RBF / URINE REGULATORS
Renin is produced by ________ and causes the production of _________________ which stimulates what 3 things?
produced by the KIDNEYS
production of ANGIOTENSIN II
thirst, ADH, aldosterone
1. What two hormones are synthesized in the kidney?
2. If I don't have one of them, what am I unable to absorb in the small intestine?
3. What is universal in almost all patients w/ CKD?
1. EPO and Vit D
2. Calcium and Phosphate
3. Anemia
What is glomerulonephritis? It is a cause of what worldwide?
Inflammation of the glomerulus
CKD, ESRD
ECF and ICF: how much total body water and % of body weight?
BONUS! what 2 compartments make up the ICF and what are their % of total body weight ?
ECF: 2/3 total body water, 40% body weight
ICF: 1/3 total body water, 20% body weight
Intravascular (5%), interstitial (15%)
What is the major intracellular cation, and can you give me 2 things that hep regulate this guy? (HINT: there are 5 total, ya girl only wants 2)
BONUS! one of these things can be given to treat high potassium... what is that?
MISS POTASSIUM!
1. kidney
2. aldosterone
3. insulin (can TREAT hyperk!)
4. catecholamines
5. pH
Juxtaglomerular cells are located ___________ and release __________?
Macula densa cells are located in __________ and are sensitive to _______________
Juxtaglomerular: in affarent arteriole, release renin
Macula densa: in DCT, sensitive to Na+
Give me 3 things that decrease in terms of the kidney and aging
How does the kidney respond to such changes?
Decrease in:
renin secretion
RBF / GFR
Vit D synthesis ability of nephron to secrete and absorb
cannot concentrate urine well
cannot eliminate drugs well
compensatory hypertrophy and hyperfiltration of working nephrons
How can we characterize renal disease? (hint: 2 ways!
1. SITE of the lesion (glomerular or interstitial)
2. Nature of the factors that have lead to the disease (immunologic, metabolic, infiltrative, infectious)
Do F or M have more total body water, and why is this?
As we age, why do we lose water?
Males do! more muscle
B/c we have more fat when we are older
Calcium and phosphate are regulated by what 3 things, and what does each do to the calcium level?
1. PTH - increased plasma Ca from bone
2. Vit D - increases Ca absorbed in small intestine
3. Calcitonin - decreases Ca level
What mechanisms work to either concentrate OR dilute urine? (hint, there is 3)
BUT WAIT.... theres more.....
water efficacy is specifically related to what? ** hint, its a structure thing
1. High concentration in medulla (maintained by urea and Na+)
2. Countercurrent flow in loops of henle
3. ADH - Mechanism that controls permeability of the distal part of the nehron to water
4. Length of loop of henle! longer the loop, more ability to concentrate
1. Nephrotic disorders result in morphologic changes of what?
2. Is there an immune response?
3. Based on question 2, what will recovery process be?
1. foot processes
2. No
3. SLOW! can take months to years to resolve
Immune injury involves the deposition of 1. ______ in the 2. ________, which results in 3. _____ GFR and can progress to 4. _________
1. immune complexes
2. glomerulus
3. decrease
4. renal failure
What are the two forces FAVORING filtration vs the two the OPPOSE?
Favoring:
1. capillary hydrostatic pressure
2. interstitial oncotic pressure
Opposing:
1. capillary oncotic pressure
2. Interstitial hydrostatic pressure
HYPOcalcemia causes _______ neuromuscular excitability VS HYPERcalcemia causes _________ neuromuscular excitability
HYPOkalemia causes _______ neuromuscular excitability VS HYPERkalemia causes _________ neuromuscular excitability
HypoCa = increased
HyperCa = decreased
HypoK = decreased
HyperK = increased
Kidneys receive 1. _____ mL blood per min which is 2. ____ % of our CO, with a normal Hct of 3. ________ with 4. _______ mL/min flowing through kidney
5. _____ mL of filtrate are formed per day
1. 1000-1200 mL
2. 20-25%
3. 45%
4. 600-700 mL
5. 120 mL
What is the difference between acute kidney injury vs acute kidney failure?
Symptoms are not seen in CKD until function drops below what %?
AKI = spectrum!
Acute renal failure = SIG LOSS of renal function! (with high Cr/BUN levels, oliguria)
25%
Acute glomerulonephritis - How can it present? (HINT: symptoms, lab tests show?) VS
SEVERE glomerulonephritis: what does the pt present with here? What's the urine output like?
ACUTE = range of sx! can have mild changes in urine and asx or SX, HTN, edema
SEVERE = oliguria! edema, weight gain
Localized edema vs general vs dependent
What can someone be at risk for as edematous fluid becomes trapped and builds up?
Localized = limited to one site or organ system
General = uniform distribution
dependent = goes w gravity
DEHYDRATION! ooo.... that reminds me, everyone take a sip of water
Volatile acids are 1. _____ acids, they are eliminated as 2. _______ and formed 3. ______ from the hydration of CO2
Non-volatile acids are 1. ____ acids, they are produced from incomplete metabolism of 2. ____ and eliminated by 3. ______
1. respiratory, 2. CO2, carbonic acid
1. metabolic 2. proteins, carbs, fat 3. kidney
THIS IS A DOOZY BUT U GOT IT! AND WILLIE DONT BOG - For each diuretic, tell me its mechanism of action?
1. Osmotic diuretic
2. Carbonic anhydrase inhibitor
3. Loop Na+ or Cl transport inhibitor
4. Aldosterone antagonist
5. Aquaretic
1. Not absorbed, so water is attracted to it osmotically = water secreted
2. Blocks H+ secretion and thus you do not reabsorb Na+ and bicarb
3. Blocks reabsorption of Na, K, and Cl in descending loop
4. Blocks aldosterone, so Na+ secreted and K+ retained
5. Blocks ADH
1. condition that increases capillary hydrostatic pressure
2. condition a/w protein loss or decreased production
3. Increased capillary permeability
4. condition causing lymphatic obstruction
1. venous obstruction, increased Na and H2O
2. less production (liver dz, malnutrition), loss = nephrotic syndrome, burns
3. inflammation or infection! trauma
4. tumor or infection
CHRONIC glomerulonephritis presents after 1. ___ years, progressing to 2. ______ with a progression to 3. ________
The sediment will show:
a. blood b. waxy casts c. protein and lipids
1. 10-20 years
2. Nephrotic
3. End stage renal disease
waxy casts!
PREDICT what will happen if I put a red blood cell into...
1. Water
2. 0.9% NaCl
3. 3% saline
1. BURST! cell has more solutes = water moves in
2. NOTHING! NaCl is isotonic and similar to normal body fluids
3. SHRINK!
At a pH of 1. _____, the ratio of bicarb to carbonic acid is 2.______
SOLVE:
1. pH = 7.63, CO2 = 19, Bicarb = 19
2. pH = 7.22, CO2 = 25, Bicarb = 12
Compensation?
1. 7.4 2. 20:1
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