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61 Cards in this Set

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  • Back
clearance of any substance = ?
urinary excretion/plasma concentration
what does the clearance of PAH equal?
effective renal plasma flow (unless the secreting mechanism is saturated)
what kind of diuretics are contraindicated in renal failure?
potassium sparing - exacerbates elevated serum potassium & hyperkalemia can lead to arrhythmia
tubular fluid with lowest osmolarity is found where?
macula densa
how is interstitial fluid volume related to inulin space?
inulin space approximates ECF volume, so interstitial fluid volume = inulin space - plasma volume
what percent of total body weight is total body water?
60%
what proportion of total body water is ECF and ICF?
1/3 ECF
2/3 ICF
what percent of ECF is plasma volume? interstitial volume?
1/4 plasma volume
3/4 interstitial volume
how is plasma volume measured?
radiolabeled albumin
how is extracellular volume measured?
inulin
formula for clearance?
C=UV/P
urine concentration x urine flow rate / plasma concentration
what forms the size barrier of the glomerulus?
fenestrated capillary endothelium
what formes the negative charge barrier of the glomerulus?
fused basement membrane with heparan sulfate
what is lost in nephrotic syndrome?
charge barrier - resulting in albuminuria, hypoproteinemia, generalized edema, and hyperlipidemia
what substance is used to calculate GFR?
inulin
creatinine clearance is an approximate measure of what?
GFR
what does renal blood flow equal?
renal plasma flow/1-Hct
effective renal plasma flow underestimates true renal plasma flow by how much?
about 10%
filtration fraction = ?
GFR/RPF
what arteriole does AT II act on?
preferentially constricts efferent arteriole - decreases RPF, increases GFR, so FF increases
what dilates the afferent arteriole? what effect does this have?
prostaglandins - increases RPF, GFR so FF remains constant
afferent arteriole constriction has what effect?
decreases RPF & GFR - FF remains constant
efferent arteriole constriction has what effect?
decreases RPF, increases GFR, so FF increases
increased plasma protein concentration has what effect on GFR?
decreases GFR, (RPF stays same so FF decreases)
decreased plasma protein concentration has what effect on GFR?
increases GFR (RPF stays same, so FF increases)
constriction of ureter has what effect on GFR?
decreases it (also decreases FF)
free water clearance = ?
urine flow rate - clearance(osm)
at what plasma glucose level does glucosuria begin? at what level does the transport mechanism become saturated?
200; 350
the osmolarity of the medulla can reach what level?
1200 mOsm
on what type of cells does aldosterone act?
principal cells of collecting ducts - activates Na+/K+ pump; intercalated cells - stimulates H+ secretion
portion of the nephron that reabsorbs all of the glucose & AAs, and most of the bicarbonate, sodium, and water; secretes ammonia, which acts as a buffer for H+
early proximal convoluted tubule
portion of the nephron that passively reabsorbs water via medullary hypertonicity
thin descending limb
portion of the nephron that contains the NKCC and indirectly induces the absorption of Mg2+ and Ca2+; impermeable to water
thick ascending limb
location of the nephron in which calcium reabsorption is under the control of PTH?
early distal convoluted tubule
actions of the early distal convoluted tubule?
actively reabsorbs Na+, Cl-; reabsorbs calcium under PTH control
portion of the nephron that reabsorbs sodium in exchange for secreting potassium or H+? what regulates this?
collecting tubules; aldosterone
reabsorption of water in this portion of the nephron is under control of ADH (vasopressin)
collecting tubules
actions of angiotensin II?
potent vasoconstriction
release of aldosterone from adrenal cortex
release of ADH from posterior pituitary
stimulates hypothamus - increases thirst
overall serves to increease intravascular volume and BP
what may be released from atria as a check on the RAA system, e.g. in CHF?
ANP
what cells secrete renin?
juxtaglomerular cells - in response to decreased renal BP, decreased Na+ delivery to distal tubule, and increased sympathetic tone
how can NSAIDs cause acute renal failure in high vasoconstrictive states?
by inhibiting the renal production of prostaglandins, which keep the afferent arterioles vasodilated to maintain GFR
where does ADH bind? what is the result?
binds to receptors on principal cells, causing an increase in the number of water channels/aquaporins and increased H2O reabsorption
what is ANF secreted in response to? what does it do?
secreted in response to increased atrial pressure, causes increased GFR and increased Na+ excretion
what effect does aldosterone have?
secreted in response to decreased blood volume (via AT II) and increased plasma K+ - causes increased Na+ reabsorption and increased K+ and H+ secretion
angiotensin II causes increased absorption of what?
Na+ and HCO3-
primary disturbance in metabolic acidosis?
decreased HCO3- (causes hyperventilation/ decreased PCO2)
primary disturbance in metablic alkalosis?
increased HCO3- (causes hypoventilation/ increased PCO2)
primary disturbance in respiratory acidosis?
increased PCO2 (causes increased renal HCO3- absorption)
primary disturbance in respiratory alkalosis?
decreased PCO2 (causes decreased renal HCO3- absorption)
acidosis with PCO2 >40?
respiratory acidosis
acidosis with PCO2 <40?
metabolic acidosis with compensation
alkalosis with PCO2 <40?
respiratory alkalosis
alkalosis with PCO2 >40?
metabolic alkalosis with compensation
causes of respiratory acidosis?
hypoventilation - airway obstruction, acute/chronic lung disease, opiods, narcotics, sedatives, weakening of respiratory muscles
causes of anion gap metabolic acidosis?
MUD PILES
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde or Phenformin
Iron tablets or INH
Lactic acidosis
Ethylene glycol
Salicylates
causes of non-anion gap metabolic acidosis?
diarrhea, glue sniffing, renal tubular acidosis, hyperchloremia
how do you calculate ion gap?
Na+ - (Cl- + HCO3-)
causes of respiratory alkalosis?
hperventilation, aspirin ingestion (early)
causes of metabolic alkalosis?
vomiting, diuretic use, antacid use, hyperaldosteronism
Winter's formula?
PCO2 = 1.5(HCO3-) + 8 +/-2
type of metabolic disturbance commonly seen in cardiopulmonary arrest?
mixed acidosis