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Patho II > Renal System Pt. 1 > Flashcards

Renal System Pt. 1 Flashcards

1
Q

Production of _____ in response to decreased renal blood flow and increased sympathetic discharge (___ effect)

A

Renin; B1

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2
Q

Why does chronic renal disease lead to hypocalcemia?

A

Kidneys responsible for activating vitamin D. Vitamin D is required for Ca absorption from the gut

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3
Q

Zone most vulnerable to ischemia secondary to hypotension

A

Inner strip of outer zone (of medulla)

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4
Q

What secretes renin?

A

Juxta glomelular cells

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5
Q

JG apparatus = ___ (Na sensor) + ____ ; this is important in ______

A

Macula densa + JG cells; volume regulation

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6
Q

Renal blood flow is ___ of cardiac output; ____ ml/min

A

25%; 1250

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7
Q

Components of Nephron:

A

Glomerulus
Afferent & efferent arterioles
Renal tubules

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8
Q

Site of bulk reabsorption, NOT under hormonal control

A

Proximal tubule

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9
Q

Establishes the osmotic gradient in medulla which is important in regulation of water
“Counter current multiplier”

A

Loop of Henle

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10
Q

Make final adjustments on urine pH, osmolarity, based on need. The reabsorption here IS under homronal control (aldosterone, ADH)

A

Distal tubule & collecting duct

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11
Q

85% of total
Located in renal cortex
Have short loop of henle

A

Cortical nephrons

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12
Q

Located close to renal medulla
Have long loop of henle which goes deep into medulla
Important in countercurrent system by which kidneys concentrate urine

A

Juxtamedullary nephrons

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13
Q

Remove water and other solutes from renal tubules also known as ______

A

Reabsorption. Peritubular capillaries

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14
Q

Excretion is the sum of what 3 processes?

A

Filtration, reabsorption, & secretion

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15
Q

Glomerular filtration results production of ____ L of glomerular fluid each day, out of which ____ L gets reabsorbed

A

180; 179

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16
Q

Filtration is under pressure

A

Ultrafiltration

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17
Q

Normal GFR = ?

A

125 ml/min

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18
Q

Factors governing filtration rate at the the capillary bed are:

A
  1. Net filtration pressure
  2. Total surface area available for filtration
  3. Filtration membrane permeability
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19
Q

GFR is directly proportional to ______

A

Net filtration pressure (NFP)

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20
Q

What happens if GFR is too high?

A

Needed substances cannot be reabsorbed quickly enough and are lost in the urine

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21
Q

What happens if GFR is too low?

A

Everything is reabsorbed, including wastes that are normally disposed of

22
Q

How do ACE inhibitors affect GFR?

A

Decrease GFR by dilating efferent arterioles —> renal insufficiency. Avoid in bilateral renal artery stenosis

23
Q

The plasma conc at wchich glucose first appears in the urine (____ mg/dL)

A

Threshold; 250

24
Q

If glucose does not reabsorb in the ___, it is ____

A

Proximal tubule; excreted

25
Q

Maximal transport of glucose (Tm) is ____ where reabsorption is saturated

A

> 350 mg/dL

26
Q

_______ serum osmolarity stimulates ADH release while _____ serum osmolarity inhibits ADH release

A

Increased; Decreased

27
Q

The triggers for release of ADH:

A

Hypovolemia, hypotension, pain, stress, CPAP, PEEP, and VA

28
Q

ADH regulates serum osmolarity by ___ H2O reabsorption (aquaporin 2) from _____ and ____ (via ___ & ____)

A

Increasing; late distal tubules & collecting ducts; V2 receptor & cAMP

29
Q

ADH is a potent vasoconstrictor via what receptor and mechanism?

A

V1 & IP3/Ca

30
Q

Why do we need an osmotic gradient in the Renal Medulla?

A

We need it to make concentrated urine. Would not be able to concentrate w/o it (polyuria)

31
Q

What is the osmotic gradient in the Renal Medulla?

A

A countercurrent multiplier system

32
Q

Where is the osmotic gradient in the Renal Medula?

A

Loop of Henle

33
Q

Inhibits release of ADH

A

Low plasma osmolarity

34
Q

Stimulates release of ADH

A

High plasma osmolarity

35
Q

____ & ____ are independent of aldosterone, so the Na reabsorption is unaffected

A

PCT & LOH

36
Q

____ % of Na is reaborbed in the PCT with _____ cotransport or in exchange with ___ by countertransport

A

67; glucose, H+

37
Q

_____ % of Na is reabsorbed in LOH by ______ transport

A

25; Na - K -2Cl

38
Q

____ % of Na is reabsorbed in DCT and collecting duct under the influence of _______

A

8; aldosterone

39
Q

Water flows out of the cells along with K

A

Hyperosmolarity

40
Q

Water flows into the cell along with K

A

Hypoosmolarity

41
Q

Treatment for hyperkalemia (in order):

A
  1. Confirm by plasma K level
  2. Stop K
  3. Calcium gluconate fo rcardiac membrane stabilization
  4. Sodium Bicarb —> drive K into cells
  5. Hyperventilation
  6. Loop diuretics
  7. Insulin (D50) —> drive K into cells
  8. Kayexalate exchange resin (exchanges Na for K in gut)
  9. Beta-2 agonist
  10. Dialysis
42
Q

Each _____ mmHg drop in PCO2 results ___ mEq/L decrease in K with hyperventilation

A

10; 0.5

43
Q

How do beta blockers cause hyperkalemia?

A
  1. Suppress catecholamine-stimulated renin release, thereby decreasing aldosterone synthesis
  2. More importantly, decreases cellular uptake of K
44
Q

While 50% is reabsorbed in PT, DT & CD are impermeable to _____

A

Urea

45
Q

Isosmotic volume expansion

A 
Addition of isotonic NaCl
ECF volume increases.
No change in osmolarity (no shift b/w ECF and ICF)
RBCs will not shrink or swell
BP increases bc ECF volume increases
46
Q

Isosmotic volume contraction

A

Diarrhea - loss of isotonic solution (also burns)
ECF volume decreases but NO change in osmolarity -> no shift of water b/w ICF & ECF
BP decreases bc ECF decreases

47
Q

Hyperosmotic volume expansion

A

Excessive NaCl intake
ECF osmolarity increases b/c osmoles (NaCl) has been added to ECF
Water shifts from ICF to ECF —> ICF osmolarity increases until it equals ECF
ECF volume increases (volume expansion) & ICF volume decreases

48
Q

Hyperosmotic volume contraction

A

Excessive sweating - lost in desert
Osmolarity of ECF increases bc sweat is hyposmotic
ECF volume ⬇️ bc of loss of volume in sweat —> water shifts from ICF (⬆️ ICF osmolarity)

49
Q

Hyposmotic volume expansion

A

SIADH - gain of water or infusion of hypotonic solution
Osmolarity in ECF ⬇️ bc excess water is retained & ECF volume ⬆️ bc excess water
Water shifts into ICF (cellular swelling) —> ⬇️ ICF osmolarity and ⬆️ ICF volume

50
Q

Hyposmotic volume contraction

A

Adrenocortical insufficiancy- loss of NaCl (Addison’s)
ECF osmolarity ⬇️, ECF volume ⬇️
Water shifts into cells —> ICF osmolarity ⬇️ & ICF volume ⬆️

Patho II (11 decks)

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