shosh: renal

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shosh: renal
2011-07-28 11:51:30

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  1. Regions of the kidney most vulnerable to ischemic injury
    PCT and ascending loop
  2. Which kidney is used for transplants?
    Left, because it has a longer renal vein
  3. Fracture of which rib can result in kidney laceration?
  4. 60 40 20 rule
    • 60% of total body weight is water
    • 40% is ICF
    • 20% is ECF
  5. What substance is used to measure extracellular volume?
    Inulin or mannitol
  6. How is renal clearance calculated?
    C=(urine concentration x urine flow rate)/plasma concentration
  7. What substance is used to calculate GFR?
    Inulin--for inulin, GFR=Clearance, so GFR=UV/P
  8. What substance is used to calculate RPF?
    PAH--filtered and secreted
  9. How is RBF calculated?
    • Use inulin to calculate RPF (RPF=inulin clearance)
    • RBF=RPF/(1-Hct)
  10. What is the filtration fraction?
  11. Effect of prostaglandins on glomerulus
    • Dilate afferent arteriole
    • Increase RBF
    • Increase GFR
  12. Effect of angiotensin II on glomerulus
    • Constrict efferent arteriole
    • Decrease RBF
    • Increase GFR
    • FF goes up
  13. Calculation of excretion rate
    ER=Urine volume x concentration of substance in urine (VU)
  14. BUN:Creatinine ratio in prerenal failure
    Over 20
  15. BUN:Creatinine ratio in intrinsic renal failure
    Under 20
  16. Where are most solutes reabsorbed?
    Early PCT
  17. Where is ammonia generated and secreted?
    Early PCT
  18. Where is the urine most dilute?
    Early DCT
  19. 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
  20. Where are the JGA and macula densa?
    • JGA--afferent arteriole, secretes renin
    • Macula densa--DCT, senses Na concentration
  21. Effects of ANP
    Increases GFR and Na filtration in the glomerulus, with no compensatory Na reabsorption, resulting in Na and water loss
  22. Five things that cause hyperkalemia
    • Low insulin
    • Beta antagonists (inhibit Na/K ATPase)
    • Acidosis (i.e. from exercise)
    • Digitalis
    • Cell lysis
  23. Three things that cause hypokalemia
    • High insulin
    • Beta agonists (e.g. albuterol for asthmatics)
    • Alkalosis
  24. If bicarb increases 1 mEq/L, what happens to carbon dioxide
    It increases .7 mmHg
  25. Causes of normal anion gap metabolic acidosis
    • Diarrhea
    • Hyperchloremia
    • Renal tubular acidosis
  26. Causes of high anion gap metabolic acidosis
    • Methanol
    • Uremia
    • DKA
    • Paraldehyde or phenformin
    • Iron or isoniazid
    • Lactic acidosis
    • Ethelene glycol poisoning
    • Salicylates
  27. 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)
  28. Type II renal tubular acidosis
    • Defect in bicarb reabsorption from the PCT
    • Associated with hypokalemia and hypophosphatemic rickets
  29. 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