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Adv Pr III > Renal I > Flashcards

Renal I Flashcards

1
Q

Kidney pain, SNS, and PNS innervation

A

Pain T10-L1. SNS T8-L1. PNS via vagus, S2-4

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2
Q

%CO kidney receives

A

25%

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3
Q

Po2 cortex v medulla

A

50 v 10-20

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4
Q

Blood flow through nephron

A

Renal A- arcuate- interlobar- cortical radial a- afferrent arteriole- glomerular capillaries- 25% to Bowman’s capsule/rest—> efferent arteriole- peritubular capillaries or vasa recta - venous system

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5
Q

Vessels supplying cortical nephrons

A

Short loops of henle, efferent arterioles drain into peritubular capillaries

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6
Q

Vessels supplying juxtamedullary nephrons

A

Long henle, efferent arterioles drain into vasa recta

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7
Q

How glomerulus affects gfr q

A

Efferent constricts- gfr increases. Afferrent constricts- decreases

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8
Q

What is freely filtered vs excluded from glomerular diltrate

A

Free filter: h20, na, glucose, urea, cations. Exc: negative, hgb, albumin

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9
Q

Areas of high metabolic activity in renal tubule, implication

A

Proximal convuluted tubule, DCT, thick ascending limb of henle. All at risk for ischemia

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10
Q

Areas of h20 reabsorp, most to least

A

Proximal tubules 65%, loops of henle 15%, distal tubules and collecting ducts 10%

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11
Q

Proximal convoluted tubule: substances resorbed

A

65% of na/k/cl/h20. Glucose, lactate, aa, ca.

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12
Q

PCT: continuation of what, what secreted/exchanged here

A

Bowmans capsule, H sec for HCO3

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13
Q

Loop of henle: contin of, forms what

A

PCT, hypertonic fluid

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14
Q

Juxtaglomerular apparatus: what it contains, function

A

Macula densa- mesangial cells contract when exp to ang II- dec area of glomerulus. Granular cells sec renin w b1 stim- dec gfr w baroreceptor activ

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15
Q

DCT: what is resorbed here, under influence of what

A

Na/cl/h20, adh/app (v2) and aldosterone

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16
Q

DCT: secretes what

A

H ions and k

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17
Q

Collecting duct: reabsorbs what thru what, secrets what

A

H20 (adh), na/h20 in each for K. Secretes H ions/reabsorbs hco3

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18
Q

Two most imp parts of kidney for acid base balance

A

Late distal tubule and collecting duct

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19
Q

Three responses via hormones to hypovolemia

A

SNS/Ang II (dec gfr/inc na reabsorption). Aldosterone- inc na reabsorption. ADH- in h20 reabs in collecting duct

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20
Q

Renal responses to hypervolemia

A

ANP (inc gfr by dilating). Red sns/ang II (dilation, filter na). Dec aldosterone- dec na reabsorption. Dec vaso- less h20 reabsortpion

21
Q

Where aldosterone effects kidney

A

Distal tubule and collecting duct

22
Q

Where ADH/vaso effects kidney

A

Collecting duct

23
Q

SNS (alpha 1) and ang II stim high v low concentration effects

A 
High= afferrent vasoconstriction 
Low= efferent vasoconstriction
24
Q

Vaso preferentially vasoconstricts

A

Efferent arterioles

25
Q

Adenosine gfr fx

A

Decreases renin release and afferrent vasoconstriction, dec renal bf

26
Q

Auto reg range for ribs and gfr

A

Map 80-200

27
Q

Myogenic mechanism of gfr auto reg

A

Inc bp- reflex afferrent vasoconstriction. Dec bp opposite fx

28
Q

Conditions when auto reg is severely reduced

A

Sepsis, ARF, CPB

29
Q

How prostaglandins work

A

Oppose actions of ang II, sns, and adh. Renal vasodilation, inc na and h20 excretion

30
Q

CRF: when long term dialysis req.

A

Creat >3 gfr <30

31
Q

Anemia in CRF: downside to EPO therapy. Hct and hgb goals

A

Can cause or exacerbate htn. Hct 36-40% hgb 12 females 13 males

32
Q

Coagulopathies in CRF can be related w what? 4

A

Desmopressin, EPO, cryo, and estrogen

33
Q

BP goal in crf

A

<130/85

34
Q

AKI: creat, creat clearance, and urine produc

A

> 0.5, 50% decrease, <400 ml/day or no urine

35
Q

AKI: pre renal

A

Dec bp to kidneys from CHF, hypotension, or low blood vol

36
Q

AKI intra renal

A

Severe ischemia, nephrotoxic exposure, parenchymal disease

37
Q

AKI post renal

A

Obstruction of urinary collecting system

38
Q

When to reduce doses of drugs cleared unchanged by kidneys

A

Gfr <50 ml/min

39
Q

What can prolong NMB in renal failure

A

Lyte imbalance, aminoglycosides, diuretics, immunosuppresants, mg antacids

40
Q

Nml levels for gfr

A

Bun 5-10, creat 0.5-1, cr cl 110-150

41
Q

Nml levels for renal tubular function

A

Sp gravity 1.003-1.03, osmolariy urine 38-1400

42
Q

Nml bun/cr ratio, when it indications pre renal issue

A

10:1. >20:1

43
Q

When bun indicative of dec gfr. When cr cl estimates gfr

A

> 50/ <25 ml/min

44
Q

Periop oliguria: urine volume, how to tell its pre renal

A

<0.5 ml/kg/hr. Urinary na <40, osmolarity >400, urine to plasma osmolarity >1.8

45
Q

How to determine periop oliguria intrarenal

A

Urinary na >40, osm 250-300, urine to plasma osm <1.1

46
Q

Where to avoid ivs in dialysis pt

A

Non dominant arm and upper portion of dominant arm

47
Q

What kinds of drugs does dialysis clear

A

Low weight, <90% protein bound, water soluble

48
Q

How to tx dialysate hypersensitivity

A

Ethylene oxide or polyacrylonitrile

Adv Pr III (4 decks)

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