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Patho II > Renal System Pt. 2 > Flashcards

Renal System Pt. 2 Flashcards

1
Q

Indicates the volume of plasma cleared of a substance per unit time (ml/min or ml/24hr)

A

Renal clearance

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2
Q

How do you calculate renal clearance?

A

C = (U x V)/ P

U= urine concentration
V= urine flow rate
P= plasma concentration
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3
Q

RBF is _____ proportional to the pressure difference b/w renal artery & renal vein, & is _____ proportional to the resistance of the renal vaculature

A

Directly; inversely

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4
Q

_______ of renal arteriols (dopamine) —> increase in RBF

A

Vasodilators

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5
Q

_____ & _____ constrict efferent arterioles —> increase GFR “protective”

A

Sympathetic stimulation & Angiotensin-II

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6
Q

Myogenic mechanism

A

⬆️ bloof flow - ⬆️ stretch in afferent arteriole —> increase entry of Ca into vascular smooth muscle —> vasoconstriction —> maintain constant blood flow

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7
Q

Tubuloglomerular feedback

A

⬆️ blood flow - ⬆️ fluid rush to macula densa - vasoconstriction of afferent arteriole —> maintain constant blood flow

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8
Q

Excess fluid retention by kidneys
Acute or chronic kidney failure
Glomerulonephritis
Mineralocorticoid excess
Decreased arteriolar resistance (vasodilators)
Increased venous pressure (CHF, venous obs, cirrohsis)

A

High capillary hydrostatic pressure

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9
Q

Low oncotic pressure
Loss of proteins (burns, wounds, nephrotic syndrome. Gastroenteropathy)
Failure to porduce proteins (malnutrition “kwashiokor”, cirrhosis, hypoalbuminemia)

A

Decreased plasma proteins

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10
Q 
Immune reactions (histamine)
Toxins
Burns
Prolonged ischemia
Vitamin deficiency (vit C)
Pre-eclampsia & eclampsia
A

Increased capillary permeability

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11
Q

Cancer cells
Surgery
Infections (filariasis or elephantitis)

A

Blockage of lymphatics

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12
Q

⬇️ ADH
⬇️ serum osmolarity/ serum Na
Hyposomotic urine
High urine flow rate

A

Primary polydipsia

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13
Q

⬇️ ADH
⬆️ serum osmolarity/ serum Na
Hyposomotic urine osmolarity
High urine flow rate

A

Central DI

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14
Q

⬆️ ADH
⬆️ serum osmolarity/ serum Na
Hyposmotic urine osmolarity
High urine flow rate

A

Nephrogenic DI

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15
Q

⬆️ ADH
High/normal serum osmolarity/ serum Na
Hyperosmotic urine osmolarity
Low urine flow rate

A

Water deprivation (lost in desert)

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16
Q

⬆️ ⬆️ ADH
⬇️ serum osmolarity/ serum Na
Hyperosmotic urine osmolarity
Low urine flow rate

A

SIADH

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17
Q

What does activation of the macula densa do when decreased Na is delivered to DCT?

A

Vasodilation of afferent arteriole -> Increase GFR

It also stimulates Jexta cells

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18
Q

The first and fastest line of defense against a change in H concentration acting within seconds

A

Buffer system
Extracellular = bicarb
Intracellular = Hgb

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19
Q

The second line of defense acting within minutes

A

Respiratory compensation

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20
Q

The third line of defense acting within hours to days

A

Renal compensation

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21
Q

Only _____ & ______ can be completely compensated

A

Respiratory acidosis & resp alkalosis

22
Q

Anion gap = ? Normal range?

A

= Na - (Cl + HCO3)

8-16 mEq/L

23
Q

Why does HCO3 decrease in metabolic acidosis?

A

It is used to buffer the extra fixed acid

24
Q

How does renal compensate for metabolic acidosis? For chronic met acidosis?

A

1) Increased excretion of the excess H as titratable acid and NH4
2) Increase reabsorption of HCO3
For chronic: adaptive increase in NH3 to aid in excretion of excess H

25
Q

Umeasured anions

A

Phosphate, citrate, sulfate, & proteins

26
Q

The serum anion gap is _____ if the concentration of an unmeasured anion is increased to replace HCO3

A

Increased

27
Q

The serum anion gap is _____ if the concentration of Cl is increased to replace HCO3

A

Normal

28
Q

How does renal compensate for metabolic alkalosis?

A

Increased excretion of HCO3 bc the filter load of HCO3 exceeds the ability of renal tubules to reabsorb it

29
Q

If metabolic alkalosis is accompanied by _____ the reabsorption of HCO3 increases, worsening the metabolic alkalosis

A

ECF volume contraction (vomiting); Contraction alkalosis

30
Q

Why does low Ca cause tetany (alkalosis)?

A

Hypocalcemia increases the permeability of Na, getting closer to the threshold for action potential

31
Q

Causes of high anion gap metabolic acidosis

A 
Methanol
Uremia
DKA
Propylene glycol
Iron tab or INH
Lactic acidosis
Ethylene glycol
Salicylate/Sepsis/Starvation
32
Q

Cause mixed metabolic acidosis and respiratory alkalosis

A

Salicylate

33
Q

Causes of normal anionic gap metabolic acidosis

A

Loss of bicarb (diarrhea MCC) or Decreased renal excretion of acids (renal tubular acidosis & Addison’s)

34
Q

Distal RTA= inability to excrete H and therefore regenerate HCO3

A

Type I

35
Q

Proximal RTA= inability to reabsorb filtered HCO3 (complication of Fanconi’s syndrome)

A

Type II

36
Q

RTA= “hyporenin hypoaldosterone”
Low aldosterone impairs K & H secretion -> hyperkalemic non-anionic gap acidosis
Failure to excret NH4
Seen in diabetes d/t destruction of juxta cells
Mild renal insufficiency

A

Type IV

37
Q

MCC of metabolic alkalosis

A

Volume & chloride depletion

38
Q

How does renal compensate for metabolic alkalosis?

A

By conserving Na (and Cl) and exchanging with H secretion

39
Q

In hypovolumia kidneys avidly reabsorb NaCl and pee out H. This means urinary chloride is ____ and the alkalosis _____ to NaCl repletion

A

Low; responds

40
Q

In the case of hyperaldosteronism (Na reabsorption/H excretion) & hypokalemia (K conserved/H excreted), urinary chloride is ____ and the alkalosis _____ to NaCl repletion

A

Normal; does NOT

41
Q

____ urinary Cl = hypovolumia (dry);

____ urinary Cl = Hypokalemia, hyperaldo (Conn’s)

A

Decreased; normal

42
Q

A carbonic anhydrase inhibitor that inhibits the reabsorption of HCO3 in the ______.
Weak diuretic properties

A

Acetazolamide; PCT

43
Q

Loop diuretics inhibit the Na/K/2Cl cotransport in the _______ resulting in retention of Na, Cl, & water in the tubule
These drugs are the most efficacious of the diuretics.

A

Ascending LOH; Bumetanide, Furosemide, Torsemide, Ethacrynic acid

44
Q

Inhibit reabsorption of Na and Cl in the _____ resulting in retention of water in the tubule.
Most commonly used diuretics.

A

thiazides; DCT

45
Q

An aldosteron antagonist, inhibits the aldosterone-mediated reabsorption of Na and secretion of K

A

Spironolactone (collecting tubule & duct)

46
Q

Block Na channels

A

Amiloride & triamterene (collecting tubule & duct)

47
Q

MOA of acetazolamide

A

Increases Na excretion d/t decreased Na/H exchange

48
Q

Diuretics used to tx hypercalcemia

A

Loop diuretics (loops lose calcium)

49
Q

S/E of loop diuretics

A

Ototoxicity -> tinnitus, hypokalemia, hyperuricemia, hypomagnesemia, hypotension

50
Q

Treat calcium stone formation

A

Thiazide diuretics (decrease Ca excretion)

51
Q

S/e of thiazide diuretics

A

Hypokalemia, hyponatremia, hypercalcemia, hyperuricemia

52
Q

Used to prevent mountain sickness (met acidosis with normal gap)

A

Carbonic anhydrase inhibitor (acetazolamide)

Patho II (11 decks)

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