Renal: Review

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Author:
jcbarbery
ID:
211190
Filename:
Renal: Review
Updated:
2013-04-03 14:11:08
Tags:
renal kidney
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Description:
Overview of basic concepts in the function of the kidney
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  1. Proximal tubule reabsorption
    • 60% of filtered Na+, Cl-, K+, Ca2+, and H20
    • 90% of filtered HCO3-
    • 100% glucose and AAs (via Na+ dep. co-transport)
  2. Loop of Henle reabsorption
    • 15% of filtered H20
    • 20 – 30% of filtered Na+, Cl-, K+
  3. Distal tubule and collecting duct reabsorption
    Na+, HCO-, H20
  4. Proximal tubule secretion
    Organic anions and cations (i.e. drugs)
  5. Distal tubule and collecting duct secretion
    • K+
    • H+
  6. Renin
    Produced and released from granular cells in the wall of renal afferent arterioles
  7. Erythropoietin
    Produced and secreted when oxygen tension in the blood decreases
  8. Prostaglandins and kinins
    Production and metabolism
  9. Metabolic Functions
    Final step in activation of vitamin D3

    Gluconeogensis

    Metabolism of endogenous compounds (i.e. insulin and steroids)
  10. Active Na transport
    • Na+ out of cells; K+ into cells
    •  via Na+ & K+-ATPase
  11. Na in Loop of Henle
    Na+,K+,2Cl-cotransport

    Furosemide, etc.
  12. Na in Distal tubule
    Na+/Cl-cotransport

    Chlorthalidone, HCTZ, metolazone
  13. Na in Collecting Duct
    Na+ channel

    Amiloride, triamterene
  14. Sympathetic NaCl regulation
    ­inc. renal sympathetic tone = ­ inc. NaCl reabsorption and dec. renal blood flow

    dec. sympathetic outflow -> RAS activation
  15. RAS NaCl regulation
    dec. arterial pressure -> inc. renin prod. -> inc. angiotensin II -> vasoconstriction of efferent arteriole -> inc. GFR

    Angiotensin II -> inc. Na/H2O reabsorption and aldosterone prod./release
  16. Atrial natriuretic peptide (ANP) NaCl regulation
    inc. ANP -> dec. Na absorption and inc. GFR -> inc. Na excretion
  17. Vasopressin (aka ADH) NaCl regulation
    • Regulated primarily by body fluid osmolarity
    • Promotes water retention
  18. Conc./dilution of Urine
    ADH + countercurrent exchange

    Occurs between descending LoH, ascending LoH and interstitium

    Allows Na, Cl and K absorption and urinary conc.
  19. K regulation
    Aldosterone increases K secretion

    Dec. H+ concentration = ­inc. secretion

    Dietary intake and tubular flow rate directly proportional to secretion
  20. Normal pH
    7.35 – 7.45
  21. Glucose absorption
    • Co-transport protein carrying Na+ and glucose
    • Maximal capacity = plasma glucose of 200
  22. Amino acid absorption
    • Highly effective
    • Co-transport protein carrying Na+ and amino acids
  23. Inulin
    • fructose polysaccharide
    • unbound
    • freely filtered
    • not secreted/reabsorbed/metabolized
    • Gold Standard of GFR
    • Not used clinically d/t cost & difficulty
  24. SCr
    90% filterd; 10% secreted

    varies w/age, gender, muscle mass
  25. BUN
    Dependent on dietary protein and hepatic function

    Filtered with ~50% reabsorption
  26. BUN:SCr
    >/= 20:1 = Prerenal cause

    < 20:1= Renal (intrinsic) cause - if SCr elevated
  27. Cockcroft-Gault
    • CrCl = (140 – age) x kg/(SCr x 72)
    • (x 0.85 if female)

    • ABW unless 30% over IBW then AjBW
    • AjBW = [(Actual BW – IBW) X 0.4] + IBW
  28. U/A Casts
    • Hyaline – clear, not indicative of renal disease
    • Cellular – WBC, RBC, tubular epithelial cells, seen with intrinsic renal disease
    • Granular – ischemic renal damage or toxic insults
  29. U/A FENa
    • < 1% = ­ reabsorption
    • 1% = normal
    • > 1% = ¯ reabsorption
  30. U/A K
    • Helpful for determining if kidney is cause of
    • hypokalemia
  31. Other Tests
    • KUB
    • CT scan
    • Ultrasound
    • Biopsy

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