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MSRA renal > renal physiology > Flashcards

renal physiology Flashcards

1
Q

what is the glomerulus?

A

epithelial pouch invaginated by capillary tuft
semi-permeable filter
- endothelium
- basement membrane
- epithelium

mesangial cells are specialised smooth muscle cells that support glomerulus _ regulate blood flow and GFR

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2
Q

how is filtration done?

A

receives 25% of cardiac output (1200ml/min)

20% of blood vol is filtered (250ml/min)

glomerular basement membrane (GBM) is negatively charted so retains anionic (neg) proteins eg albumin which are small enough to pass

filtration is key to excretion of waste, remains constant over range of pressures (80-200mmhg)

glow will depend on Na + water reabsorption

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3
Q

describe Na reabsorption

A

main factor in determining extracellular volume
low BP and low NaCl at macula densa (that lines DCT distal convoluted tubule)

so renin release

so aldosterone release

more Na/K pumps

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4
Q

describe water reabsorption

A

determined extracellular fluid osmolality

high osmolality or low BP leads to ADH release

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5
Q

what are the different aspects of the nephron?

A

PCT- proximal convoluted tubule

thick ascending limb

DCT- distal convoluted tubule

medullary collecting duct

cortical collecting duct

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6
Q

what occurs at proximal convoluted tutuble?

A

reabsorption of filtrate
70& total Na reabsorption
reabsorption of amino acids, glucose, cations
bicarbonate reabsorbed using carbonic anhydrase

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7
Q

what occurs at thick ascending limb?

A

creation of osmolality gradient
20% na reasbsorption
Na/K/2Cl triple symporter

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8
Q

what occurs at distal convoluted tubule?

A

pH + Ca reabsorption
5% Na reabsorption
apical NaCl co-transporter
Ca reabsorption under control of PTH

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9
Q

what occurs at medullary collecting duct?

A

pH + K regulation
Na reabsorption coupled to K or H excretion
basolateral aldosterone-sensitive Na/K pump

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10
Q

what occurs at cortical collecting duct?

A

regulation of water reabsorption
controlled by aquaporin-2 channels

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11
Q

what is endocrine function?

A

secretion of renin by juxtaglomerular apparatus
EPO synthesis
1alpha-hydroxylation of vitamin D controlled by PTH

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12
Q

what are examples of loop diuretics

A

furosemide
bumetanide

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13
Q

what is the MOA of loop diuretics?

A

inhibit Na/K/2Cl symporter in thick ascending limb

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14
Q

what is the effect of loop diuretics?

A

massive NaCl excretion, Ca + K excretion

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15
Q

what is the use of loop diuretics?

A

rx of oedema in CCF, nephrotic syndrome, hypercalcaemia

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16
Q

what are the SE of loop diuretics?

A

hypokalaemia
metabolic alkalosis
ototoxic
hypovolaemia

17
Q

what is an example of thiazide diuretic?

A

bendroflumethiazide

18
Q

what is the MOA of thiazide diuretic?

A

inhibit NaCl co-transporter in distal convoluted tubule

19
Q

what is the effect of thiazide diuretic?

A

moderate NaCl excretion
increased Ca reabsorption

20
Q

what is the use of thiazide diuretics?

A

HTN
reduce renal stones
mild oedema

21
Q

what are the SE of thiazide diuretics?

A

hypokalaemia
hyperglycaemia
increased urate (CI in gout)

22
Q

what are examples of K sparing diuretics?

A

spironolactone
amiloride

23
Q

what is the MOA of K sparing diuretics?

A

spiro- aldosterone antagonist
amiloride- blocks DCT/CD luminal Na channel

24
Q

what is the effect of K sparing diuretics?

A

increased Na excretion
reduced K + H excretion

25
Q

what is the use of K sparing diuretics?

A

w loop or thiazide diuretics to control K loss
spiro has long-term benefits in aldosteronism (LF, HF)

26
Q

what are the SE of K sparing diuretics?

A

hyperkalaemia
anti-androgenic eg gynaecosmastia

27
Q

what are examples of osmotic diuretics?

A

mannitol

28
Q

what is MOA of osmotic diuretics?

A

freely filtered + poorly reabsorbed

29
Q

what is the effect of osmotic diuretics?

A

reduce brain volume
reduce ICP

30
Q

what is the use of osmotic diuretics?

A

glaucoma
raised ICP
rhabdomyolysis

31
Q

what are the SE of osmotic diuretics?

A

hyponatraemia
pulmonary oedema
n+v

MSRA renal (26 decks)

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