Renal - Exam 4

Question 1

Kidneys regulate body fluid

Answer 1

osmolarity and electorlytes

Question 2

sodium salts are what % of osmolarity?

Answer 2

90%

Question 3

Normal osm =

Answer 3

300 mOsm/kg

Question 4

kidneys reabsorb what?

Answer 4

• water
• glucose
• Proteins
• vitamins

Question 5

Production of renin in response to

Answer 5

• decreased renal blood flow

- Increased sympathetic discharge (beta 1 effect)

Question 6

**This area of the kidney is most vulnerable to ischemia secondary to hypotension:

Answer 6

Inner stripe of outer zone (in medulla)

Question 7

** What structures are within the inner zone of the Medulla?

Answer 7

Collecting duct
duct of bellini
Thin loop of Henle

Question 8

This structure is important in countercurrent mechanism:

Answer 8

Vasa Recta

Question 9

Juxtaglumerular (JG) apparatus is made up of these two structures:

Answer 9

1. ) Macula Densa (sensor)

2. ) Juxtaglomerular cells (Secrete)

Question 10

Role of juxtaglomerular apparatus?

Answer 10

sodium control

Question 11

JG cells secrete:

Answer 11

RENIN

Question 12

Afferent arterioles protrude into bownman’s capsule doing what?

Answer 12

bringing blood IN arriving

Question 13

Efferent arterioles do what?

Answer 13

EXIT bowmans capslule and take blood out

Question 14

Vasa recta is a capillary bed along the

Answer 14

loop of Henle

Question 15

the sum of filtration, reabsorption and secretion =

Answer 15

excretion

Question 16

Net filtration pressure needed for glomerular filtration to occur?

Answer 16

10mmHg

Question 17

glomerular fluid each day results in production of,

out of which how many liters is reabsorbed

Answer 17

180 liters

179 liters

Question 18

normal GFR =

Answer 18

125ml/min

Question 19

Factors governing filtration rate at cap. bed:

Answer 19

1. net filtration rate
2. total surface area availalbe for filtration
3. filtration membrane permeability

Question 20

GFR is directly proportional to the

Answer 20

net filtration pressure

Question 21

changes in GFR results from changes in

Answer 21

glomerular blood pressure

decreae bp, decrease filtration, decrease urine

Question 22

if GFR is too high

Answer 22

substances can’t be reabsorbed fast enough

lost in urine

Question 23

if GFR is too low

Answer 23

everything is reabsorbed

-including toxins/waste that normally are disposed

Question 24

BUN and CRT increase when

Answer 24

GFR decreases

Question 25

GFR decreases with

Answer 25

age

Question 26

vasoconstriction of afferent arteriole =

Answer 26

decrease GFR blocking entry

Question 27

vasoconstriction of efferent arteriole =

Answer 27

increased GFR blocking outlet Angiotensin II

Question 28

Ureteral stone impact on RBF and GFR:

Answer 28

RBF - no change | GFR - decreases

Question 29

Ace inhibitors do what to arterioles? results in?

Answer 29

dilate efferent arterioles - decreased Glomerular pressure - decrease GFR **leads to renal insufficiency

Question 30

avoid ace inhibitors in what patients?

Answer 30

those with bilateral renal artery stenosis *will make GFR worse

Question 31

avoid ace inhibitors in what patients?

Answer 31

those with bilateral renal artery stenosis *will make GFR worse

Question 32

what level is all glucose reabsorbed?

Answer 32

<250 mg/dl (or 200?)

Question 33

glucose >350 mg/dl means?

Answer 33

all carriers are saturated no reabsorption occurs above 350 mg/dl it's excreted

Question 34

plasma threshold at which glucose first appears in urine:

Answer 34

200 mg/dl

Question 35

where is glucose reabsorbed?

Answer 35

Prox. Tubule

Question 36

ADH is synthesized in

Answer 36

hypothalamus by supraoptic and paraventricular nuclei

Question 37

increase serum osm stimulates

Answer 37

ADH release and vis versa: decrease: inhibits

Question 38

actions of ADH

Answer 38

1. increase H2O reabsorption from LDT and CD's via V2 receptor (cAMP) 2. Vasoconstrictor via V1 receptor (IP3 )

Question 39

**where does the osmotic gradient occur?

Answer 39

**loop of henli

Question 40

**why do we need osmotic gradient?

Answer 40

to make concentrated urine

Question 41

dehydration results in:

Answer 41

increase serum osm ADH release

Question 42

in the presence of ADH what happens to the nephron?

Answer 42

the collecting duct changes and becomes completely impermeable to water so increase water absorption this happens when dehydrated!

Question 43

Affect of ADH on Urine vol and osmolarity

Answer 43

with ADH: Low vol/ High osm without ADH: High Vol, low osm

Question 44

countercurrent exchange occurs where?

Answer 44

in the vasa recta

Question 45

NA exchange and transport with?

Answer 45

exchange: acid (H+) transport : Glucose b/c of Na/K pump

Question 46

Na reabsorption occurs where?

Answer 46

early Prox tubule

Question 47

na absorption in the PCT % and effect of aldosterone:

Answer 47

in the presence or not of Aldosterone PCT will absorb 67% of sodium

Question 48

** Aldosterone saves:

Answer 48

saves sodium Gets rid of K+ and H+

Question 49

MCC of hyponatremia

Answer 49

hospitalized pt | and SIADH

Question 50

tx for symptomatic hyponatremia:

Answer 50

3%NaCl *symptomatic with seizures delirium

Question 51

Hyper and hyponatremia both have a profound effect on the brain. Examples:

Answer 51

1. altered neuro function 2. rapid shrinking can tear vessels and lead to HEMORRHAGE 3. rapid swelling can cause HERNIATION

Question 52

the brain cannot increase its vol by more than what % before herniation?

Answer 52

10%

Question 53

K handling in the presence or absence of aldosterone:

Answer 53

- increase aldosterone: increase K secretion | - decrease aldosterone : decreases K secretion

Question 54

alkalosis effect on K+

Answer 54

HYPOKALEMIA | exchange of IC H+ for EC K+

Question 55

Acidosis effect on K+

Answer 55

HYPERKALEMIA

Question 56

why does hypokalemia cause weak skeletal muscles?

Answer 56

hyperpolarization

Question 57

Magnesium deficiency will make what worse?

Answer 57

hypokalemia replace the Mg first and the K will "stick"

Question 58

in presence of hypokalemia, dose of muscle relaxant should be:

Answer 58

reduced

Question 59

with hypokalemia, avoid

Answer 59

hyperventilation

Question 60

hyperventilation does what to K?

Answer 60

each reduction 10mmHg of PCO2 = 0.5 mEq/L reduction in K+

Question 61

Things we can do to treat hyperkalemia:

Answer 61

- Calcium gluconate (protect cardiac membrane) - Sodium bicarb - Hyperventilation - Loop Diuretics - Insulin, D50 - Kayexalate - Beta 2 agonist - Dialysis in RF

Question 62

best forms of fluid replacement for hypovolemia?

Answer 62

NS LR Blood loss: crystalloid 3:1