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MRCEM Primary > Renal physiology > Flashcards

Renal physiology Flashcards

1
Q

What are the 4 causes of metabolic acidosis with a normal anion gap?

A

Renal tubular acidosis
Diarrhoea
Ammonium chloride ingestion
Adrenal insufficiency

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2
Q

What are the 4 causes of metabolic acidosis with a raised anion gap?

A

Lactic acidosis (hypoxia, sepsis, infarction)
Ketoacidosis (DM, starvation, alcohol)
Renal failure
Poisoning (late stages aspirin OD, methanol, ethylene glycol)

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3
Q

Give 5 causes of metabolic alkalosis.

A

Vomiting
Cardiac arrest
Multi-organ failure
CF
Potassium depletion (diuretics)
Cushing’s syndrome
Conn’s syndrome

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4
Q

Give 5 causes of respiratory alkalosis.

A

Hyperventilation
PE
Pneumothorax
CNS disorders (CVA, SAH, encephalitis)
High altitude
Pregnancy
Early stages of aspirin OD

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5
Q

Give 5 causes of respiratory acidosis.

A

COPD
Life-threatening asthma
Pulmonary oedema
Respiratory depression (Opiates, BDZs)
Neuromuscular disease (GBS, muscular dystrophy)
Incorrect ventilatory settings (hypoventilation)
Obesity

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6
Q

What doe/s the anion gap represent

A

The concentration of all the unmeasured anions in the plasma.

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7
Q

How do you calculate the anion gap?

A

Na - Cl - HCO3

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8
Q

What are the causes of a high anion gap metabolic acidosis?

A

Mnemonic CAT MUD PILES:

Carbon monoxide
Alcoholic ketoacidosis
Toluene
Metformin/ Methanol
Uraemia
Diabetic Ketoacidosis
Propylene glycol
Iron/ Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates

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9
Q

What are the causes of a normal anion gap metabolic acidosis?

A

Mnemonic CAGE:

Chloride excess
Acetazolomide/ Addison’s disease
GI causes (diarrhoea, vomiting, fistulae)
Extra (renal tubular acidosis)

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10
Q

A high anion gap metabolic acidosis normally occurs due to what?

A

Accumulation of organic acid or impaired excrete of H+.

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11
Q

A normal anion gap metabolic acidosis normally occurs due to what?

A

Loss of HCO3 from extracellular fluid.

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12
Q

How is lactic acidosis defined?

A

pH <7.35
AND
lactate >5

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13
Q

What happens to the anion gap in lactic acidosis?

A

It is raised

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14
Q

What is type A lactic acidosis due to?

A

Tissue hypoxia

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15
Q

What is type B lactic acidosis due to?

A

Non-hypoxic processed affecting production and elimination of lactate.

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16
Q

Give some causes of type A lactic acidosis.

A

Shock (sepsis)
LV failure
Severe anaemia
Asphyxia
Cardiac arrest
CO poisoning
Respiratory failure
Severe asthma
COPD
Regional hypoperfusion

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17
Q

Give some causes of type B lactic acidosis.

A

Renal failure
Liver failure
Sepsis (non-hypoxic sepsis)
Thiamine deficiency
Alcoholic ketoacidosis
Diabetic ketoacidosis
Cyanide poisoning
Methanol poisoning
Biguanide poisoning

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18
Q

What is the RAAS system responsible for?

A

Regulation of arterial BP
Concentration of sodium in the plasma

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19
Q

Where is renin released from?

A

Juxtaglomerular cells

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20
Q

Where are juxtaglomerular cells located?

A

Afferent arterioles of the kidney

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21
Q

Which 3 things can cause renin to be released?

A

Decreased arterial BP (reduced renal perfusion)

Decreased sodium load delivered to the DCT

Sympathetic nervous system stimulation

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22
Q

Where is angiotensinogen produced?

A

Liver

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23
Q

What 4 factors cause an increase of angiotensinogen?

A

Increased corticosteroid levels
Increased thyroid hormone levels
Increased oestrogen levels
Increased angiotensin II levels

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24
Q

What is the function of renin?

A

Cleaves the peptide bond between leucine and valine on angiotensinogen, converting it to angiotensin I.

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25
Q

What is the overall effect of the RAAS?

A

Increase mean arterial BP and restore perfusion to the kidneys

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26
Q

Release of renin is inhibited by what?

A

Atrial natriuretic peptide (ANP)

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27
Q

When is atrial natriuretic peptide (ANP) released?

A

In response to the atria being stretched during periods of high blood pressure

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28
Q

Where are macula dense cells located?

A

DCT

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29
Q

What does angiotensin converting enzyme do?

A

Removes 2 c-terminals from angiotensin I to form angiotensin II.

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30
Q

Where is ACE produced?

A

Lungs

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31
Q

Where is angiotensin I converted to angiotensin II?

A

Lungs

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32
Q

What is the main bioactive product of RAAS?

A

Angiotensin II

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33
Q

What does angiotensin II do to vascular smooth muscle?

A

Constricts it (increased BP)

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34
Q

What does angiotensin II do the efferent arteriole of the glomerulus?

A

Constricts it (increased filtration fraction)

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35
Q

What does angiotensin II stimulate the release of?

A

Aldosterone
ADH

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36
Q

Where is aldosterone released from?

A

Zona glomerulosa of the adrenal cortex

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37
Q

Were is ADH released from?

A

Posterior pituitary gland

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38
Q

Where is the thirst centre of the brain?

A

Hypothalamus

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39
Q

What exchanger does angiotensin II act on?

A

Na+/H+ exchanger in PCT = Na+ reabsorption and H+ secretion

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40
Q

What are the 3 effects of angiotensin II on renal measurements?

A

Decreased renal plasma flow
Increased filtration fraction
Increased GFR

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41
Q

What is the main mineralocorticoid hormone?

A

Aldosterone

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42
Q

What 3 things is aldosterone released in response to?

A

Increased angiotensin II levels
Increased potassium levels
Increased ACTH levels

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43
Q

What substances does aldosterone cause reabsorption of?

A

Reabsorption of Na+ from DCT
Reabsorption of water from DCT
Reabsorption of C- from DCT

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44
Q

Where is the majority of water reabsorbed in the nephron?

A

PCT

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45
Q

Which limb of the loop of henle is permeable to water?

A

Descending limb

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46
Q

Where is the majority of sodium reabsorbed in the nephron?

A

PCT

47
Q

Which part of the loop of Henle reabsorbs 25% sodium?

A

Thick ascending limb

48
Q

How is water reabsorbed in the PCT?

A

Osmosis

49
Q

How is sodium reabsorbed in the PCT?

A

Active transport

50
Q

How is sodium reabsorbed in the thick ascending limb of the loop of henle?

A

Active transport

51
Q

Where is 65% (majority) of chloride reabsorbed in the nephron?

A

PCT

52
Q

How is chloride reabsorbed in the PCT?

A

Via a symporter with Na+

53
Q

How is chloride reabsorbed in the ascending loop of henle?

A

Diffusion (in thick and think ascending LoH)

54
Q

How is chloride reabsorbed in the DCT?

A

Diffusion

55
Q

How is chloride reabsorbed in the collecting duct?

A

Symporter

56
Q

Which part of the nephron are proteins reabsorbed?

A

PCT (almost 100%)

57
Q

Where is 65% potassium reabsorbed in the nephron?

A

PCT by diffusion

58
Q

Where is almost 100% glucose reabsorbed in the nephron?

A

PCT

59
Q

How is glucose reabsorbed in the PCT?

A

Secondary active transport with Na+

60
Q

What is the basic functional unit of the kidney?

A

Nephron

61
Q

How many nephrons are in each kidney?

A

~1 million

62
Q

In which part of the kidney does plasma undergo filtration?

A

Renal corpuscle (glomerulus + bowman’s capsule)

63
Q

Where does the majority of solute reabsorption occur?

A

PCT

64
Q

What are the adaptations of the PCT?

A

Cuboidal
Abundant mitochondria
Brush border

65
Q

Which part of the kidney does the loop of henle lie in?

A

Renal medulla

66
Q

Which part of the loop go henle allows water to move via osmosis but does not take part in solute transport?

A

Descending loop of henle

67
Q

What happens in the thick ascending loop henle?

A

NO water reabsorption
NaK2Cl transporters absorb solutes

68
Q

What happens in the DCT?

A

Fine control of urine composition

69
Q

Where are macula dense cells?

A

Wall of DCT

70
Q

Where are juxtaglomerular cells?

A

Wall of afferent arteriole

71
Q

High sodium concentration in the DCT means what has happened to the GFR?

A

Increased (faster flow = less sodium reabsorbed)

72
Q

What volume of plasma is filtered per minute at the glomerulus?

A

125ml

73
Q

What is arterial supply to the kidneys?

A

Renal arteries

74
Q

What vertebral levels do the renal arteries come off the aorta at?

A

L2

75
Q

Which renal artery is longer?

A

Right renal artery

76
Q

Where does the right renal artery pass in relation to the IVC?

A

Behind it

77
Q

What does the right renal artery pass behind on route to the kidney?

A

IVC
Right renal vein
Head of pancreas
Second part of duodenum

78
Q

What does the left renal artery pass behind on route to the left kidney?

A

Left renal vein
Body of pancreas
Splenic vein

79
Q

At what vertebral level do the hila of the kidneys lie?

A

L1 (transpyloric plane)

80
Q

What are the 3 layers of the glomeruli filtration membrane?

A

Fenestrated capillary endothelium
Basement membrane
Filtration slits formed by foot processes of podocytes

81
Q

What charge does the basement membrane in the glomerulus have?

A

Negative

82
Q

What is the mean GFR in men and women?

A

130ml in men
120ml in women

83
Q

Reabsorption in the PCT is driven by what?

A

ATP-dependent transporters

84
Q

What is the main way that reabsorption occurs in the PCT?

A

Bulk transport (solvent drag).

Means solutes are transported by the flow of water.

85
Q

What percentage of the following substances is reabsorbed in the PCT?

Glucose
Amino acids
Sodium
Water
Potassium
Chloride

A

Glucose = 100%
Amino acids = 100%
Sodium = 67%
Water = 65%
Potassium = 65%
Chloride = 65%

86
Q

What acts as the driving force for reabsorption in the PCT?

A

Sodium

87
Q

How does glucose reabsorption occur at the PCT?

A

Sodium-glucose co-transporters (one glucose molecule with 2 sodium molecules)

88
Q

How are amino acids transported across the PCT?

A

Co-transport (Na/amino acid symporters)

89
Q

Where does acetazolamide act?

A

PCT

90
Q

What does acetazolamide inhibit?

A

Carbonic annhydrase

91
Q

What is the overall effect of acetazolamide?

A

Reduces sodium and water resorption.

92
Q

Where is erythropoietin produced?

A

PCT

93
Q

Which cells produce erythropoietin in the PCT?

A

Interstitial fibroblasts

94
Q

What percentage of sodium is reabsorbed in the loop of henle?

A

20-25%

95
Q

Which part of the loop of henle is highly permeable to water?

A

Thin descending limb

96
Q

What is reabsorbed in the descending limb of the loop of henle?

A

Water (aquaporin 1 channels)

97
Q

What is reabsorbed in the thin ascending limb of the loop of henle?

A

Ions - sodium, chloride, urea

NO water

98
Q

How does ion reabsorption occur in the thin ascending loop of henle?

A

Paracellularly

99
Q

What is reabsorbed in the thick ascending limb of the loop of henle?

A

Ions - sodium, chloride, potassium

NO water

100
Q

Why does the interstitial around the loop of henle become concentrated with ions as the fluid descends?

A

Counter current mechanism creates an osmotic gradient

101
Q

Which type of diuretics act on the loop of henle?

A

Loop diuretics

102
Q

How do loop diuretics act?

A

Inhibit NaK2Cl transporter = urine less concentrated.

103
Q

What percentage of water is reabsorbed in the DCT?

A

10-15%

104
Q

What are the 2 sections of the DCT?

A

Early DCT (1)
Late DCT (2)

105
Q

Where does the DCT start?

A

Just after the macula dense.

106
Q

Sodium reabsorption is driven by which proteins in the primary DCT?

A

Na+/K+ ATPase

107
Q

How does the movement of sodium ions occurs in the late DCT?

A

ENAC (epithelial sodium channel)

108
Q

What do intercalated cells do in the DCT?

A

Assist with the acid-base balance

109
Q

Which diuretics act on the DCT?

A

Thiazide diuretics
Aldosterone antagonists

110
Q

Where do thiazide diuretics work?

A

DCT

111
Q

What do thiazide diuretics inhibit?

A

NaCl co-transportters (reduce sodium and water reabsorption)

112
Q

Where do aldosterone antagonists work?

A

DCT

113
Q

What do aldosterone antagonists do?

A

Inhibit aldosterone.

MRCEM Primary (39 decks)

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