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CPR > Renal Physiology I > Flashcards

Renal Physiology I Flashcards

1
Q

60/40/20 rule

A

60% of body weight is total body water
40% of body weight, or 2/3 of total body water is intracellular fluid
20% of body weight, or 1/3 of total body water is extracellular fluid

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2
Q

Intracellular fluid ion levels - Na, phosphate, K, protein anions

A 
Low Na
High K
High phosphate
Higher protein anions than ECF
No HCO3
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3
Q

Interstitial fluid ion levels - Na, phosphate, K, Cl, HCO3

A

High Na
High Cl
Low K
Medium HCO3

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4
Q

Plasma fluid ion levels- Na, Cl, HCO3, K, protein anions

A 
High Na
High Cl
Medium HCO3
Low K
Low protein anions
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5
Q

Electrolytes

A

Eg.. NaCl - molecules that can dissociate into two ions

Have greater ability to cause fluid shift

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6
Q

Normal serum osmolality

A

285-295

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7
Q

Water diuresis

A

Increased water excretion without corresponding increase in salt excretion

  • Primary cause is increased water intake
  • also polydipsia, diabetes insipidus
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8
Q

Solute diuresis

A

Increased water excretion concurrent with increased salt excretion
Primary cause- significant increase in salt present in tubular fluid
–IV NaCl, hyperglycemia, high protein intake, recovery from AKI

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9
Q

Free water clearance

A

If free water clearance is positive - excess water Is being excreted
If it is negative, excess solutes are being removed from blood by kidneys and water is being conserved
–Whenever urine osmolarity is greater than plasma osmolarity, free water clearance is negative, indicating water conservation

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10
Q

Free water clearance equation

A 
FWC= V - Cosm = V - (Uosm x V)/(Posm)
Cosm- osmolar clearance
V- urine flow rate
U- urine osmolarity
P- plasma osmolarity
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11
Q

Indicators for total body water volume

A

radioactive H2O (D2O), antipyrine

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12
Q

Indicators for EC fluid volume

A

Na, I-iothalamate, thiosulfate, insulin

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13
Q

Indicators for IC fluid volume

A

Total body water - EC fluid volume

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14
Q

Indicators for plasma volume

A

Albumin, evans blue dye

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15
Q

Indicators for blood volume

A

Plasma volume/1-hematocrit

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16
Q

Indicators for interstitial fluid

A

EC fluid volume - plasma volume

17
Q

Plasma osmolarity equation

A

(Na x2) + Glucose/18 + BUN/2.8

Eyeballing: 2x plasma sodium

18
Q

Gibbs donnan effect

A

Negatively charged proteins inside capillary generates both osmotic and electrochemical gradient favoring fluid and positive charge flow inwards

19
Q

What would happen if gibbs donnan effect was not countered

A

IC proteins would result in an influx of water into cell- cell swelling and death
Na/K exchanger counteracts the effect, preventing water influx

20
Q

ICF volume lost/gained effect on RBC

A

ICF loss leads to decreased hematocrit because of RBC shrinkage
ICF gain is opposite

21
Q

Cyrstalloids replacement therapy

A

Organic or inorganic salts dissolved in sterile water
Do not cross plasma membrane- remain in ECF
Distributed evenly in ECF b/w intravascular and interstitial
Glucose and NaCl commonly used as solutes

22
Q

Colloids

A

Contain large molecules that don’t pass through semipermeable membranes
Remain in intravascular compartment and expand intravascular volume by drawing fluid from extravascular spaces
-Hydroxyethyl starches HES, albumin

23
Q

Body fluid volumes are regulated by

A

Changes in Na balance

24
Q

Serum osmolality and Na concentration regulated by

A

Changes in H2O balance

25
Q

Hyponatremic dehydration

A

Loss of sodium is greater than loss of water in ECF
Serum Na concentration in the ICF is greater than that of ECF
Water shifts from ECF to ICF to establish equilibrium
Serum Na and serum osmolality will be less than normal range
Brain swelling, confusion, weakness, hypotension, tachycardia

26
Q

Hypernatremic dehydration

A

Loss of water is greater than loss of sodium in ECF
Serum Na concentration in the ECF is greater than in the ICF, water shifts from ICF to ECF
Serum osmolality exceeds 300mOsm/kg
Serum Na will be more than 150mEq/L
Edema, increased BP, muscle weakness, hyperreflexia

27
Q

Isosmotic volume contraction

A

Acute fluid loss conditions hemorrhage, diarrhea and vomiting
Diarrhea causes loss of isosmotic fluid from the GI tract
Decrease in ECF volume and no change in body osmolality or ICF volume

28
Q

Hyperosmotic volume contraction

A

Hypotonic fluid loss conditions - Dehydration, diabetes insipidus, alcoholism
Insensible water loss from ECF, solute is left behind and becomes concentrated
Decrease in ECF and ICF volume but increase in body osmolality

29
Q

Hyposmotic volume contraction

A

ICF volume increases, ECF volume decreases, osmolarity decreases
Adrenal insufficiency due to loss of aldosterone leading to excessive loss of NaCl in urine
Transient response is that ECF osmolarity decreases and fluid shifts to ICF until equilibrium

30
Q

Isosmotic volume expansion

A

ECF volume increases, ICF volume stays the same, osmolarity stays the same, hematocrit and plasma protein decrease

31
Q

Hypertonic volume expansion

A 
ECF volume increases
ICF volume decreases
Osmolarity increases
Fluid shift from intracellular to extracellular until equilibrium
-mimics high salt intake
32
Q

Hyposmotic volume expansion

A

Gain of hypotonic fluid
Conditions like excess water drinking and syndrome of inappropriate ADH secretion cause this
Increase in ECF and ICF volume, decrease in body osmolality

33
Q

Congestive heart failure

A

Low effective circulating volume due to decreased cardiac output
Sensed as low pressure
Na and fluid retention resulting in edema in which venous and capillary hydrostatic pressures increase
Patients continue to retain Na, increasing ECF volume without correcting the effective circulating volume

34
Q

Renin is stimulated by

A

Drop in blood pressure and B1 adrenergic receptor activation

35
Q

Renal vasoconstrictors

A

Sympathetics
Endothelin
ATP/adenosine
Angiotensin II

36
Q

Renal vasodilators

A 
Prostaglandins
Bradykinin
NO
Dopamine
ANP
ACE-inhibitor
37
Q

Angiotensin II constricts which arteriole

A

Efferent arteriole, raising GFR during diminished renal perfusion pressure
ACE inhibitors will lower GFR but blocking angiotensin II production

38
Q

Sympathetic effect on RBF/GFR

A

Sympathetic stimulation will vasoconstrict many renal blood vessels, but there is a particularly high level of a-1 receptors on the afferent arteriole, meaning there will be a decrease in RBF/GFR

CPR (24 decks)

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