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Regions of the kidney most vulnerable to ischemic injury
PCT and ascending loop
Which kidney is used for transplants?
Left, because it has a longer renal vein
Fracture of which rib can result in kidney laceration?
60 40 20 rule
- 60% of total body weight is water
- 40% is ICF
- 20% is ECF
What substance is used to measure extracellular volume?
Inulin or mannitol
How is renal clearance calculated?
C=(urine concentration x urine flow rate)/plasma concentration
What substance is used to calculate GFR?
Inulin--for inulin, GFR=Clearance, so GFR=UV/P
What substance is used to calculate RPF?
PAH--filtered and secreted
How is RBF calculated?
- Use inulin to calculate RPF (RPF=inulin clearance)
What is the filtration fraction?
Effect of prostaglandins on glomerulus
- Dilate afferent arteriole
- Increase RBF
- Increase GFR
Effect of angiotensin II on glomerulus
- Constrict efferent arteriole
- Decrease RBF
- Increase GFR
- FF goes up
Calculation of excretion rate
ER=Urine volume x concentration of substance in urine (VU)
BUN:Creatinine ratio in prerenal failure
BUN:Creatinine ratio in intrinsic renal failure
Where are most solutes reabsorbed?
Where is ammonia generated and secreted?
Where is the urine most dilute?
Describe the interacalated cells of the DCT
- Luminal transporter reabsorbs Ca in exchange for protons, and secretes protons
- Basal channel allows for secretion of chloride, to balance loss of positive charges from secreted protons
Where are the JGA and macula densa?
- JGA--afferent arteriole, secretes renin
- Macula densa--DCT, senses Na concentration
Effects of ANP
Increases GFR and Na filtration in the glomerulus, with no compensatory Na reabsorption, resulting in Na and water loss
Five things that cause hyperkalemia
- Low insulin
- Beta antagonists (inhibit Na/K ATPase)
- Acidosis (i.e. from exercise)
- Cell lysis
Three things that cause hypokalemia
- High insulin
- Beta agonists (e.g. albuterol for asthmatics)
If bicarb increases 1 mEq/L, what happens to carbon dioxide
It increases .7 mmHg
Causes of normal anion gap metabolic acidosis
- Renal tubular acidosis
Causes of high anion gap metabolic acidosis
- Paraldehyde or phenformin
- Iron or isoniazid
- Lactic acidosis
- Ethelene glycol poisoning
Type I renal tubular acidosis
- Defect in proton excretion in the DCT. Associated with hypokalemia and risk of Ca kidney stones
- (NB: only case of acidosis with hypokalemia)
Type II renal tubular acidosis
- Defect in bicarb reabsorption from the PCT
- Associated with hypokalemia and hypophosphatemic rickets
Type III renal tubular acidosis
Aldosterone deficiency leads to increased potassium and impaired ammonia excretion from the PCT. Urine pH falls, due to loss of buffering capacity. Plasma pH falls due to impaired proton secretion in the DCT and collecting ducts
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