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Person Renal > Renal Pathology, Diuretics and Anesthesia PP#5 > Flashcards

Renal Pathology, Diuretics and Anesthesia PP#5 Flashcards

1
Q

ANP is produced by what?

A

Atrial Myocytes (heart muscle)

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2
Q

What are 2 functions of ANP?

A
  • Relax smooth muscles

- Promote NaCl (salt) Water excretion

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3
Q

What stimulus causes release of ANP?

A

Atrial stretch

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4
Q

What is the overall function of ANP?

A

Reduce volume

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5
Q

What are the 5 ways ANP decreases fluid volume?

A
  • Inhibit Renin
  • Inhibit Aldosterone
  • Inhibit ADH
  • ↓ Salt reabsorption
  • ↑ GFR
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6
Q

How does ANP increase GFR?

A
  • Dilation of afferent

- Constriction of efferent

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7
Q

Where does ANP decrease salt reabsorption?

A

Directly on the Collecting ducts

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8
Q

What is Natrecor?

A

Recombinant form of B-type naturetic peptide

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9
Q

What other name is Natrecor known by?

A

Brain natriuretic peptide (BNP)

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10
Q

Where is Natrecor (BNP) made?

A

Ventricular myocardium

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11
Q

What 3 things does Natrecor (BNP) do to treat CHF?

A
  • Vasodilate
  • Diuresis
  • Natriuresis
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12
Q

Natrecor (BNP) is also used as a lab marker for heart failure, what is a positive finding?

A

> 500

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13
Q

How do most diuretics work?

A
  • Decrease Na reabsorption from the tubules
  • Increased natriuresis
  • H20 follows Na (diuresis)
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14
Q

4 Common uses of diuretics.

A
  • ↓ ECF
  • Edema
  • CHF
  • HTN
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15
Q

What happens to diuretics w/ chronic use?

A

Potency decreases

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16
Q

How do diuretics lose potency after chronic use?

A

-↓ in ECF will lead to decreases in MAP and GFR and will eventually start the renin - angiotensin system.

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17
Q

Name the 6 types of diuretics.

A
  • Osmotic
  • Loop
  • Thiazide
  • Carbonic anhydraze inhibitors
  • Aldosterone inhibitors
  • Sodium channel blockers
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18
Q

Name 2 examples of osmotic diuretics

A
  • Urea

- Mannitol

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19
Q

How do osmotics work?

A

-Draw fluid into tubules

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20
Q

In diabetics glucose can mimic what kind of diuretic?

A

Osmotic

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21
Q

Give 3 examples of loop diuretics.

A
  • Lasix
  • Bumex
  • Ethacrynic acid
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22
Q

What do loop diuretics inhibit?

A

Na-Cl-K co-transporter in the TAL of the loop of Henle

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23
Q

How does na/cl/k pump inhibition cause diuresis?

A

-Increasing solutes in which draws fluid into tubule.

24
Q

What causes the counter current multiplier to be disrupted with loop diuretics?

A

-interstitium can’t become hyperosmolar

25
Q

What is an example of a thiazide diuretic?

A

HCTZ

26
Q

How do thiazide diuretics work?

A

Inhibit NaCl (salt) reabsorption in the early distal tubule

27
Q

What is an example of a Carbonic anhydrase inhibitor diuretic?

A

-Acetazolamide (Diamox)

28
Q

How does carbonic anhydrase work?

A

-Reduce Na+ by decreasing bicarb

29
Q

What is the disadvantage of carbonic anhydrase inhibitors?

A

Acidosis through bicarb loss

30
Q

What is an example of an aldosterone antagonist?

A

Spironolactone (aldactone)

31
Q

How does aldosterone antagonists work?

A

Decrease Na reabsorption by competing with aldosterone binding sites.

32
Q

What two diuretics spare K?

A
  • Aldosterone antagonists

- Na channel blockers

33
Q

What is an example of Na channel blocker?

A
  • Amiloride

- Triamterene

34
Q

How does Na channel blocker work?

A

Decrease activity of Na/K pump in the collecting duct and decreases Na reabsorption

35
Q

Acute renal failure is ________ reversible

A

potentially

36
Q

Chronic renal failure is an irreversible decrease in what?

A

Functional nephrons

37
Q

What do end stage renal patients need to live?

A

Dialysis

38
Q

What are the 3 types of acute renal failure?

A

Pre-renal
Intra-renal
Post-renal

39
Q

What are 2 examples of acute pre-renal failure?

A
  • Heart failure

- Hypovolemia

40
Q

In acute pre-renal kidney failure, the kidney does not get enough ________, and becomes _________.

A
  • Blood

- Ischemic

41
Q

What is acute intra-renal kidney failure?

A

Damage to the kidney

42
Q

What can cause Acute intra-renal kidney failure?

A
  • Toxins
  • Infection
  • Autoimmune
  • Direct injury
43
Q

What is an acute post-renal kidney failure?

A

Obstruction of collecting system

44
Q

What 4 examples of acute post-renal kidney failure?

A
  • Stones
  • Urethral valves
  • Tied off ureter
  • Kinked foley
45
Q

When do chronic renal symptoms appear?

A

w/ at least 70% of nephrons not working

46
Q

4 things that cause chronic renal injury.

A
  • Renal vascular injury
  • Glomerulonephritis
  • Infection
  • Nephrotic syndrome
47
Q

What 3 things cause injury to renal vasculature?

A
  • Atherosclerosis
  • Fibromuscular dysplasia
  • Nephrosclerosis
48
Q

What is nephrosclerosis?

A

sclerotic lesion to small arteries

49
Q

3 causes of glomerulonephritis

A
  • deposition antigen-antibody complexes (most commmon)
  • Sterptococcal infection
  • Lupus
50
Q

What is vesicoureteral reflux?

A
  • Bladder fails to occlude ureter

- Urine moves up into kidney

51
Q

Describe nephrotic syndrome.

A
  • Loss of negative charge in basement membrane of glomerulus

- Leads to protein in urine

52
Q

What are the effects renal failure on the body?

A
  • Edema (generalized & Pulm)
  • Acidosis
  • Nitorgeneous waste build-up
  • Anemia
  • Increase in K
  • Glucose intolerance
  • Platelet/WBC dydfunction
  • Gastric ulcers
  • Perpherial neuropathy
53
Q

What are the effects renal failure on the Heart?

A

Increase in CO to compensate for decreased O2 capacity

54
Q

What are the effects renal failure on the respiratory system?

A
  • Decreased minute ventilation to compensate for acidosis

- Autonomic neuropathy decreases gastric emptying = increased risk of aspiration.

55
Q

How does renal failure cause Osteomalacia?

A
  • Decrease in Vitamin D = no calcium absorption

- Elevated phosphate stimulates parathyroid which causes skeletal demineralization

56
Q

How does renal failure cause HTN?

A
  • Kidney lesion ↓ H2O and Na excretion.

- The body compensates w/ HTN to force out the H2O and Na

57
Q

How does one damaged kidney effect the good kidney?

A

Renin and Angiotensin 2, needed for the bad kidney, also affects good kidney and drive up BP

Person Renal (6 decks)

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