Pathophysiology Renal I

Front 1

Functions of the Kidney

Back 1

-regulates the composition of body fluids and pH
-regulates plasma osmolality-ADH hormone
-important in BP regulation
-endocrine function
-eliminate metabolic waste

Front 2

Regulates the composition of body fluids and pH through what electrolytes?

Back 2

-Na, K, hydrogen, Calcium, Chloride

Front 3

Endocrine function of the kidney

Back 3

-activates vitamin D, produces renin, erythropoetin

Front 4

The kidney regulates the elimination of these 3 things?

Back 4

1. H20
2. electrolytes
3. metabolic waste

Front 5

Renin yields

Back 5

-Angiotensin II
-Aldosterone

Front 6

The tubules _______ what we must have

Back 6

reabsorb

Front 7

Blood pressure in the kidneys is ________; why?

Back 7

high; because the renal arteries are a straight shot into the kidney

Front 8

The kidney is inside or outside the peritoneal cavity?

Back 8

outside

Front 9

The Right Kidney is ____ than the left

Back 9

Lower

Front 10

Outer cortex contains

Back 10

-golmeruli and convoluted tubules of nephron and blood vessels

Front 11

Inner medulla

Back 11

contains renal pyramids, renal papillae, renal pelvis

Front 12

The nephron-renal blood flow

Back 12

-renal artery >> afferent arteriole >> glomerular capillaries >> efferent arteriole >> peritubular capillaries >> venules >> renal vein

Front 13

Two capillary systems, the nephron, renal blood flow

Back 13

1. Glomerulus
2. Peritubular system

Front 14

Glomerulus capillary system

Back 14

-high pressure
-FILTERS blood

Front 15

Peritubular capillary system

Back 15

low pressure
-reabsorption/secretion between blood and filtrate

Front 16

The nephron: flow of the filtrate

Back 16

bowman's capsule >> proximal convoluted tubule >> descending limb of Henle >> loop of Henle >> ascending limb of Henle >> (contact again with Bowmans and JGA) >> distal convoluted tubule >> collecting tubule

Front 17

GFR is _____ mL/min

Back 17

110-120

Front 18

Glomerular capillary membrane

Back 18

-basement membrane determines permeability of glomerular capillary membrane

Front 19

Glomerular capillary membrane prevents the passing of ________ and ________

Back 19

RBCs and proteins

Front 20

If you see protein in the urine

Back 20

membrane broken, glomeronephritis

Front 21

FIltrate moves into tubules and is

Back 21

modified

Front 22

Loop diuretics work here

Back 22

in the ascending loop of Henle

Front 23

If we do not absorb Na and H20 in the loop of Henle it is

Back 23

excreted

Front 24

This is where REGULATION occurs; principal cells work here (ALDOSTERONE) and intercalated cells

Back 24

late distal tubule and collecting duct

principal cells: reabsorption: Na Cl
Secretion: K
ADH mediated H2O reabsorption

Intercalated cells: reabsorption HCO3, K
Secretion: H

Front 25

Proximal tubule filtrate modification

Back 25

-reabsorbs MAINLY glucose AA
-secretes H+ organic acids and bases

Front 26

Thin descending loop of Henle role in filtrate modification

Back 26

reabsorption of H2O into the interstitium
-filtrate becomes hypertonic

Front 27

Thick ascending loop of Henle >> filtrate modification

Back 27

-powerful pumps, reabsorb Na, K and 2 Cl
-absorb from filtrate into interstitium

Front 28

Early/late distal tubule and collecting duct role in filtrate modification

Back 28

**Na H2O Bicarb regulated here
-regulates needs depending on organism

MAIN SITE OF REGULATION

aldosterone: absorb NA AND SECRETE K

ADH--> regulated here

Front 29

Glomerular filtration determined by

Back 29

-capillary hydrostatic pressure
-colloidal osmotic pressure
-membrane permeability

Front 30

Blood flow into kidney per minute is about how much of CO?

Back 30

20%

Front 31

Regulation RBF: Neuro hormonal mechanisms

Back 31

1. SNS
2. Angiotension II and ADH
3. Prostaglandins and NO

Front 32

Regulation RBF:

SNS

Back 32

constricts both efferent and afferent arteriole causing decrease of RBF and GFR

Front 33

Regulate RBF

Angiotensin II and ADH

Back 33

vasoconstriction of renal blood vessels causing decrease in RBF

Front 34

Regulation of RBF

Prostaglandins and NO

Back 34

causes vasodilation protecting the kidneys during intense stimulation of the SNS

Front 35

Regulation of RBF: Autoregulation

Back 35

-keeps the RBF and GFR constant despite fluctuation in BP
1. myogenic
2. glomerular tubular feedback
3. effect of increase protein and glucose load

Front 36

Regulation RBF: myogenic response

Back 36

-change of diameter of afferent and efferent arterioles depending on the stretch of the afferent arteriole

*bp high afferent constrict - constant amount of fluid
* bp low dilate- blood into glomerular capillaries
*maintains constant

Front 37

Regulation RBF: Glomerular tubular feedback

Back 37

-the juxtaglomerular complex-amount of the NaCl in the macular densa is monitored

-decrease glomerular filtration rate >> not enough filtrate to fit into bowman's capsule >> more Na absorbed >> less Na in macula densa >> sense BP low >> renin increase >> increase constriction of efferent arteriole >> increase pressure in glomerular >> increase filtrate >> increase pressure

Front 38

Reabsorption passive vs active transport

Back 38

-water, urea via passive transport (concentration gradients)
-Na K Cl Ca Phosphorus glucose Amino Acids via ACTIVE transport

Front 39

Secretion

Back 39

H, K

Front 40

Transport mechanisms: secondary active transport

Back 40

Na K pump
ATP dependent

Front 41

Transport mechanisms: Cotransport

Back 41

Na Glucose/AA

Front 42

Transport Mechanisms: Antiport

Back 42

Na, H

Front 43

Renal threshold

Back 43

-the plasma level at which the substance appears in the urine
-the amount filtered in the glomerulus exceeds the transport maximum

Front 44

At what level will glucose spill into urine?

Back 44

increase blood glucose >> increase filtered >> exceeds transport max >> glucosuria

glucose passes into urine

Front 45

Elimination functions

Back 45

-renal clearance of metabolic products
-regulation of Na, K elimination
-regulation of pH: H+ ion elimination
-urea, creatinine, uric acid elimination
-drug elimination

Front 46

Aldosterone __ na excretion and ___ k excretion

Back 46

when blood pressure decreases, aldosterone holds onto Na and excretes K

if hypernatremic, aldosterone suppressed and Na is excreted and K is absorbed

Front 47

In response to atrial stretching ________ & ________ are released and Na is _____________

Back 47

ANP and BNP


excreted (naturesis)

Front 48

BUN

Back 48

urea end product of protein metabolism
-depends on renal excretion, protein metabolism, dietary intake protein intake, volume status

Front 49

BUN increased synthesis

Back 49

TPN, catabolic state, GI bleed, steroids, muscle breakdown

Front 50

BUN decreased synthesis

Back 50

malnutrition, liver failure, volume expansion

Front 51

Good indicator of kidney function

Back 51

creatinine

Front 52

Normal BUN/Cr ration

Back 52

10-15/1

Front 53

Cr Clearance reflects the

Back 53

GFr

Front 54

Cr Clearance

Back 54

muscles release at a basal constant rate depending of muscle mass-kidneys filter and minimally secrete

-affected by muscle injury

Front 55

Cr Clearance is the amount of plasma cleared from creatinine in

Back 55

1 minute

Front 56

Endocrine Functions

Back 56

1. Renin Aldosterone Angiotensin
2. Erythropoietin
3. Vitamin D

Front 57

Erythropoetin

Back 57

hormone regulate RBC production in the bone marrow

made in kidneys-stimulated by hypoxia
kidneys-sense O2 in blood

COPD-sense lack of O2, high Hct

Front 58

Vitamin D in kidneys

Back 58

-transformed to active form in the kidneys
-vitamin D increases calcium absorption from the GI tract

Front 59

Distribution of Body Water

Back 59

fluid is 60% body weight
-most water is in the intracellular space
-more H20 in cells than outside

Front 60

Electrolytes

Back 60

substances that dissociate in solution to form charged particles (ion); opposites attract

Front 61

Diffusion

Back 61

movement of particles down a concentration gradient

Front 62

Osmosis

Back 62

movement of water across a semi permeable membrane

particles pull the water

the more particles the more osmotic pressure

Front 63

The main factor that determines the osmotic pressure of blood is

Back 63

SODIUM

Front 64

Hypotonic

Back 64

decrease in osmolarity than intracellular fluid
-more water in plasma
-water will move into the cell
-cell swells
-give patient saline

Front 65

Hypertonic soln

Back 65

increase in osmolarity than intracellular fluid
-water moves out of cell from higher to lower outside
-cell shrinks
-give hypotonic soln

Front 66

Our body is

Back 66

isotonic

Front 67

Osmotic pressure depends on

Back 67

number of particles

Front 68

Na and H2O balance

Back 68

regulates movement of fluids at the cell membrane
-Na controls extracellular fluid osmolality
-If sodium changes, change in water volume

Front 69

Change in sodium means change in

Back 69

water

Front 70

Most Na is in _________________ fluid compartment

Back 70

extracellular fluid compartment

Front 71

Resting cell membrane is impermeable to ____

Back 71

Na

Front 72

Sodium determines _____ volume in the cell, helps in regulation of ____________ and contributes to __________-

Back 72

-ECF volume and osmolality
-helps in the regulation of blood pH
-contributes to the nervous system function

Front 73

Na enters through

Back 73

the GI tract

Front 74

Na eliminated through

Back 74

-kidneys
-GI tract - n/v/d
-skin

Front 75

Na requirements

Back 75

500mg/day

Front 76

What organ is the regulator of Na

Back 76

the Kidney

Front 77

Mechanisms of Na regulation

Back 77

-kidney is main regulator
-coordinated by SNS and RAA mechanisms
-organism monitors BP, retain Na when BP drops
-ANP, BNP released in response to atrial stretching
-increase in sodium excretion

Front 78

Mechanism of water regulation --Thirst

Back 78

-regulator of INTAKE
-responds to ECF changed in osmolarity and volume
-conscious sensation
-emergency response
-polydipsia

Front 79

Water gains from __________________?

Back 79

oral intake, absorbed from GI tract

Front 80

Water Losses from ______________________ ?

Back 80

-kidneys, GI tract
-skin, lungs, insensible losses
-sweating

Front 81

If you have the conscious Sensation of thirst this means that .....

Back 81

you are already dehydrated

Front 82

Mechanism of Water Regulation-ADH

Back 82

-regulator of output
-responds to ECF changes to osmolarity and volume
-acute conditions produce greater changes than chronic conditions

Front 83

If Na is 150-160 how does ADH respond

Back 83

-tries to lower osmotic pressure by releasing ADH
-ADH goes to the kidney to absorb H20
-osmotic pressure decreases

Front 84

Diabetes Insipidus

Back 84

-deficiency or decrease response to ADH
-large diluted urine output up to 40L/day, thirst
-treat with ADH, HCTZ

Front 85

DI causes

Back 85

-neurogenic-strokes, head injury, sx
-nephrogenic-lithium
-Gestational-breakdown ADH

Front 86

If you have no ADH you pee a lot or a little?

Back 86

a LOT

Front 87

Proportionate disorder of na and water balance

Back 87

-lost same amt of water and na
-NO CHANGE in osmotic pressure of extracellular fluid

HYPER or HYPO volemic

Front 88

Disproportionate disorder or water and Na balance

Change in Osmotic Pressure

Back 88

If ECF HYPOVOLEMIC: water moves into cells; cells swell

If ECF HYPERTONIC: water moves out of cells


Na--> brain/neuro cells first effected
K--> cardiac/muscle cells effected

Front 89

Isotonic fluid deficit

Back 89

-decrease ECF
-decrease circulating blood volume

Front 90

Causes of isotonic fluid deficit

Back 90

-decrease fluid intake
-increase GI fluid losses
-increase renal losses (diuretics, osmotic diuresis (hperlycemia), kidney disease)
-increase skin losses
-third space losses

Front 91

Isotonic fluid excess

Back 91

increase ECF
increase circulating blood volume

Front 92

Causes of isotonic fluid excess

Back 92

-decrease Na and H2O elimination (HF, renal failure, liver failure)
-increase na intake
-increase fluid intake

Front 93

Hyponatremia

Back 93

Na < 135, Serum Osmo < 275

decrease Na
increase H20

Front 94

Decrease serum sodium caused by

Back 94

-excessive losses
-sweating
-GI losses
-diuretics

Front 95

Increase serum water "dilutional"

Back 95

-H2O shifts from cells to EC fluid (hyperglycemia)
-excess IVF/PO water intake
-water retention (CHF, ARF, cirrhosis, increase ADH levels)

Front 96

In Hyperglycemia, osmotic pressure is _____ which ___ fluid from the cell

Back 96

-osmotic pressure high
-pulls fluid from cell

Front 97

Manifestations of hyponatremia

Back 97

-cramps, weakness, fatigue
-n/v/d
-h/a
-confusion, lethargy, sz, coma

Front 98

What cell is first effected in hyponatremia?

Back 98

NERVE CELL

Front 99

Hypernatremia

Back 99

Na > 145

Serum osmo > 295

-water moves from cells to ECF cells shrink

Front 100

Decrease serum water caused by

Back 100

-losses (diarrhea, sweating, increase RR, DI)
-decrease intake (drought, no thirst)

Front 101

Increase serum sodium

Back 101

-rapid excessive IVF
-salt water near drowning
-meds

Front 102

manifestations of hypernatremia

Back 102

-cellular dehydration
-increase thirst, decrease urine output, increase urine osmolality
-water pulled from CNS cells-- decrease reflexes, agitation, h/a, restlessness, sz, coma

Front 103

Na alterations =

Back 103

neuro alterations

Front 104

Potassium is mainly ___cellular

Back 104

intracellular

Front 105

Intake of K

Back 105

-dietary sources

Front 106

-Function of K

Back 106

-regulates electrical membrane potentials controlling excitability of skeletal, cardiac, and smooth muscle tissue

Front 107

Regulation of potassium

Back 107

-renal
-intracellular and extracellular shifts

Front 108

Cells effected first in changes in K

Back 108

muscle cells

Front 109

IC-EC shifts of K

Back 109

-controlled by Na-K-ATPase pump
-influenced by Epi, Insulin (increase cellular uptake of K)
-influenced by pH (acidosis H= in K=out)
-muscular contraction

Front 110

If patient hyperkalemic give ______ and ______ together to rev up pump

Back 110

insulin and glucose together
-albuterol (beta 2 agonist)

Front 111

In acidosis, explain what happens to H ions and K

Back 111

H+ inside and K outside
-hyperkalemia

Front 112

In hyperkalemia, what drug do you give to buffer?

Back 112

bicarb
-alkalotic environment
-H+ out to compensate get K in

Front 113

Hypokalemia

Back 113

K <3.5

Front 114

Causes of hypokalemia

Back 114

-dietary: decrease intake
-increase losses: vomiting, diarrhea, suctioning, sweat, kidneys (diuretics, SNS)
-redistribution EC and IC: alkalosis

Front 115

manifestations of hypokalemia

Back 115

-n/v/d
-decrease bowel sounds
-weakness
-fatigue
-cramps
-cardiac changes
-confusion
-depression

Front 116

Cardiac activity and hypokalemia

Back 116

decrease cardiac excitability; cardiac arrest

Front 117

Hyperkalemia

Back 117

> 5.0

Front 118

Hyper kalemia causes

Back 118

-dietary: increase intake, K supplementas
-redistribution EC and IC: cell trauma, death, burns, injuries, sz, exercise
-decrease elimination: renal failure, ACEI, K sparing diuretics

Front 119

Manifestations of hyperkalemia

Back 119

-neuormuscular excitability, EKG changes

Front 120

HyperK t waves

Back 120

peaked

Front 121

Acid

Back 121

a molecule that can release a H+

Front 122

Base

Back 122

molecule that can accept an H+

Front 123

Chemical buffer system consists of

Back 123

a weak acid and its base or a weak base and its acid

Front 124

Henderson-Hasselbalch Equation

Back 124

HCO3/CO2

pH= HCO3 (kidneys)/CO2 (lungs)

Front 125

volatile

Back 125

flies-CO2

Front 126

nonvolatile

Back 126

bicarb

Front 127

Acid base regulation

Back 127

-chemical buffer systems
-respiratory control systems
-renal control mechanisms

Front 128

Respiratory control mechanisms

Back 128

CO2 transported 3 ways
1. dissolved CO2
2. HbCo2
3. HCO3

Front 129

How does a buffer system work?

Back 129

-it substitutes a strong acid or base for a weak acid or base preventing big changes in pH

Front 130

Three buffer systems in the body

Back 130

1. Bicarb buffer system
2. Proteins can release or bind H+
3. Hydrogen Potassium exchange

Front 131

CO2 is mostly transported as

Back 131

HbCO2

Front 132

Respiratory system controls carbonic acid concentration by changing the _____ and _________ of respirations

Back 132

rate and depth

Front 133

Renal control mechanisms

Back 133

-production of metabolic acids
-major source: metabolism of dietary proteins (sulfuric acid, hydrochloric acid, phosphoric acid)

-anaerobic metabolism ---> lactic acid

-incomplete oxidation of fats --> keto acids

-acid production > base production

Front 134

Renal regulation of pH is controlled in

Back 134

proximal tubule

Front 135

Renal regulation of pH occurs through excreting _______ or __________ urine

Back 135

acid or alkaline urine

Front 136

Renal control mechanisms

Back 136

- regeneration of bicarb and secretion of H+ ions

-tubular buffer systems (ammonia, phosphate)

-potassium hydrogen exchange

-chloride bicarb exchange

Front 137

Lab Tests

Back 137

ABGs

base excess or base deficit

Front 138

Base deficit

Back 138

-amount of base that must be added to a blood sample to achieve pH 7.4

Front 139

Anion gap

Back 139

-difference between cation (Na+), anions (Cl, HCO3)

normal 8-12

Front 140

Increased ion gap

Back 140

-ketoacidosis, lactic acidosis

Front 141

Decreased ion gap

Back 141

-fall in unmeasured anions (albumin) or rise in unmeasured cations (K, Ca, Mg)

Front 142

Metabolic acidosis

Back 142

decrease in pH due to decrease in HCO3

Front 143

Metabolic alkalosis

Back 143

increase in pH due to increase in HCO3

Front 144

Respiratory acidosis

Back 144

decrease in pH due to increase CO2 (decrease in ventilation)

Front 145

Respiratory alkalosis

Back 145

-increase in pH due to increase in alveolar ventilation, decrease in PCO2

Front 146

Compensatory mechanisms

Back 146

Renal mechanisms compensate for respiratory induced dx., respiratory mechanisms compensate for renal induced change in acid-base balance.

Front 147

Respiratory system compensates by

Back 147

increasing or decreasing

Front 148

Kidneys compensate by conserving

Back 148

HC03- or H+ ions.

Front 149

pH < 7.40 =

Back 149

acidosis

Front 150

pH > 7.40

Back 150

alkalosis

Front 151

Causes of metabolic acidosis

Back 151

-increase metabolic acids
-decrease acid secretion by the kidneys
-increase loss of HCO3
-increase in chloride

Front 152

Metabolic alkalosis causes

Back 152

-increase in HCO3
-decrease in H+ ions
-volume depletion
-lung compensates

Front 153

Causes of respiratory acidosis

Back 153

Depression respiratory center (OD, Head injury)

Lung disease
(Asthma, emphysema, pneumonia, pulmonary edema)
Airway obstruction, abnormal chest wall motion/respiratory muscles
(Paralysis, chest injuries, obesity)

Breathing air with high C02 content

Front 154

Causes of respiratory alkalosis

Back 154

-excessive ventilation-anxiety
-hypoxic with reflex stimulation of increase ventilation
-stimulation of resp center-fever
-mechanical ventilation

Front 155

Increase in sodium _________________ aldosterone

Back 155

SUPPRESSES

--eat a bag of potato chips, increase sodium in the urine