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PM2A Spring Amy L > Renal Therapeutics I > Flashcards

Renal Therapeutics I Flashcards

1
Q

List the 2 major roles of the kidneys

A

Homeostatic regulation of water and inorganic ion balance

Removal of metabolic waste products and foreign chemicals from the blood and their excretion in the urine

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2
Q

Label the kidney

A

[Labelled kidney]

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3
Q

What is a nephron?

A

The functional unit of the kidney

Loops between the cortex and the medulla

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4
Q

List 4 essential secretions (from blood to tubular fluid)

A

Renin
Vitamin D3
Prostaglandins
Erythroprotein

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5
Q

List the 3 processes involved in the elaboration of the urine complex

A

Filtration
Reabsorption
Secretion

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6
Q

Explain the process of filtration during the elabortion of the urine complex

A

Occurs in the glomerulus under very high pressure
Forms the filtrate, which then enters the tubules
Then called tubular fluid

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7
Q

Explain the process of reabsorption during the elaboration of the urine complex

A

Movement from tubular fluid to blood

Transcellular or paracellular

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8
Q

Explain the process of secretion during the elaboration of the urine complex

A

Movement of molecules from blood to tubular fluid

Transcellular or paracellular

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9
Q

Why are the 3 process which occur during the elaboration of the urine complex so important?

A

In order to conserve electrolytes and regulate osmolality

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10
Q

Explain the route the blood takes in order to pass the Bowman’s capsule

A

Afferent arteriole

  • -> Efferent arteriole
  • -> Peritubular capillary
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11
Q

Where are molecules reabsorbed to from the nephron?

A

Peritubular capillary

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12
Q

Where are molecules secreted from the blood and into the nephron?

A

Peritubular capillary

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13
Q

How does the kidney regulate blood pressure?

A

By controlling how much water is removed from the bloodstream and excreted as urine (during reabsorption)

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14
Q

What happens to the electrolytes present in the tubular fluid at the Loop of Henle?

A

Descending loop = H2O passes out via passive diffusion (tubular fluid becomes more concentrated compared to its environment)
Ascending loop = NaCl passively and then actively transported out, little water permeability

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15
Q

What happens to electrolytes present in the tubular fluid at the collecting duct?

A

Water and urea passively pass out of the nephron

The urea passes back into the descending Loop of Henle

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16
Q

List 3 molecules which can pass into the tubular fluid

A

Glucose
Water
Urea

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17
Q

Where is renin produced?

A

Kidney

Protease/enzyme

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18
Q

Where is angiotensinogen produced?

A

Liver

Protein

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19
Q

What role does renin play in the renin-angiotensin-aldosterone system (RAAS)?

A

Renin cleaves angiotensinogen into angiotensin I

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20
Q

Explain the processes which occur in the renin-angiotensin-aldosterone system (RAAS)

A

The kidney produces the enzyme renin which cleaves angiotensinogen made in the liver
This produces angiotensin I
Angiotensin I is cleaved by ACE (protease) to produce angiotensin II

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21
Q

What is ACE?

A

Angiotensin-converting enzyme

Protease

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22
Q

Where is ACE produced?

A

Either the kidney or the lungs

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23
Q

What effects can angiotensin II have on the body?

A

The arterioles - vasoconstriction to increase/maintain BP
Pituitary gland - ADH secretion affecting H2O absorption at the collecting duct
Sympathetic activity
Causes the adrenal gland to secrete aldosterone

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24
Q

What is aldosterone

A

Steroid hormone
Controls BP
Causes water to be reabsorbed as well as sodium = increased blood volume = increased BP

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25
Q

What is the role of ADH/vasopressin?

A

It regulates plasma volume by controlling how much water is secreted/reabsorbed in the kidneys
ADH/vasopressin makes the distal convoluted tubule and collecting duct more permeable to water (excretes less)

26
Q

How is ADH/vasopressin released?

A

Pre-optic nerve detects drop in BP from losing too much water
Osmoreceptors in the hypothalamus detect changes in the osmotic pressure
So it releases ADH to keep more water in the body

27
Q

What is ADH also known as?

A

Vasopressin

28
Q

What does ADH stand for?

A

Anti-diuretic hormone

29
Q

Where is ADH produced?

A

Hypothalamus

30
Q

Where is ADH released?

A

Posterior pituitary gland

31
Q

What do osmoreceptors do?

A

Detect changes in osmotic pressue

32
Q

What is Diabetes insipidus caused by?

A

Caused by the inability of the kidney to conserve water

Therefore frequent urination and extreme thirst

33
Q

What is Central diabetes insipidus caused by?

A

Caused by lack of ADH due to damage of hypothalamus or result of surgery

34
Q

What is Nephrogenic diabetes insipidus caused by?

A

Kidneys fail to respond to ADH

35
Q

Name the 2 types of diabetes insipidus

A

Central diabetes insipidus

Nephrogenic diabetes insipidus

36
Q

What are micturition abnormalities?

A

Problems with the process of passing urine

37
Q

What is normally the root of micturition abnormalities?

A

The lower urinary tract

38
Q

What do abnormalities in urine volume usually imply?

A

A more serious cause

39
Q

List 5 symptoms of micturition abnormalities

A 
Dysuria = painful
Hesitation = difficulty starting
Frequency
Incontinence = difficulty stopping
Noctuia = frequency at night
40
Q

List 5 possible causes of these micturition abnormalities

A 
UTI/inflammation
Outflow obstruction
Heart failure
Diabetes
Polyuria = production of an abnormally large amount of urine
41
Q

List 3 symptoms of urine volume abnormalities

A 
Polyuria = production of an abnormally large amount of urine
Oliguria = production of an abnormally small amount of urine
Anuria = failure of the kidneys to produce urine
42
Q

List 4 possible causes of urine volume abnormalities

A 
Diet
Climate
Renal tubular disease (RTD)
Diabetes (mellitus or insipidus)
Chronic renal failure (CRF)
43
Q

List 3 systemic symptoms of renal impairment

A

Fluid and electrolyte imbalances
Osmotic imbalance can cause neurological issues
Uraemia = high level of blood urea –> lethargy, nausea, vomiting

44
Q

Name 3 measurements which can be used for urine analysis

A

Specific gravity = concentration of the urine
pH
Abnormal constituents

45
Q

List 5 abnormal constituents which could be found in the urine and what this could indicate

A

Proteins (proteinuria) = glomerular diease
Blood (haematuria) = infection, inflammation, tumour
Haemoglobin = haemolytic anaemia
Pus (pyuria) = renal or urinary tract infection
Crystals (crystalluria) = depends on crystals

46
Q

What is the rate of filtration?

A

Initial filtrattion of compounds from the bloodstream to the collecting duct
Indication for efficacy of kidney
Difficult to measure

47
Q

What is Clearance?

A

Hypothetical volume of blood from which a substance would be completely removed by filtration in 1 minute

48
Q

Which 3 pieces of information are required in order to calculate the rate of filtration and clearance?

A

Plasma concentration of substance
Urine flow rate (over 24 hours)
Urine concentration of substance

49
Q

List 4 things which may result from problems with kidney function

A

Loss of nutrients from the body
Failure to remove toxins
Affect drug treatments
Affect BP

50
Q

What is GFR?

A

Glomerular filtration rate
Used to measure clearance
Dependent on the net filtration pressure, glomerular surface and the permeability if the glomerular membrane

51
Q

Describe the relationship between plasma clearance and GFR and the implications of this

A

Plasma clearance should = GFR

Plasma clearance GFR = substance filtered and secreted but not reabsorbed

52
Q

List 3 factors that must apply to a substance if its renal clearance is to equal the GFR

A

The substance is:
Freely filtered from the blood capillaries into the Bowman’s capsule
Neither absorbed or secreted by the tubules
Has no overt effect on renal metabolism

53
Q

Which substance is used to calculate GFR?

A

Creatinine

54
Q

What is the equation used to calculate GFR from creatinine?

A 
CrCl = [F(140-age) x weight] /SrCr
F = 1.04 in females, 1.23 in men
55
Q

What is RPF?

A

Renal plasma flow

The volume of blood plasma delivered to the kidneys oer unit time

56
Q

What is the relationship between PAH and RPF?

A

PAH clearance is used to estimate RPF
This is because PAH enters via glomerular filtration and is secreted but not reabsorbed
Therefore clearance = RPF

57
Q

What is filtration fraction?

A

The fraction of plasma through the kidney which is filtered

= GFR/RPF

58
Q

List 6 things that should be monitored in order to estimate renal function

A 
Creatinine
Plasma sodium
Plasma bicarbonate
Plasma calcium
Plasma phosphate 
pH
59
Q

What is an intravenous excretory urogram (IVU)?

A

Use of x-ray contrast medium to produce a series of images which will show any inequality of perfusion of kidneys, rate of renal and bladder filling etc

60
Q

What is the purpose of a kidney biopsy?

A

Useful in differential diagnosis of nephritis and in assessing transplant rejection

PM2A Spring Amy L (15 decks)

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