Renal

Question 1

Main aim of the Kidney

Answer 1

To always normalise sodium

Question 2

Proximal convoluted tubule

Answer 2

Toxins come into nephron
Glucose out
Phosphate Out
Bicarb Out

Question 3

Ascending LOH

Answer 3

Antiports - swap molecules

Potassium
Sodium
Chloride

Question 4

Descending LOH

Answer 4

Not much pumping

Question 5

Distal Convoluted Tubule

Answer 5

Sodium - potassium
Sodium - Hydrogen
Calcium

Number of pumps directly associated with how much aldosterone

Question 6

Collecting Duct

Answer 6

Water reabsorption
ADH

Question 7

PTH role at PCT?

Answer 7

Stimulates reabsorption of PO4

Question 8

PTH role at Ascending LOH

Answer 8

Blocks reabsorption of Calcium

Question 9

Daily renal fluid loss

Answer 9

55%

Skin (30%)
Resp (15%)

Question 10

Sodium/ day

Answer 10

4mmol/kg/day

Question 11

Potassium/day

Answer 11

2mmol/kg/day

Question 12

Glucose

Answer 12

100-200mg/kg/day

Question 13

PCT water absorption

Answer 13

1/3 absorbed

Question 14

Descending LOH water absorption

Answer 14

1/3 further absorption

5% by botton of Loop

Question 15

DCT water content

Answer 15

Fluid starts to re-enter nephron

Question 16

Collecting duct water content

Answer 16

Variable depending on hydration status
0.5 - 5%

Question 17

Causes of reduced U/O

Answer 17

Hypovolaemia - Replace fluid
Hypotension - Inotropes
Renal damage - Stimulate e.g. diuretics
Obstruction - unblock

Question 18

Cation

Answer 18

Positive charge
Na2+

Question 19

Anions

Answer 19

Negative charge
Cl-
HCO3-

Question 20

Anion Gap calculation

Answer 20

Na - (Cl+HCO3)
Should be 3-11, Increased to 10-16 if including potassium.

Question 21

If AG Gap is high in metabolic acidosis:

Answer 21

Lactate
Ketones
Renal Failure
Toxins

Question 22

If AG is normal

Answer 22

Hyperchloraemic acidosis
HCO3 loss - renal or gastro
Addison’s disease

Question 23

If AG is low

Answer 23

Likely artefact from low albumin

Question 24

Osmolality (definitions)

Answer 24

Amount of ‘stuff’ in the fluid

Question 25

SIADH

Answer 25

Low serum sodium High urine sodium Low urine output

Question 26

Cerebral salt wasting

Answer 26

Post traumatic brain injury Low serum sodium High urine sodium High urine output

Question 27

Diabetes insipidus

Answer 27

High serum sodium Low urine sodium High urine output

Question 28

Dehydration

Answer 28

Serum sodium - any Urine sodium Low Urine Output Low

Question 29

Diuretics PCT

Answer 29

Carbon Anhydrase Inhibitors Acetozolomide

Question 30

Loop of Henle Diuretics

Answer 30

Loops diuretics

Question 31

DCT diuretics

Answer 31

Thiazides Aldosterone antagonists (more distal)

Question 32

Renin

Answer 32

Excreted by kidneys when drop in plasma volume or BP Angiotensinogen into Angiotensin 1

Question 33

ACE

Answer 33

Converts Angiotension 1 (10 amino acids) into Angiotensin 2 (8 amino acids) Which acts on adrenal glands to release Aldosterone

Question 34

Aldosterone

Answer 34

increases Thirst Salt craving Increases pump channels Reduces GFT and renal blood flow Vasoconstriction Reduces salt and water excretion Aims for normal plasma volume or BP

Question 35

Acidosis

Answer 35

Hydrogen ions are high Normal sodium Raised potassium

Question 36

Low aldosterone

Answer 36

Sodium decreases Potassium increases Hydrogen increases

Question 37

High Aldosterone

Answer 37

Sodium increases Potassium Low Hydrogen low

Question 38

Distal renal tubular acidosis

Answer 38

Sodium- hydrogen pump error Sodium normal Potassium decreases Hydrogen increases

Question 39

Bartter's Syndrome

Answer 39

Knocks out Cl-K-Na pump Sodium normal or low Potassium very low Hydrogen low