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104 final > Theme 3 lectures - CHatterjee > Flashcards

Theme 3 lectures - CHatterjee Flashcards

1
Q

Elimination

A

Environment

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2
Q

Excretion

A

Body fluid

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3
Q

Cortical nephrons [2]

A

Short LOH -> Medulla

Peritubular capillaries

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4
Q

Juxtamedullary nephron [2]

A

Deeper into pyramid

Vasa recta

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5
Q

Organic acid [3]

A

Uric acid
Antibiotic - penicillin
Diuretic

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6
Q

Organic base [2]

A

Creatinine

Procainamide

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7
Q

Renal filtration [3]

A

BP
Different diameters
Renal blood flow

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8
Q

Glomerular filtration [3]

A

Pores in glomerular cap endothelium

Basement membrane of Bowman’s capsule

Epithelial cells of Bowman’s capsule - Podocytes via filtration slits

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9
Q

Two forces filter fluid out

A

Glomerular cap hydrostatic pressure

Bowman’s capsule oncotic pressure (almost zero)

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10
Q

Two forces oppose ultrafiltration

A

Glomerular cap oncotic pressure

Bowman’s capsule hydrostatic pressure

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11
Q

Filtration pressure

A

(PGC) – (PBS + piGC)

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12
Q

Autoregulation of RBF

A

BP 90-200mmHg

Myogenic or metabolic

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13
Q

GFR increased by [5]

A

Prostaglandins, ANP, dopamine, NO, kinins

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14
Q

GFR decreased by [4]

A

Noradrenaline

(from symp nerves), endothelin, adenosine, ADH

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15
Q

Filtration pressure drop = GFR drop [4]

A

Less Na+ enter PT

Macula densa senses change in tubular Na+ levels

Stimulate juxtaglomerular cells to release renin

Ang II generated

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16
Q

Na+ co-transported with [2]

A

Sulphate

Phosphate

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17
Q

SGLT2 inhibitors

A

Dapagliflozin
Canagliflozin
Empagliflozin

APICAL

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18
Q

PAH [4]

A

Non-endoegenous compound

Transported into PT via alpha-ketoglutarate or di/tri carboxylates

Transported out in exchange for another anion

Tubular secretion

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19
Q

Thin limb

A

AQP1 and passive TJ movement

Flat cells

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20
Q

Thick limb

A

Na+K+2Cl-

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21
Q

Cl- and Na+ for K+ in

A

DT (throughout)

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22
Q

Na+ for K+ in

A

Late DT and early CD

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23
Q

Principal cells

A

Sensitive to aldosterone

Exchange Na+ for K+ in late DT and early CD

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24
Q

alpha-Intercalated Cells

A 
Secretes acid (H+)
via H+/Na+ or H+/K+ exchange,
involving ATPase or H+ATPase

Reabsorbs bicarbonate (HCO3-)

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25
Q

beta-Intercalated Cells

A 
Secrete bicarbonate (HCO3-)
via Pendrin

Reabsorbs acid (H+)

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26
Q

CD & ADH [3]

A

Vasopressin V2 receptor

10-15min plasma half life Activate intracellular AQP2

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27
Q

Nephrogenic - diabetes inspidius

A

Inability of kidney to respond to ADH

Chlortalidone (diuretic)

Indometacin (anti-inflammatory

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28
Q

Neurogenic - diabetes inspidius

A

Due to lack of ADH production
by the brain

Desmopressin (ADH analogue)
Vasopressin
Carbamezapine (anti-convulsive)

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29
Q

SIADH can cause

A

Hyponatraemia

Fluid overload

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30
Q

ADH

  • increased
  • decreased
A

Nicotine
Ether
Morphine
Barbiturates

Alcohol

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31
Q

Diuretic use

A

Reduce circulating volume

Remove excess fluid

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32
Q

Loop diuretic use [6]

A

Inhibit NaK2Cl in THICK asc LOH
Reduced Na+ reabsorption

Acute pulmonary oedema
Chronic heart failure
Cirrhosis of the liver
Resistant hypertension

Nephrotic syndrome
Acute renal failure

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33
Q

Loop diuretic disadvantages [5]

A

Dehydration

K+ loss leading to low plasma K+ (hypokalaemia)

Metabolic alkalosis (due to H+ loss in urine)

Hypokalaemia can potentiate effects of cardiac glycosides

Deafness (when used with aminoglycoside antibiotics)

34
Q

Thiazide diuretic use

A

DT to inhibit apical Na+Cl- cotransporter

Hydrochlorothiazide prototype

Hypertension

Oedema

Mild heart failure

35
Q

Thiazide diuretic disadvantages

A

Plasma K+ depletion (due to urinary K+ loss)

Metabolic alkalosis (due to urinary H+ loss)

Increased plasma uric acid – gout

Hyperglycaemia (increased blood glucose)

Increased plasma cholesterol (with long-term use)

Male impotence (reversible)

36
Q

eplerenone, spironolactone

A

Aldosterone antagonists

Spironolactone metabolised to canrenone
Competitive inhibitor of aldosterone

Reduction of protein expression in DT

37
Q

Aldosterone antagonists

A

eplerenone, spironolactone

38
Q

Non-Aldosterone antagonists

A

amiloride, triamterene

39
Q

amiloride, triamterene

A

Non-Aldosterone antagonists

Weak diuretic - act on DT to inhibit Na reabsorption and decrease K+ excretion

Luminal Na+ channel

40
Q

Spironolactone uses [2]

A

Heart failure

Oedema

41
Q

Spironolactone disadvantages [5]

A

Hyperkalaemia (increased plasma K+ levels) – needs to be monitored regularly

Metabolic acidosis (due to increased plasma H+)

GI upsets (peptic ulceration reported)

Gynaecomastia, menstrual disorders, testicular atrophy

Eplerenone produces less unwanted effects than spironolactone

42
Q

Carbonic anhydrase inhibitor

A

Acetazolamide
Block NaHCO3 reabsorption in PT

Glaucoma (decrease intraoccular p) & epilepsy

Can lead to met acidosis and enhance renal stone formation

43
Q

Mannitol

A

Osmotic diuretic
Non reabsorbable and excreted 30-60mins
6-8hrs

Increased intercranial p, intraoccular p and acute renal failure

Osmotic p can increase plasma vol = not sued in hypertensive patients

44
Q

Renal failure risk factors [7]

A 
Extreme age 
Polypharmacy 
Specific disease states 
Long term analgesia 
Transplants 
Drug therapy 
Patients undergoing imaging procedures
45
Q

Clinical assessment [6]

A 
Fluid balance 
Electrolyte regulation 
EPO production 
Vitamin D3 
Excretion 
Acid-base balance
46
Q

Electrolyte regulation [4]

A

Abnormal ECG
Absent P wave
Broad QRS complex
Peaked T wave

47
Q

Bedside Clinical Data [4]

A

Weight chart
Fluid balance chart
Degree of oedema
Result of urine dipstick testing

48
Q

Modern Imaging Technique [3]

A

Gamma camera planar scintigraphy

Positron emission tomography (PET)

 Single photon emission 
   computerised tomography (SPECT)
49
Q

Creatinine increased by [5]

A

Large muscle mass, dietary intake
(Audley Harrison vs. Audrey Hepburn)
Drugs which interfere with analysis (Jaffe reaction)
e.g. methyldopa, dexamethasone, cephalosporins
• Drugs which inhibit tubular secretion
e.g. cimetidine, trimethoprim, aspirin
Ketoacidosis (affects analysis)
Ethnicity (higher creatine kinase activity in black population)

50
Q

Creatinine decreased by [5]

A

Reduced muscle mass (e.g. the elderly)
Cachexia / starvation
Immobility
Pregnancy (due to increased plasma volume in the mother)
Severe liver disease (as liver is also a source of creatinine)

51
Q

Drugs which interfere with analysis [3]

A

Methyldopa, dexamethasone, cephalosporins

52
Q

Drugs which inhibit tubular secretion [3]

A

Cimetidine, trimethoprim, aspirin

53
Q

Urea increased by [6]

A 
High protein diet
Hypercatabolic conditions 
	e.g. severe infection, burns, hyperthyroidism
Gastrointestinal bleeding
	(digested blood is a source of urea)
Muscle injury
Drugs e.g. Glucocorticoids, Tetracycline
Hypovolaemia
54
Q

Urea decreased by [4]

A

Malnutrition
Liver disease
Sickle cell anaemia (due to GFR)
SIADH (syndrome of inappropriate ADH)

55
Q

Freely filtered but not reabsorbed or secreted
Freely filtered and partly or mostly reabsorbed
Freely filtered but fully reabsorbed
Freely filtered, not reabsorbed, fully secreted

A

INULIN
Electrolyte
Glucose and AA
PAH

56
Q

Renal disease biomarkers [5]

A

Kidney injury molecule – 1 (KIM-1) (urine)

Interleukin (IL)-18 (urine)

Fatty-acid binding proteins (FABPs) (urine)

Neutrophil gelatinase-associated lipocalin (NGAL) (plasma & urine)

Cystatin C (plasma)

57
Q

Renal can also branch into

A

Suprarenal

Segmental

58
Q

Transcellular transport involves

A

AQP on apical & basolateral surface

59
Q

ADH

A

Vasopressin (basal membrane of principal cells)

AQP2 on apical membrane

60
Q

Central vascular sensors - low p BV receptors [3]

A

Systemic
Cardiac atria
Pulmonary vasculature

61
Q

Central vascular sensors - high p BV receptors [3]

A

Carotid sinus
Aortic arch
Renal aff arteriole

62
Q

Renal baroreceptors senses

A

Decrease perfusion p in aff arteriole

63
Q

Renal Na+ sensors senses

A

Decrease Na+ in DT

64
Q

SNS supplying JGA senses

A

Decrease systemic BP

65
Q

Decrease perfusion p in aff arteriole sensed by

A

Renal baroreceptors

66
Q

Decrease Na+ in DT sensed by

A

Renal Na+ sensors

67
Q

Decrease systemic BP sensed by

A

SNS supplying JGA

68
Q

RAAS

A

Renal baroreceptors & Na+ sensors

69
Q

ANS

A

Peripheral baroreceptors -> Hypothalamus -> ANS (Haemodynamic and RAAS)

70
Q

ADH

A

Peripheral baroreceptors -> Hypothalamus -> ADH -> Water reabsopriton increases

71
Q

ADH

A

Increase plasma osmolality -> Hypothalamus osmoreceptors -> ADH in circ

72
Q

Urine out of the end of the collecting duct [2]

A

Tubular fluid travels through common collecting duct deep into inner medulla of kidney

Tubular fluid exits collecting duct at tip of renal pyramid - also known as the renal papilla

73
Q

Urine into the renal pelvis and ureter [3]

A

Minor and major calyces lead to renal pelvis
Fluid stretch renal pelvis SM
Peristaltic contractions at hilus -> bladder

BONUS: the epithelium is impermeable to water and solutes

74
Q

Ureter structure [5]

A 
30cm 
Transitonal epithelium - impermeable to urine 
Inner longitundinal 
Outer circular/spiral
Extra longitudinal layer
75
Q

Ureter function [3]

A

Dilation of renal pelvis generates action potential from pacemaker cells in hilum

Peristaltic waves generated – between
1 to 6 per minute…
P NS enhance

76
Q

Peristalsis in ureter [3]

A 
Longitudinal m contracts followd by circular m relaxation 
Longitudinal relax (forms bolus) and circular muscle pushes against it

VERMICULATION

77
Q

Entrance into bladder [3]

A

Ureter attach to the posterior wall of urinary bladder
Pass through wall at oblique angle 2-3 cm
Slits = ureteral openings (backflow)

78
Q

Urinary bladder structure [4]

A

Hollow muscular organ - fundus and neck
Outer detrusor muscle layer - longitudinal and circular/spiral m
Inner mucosal layer: Transitional epithelium - rugae (empty = folded) and highly elastic

79
Q

Trigone [2]

A

Triangular area bounded by openings of ureters and entrance to urethra
acts as a funnel to channel urine towards neck of bladder

80
Q

Internal urethral sphincter [4]

A

Loop of smooth muscle
Convergence of detrusor muscle
Under involuntary control

Normal tone keeps neck of bladder
and urethra free of urine

81
Q

External urethral sphincter [4]

A

Circular band of skeletal muscle where urethra passes through urogenital diaphragm
Acts as a valve with resting muscle tone
Under voluntary control

Voluntary relaxation permits micturition

82
Q

Elimination of urine

A

Females:
Opens via external urethral
orifice located between clitoris and vagina

Males:
Urethra passes through prostrate gland and through uro-genital diaphragm and penis

104 final (15 decks)

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