43
Q

How do you calculate the anion gap?

A

Na - (Cl + HCO)

44
Q

What number indiactes an anion gap metabolic acidosis?

A

anion gap > 12

45
Q

What number indicates an NORMAL anion gap?

A

<12

46
Q

List the causes of anion gap metabolic acidosis (MUDPILES)

A 
MUDPILES
Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets or INH
Lactic acidosis 
Ethylene glycol
Salicylates (late)
47
Q

Which substances are found in antifreeze?

A

methanol (formic acid) and propylene glycol

48
Q

Presentation of antifreeze poisoning

A

vision loss

49
Q

What are the causes of normal anion gap metabolic acidosis? HARDASS

A 
hypercholermia/hyperalimentation
Addisons disease
renal tubular acidosis
diarrhea
acetazolamide
spironolactone
saline infusion

Renal ERIN (5 decks)

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