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41 Cards in this Set
- Front
- Back
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If I decide to give someone a kidney, which one are the docs going to take? why?
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the Left kidney
The vein is longer |
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What is the course of the Ureters?
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The Ureters pass Under the uterine artery and Under the ductus deferens
water under the bridge |
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How is fluid distributed in the body?
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I'm 60% water
1/3 of which is ECF 2/3 is ICF 1/4 of ECF is plasma vol 3/4 of which is Interstitial vol |
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Electrolyte composition of ECF and ICF?
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ECF is high in NaCl and low in K
ICF is low in NaCl and high in K |
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What is Clearance?
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(U*V)/P
(urine [x] * Urine flow rate) /plasma [x] |
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Relationship between Clearance and GFR?
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CL < GFR if there is net tubular reabsorption
CL > GFR if there is net tubular secretion CL=GFR if there is neither |
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What makes up the Glomerular filtration barrier?
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Fenestrated capillary endothelium
Fused BM w/ heparan sulftate (negative charge barrier) Podocyte foot processes |
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Measure of GFR?
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Inulin clearance b/c there is no net tubular secretion or reabsorption
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When talking about pressures, what is the equation for GFR?
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GFR = Kf [(Pgc - Pbs) - (@gc -@bs)]
Kf = coefficient that is mostly permeability P's are hydrostatic pressures @'s are oncotic pressure oncotic pressure of bowman's space is usually 0 since proteins are freely filtered. |
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what do we use to measure ERPF? why?
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PAH
b/c PAH is completely filtered and secreted to where whatever PAH comes in is excreted. |
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What is Filtration Fraction?
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GFR/RPF
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What is the Filtered load?
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GFR X Plasma [ ]
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Role of PG's on renal blood flow? effects on RPF, GFR, FF?
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PG's dilate afferent arteriole---> inc RPF, Inc GFR, so FF stays the same
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Role of Ang II on renal blood flow? effects on RPF, GFR, FF?
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Vasoconstricts Efferent Arteriole---> Dec RPF, Inc GFR, Inc FF
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How does inc/dec plasma protein concentration affect GFR and FF?
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If you inc plasma protein concentration, you'll dec GFR and FF
if you dec plasma protein concentration, you'll inc GFR and FF |
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What is Free Water Clearance? equation?
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ability to dilute urine
look it up |
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How do values for Free Water Clearance differ w/ or w/o ADH?
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W/ ADH, clearance is < 0 (retention of water)
w/o ADH, clearnace is > 0 (water excretion) Isotonic Urine has a clearance = to 0 |
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When does glucosuria begin? when is the glucose reabsorber completely saturated?
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Glucosuria begins w/ plasma [ ] of 200
When its at 350, the transport mech is saturated (Tm) |
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Which segment of the nephron is impermeable to water? significance?
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The Thick Ascending Loop of Henle
It actively reabsorbs Na, K, Cl and is impermeable to H20 (thus diluting the pee) |
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Aldo vs ADH mech?
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Both work in Distal Convoluted Tubules
Aldo---> ENaC incorporation and Na reabsorption ADH--->insertion of aquaporin--> water reabsorption |
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How does the RAAS system work?
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Kidney releases Renin via dec in BP (JG cells) or dec Na at MD
Angiotensinogen---> Ang I (via renin) Ang I-->Ang II (via ACE) |
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Fxns of ANG II?
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Stimulates Vascular Smooth Muscle---> Inc BP
Constricts Efferent Arteriole--> inc FF Stimulate Aldo secretion-->Na reabs (subsequent H20 reabs) Stimulates ADH secretion Inc Proximal Tubule Na/H Activity Stimulates Hypothalamus--->thirst |
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What do Aldo and ADH primarily affect?
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Aldo: blood volume
ADH: osmolarity |
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What is the Juxtaglomerular Apparatus?
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JG Cells (modified smooth muscle of afferent arteriole)
Macula Densa (Na sensor, DCT) JG's secrete Renin |
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Endocrine Fxns of Kidney?
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Endothelial Cells or peritubular caps secrete Erythropoietin in response to hypoxia
Proximal Tubule Cells activate Vit D PTH directly stimulates renal Ca reabs and dec renal Phosphate reabs JG cells secrete Renin Renal secretion of Prostaglandins to vasodilate Aff. Arteriole---> Inc GFR |
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How can NSAIDs affect Renal Endocrine Fxns?
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NSAID's dec produciton of prostaglandins. This can be Bad Bad if the kidney is secreting prostaglandins to keep the afferent arteriole dilated.
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How does ANP affect Renal Fxn?
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Causes Inc GFR
Causes Inc Na Filtration w/o compensatory Na reabsorption --->net loss of Na and volume |
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Where in the nephron does PTH fxn?
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PCT for dec PO4 reabs
DCT for inc Ca reabs |
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Compensatory Response to Metabolic Acidosis? Metabolic Alkalosis?
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Metabolic Acidosis--->Hyperventilation
Metabolic Alkalosis--> hypoventilation |
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Compensatory response to Resp. Acidosis? Resp Alkalosis?
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Resp Acidosis--->inc renal HCO3 reabs
Resp. Alkalosis---> Dec renal HCO3 reabs |
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What are the first two lab values to check for an acid-base disturbance? what do they tell you?
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pH --> acidosis or alkalosis
PCO2 acidosis w/ Pco2 > 40 = Resp Acidosis if Pco2 < 40 Met. Acidosis w/ resp comp. ALKALOSIS Pco2 < 40 = resp alkalosis Pco2 > 40 = met alkalosis w/ comp. |
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So you've got Resp Acidosis, what can cause that?
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HYPOVENTILATION
airway obstruction acute lung disease chronic lung disease Opioids, narcotics, sedatives |
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So you've got Metabolic Acidosis, what next?
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check Anion Gap
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Causes of Inc AG Met. Acidosis?
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MUDPILES
methanol uremia DKA paraldehyde/phenformin INH or Iron tablets Lactic acidosis Ethylene glycol Salicylates |
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Causes of Normal AG Met Acidosis?
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Diarrhea
Glue sniffing Renal Tubular Acidosis Hyperchloremia |
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Causes of Resp. Alkalosis?
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HYPERVENTILATION
(high altitude) Aspirin Ingestion |
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Causes of Met Alkalosis?
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Diuretics
Vomiting Antacids HyperALDO |
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Types of Renal Tubular Acidosis?
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Type 1
Type 2 Type 4 |
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What causes Type 1 RTA?
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Defect in H/K ATPase of collecting tubules--->inability to secrete H--->hypokalemia
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What causes Type 2 RTA?
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Defect in Proximal Tubule HCO3 reabsorption. can lead to hypoK
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What causes Type 4 RTA?
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Hypoaldosteronism--->hyperK--->inhibition of ammonia excretion in proximal tubule
Cause a drop in urine pH due to buffering capacity |
