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General Boards > Renal/Urinary/Acid-Base > Flashcards

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
Q

What tubular disorder has a defect with the alpha intercalated cells

A

Distal tubular (type 1) - DCT/CD –> unable to acidify urine

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26
Q

Increased fluid delivery to the DCT will do what to the K

A

cause secretion (leading to hypokalemia –> overhydration/diuresis)

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27
Q

What is produced in the juxtaglomerular cells of the kidneys

A

renin

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28
Q

What is the major stimulus of thirst

A

hypotension/low volume/hemorrhage

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29
Q

What enzyme in the RAAS is decreased with pulmonary hypertension

A

ACE

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30
Q

What are the effects of ANP (atrial natriuretic peptide)

A

Inhibits Na and H2O reabsorption (inhibits RAAS), vasodilation of the afferent arteriole (increase GFR), and increased vascular permeability

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31
Q

What happens to K when the RAAS is activated

A

It will go down

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32
Q

What stimulates ADH

A

hypertonic plasma (dehydration)

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33
Q

What stimulates renin release

A

hypotension, low Na in ultrafiltrate, sympathetic activity, PGs

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34
Q

What can decrease GFR

A

vasoconstriction/epi

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35
Q

What is an alternative breakdown of angiotensin II

A

chymase

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36
Q

Which class of antibody can cause nephrotoxicity

A

IgG and IgM

37
Q

patient with iris stage III and UPC 0.5 what is the next treatment step

A

Start ACE-I

38
Q

What are the classic histological changes in the kidney seen with lepto

A

tubular necrosis and interstitial nephritis

39
Q

Cat with iris stage III and NEW UPC of >0.5 what is the next step

A

urine culture - if persistent UPC elevation with negative culture then start ARB or ACE-I

40
Q

What causes increased renal blood flow in CKD

A

hypertension

41
Q

What is the mechanism of action for dilute urine with CKD

A

osmotic diuresis and increased blood flow to damaged kidney

42
Q

True or false - lily toxicosis in cats often have a much higher creatinine and BUN

A

True

43
Q

What kind of protein is found in the dogs urine with the UPC is 6.2

A

Albumin

44
Q

What passes through the glomerulus with nephrotic syndrome

A

RBCs

45
Q

What type of vasculopathy can you see with cutaneous/renal glomerulonephropathy of greyhounds

A

cutaneous and renal

46
Q

What toxin is linked to glomerulonephropathy of greyhounds

A

E.coli

47
Q

What is the clin path finding of fanconi syndrome

A

normal glucose with glucosuria, metabolic acidosis, aminoaciduria, proteinuria, phosphaturia with hypophosphatemia

48
Q

What type of acidosis will you see with renal tubular acidosis

A

Hyperchloremic metabolic acidosis

49
Q

What do you see with Type 1 RTA (distal)

A

hypokalemia, alkaline urine, unable to secrete H into the distal tubules

50
Q

What do you see with Type II RTA (proximal CT)

A

Fanconi syndrome, nephrotic syndrome, acidic urine (still able to resorb some HCO3, metabolic acidosis

51
Q

Where does the gentamicin (aminoglycosides) -associated renal toxicity occur

A

PCT

52
Q

How can you prevent CaOx formation

A

increase water consumption

53
Q

Cat with elevated renal values, pyuria, bacteriuria, and no improvement on fluids what surgery should be performed next if obstructed

A

subcutaneous ureteral bypass

54
Q

What breed do urate stones occur in and what is the defect

A

Dalmatians and English Bulldogs; defect in the uric acid transport (prevents movement of uric acid into the hepatocytes for conversion to allantoin)

55
Q

How do you treat urate stones

A

Allopurinol (xanthine oxidase inhibitor) and low protein diet

56
Q

What electrolyte abnormality do you see with nephrogenic diabetes insipidus

A

hypokalemia (and often hypernatremic from dehydration)
Kidneys do not respond to ADH leading to medullary wash out

57
Q

Patient that is PU/PD and not responsive to DDAVP (desmopressin) what is the dx

A

Nephrogenic diabetes insipidus

58
Q

What condition would lead to <1% K in the urine

A

Addison’s

59
Q

What are other causes of PU/PD outside of medullary tonicity

A

liver dz, altered cortisol, increased Ca

60
Q

What are the risks of Iohexol clearance

A

anaphylaxis, cardiac arrhythmia, hypotension, GI signs, ARF, dehydration

61
Q

MOA of Calcium gluconate with hyperkalemia

A

raises the threshold potential of the cell membrane that allows it to move into the cell

62
Q

How do you calculate anion gap

A

AG = (Na+K) - (Cl+HCO3)

63
Q

Blood gas analysis:
Na 140, Cl 92, K 5.2, bicarb 8

A

AG = 145.2-100=45.2 (elevated - metabolic acidosis)

64
Q

What are causes of an increased AG

A

D(DKA) U(uremia) E(ethylene) L(lactate) S(salicylate - aspirin)

65
Q

Low pH, low HCO3, high pCO2

A

mixed respiratory and metabolic acidosis

66
Q

What metabolic disturbance will lead to hyperventilation

A

metabolic acidosis

67
Q

What influences acid base balance and H+ secretion into the kidneys

A

Aldosterone

68
Q

when would you see paradoxical aciduria

A

primary metabolic alkalosis

69
Q

what % of today body water by weight is extracellular fluid volume

A

20%

70
Q

What % of total body water by weight is intracellular

A

40%

71
Q

What is the definition of osmolality

A

concentration of osmotically active particles in a solution

72
Q

What is the definition of osmolarity

A

calculated from osmolality - solute concentration/volume of solvent

73
Q

Na is absorbed from the gut by what mechanism

A

active transport often cotransported

74
Q

Maintenance fluids have

A

decreased amounts of Na and increased amounts of K

75
Q

Urine dip stick changes

A

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
Q

What results in false positive protein on dipstick

A

pH>8 or prolonged exposure and bence jones proteins

77
Q

MOA mannitol

A

osmotic diuresis - freely filtered at glomerulus and poorly reabsorbed in tubule that prevents water reabsorption

78
Q

Normal plasma, dark red urine, positive for occult blood

A

rhabdomyolysis

79
Q

What is the hormone that aids in vitamin D production in the kidneys

A

PTH

80
Q

What increases GFR

A

PG (vasodilation)
NO
Bradykinin

81
Q

What decreases GFR

A

Norepi
epi
endothelin

82
Q

What do JG cells secrete

A

renin

83
Q

What is the function calcitonin

A

stimulates osteoclast to release Ca from the bones

84
Q

What is the parasympathetic innervation to the urethra

A

pelvic nerve

85
Q

What would cause a urinary fraction excretion of Na <1%

A

severe volume depletion

86
Q

How is calcitriol used with renal disease

A

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
Q

Normal protein found in urine

A

Albumin

88
Q

What is SDMA

A

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
Q

What is paradoxical aciduria

A

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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