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55 Cards in this Set
- Front
- Back
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Value of normal blood osmolality?
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290 mOsm/kg water
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Three hormones that the kidney releases?
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Calcitriol, Erythropoetin and Renin
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Calcitriol
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regulation of blood levels of Ca++ and phosphate
1) active form of Vitamin D 2) increases intestinal absorption of Ca++ and phosphate |
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Erythropoetin
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-Regulation of red blood cell production
1) Glycoprtein 2) Promotes maturation of bone marrow stem cells into erythrocytes 3) Stimulus for release: decrease in the partial pressure of O2 (hypoxia) 4)In chronic renal disease, erythropoetin insufficiency results in anemia |
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Hypovolemic Hyponatremia
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-Lower than normal plasma concentration of sodium ions
-Deficiency in TBW, ECF and Na+ content although proportionally more Na+ is lost (vomiting with hypotonic fluid intake, hypoalsosteronism) |
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euvolemic Hyponatremia
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-Lower than normal plasma concentration of sodium ions
-TBW is increased and ECF volumed is not diminished, while Na+ content is close to normal (SIADH, hypoaldosternism with compensated Na+ loss and excessive water intake) |
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Hypervolemic Hyponatremia
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-Lower than normal plasma concentration of sodium ions
-TBW and ECF are increased and edema is present. Na+ content can also be higher than normal ( |
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Hypernatremia
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high plasma sodium
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Primary hyperaldosteronism
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-renin independent alsosterone overproduction
-( Conn's syndrome- adreanal gland tumors) |
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Aldersterone escape
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-Triggered by increased ECF
-polyuria due to elevation in plasma ANP level (plus possible decrease in ADH mediated tubular water and Na+ reabsorption) -Pts have normal BP and normal concentration of Na+ in plasma and urine, edema is rare |
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amileride
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-sparing diurietic
-aldosterone anatagonist -blocks Na/K pump and reducing secretion of K in distal tubule |
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Thiazide diuretics
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-promote urinary water loss and decrease blood pressure
-Active in distal tubule, less potent than loop -Increase NaCl, and K excretion - decrease Ca2+ excretion -Increase flow of filtrate |
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Loop diuretics
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- promote urinary water loss and decrease blood pressure, Increase tubular flow
- Active in thick ascending loop - Increase NaCl, Ca 2+, Mg, and and K excretion -causes fatigue, muscle weekness and depression |
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Frequent side affect of loop and thiazide diuretics?
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hypokalemia
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What factors shift K into cells?
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insulin, alkalosis, B2-agonist (epinephrine)
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What factors shift K out of cells?
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Insulin deficiency, hypoxia, Acidosis, B2-blockers, Cell lysis
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What are the conditions that would cause hypokalemia and that are paired with acidosis (even tho hypokalemia is usually paired with alkalosis)
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-insulin injection in patient with diabetic ketoacidosis
-distal tubular (type I) renal acidosis) |
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For a pH of 7.4 what is the ratio of [HCO3(-)/CO2?
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20:1
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Metabolic acidosis
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-HCO3(-) is less than 22 mEq/L***
-Hypotension, severe diarrhea, Renal failure, Acid overproduction (diabetes), Loss of alkali (diarrhea), Failure to excrete acid (renal failure) |
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Metabolic alkalosis
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-HCO3 exceeeds 28 mEq/L***
-Diuretic use, vomiting (loss of acid), ingestion of alkali (antacids), |
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Respiratory alkalosis
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-PaCO2 is below 35 mm Hg***
-Decreased H, CO2 and HCO3 -Is caused by Pulmonary embolus, Cirrhosis, Sepsis, and Pregnancy, high altitude, fever, anxiety, heat exposure etc. |
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Respiratory acidosis
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-PaCO2 exceeds 45 mm Hg***
-inceased H, CO2 and HCO3 -Is caused by pulmonary insufficiency (COPD, lung edema, respiratory muscle mulfunction, drugs-sedatives, anesthetics, morphin) |
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Only place Carbonic anhydrase is present?
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apical membrane of proximal tubule
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Normal values for anion gap?
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8-16 mEq/L plasma
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Hypercholoremic metabolic acidosis
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-Normal anion gap
-diarrhea, carbonic anhydrase inhibitors, and renal acidosis |
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increased anion gap?
What does is cause? |
-Diabetic ketoacidosis***, salicilate poisoning and chronic failure.
-Causes hypokalemia |
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Furosemide
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decreases calcium reabsorption. (Also Na and Cl and K)
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What nephron segment has the highest Na/K pump activity?
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Distal convuluted tubule
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Actions of PTH
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1) increases reabsporption of Ca++ in the distal tubule
2) stimulates production of vitamin D 3) Decreases phsophate reabsoprtion in the proximal tubule promoting loss of phosphate |
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Hypocalcemia
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- Higher than normal motor neurons frequently manifested in hypocalcemic tetany
-Trousseau's sign -numbness, paresthesias***, epilepsy, arrythmias, and osteoporosis*** -Can be caused by Hypoparathyroidism |
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Bisphosphonates
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-treatment for Hypercalcemia, inhibits bone absorption by osteoclasts
-ex. Fosamar -can cause Jaw Necrosis |
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What is common for pts with chronic renal failure (hyperphophatemia) to develop? How common is it?
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-secondary hyperparathyroidism
-90% will get this |
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Hypophasphatemia
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-frequent in malnourished alcoholics
-can cause complications such as rhabdomyolysis (lysis of muscle cells) -results most frequently from shift of plasma phosphate into cells -typical mistake in treatment is infusion of glucose which increases phosphate into cells |
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Superficial vs Juxtamedullary nephron?
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Superficial = 85%
juxtamedullary = 15% (more important for water conservation) |
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% water content in muscle and adipose tissue? What's important about this?
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muscle = 76%
adipose tissue = >10% -The fatter you are the less total body water you have. -Women have more body fat and less muscle so they have less total body water -The older you are the less % total body water you have |
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Filterability of a substance?
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-molecular radius larger than 42 angstroms are not filtered
-molecular with a molecular charger and have a radius between 20-42 will not be filtered |
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Nephritic syndrome
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-Hematuria (red blood cells in urine)
-inflammation (of renal parencyma) -Moderate proteinuria (loss of proteins in urine) |
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oliguria/anuria
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production of urea
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Nephrotic syndrome
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-profound porteinuria (loss of proteins)
-hypoalbuminemia (depressed plasma albumin level) edema |
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Minimal change disease
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-Combines two syndromes: Nephrotic syndrome (+++++) and Nephritic syndrome (-)
-Leak of proteins with filtrate is increased due to loss of negative charge after fusion of podocytes. -most often periorbital edema in children -steroids are used as treatment (anti-inflammatory) |
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3 vasoconstrictors that decrease GFR and RBF?
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Sympathetic nerves, angiotension II, endothelin
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3 vasodilators that increase GFR and RBF?
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Prostaglandins, Nitric oxide, bradykinin, ANP
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Effect of dopamine?
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-Causes renal vasodilation at low rates of infusion (beta-1 adrenoreceptors)
-Causes renal vasoconstriction at high rates of infusion (alpha adrenoreceptors) |
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High plasma creatine (>1.3) suggests what?
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low GFR and indicated impaired kidney function
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Side effects of acetazolamide (glaucoma medication)?
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-Its a carbonic anhyrdrase inhibitor so it supresses HCO3 (-) reabsorption and can induce side effects such as acidosis
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Diuresis
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peeing a lot
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Regulators that will cause an increase in ADH?
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-increase in plasma osmolality
-Decrease ECF volume or blood pressure -Angiotension II -Stress and heat -Nicotine -Pain, Nausea and vomiting |
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Regulators that decrease ADH?
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-Atrial Natriutetic peptide
-Ethanol |
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What is DDAVP used to treat? What disease is it not effective with?
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-Synthetic analog of ADH
-treats central diabetes -Pts with nephrogenic diabetes insipidous do not respond to DDAVP |
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SIADH
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-Syndrome of inappropriate ADH secretion
-Abnormally high release of ADH -can result from lung diseases, CNS disease and drug interactions -results in water retention, low plasma osmolality, high urine osmolality |
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Factors which increase release of renin?
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-Decrease renal perfusion
-increase sympathetic nervous activity -decrease in Na+ concntration |
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rate limiting step in angiotension II formation?
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-Secretion of renin from the granular cells of the juxtaglomerular apparatus
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Typical problems of renal failure?
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-hyperkalemia
-hyperphosphatemia -plasma pH decreases due to reduced secretion of hydrogen and bicarbonate |
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Tubular interstitial nephritis
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results in impeded reabsorption and loss of filtered organic molecules and ions including bicarbonate
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Factors that decrease reabsorption of Mg+?
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Volume expansion, Furosemide and related loop diruetics, mannitol, high plasma (Mg2+ or Ca++), metabolic acidiosis, K+ or phosphate depletion
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