Kidneys Flashcards by Andrew Skuta

Inadequate oxygen delivery to the kidney causes it to release ______.

erythropoietin

-anemia, reduced intravasular volume, hypoxia, high altitude

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Severe kidney disease reduces _____ and leads to chronic anemia

EPO

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______ controls extracellular fluid volume

Aldosterone

(Na+ and water are reabsorbed together)

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_____ controls plasma osmolarity

ADH (vasopressin)
(water is reabsorbed, but Na+ is not)

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How much CO do the kidney receive?

20-25%
1000-1250 mL/min

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Describe the surgical stress response on the kidneys:

transient vasoconstriction and sodium retention —> oliguria and edema

predisposes kidney to ischemia and effects of nephrotoxic drugs

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What 3 things increase renin release:

reduced renal perfusion (PEEP)
Beta-1 stimulation
decreased sodium and chloride delivery to distal tubule

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Where is Aldosterone produced?

zona glomerulosa of the adrenal gland

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ADH restores BP in 2 ways:

V1 receptor stimulation causes vasoconstriction in the vasculature (increased SVR)
V2 receptor stimulation in the collecting ducts causes water retention

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Perioperative factors that increase ADH release (renal water retention):

-PEEP
-Positive pressure ventilation
-hypotension
-hemorrhage

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ADH is produced in the _____ and _____ nuclei of the ______.

supraoptic and paraventricular
hypothalamus

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The half life of ADH:

5-15 mins

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ADH stimulates the ___ receptor in the collecting ducts ( increases _____.)

V2
cAMP

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3 pathways of renal vasodilation:

-prostaglandins (antagonize RAAS)

-Natriuretic peptides (inhibit RAAS and cause sodiium and water excretion)

-Dopamine: DA1 and DA2

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Constriction of the afferent arteriole reduces ___ and ____.

RBF and GFR

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Cyclooxygenase inhibition by _____ increases the _____ and ______ RBF and GFR

NSAIDS
renal vascular resistance
reduces

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Constriction of the ______ _____ increases the hydrostatic pressure and GFR

efferent arteriole

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Normal GFR:

125 mL/min

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Most important determinant of GFR?

glomerular hydrostatic pressure

determined by BP, afferent arteriole resistance and efferent arteriole resistance

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Kidney disease destroys the basement mebrane, which allows the filtration of _____ into the tubules.

protein

protein in uring excreted –> hypoalbuminemia

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Where does MOST of the sodium reabsorption occur in the nephron?

Proximal tubule

Water follows!

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ADH and aldosterone work in the ______ of the nephron

collecting duct

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Where do Hydrochlorothiazides work?

Distal tubule

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Where does Bumex work?

Ascending loop

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Where does Azetazolamide work?

proximal tubule

Where does spironolactone work?

collecting duct

Tests for GFR:

BUN and creatinine

Tests for tubular function:

fractional excretion of sodium urine osmolality

produced by skeletal muscle and metabolic byproduct of the breakdown

creatinine

normal BUN:Cr ration

10:1

Most common cause of CKD: 2nd?

diabetes mellitus HTN

Do Sevo, Des or Iso cause kidney dysfunction?

Is succs safe in patients with renal failure who have normal potassium level?

yep

______ is not recommended in patients with severe renal impairment

Sugammadex

TURP: distilled water --> glycine --> sorbitol --> normal saline -->

distilled water --> hemolysis glycine --> transient blindness sorbitol --> hyperglycemia normal saline --> risk of electrocution

Most common approach to a TURP?

Spinal T10 level required

TURP: absorbed volume can be up to ___-___ mL/min of resection time. Resection time should be limited to __

10-30 1 hour

Triad of TURP syndrome:

HTN, Bradycardia, change in mental status

Absolute contraindictions for ESWL

pregnancy and coagulopathy

ESWL: pulse wave time to the __ wave on EKG

R to avoid "R on T" phenomenon

______ is primarily eliminated by the kidneys so it should be avoided in patients with renal failure

pancuronium

GFR calculation =

GFR = (140 - age) x body weight (kg) / 72 x Cr

65% of sodium, water, potassium, chloride and bicarb are absorbed in the ____

Proximal convuluted tubule (PCT)

Reabsorption of solutes and water is proportional in the _____.

PCT

Primary function of the loop of Henle is.....

forming concentrated or dilute urine.

The ______ loop of Henle is highly permeable to water (__% is reabsorbed)

descending

The ____ ____ are peritubular capillaries that run parallel to the loop of Henle.

Vasa Recta

The thin and thick sections of the _______ limb of the loop of Henle are not permeable to water.

ascending

The ___ fine tunes solute concentration.

DCT

The ____ is home to the JGA

DCT

_______ increases Na+ and water reabsorption and increases K+ and H+ secretion. This happens in the ___

Aldosterone DCT

_____ increases water reabsorption only (no solutes)

ADH (vasopressin)

ADH and Aldosterone also work in the _____ _____

collecting duct.

Collecting duct: __% reabsorption of sodium

Where does ADH and Aldosterone act on the nephron?

DCT and Collecting Duct

Where in the nephron does parathyroid hormone promote Ca+2 reabsorption?

DCT

Key complications of loop diuretics include ____,____, _____ and _____.

hypokalemia, hypocalcemia, metabolic alkalosis, and ototoxicity.

_______ diuretics inhibit the Na-Cl co-transporter in the distal tubule

Thiazides

Which diuretics should be avoided in patients who take NSAIDs, beta-blockers, and ACE inhibitors? Why?

Potassium-Sparing, these meds increase K+

Primary site of Loop diuretics action:

thick portion of the ascending loop

Unique symptom of thiazide diuretics?

Hyperglycemia

Which potassium-sparing diuretic antagonizes aldosterone at the mineralcorticoid receptors?

Spironalactone

Which diuretic causes nephrolithiasis?

Triamterene (K+ sparing)

Which tests are best for tubular function (concentrating ability)?

Urine osmolality Fractional excretion of sodium

Best tests for glomerular function:

BUN Serum creatinine Creatinine clearance

Fractional excretion of Sodium:

1-3%

Urine osmolality:

65-1,400 mOsm/L

Urine sodium concentration:

13-260 mEq/day

Urine specific gravity:

1.003 - 1.030

____ is the primary metabolite of protein metabolism in the liver

Urea

______ _____ undergoes renal filtration but NOT reabsorption, which makes it a useful indicator of GFR

Serum creatinine

A ___% increase in creatinine indicates a __% reduction in GFR.

100% 50%

_____ ____ is the MOST useful indicator of GFR

Creatinine Clearance

Creatinine Clearance equation:

GFR= (140-age) x body weight (kg) / 72 x serum Cr

Working kidneys can ____ sodium while failing kidneys ____ sodium

conserve waste

How does perioperative stress cause oliguria?

increased ADH during surgery

First line treatment for Uremic bleeding?

Desmopressin

Best NDNMBs for renal failure?

cisatracurium and atracurium

Morphine-6-glucuronide is ____ potent than morphine and relies on renal excretion,

Kidneys Flashcards

(80 cards)