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Renal > Renal handling of solutes and renal stones > Flashcards

Renal handling of solutes and renal stones Flashcards

1
Q

What are kidney stones?

A

Precipitated salts which grow into calci

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2
Q

Urolithiasis

A

In urinary tract

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3
Q

Nephrolithiasis

A

In kidney

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4
Q

Nucleation

A

Ions come together in CD

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5
Q

Aggregation

A

Crystals aggregate in renal pelvis

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6
Q

Renal colic

A

pain associated with kidney stone - lower back pain, nausea and vomiting, intermittent pain

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7
Q

5 types of kidney stones

A
  • Calcium-containg stones (calcium oxalate (alkaline/acidic) and calcium phosphate(alkaline))
  • Magnesium ammonium phosphate - alkaline conditions
  • Uric acid stones - acidic conditions
  • Cystone stones - acidic conditions
  • Xanthine stones
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8
Q

Risk factors for calcium stones

A
  • Calcium supplements
  • Calcium antacids
  • Foods high in oxalates - spinach, pecans, peanuts
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9
Q

Risk factors for magnesium ammonium phosphate stones

A
  • Women, UTIs

- Alkaline environment favours crystal formation

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10
Q

Risk factors for urate stones

A
  • High uric levels in blood plasma (hyperuricemia)
  • Probenecid - increased urate excretion
  • Not visible on x-rays
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11
Q

Treatment for kidney stones

A
  • Tamsulosin is a alpha1a antagonist to dilate ureter
  • Keterolac is NSAID
  • Hydromorphone or morphine is opioid for pain
  • Zofran for vomiting
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12
Q

Shock wave lithotripsy

A
  • High frequency ultrasound targets stone

- Breaks it up

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13
Q

Uteroscopy

A
  • Medium stones
  • General anaesthesia
  • Ureteroscope to visualise stone
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14
Q

Percutaneous nephrolithotomy

A
  • Hole into back at kidney level
  • Camera inserted
  • Visualise stone
  • Pulverised using ultrasound
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15
Q

prevention of kidney stones

A
  • Lots of fluids
  • Limit oxalates and calcium supplements
  • Decrease nondairy animal protein
  • Decrease sodium
  • Decrease fructose and sucrose
  • Increase potassium
  • Increase phytates
  • Apple cider vinegar
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16
Q

How do thiazide diuretics prevent kidney stones?

A

stop sodium-calcium symporter in DCT so decreases intracellular sodium and increase sodium movement into cell by anti-porter so more calcium reabsorbed

17
Q

What do SGLT2 cotransporters move?

A

Na+ anf glucose

18
Q

When is acetazolamide used?

A

Altitude sickness

19
Q

What is empahglifloxin

A

Reversibly inhibits sodium-glucose co- transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose in diabetics

20
Q

Which substances does empaglifloxin move?

A

Cl-, K+, water, amino acids out of lumen and H+ in

21
Q

Which substances does acetazolamide move?

A

HCO3-

22
Q

What is the purpose of the countercurrent principle?

A

Maintains hypertonic interstitial

23
Q

What happens in ascending LOh

A

Reabsorbs solutes but no water - creates hypertonic medulla

24
Q

Which substances does the NKCC2 cotransporter and loop diuretics move and where

A

Na+, Cl-, K+ out of lumen

25
Q

Which molecules determine the paracellular voltage and what is this

A

Ca2+ and Mg2+ moving out - voltage is 8mV

26
Q

Why is the inside of the cell positive?

A

Backleak of potassium through cells

27
Q

PTh effect on calcium

A

Stops it being excreted

28
Q

What happens to glucose concentration in PCT?

A

Falls to 0

29
Q

What happens if we block SGLT2

A

Blocking SGLT2 so urinate sugar in diabetics - line would be less steep

Concentration would increase in descending limb and then stay constant in rest of LOH

In DCT concentration would steeply increase

30
Q

Characteristics of calcium oxalate crystals

A

radio-opaque
Small and numerous
Can form in any urine

31
Q

Characteristics of calcium phosphate crystals

A

Radio-opaque
Small and numerous
Form in alkaline conditions - hyperparathyroidism

32
Q

Characteristics of magnesium crystals

A

radio-opaque
alkaline urine
Staghorn

33
Q

Characteristics of uric acid crystals

A

High purine diets, malignancies and metabolic defects
Radio-lucent
Acidic urine
Small, numerous, stag horn

34
Q

Characteristics of cystine and xanthine crystals

A

Metabolic defects
Soft and waxy
Faint on x-ray
especially in children

35
Q

Function of ANP

A

ANP counteracts aldosterone

ANP released in response to increased intravascular volume

36
Q

What are type A and B cells

A

Type A and B are both intercalated cells

Type A cells like to get rid of Hydrogen ions into tubular lumen and hold onto bicarb - correct acidosis

pCO2 increases due to hyperventilating

Type B cells hang onto hydrogen and get rid of bicarb

37
Q

What is spironolactone

A

Aldosterone antagonist - sodium/chloride potasisum exchange

38
Q

Impact of aldosterone and ANP on tubule

A

Move sodium and chloride out and potassium in

39
Q

Impact of aldosterone on tubule

A

Moves HCO3- and K+ out and H+ in

Renal (26 decks)

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