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Physio post midterm > Renal Facts > Flashcards

Renal Facts Flashcards

1
Q

Large pressure drop between what arterioles?

A

afferent arterioles (100 (55mmHg)) and then at the Efferent arterioles (50(20mmHg).

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2
Q

Does glomerular capillary pressure remain constant?

A

yes it does about 55mgHg so it favors filtration

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3
Q

what will reduce renal K+ secretion?

A

Vomiting aka alkalosis (because hypokalemia induced by K+ moving intracelluarly to release H+ to help cellular pH)

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4
Q

what do thiazide diuretics do to the calcium levels?

A

Block NNCT (Na+Cl- cotransporter)–> increased activity of basolateral Na+/Ca2+ exchanger to compensate –> hypercalcemia

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5
Q

loop diuretics…how will it effect the fractional excretion of cations?

A

loop diuretics block NKCC2 channels at Thick ascending limb (tubule becomes much more negative and doesnt want these positive cations to get reabsorbed) remember before the positive charge was kicking these cations out.
this will decrease reabsorption of all cations (directly Na and K) but also Mg2+ and Ca2+ because of paracellular drag.
Mg2+ is effected most because majority of Mg2+ is reabsorbed in the thick ascending limb
therefore FE of Mg2+ will increase most because more will be excreted.

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6
Q

Glucose increases ATP which blocks ATP sensitive K channels causing depolarization leading to VG calcium channels to open, what happens next?

A

intracellular Ca2+ increases exocytosis of vesicles and therefore insulin release.

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7
Q

If a substance is freely filtered and has lower clearance than inulin it is what??

A

reabsorbed (because inulin in not reabsorbed or secreted)

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8
Q

Wha does aldosterone act on and where?

A

Mainly distal tubule of nephron (increases the number of K channels, Na channels and Na/K pump) creates Na gradient for Na and H2O reabsorption
ENac, ROMK, Na/K atpase and increases ATP
some action in skeletal muscle and some in colon (increase K secretion, favor Na reabsorption and favor water reabsorption

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9
Q

what happens if you block NKCC2 to the fractional excretion of Mg, Ca, Na? put them in order

A 
Magnesium is most affected
Ca
Na 
K 
Cl
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10
Q

What happens to the body if you have an H+ inhibitor?

A

Metabolic acidosis

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11
Q

what happens to the body during vomiting?

A

metabolic alkalosis

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12
Q

If you give a patient a carbonic acid inhibitor what happens?

A

loss of HCO3- (bicarb) more stays in the lumen and is excreted because CA is not able to convert H2O3 into H2O and C2O
does not have an effect on K

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13
Q

If a person is lost in the desert without food or water for 2 days, what happens to their plasma osmolarity, their ECW and how does the box shift?

A

Plasma Osmolarity –> Hyperosmotic volume (due to no proteins or water)
ECW will then shrink so hyperosmotic volume with contraction
ECW is the more concentration (Compared to ICW) so the water moves into the ECW
so therefore contraction

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14
Q

If a person is lost in the desert without food or water for 2 days what happens?

A

RAA system will be activated and therefore an increase in Angiotension II and ADH ( need to increase water channels for more H20 reabsorption).
Decrease in ECV as well

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15
Q

During maximum ADH secretion where is most of the water reabsorbed?

A

proximal tubule (remember that even though its acting on the distal tubule; 65% is still being reabsorbed in the proximal tubule)

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16
Q

if you have amino acids and glucose in your urine, then where is the problem?

A

PT

but also if there could be too much glucose saturating the transporters, over the threshold.

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17
Q

what happens to the flow rate as you increase your sodium intake?

A

As you increase Na intake you increase your ECF and therefore increase ANP (need to get of this excess Na) –> constricting the efferent arterioles and decreasing Na in the collecting duct and therefore increasing Na excretion.
Sympathetic activity, osmotic pressure of capillary and RAA system are all decreased

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18
Q

what is autoregulation?

A

keeps GFR and RBF constant between 80-180mmHg
reduced renal blood flow
>180mmHg –> severe HTN and autoregulation stops

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19
Q

what are the two autoregulation responses?

A

Myogenic response –> increases arterial pressure and stretches SM in BV walls. so you get increased afferent arteriole contraction
opens calcium channels
increases GFR
Tubuloglomerular Feedback –> involves macula densa and vasoactive substances to constrict afferent/efferent arterioles.

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20
Q

what are the three main points in regards to counter current exchange?

A

ATP dependent solute transport
Increase in osmolality in medullary interstitium
slow tubular fluid flow ( allows for less reabsorption)

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21
Q

what are some basics of the counter current exchange?

A

In the thick portion of the ascending limb, Na and Cl are actively removed.
Na and Cl leave by diffusion in the thin ascending limb
H20 movement is from descending limb to equilibrate increasing interstitial concentrations
Filtrate is super concentrated by the bottom of the loop (because all your water has been reabsorbed and your solutes have been impermeable)

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22
Q

At the end of the counter current exchange what should happen?

A

equilibrate the collecting duct with the interstitium

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23
Q

If a patients creatinine is elevated then what goes up and what does that mean?

A

Inversely rated to GFR so there is a decrease in GFR
freely filtered and not usually reabsorbed, so if there is creatinine in the patients plasma then its not getting filtered and that means that the GFR is down

24
Q

If there is a PTH secreting tumor then what happens?

A

Addisons Disease (primary hyperparathyroidism)

25
Q

What are some features of central diabetes insipidus?

A

Serum ADH –> decreased
Plasma Osmolarity –> high (excretion of excess water)
Urine Osmolarity –> hyposmotic
Urine Flow rate –> high

26
Q

what are some features of peripheral (nephrogenic) diabetes insipidius?

A

Serum ADH–> High (the receptors in the nephron have been damaged) does not respond to exogenous ADH
Plasma Osmolarity –> High (excretion of excess water)
Urine Osmolarity –> Hyposmotic
Urine Flow Rate–> High

27
Q

If a patient comes in urinating often and you give her a dose of vasopressin, what happens?

A

Central Diabetes will respond to the exogenous ADH and therefore the urine becomes concentrated
however peripheral will not respond and the values will stay the same

28
Q

If someone drinks a lot of water and proceeds to pee it out,what happens to their free water clearance??

A

Ch20 increases

29
Q

what does hypervolemia mean?

A

too much fluid in the blood

30
Q

If a patient comes into the office and has an aldosterone secreting tumor, what will you see int he patient?

A

increase in atrial natriatic peptide because of the hypervolemia (too much fluid in the blood)

31
Q

what are the actions of ANP?

A

Vasodilate the afferent arterioles and constrict the efferent arterioles
Inhibits Na reabsorption at medullary CD
Inhibits norepinephrine and angiotensin II induced vasoconstriction
Inhibits renin and aldosterone secretion
inhibits ADH secretion

32
Q

If there is an increase in plasma osmolarity then what will happen to the renin release?

A

renin release ill be decreased

Remember renin release is triggered by decreased BP and BV

33
Q

If you have an increase in renal blood flow then the tubuloglomerular autoregulation will kick in and what happens?

A

The afferent arteriole is constricted therefore decreasing your GFR
(if decrease in renal blood flow then constriction of efferent arteriole)

34
Q

what happens in chronic renal failure??

A 
plasma creatinine goes up
bicarb goes down = metabolic acidosis 
Hyperkalemia = malaise 
decreased GFR
only a transient reduction in Na and creatinine excretion they will normalize. 
Erythropoietin failure (anemia) 
Na/H20 retention 
Creatinine clearance goes down
35
Q

why does one get edema in nephrotic syndrome?

A

increase in hydrostatic pressure (favoring reabsorption)
decrease in plasma oncotic pressure
low protein level causes the edema
increase of protein in urine

36
Q

what happens when you constrict the afferent arteriole?

A

GFR goes down and therefore the renal plasma flow goes down as well as filtration

37
Q

A patient is infused with para-amino-hippuric acid (PAH) to measure renal blood flow (RBF). She has a urine flow rate of 1mL/min, a plasma PAH of 1mg/mL, a urine PAH of 600mg/ml, and a hematocrit of 45%. What is her effective RBF?

A

Effective renal plasma flow (RPF) is calculated from the clearance of para-aminohippuric acid (PAH)
Cpah = Upah x V / Ppah = 600mL/min.
Renal blood flow RBF=RPF/1-Hematocrit= 1091mL/min
PAH has the greatest clearance of all substances it is filtered and secreted

38
Q

Causes of K shift into the cells: Hypokalemia

A 
Insulin 
B2 Adrenergic Agonists 
Alpha Adrenergic Antagonists 
Alkalemia (works the best H+ is decreased so H+ moves into the blood/K+ exchanges into cells
Hyposmolarity
39
Q

What would a lesion to the parathyroid gland do to the phosphate/calcium balance in your body?

A

Ca reabsorption will decrease in the DCT and phosphate secretion is decreased in the PCT

40
Q

If you drink a lot of distilled water, what is going to happen to free water clearance?

A

its going to be positive.

41
Q

what is titratable acid?

A

A way for your body to get rid of excess H ions (H2PO2)

42
Q

Vomiting has what affect on K levels?

A

Hypokalemia

43
Q

How would you increase your serum K levels after you have given someone a diuretic?

A

infusing a hypertonic solution which will cause it to release aldosterone

44
Q

If a patient presents with thirst, frequent urination, and an increase in ADH, what type of diabetes is this?

A

Nephrogenic (peripheral) diabetes insipidus (receptors are not responding)
remember central, dipsogenic and gestational all lead to a decrease in ADH

45
Q

Glucose, AA, phosphate are all reabsorbed where?

A

PT

46
Q

Increase in GFR then what?

A

increase of the rate at which the ultrafiltrate forms in the bowmans space.

47
Q

how does a patient compensate in metabolic alkalosis?

A

respiratory acidosis

48
Q

Renal Threshold means?

A 
concentration amount (mg/mL or dl) in the blood of a substance 
plasma concentration at which saturation is going to occur
49
Q

Patient states that she hasnt peed in a week. her blood results and urine results: bun=49mg/dl, serum sodium=135mmol/L, serum creatinine=7.5mg/dl, urine sodium=33mmol/L, and urine creatinine=90mg/dl. Whats her fractional Na+ excretion?

A

FEna= measures Na excreted in urine relative to amount reabsorbed by kidney
FEna=ER (amount excreted)/FL (filtered load)
FEna= Una x Pcreatinine/Pna x Ucreatinine
low fractional excretion –> Na retention by kidney - extrinsic to urinary system
High fractional excretion –> Na wasting due to tubular damage/intrinsic renal failure

50
Q

Kidney function testing shows GFR=120ml/min, plasma concentration x=20mg/dl and excretion rate of x=1000mg/min. How much of substance x was reabsorbed?

A

FL-TR (reabsorbed) = ER
FL=GFR x Px
FL= 0.120L/min x 20mg/dl (suppose to convert to mEq/L)
TR(reabsorbed) = FL-ER (unsure of units on this)
If FL>ER then net reabsorption
If FL<ER then net secretion

51
Q

Lithium binds to kidneys creating nephrogenic disease

A

lithium binds to kidneys and doesnt allow ADH to do its job

52
Q

where is the ENAC channel?

A

distal tubule

53
Q

bartter’s syndrome symptoms?

A

decrease Mg

decrease Ca

54
Q

Tonicity of urine at PT, loop of henle, ascending limb of henle

A

PT –> isotonic
Loop of Henle –> hypertonic (loss of H20)
Ascending limb of Henle –> Hypotonic (loss of solutes)

55
Q

decrease in PTH?

A

less excretion of PO4 and more excretion of Ca2+

Physio post midterm (4 decks)

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