Renal Review PPT-josh Flashcards
there are 2 kidneys with how many regions?
2
What are the 2 regions?
Cortex
Medulla
what is the functional unit of the kidney?
Nephron
What are 3 improtant functions of the nephron?
Hold filtrate
Excrete end products of metabolism
Absorb Important sunstances
The kidney gets what % of CO?
20-25%
how many mLs of blood does the kidney receive?
1100-1200 mL
what part of the kidney receives the most blood?
Cortex
The renal artery divides at the __1__, into several lobar arteries, they run b/t the __2__ of the medulla and turn into the __3__ then into __4__ and to the __5__.
- hilus
- pyramids
- interlobular arteries
- afferent arterioles
- glomerulus
Unfiiltered blood exits the kidney via what, to the venous system?
efferent arteriole
filtered blood goes where?
back to the body
waste is excreted from the kidneys as what?
urine
renal blood flow if determined by the ________ ______ ______ across the vascular bed
arteriovenous pressure difference
what is the formula to calculate renal blood flow?
Renal blood flow = (MAP - VP) x VR
- MAP- mean arterial pressure
- VP- venous pressure
- VR- vascular resistance
Renal blood flow is regulated by what 2 ways?
intrinsic autoregulation
Neural regulation
Autoregulation of the kidneys is with a MAP of what?
75-160mmHg
w/ neural regulation afferent and efferent arterioles are inervated by the SNS, stimulation of which is associated w/ what? and thus should be avoided
vasoconstriction
4 main functions of the kidney?
- maintenance of ECF composition
- Maintenance of ECF volume
- Endocrine functions
- Regulation of Arterial BP
Fx of the Kidneys:
what is maintained in the maintenance of ECF composition?
- Ionic composition (electrolytes)
- Osmolality (Na+ comcentration
- Conservation of non-ionic components (glucose, amino acids, proteins, water, vitamins)
- Excretion of products of metabolism (urea, creatine, lactic acid, uric acid)
Fx of the Kidneys:
how does the kidney perform maintenance of ECF volume
regulation of Na+ and h2o excretion
Fx of the Kidneys:
what endocrine fx does the kidneys perform?
- erythropoietin
- RAAS
- Vit D
What are the main structures of teh nephron? do it in order as if you were fluid going through it!
- arteriole from renal artery
- Bowman’s capsule
- Glomerulus
- Proximal tubule
- Loop of henle
- Distal tubule
- Collecting ducts
What structures are in teh Cortex and what structures are in the Medulla?
- Cortex
- Renal corpuscle (bowmans capsule)
- proximal tubule
- Distal tubule
- Medulla
- Loop of henle
- Collecting duct
What are the 3 steps of Urine formation and excretion
Glomerular filtration
Tubular reabsorption
Tubular secretion
Glomerular Filtration:
GFR get what % of RBF?
20% (125mL/min)
Glomerular Filtration:
the GFR is regulated by what?
Juxtaglomerular complex
Glomerular Filtration:
What 3 things can increase GFR?
- Increased RBF
- Dilation of Afferent arteriole
- Increased resistance inefferent arteriole
Glomerular Filtration:
what 2 things can decrease GFR?
- afferent arteriole constriction
- Efferent arteriole dilation
What reabsorbs the bulk of the glomerlar filtrate?
Proximal tubule
what iare the main function of the Loop of henle?
- establishes and maintains an osmotic gradient in the medulla of the kidney
- regulation of water balance
- Concentration/dilution of urine
The descending loop is highly permeable to ________ but impermeable to ______
Water
Solutes
The ascending loop is nearly impermeable to _____, but highly permeable to ___ and ____
water
Na+ and Cl-
The ECF is controlled by what hormone?
Aldosterone
ECF Volume and Osmolality:
Volume is controlled by aldosterone via ______ reabsorption
Sodium
ECF Volume and Osmolality:
where is aldosterone produced?
Adrenal Cortex
ECF Volume and Osmolality:
Osmolality is controlled by what?
ADH
ECF Volume and Osmolality:
osmolality is controlled by ADH via ___ reabsorption
Water
ECF Volume and Osmolality:
ADH is released from what?
the neurohypophysis (AKA posterior putuitary)
*****
Where does aldosterone work?
distal tubule
******
where does ADH work?
Collecting ducts
Osmolality: ADH
explain what the body does if ADH is pressent? and also when it is absent?
- ADH present
- Collecting duct is highly permeable to H20= you get small amount of very concentrated urine
- ADH Absent
- Collecting duct is not pearmeable to water= you get large amounts of dilute urine
what part of kidney os responsible for the fine tunning, makes final adjustment to urine pH and osmolality?
Distal tubule
what does aldosterone reabsorb? and secrete?
reabsorbs- Na+
Secretes K+
What is excreted in the proximal tubule?
Na+
H2O
What is excreted in the descending loop of henle
H2O
What is excreted in the ascending loop of Henle
Na+
Cl-
What is excreted in the Distal Tubule
Na+
H2O
what is excreted in the collecting ducts?
H20
What is the basic equaltion for Acid Base balance?
Carbonic Anhydrase
CO2 + H2O ⇔ H2CO3 ⇔ HCO3_ + H+
refere to acid base disturbances on own I am not going over that
Know your different ranges and how to determine them
Mind the Gap:
what is the anion gap used for?
to differentiate b/t metabolic acidosis
Anion Gap:
Is the difference b/t the primary measured what?
- cations (Na+ and K+) and the primary measured Anions (Cl- and HCO3) in serum
Anion Gap:
what is the equation?
Normal: (Na+ + K+) - (Cl- + HCO3)
or ususally done w/o K+ as
(Na+) - (Cl- + HCO3)
Mind the Gap:
What is te normal Anion Gap
8-12mM
Mind the Gap:
what does high Anion Gap Indicate?
- increased non-chloride acids (H+) uses more HCO3- therby Increaseing Anion Gap
- Normachloremia
- Lactic Acidosis
- DKA
Mind the Gap:
what does normal Anion Gap Mean?
- Decreased HCO3- from loss of body fluids (emesis/diarrhea), is replaced by Cl- resulting in no change to anion GAp
- Hyperchloremia
Diuretics:
what is a peptide hormone synthesized, stored, and secreted by teh cardiac atria
Atrial Natriuretic Factor
Diuretics:
what is teh stimulis for ANF release?
atrial stretch, distention, or pressure
Diuretics:
what is one of the most potent diuretics known?
ANF
Diuretics:
ANF acs on the kidneys to increase urine flow and Na+ excretion, it antagonizes both the release and end organ effects of ______, ______, and ____.
- renin
- Aldosterone
- ADH
Loop Diuretics:
what are 2 examples of them
lasix
bumex
Loop Diuretics:
how do they basically work?
stop reabsortion of Ions in ascending loop thus decreasing osmolality.
Increass water excretion
Diuretics:
What are ex of thiazide diuretics work?
HCTZ
Zaroxoyln
Diuretics:
what are examples of K+ sparing diuretics?
spironlactone
Diuretics:
whare to thiazides work?
distal convoluted tubule
Diuretics:
how do Thiazides work
Inhibit Na+ reabsorbtion thus decreasing water reabsortion
Diuretics:
Where do K+ sparing diuretics work
i think in the collecting ducts
Diuretics:
how do K+ sparing diuretics (spironlactone work?
competitively inhibits aldosterone increasing sodium excretion and promoting sodium retention
Diuretics:
where do Carbonic-anhydrase inhibitors work?
Proximal tubule
Diuretics:
what type of diuretic is impermeable to teh renal tubule and exerts osmotic force dereasing the reabsorption of water
Osmotic diuretics Mannitol
Describe the RAAS! (basic don’t need to say that renin is released from the juxta…. blah blah blah)
- Kidney releases renin into blood
- Liver releases angiotensinogen
- they meet and convert into ATI
- ACE from the lungs then cahnges ATI into ATII
- ATII stimulates aldonsterone secretion by the adrenal cortex
- aldosterone stimulates Na+ and H2O reabsorption in the nephrons
(ATII also works on the neurohypophysis to release ADH and such, but the basics is above)
remember from previous slides ADH works in collecting ducts, and ALdosterone works in the distal tubule
Blocking the actions of what can cause refractory Hypotension how?
Blocks the release of both aldosterone and ADH
what are the pros of Colloid?
- increased plasma volume
- Less peripheral edema
- Smaller volumes for resuscitation
- Intravascular half-life 3-6 hrs
What are the advantages of Crystalloids?
- Inexpensive
- Unse for maintenance fluid and inital resuscitation
- restore 3rd space loss
- Intravascular half-life 20-30 minutes
K+ controls what with the membrane potential
resting membrane potential
Ca++ controls what w/ the membrane potential
threshold
Treatment of Hyperkalemia:
why give Ca++
move threshold away from resting membrane potential
Treatment of Hyperkalemia:
whay give HCO3 and hyperventilate the pt?
decrease Concentration of H+ in the plasma (H+ from ICF to ECF, K+ back inside the cell)
Treatment of Hyperkalemia:
why give a Beta-2 agonist (albuterol) and insulin?
to stimulate Na-K pump, drives K back into cells
Treatment of Hyperkalemia:
why give dextrose?
to prevent hypoglycemia
thats it for for that next is Renal patho!!!!!
whooooo hoooooo
