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Renal/Urinary/Acid-Base Flashcards

1
Q

What is the main mechanism to keep protein out of the glomerular filtrate

A

Pore size and membrane negative charge

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2
Q

Mechanism of increased GFR

A

increased tubular flow (afferent vasodilation) and Na/CL delivery to the macular densa

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3
Q

Afferent arteriole constriction causes what to happen to the GFR and renal blood flow

A

Decrease

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4
Q

What does ANP do to the afferent arteriole

A

vasodilation (increase GFR)

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5
Q

How does angiotensin II increase GFR

A

Vasoconstriction of efferent arteriole

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6
Q

How does Adenosine decrease GFR

A

Vasoconstriction of the afferent arteriole

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7
Q

What are vasoconstrictors

A

NE/epi, endothelin, ADH (V1 receptors)

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8
Q

What are vasodilators

A

Nitric oxide, bradykinin, PG

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9
Q

What happens to the GFR when the capillary oncotic pressure is eleveted

A

Decrease

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10
Q

What is the main driving force of glomerular filtration

A

capillary hydrostatic pressure

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11
Q

What is the main opposing force of filtration in the glomerulus

A

Capillary oncotic pressure and bowman’s hydrostatic pressure

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12
Q

Why do normal dogs not have glucosuria

A

Reabsorption in the proximal tubule

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13
Q

What does Na fractional excretion of < 1% in the urine mean

A

pre-renal azotemia/dehydration/effective volume depletion

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14
Q

What % of HCO3 is reabsorbed in the PCT

A

90%

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15
Q

What % of Na is reabsorbed in the PCT

A

65%

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16
Q

What % of Na is reabsorbed in the LoH

A

25%

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17
Q

What % of Na is reabsorbed in the DCT

A

5%

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18
Q

What % of Na is reabsorbed in the CD

A

5%

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19
Q

Where is Mg primary absorbed

A

Thick ascending loop of henle

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20
Q

What are the two channels that support renal glucose reabsorption

A

SGLT1 and 2 channels of the PCT

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21
Q

Name the tonicity of each part of the nephron

A

PCT - isotonic
Descending LoH - hypertonic
Ascending LoH - hypotonic
DCT - hypotonic
CD - variable

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22
Q

Name the cells of the collecting duct

A

principle and intercalated

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23
Q

What hormones acts on principle cells in the CD

A

Aldosterone –> reabsorb Na/H2O and secrete K
ADH –> binds to V2 receptors to insert aquaporins in the CD to resorb water

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24
Q

Name the two types of intercalated cells and their jobs

A

Alpha - actively excretes H+ from the blood to the lumen (acid urine)
Beta - passively excretes HCO3 from the blood to the lumen (basic urine)

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25
What tubular disorder has a defect with the alpha intercalated cells
Distal tubular (type 1) - DCT/CD --> unable to acidify urine
26
Increased fluid delivery to the DCT will do what to the K
cause secretion (leading to hypokalemia --> overhydration/diuresis)
27
What is produced in the juxtaglomerular cells of the kidneys
renin
28
What is the major stimulus of thirst
hypotension/low volume/hemorrhage
29
What enzyme in the RAAS is decreased with pulmonary hypertension
ACE
30
What are the effects of ANP (atrial natriuretic peptide)
Inhibits Na and H2O reabsorption (inhibits RAAS), vasodilation of the afferent arteriole (increase GFR), and increased vascular permeability
31
What happens to K when the RAAS is activated
It will go down
32
What stimulates ADH
hypertonic plasma (dehydration)
33
What stimulates renin release
hypotension, low Na in ultrafiltrate, sympathetic activity, PGs
34
What can decrease GFR
vasoconstriction/epi
35
What is an alternative breakdown of angiotensin II
chymase
36
Which class of antibody can cause nephrotoxicity
IgG and IgM
37
patient with iris stage III and UPC 0.5 what is the next treatment step
Start ACE-I
38
What are the classic histological changes in the kidney seen with lepto
tubular necrosis and interstitial nephritis
39
Cat with iris stage III and NEW UPC of >0.5 what is the next step
urine culture - if persistent UPC elevation with negative culture then start ARB or ACE-I
40
What causes increased renal blood flow in CKD
hypertension
41
What is the mechanism of action for dilute urine with CKD
osmotic diuresis and increased blood flow to damaged kidney
42
True or false - lily toxicosis in cats often have a much higher creatinine and BUN
True
43
What kind of protein is found in the dogs urine with the UPC is 6.2
Albumin
44
What passes through the glomerulus with nephrotic syndrome
RBCs
45
What type of vasculopathy can you see with cutaneous/renal glomerulonephropathy of greyhounds
cutaneous and renal
46
What toxin is linked to glomerulonephropathy of greyhounds
E.coli
47
What is the clin path finding of fanconi syndrome
normal glucose with glucosuria, metabolic acidosis, aminoaciduria, proteinuria, phosphaturia with hypophosphatemia
48
What type of acidosis will you see with renal tubular acidosis
Hyperchloremic metabolic acidosis
49
What do you see with Type 1 RTA (distal)
hypokalemia, alkaline urine, unable to secrete H into the distal tubules
50
What do you see with Type II RTA (proximal CT)
Fanconi syndrome, nephrotic syndrome, acidic urine (still able to resorb some HCO3, metabolic acidosis
51
Where does the gentamicin (aminoglycosides) -associated renal toxicity occur
PCT
52
How can you prevent CaOx formation
increase water consumption
53
Cat with elevated renal values, pyuria, bacteriuria, and no improvement on fluids what surgery should be performed next if obstructed
subcutaneous ureteral bypass
54
What breed do urate stones occur in and what is the defect
Dalmatians and English Bulldogs; defect in the uric acid transport (prevents movement of uric acid into the hepatocytes for conversion to allantoin)
55
How do you treat urate stones
Allopurinol (xanthine oxidase inhibitor) and low protein diet
56
What electrolyte abnormality do you see with nephrogenic diabetes insipidus
hypokalemia (and often hypernatremic from dehydration) Kidneys do not respond to ADH leading to medullary wash out
57
Patient that is PU/PD and not responsive to DDAVP (desmopressin) what is the dx
Nephrogenic diabetes insipidus
58
What condition would lead to <1% K in the urine
Addison's
59
What are other causes of PU/PD outside of medullary tonicity
liver dz, altered cortisol, increased Ca
60
What are the risks of Iohexol clearance
anaphylaxis, cardiac arrhythmia, hypotension, GI signs, ARF, dehydration
61
MOA of Calcium gluconate with hyperkalemia
raises the threshold potential of the cell membrane that allows it to move into the cell
62
How do you calculate anion gap
AG = (Na+K) - (Cl+HCO3)
63
Blood gas analysis: Na 140, Cl 92, K 5.2, bicarb 8
AG = 145.2-100=45.2 (elevated - metabolic acidosis)
64
What are causes of an increased AG
D(DKA) U(uremia) E(ethylene) L(lactate) S(salicylate - aspirin)
65
Low pH, low HCO3, high pCO2
mixed respiratory and metabolic acidosis
66
What metabolic disturbance will lead to hyperventilation
metabolic acidosis
67
What influences acid base balance and H+ secretion into the kidneys
Aldosterone
68
when would you see paradoxical aciduria
primary metabolic alkalosis
69
what % of today body water by weight is extracellular fluid volume
20%
70
What % of total body water by weight is intracellular
40%
71
What is the definition of osmolality
concentration of osmotically active particles in a solution
72
What is the definition of osmolarity
calculated from osmolality - solute concentration/volume of solvent
73
Na is absorbed from the gut by what mechanism
active transport often cotransported
74
Maintenance fluids have
decreased amounts of Na and increased amounts of K
75
Urine dip stick changes
Alkaline urine can lead to false positives Acidic urine can lead to false negatives WBC - high specificity low sensitivity (false neg) dogs WBC - Sensitive, but not specific in cats pH high from glucose USG high from protein Bilirubin high from chlorpromazine and some NSAIDs Ketones with pigmenturia Blood - cant tell RBC/Hb/myglobin
76
What results in false positive protein on dipstick
pH>8 or prolonged exposure and bence jones proteins
77
MOA mannitol
osmotic diuresis - freely filtered at glomerulus and poorly reabsorbed in tubule that prevents water reabsorption
78
Normal plasma, dark red urine, positive for occult blood
rhabdomyolysis
79
What is the hormone that aids in vitamin D production in the kidneys
PTH
80
What increases GFR
PG (vasodilation) NO Bradykinin
81
What decreases GFR
Norepi epi endothelin
82
What do JG cells secrete
renin
83
What is the function calcitonin
stimulates osteoclast to release Ca from the bones
84
What is the parasympathetic innervation to the urethra
pelvic nerve
85
What would cause a urinary fraction excretion of Na <1%
severe volume depletion
86
How is calcitriol used with renal disease
With renal disease there is low Ca and high Phos. Renal disease can lead to secondary renal hyperparathyroidism which upregulates PTH --> upregulation of calcitriol from kidneys --> goal is Increased Ca (diet) and decreased Phos chronic disease leads to excessive phos and the Ca in the blood is going to bind to that excessive phos eventually leading to hypocalcemia. Which further stimulates PTH production, Loss of inhibition - need to give calcitriol to aid in increasing Ca from the diet and shutting off PTH production.
87
Normal protein found in urine
Albumin
88
What is SDMA
sensitive early marker (more sensitive than creatinine) of declinging GFR in dogs and cats Produced by all nucleated cells which highest concentration in the brain excreted by the kidnes and does not appear to be reabsorbed in the renal tubules
89
What is paradoxical aciduria
metabolic alkalosis (high bicarb on labwork) - measure anion gap can occur with proximal rental tubular acidosis (type 1) --> more time for bicarb in urine to reabsorbed can also occur with excessive vomiting and loss of HCl and dehydration --> metabolic alkalosis --> body retains Na due to dehydration and looses K and H in CD

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