Pathophys Renal

Question Answer
which kidney is lower Right r/t liver
kidney located ______ retroperitoneal
Outer section of kidney Renal Cortex
houses the glomerulus, Bowman's capsule, proximal tubules, & distal tubules Renal Cortex
divided into pyramid & apex of each pyramid towards the renal pelvis Renal Medulla
Apex of each pyramid is called ____ & contains collecting ducts Papilla
Papilla drain urine into the _____ calcyes MINOR
Multiple MAJOR calcyes converge to form _____ renal pelvis
functional unit of the kidney NEPHRON
Kidneys regulate volume & composition of INTRA or EXTRA cellular fluid EXTRA
Electrolyte balance comprised on which IONS Na, K, CA, Mg, Cl
when talking about regulating OSMOLALITY, we are talking about regulating ______ concentration SODIUM
LONG term control of BP carried out by _____ Intake (thirst) & output (NA & H20 excretion)
INTERMEDIATE term control is carried by ____ Renin-Angiotensin-Aldosterone
SHORT term control of BP is carried by ______ barorecptor
Renal hormone that acts on bone marrow and stimulates RBC production Erythropoietin
Chronic renal dx are anemic r/t to deficieny in ____ Erythropoietin
_____ is synthesized from ingested Vit D or exposure to UV light Calciferol
Inactive form of CALCIFEROL 25 OH vitamin D3
In kidney under PTH > 25 OH is converted to ____ the active from of D3 CALCITROL (1,25, [OH]2 vit D3
3 functions of CALCITROL stimulate the intestine to absorb Ca from food, bone to store Ca, kidney to reabsorb Ca & Phosphate
Kidney rival LIVER to perform _____ GLUCONEOGENESIS
How many liters of blood pumped by the heart each min 5
how much of cardiac output is delivered to the kidney each minute 1.25 L or 25%
how many ML of blood plasma is filtered into renal tubules 125
Renal cortex receives ____% of renal blood flow 90%
______ & ______ receive 10% of the renal blood flow Renal Medulla & juxtamedullary nephrons
renal BF decreases ____% per decade of life after 50 10%
in neonates RBF ____ in the first 2 weeks of life & achieves adult level by 2 years old DOUBLES
___% of all that is filtered is reabsorbed as GLOMERULAR FILTRATE 99%
Substances that are transferred from the tubule to the capillaries Reabsorption
Substances transferred from the capillaries to the tubules Secretion
Substances that are removed from the body in urine Excretion
each kidney is made up of _______ million nephron 1 MILLI
Blood flow to the nephron is supplied by _____ arteriole and drained by _____ arteriole afferent & efferent
two types of nephrons CORTICAL & Juxtamedullary
have short loop of henle and located near the surface of kidney CORTICAL
have long loops of henle and are located deep in the medulla cortex near the cortical medullary junction Juxtamedullary
SIX anatomic & functional divisions of nephron Bowman Capsule, PT, Loop, DT, CD, Juxtaglomerular apparatus
Main for of filtration in nephron HYDROSTATIC pressure of glomerulus
Pressures that prevents filtration Osmotic pressure of blood plasma & hydrostatic pressure of BS
Major function of PT NA reabsorption
Drugs that enhance Na reabsorption at this PT Angiotensin II & NE
Drugs that decrease absorption of NA in the PT DOPAMINE
Regulates concentration of urine LOOP of Henle
______ inhibits Na & Cl reabsorption in the thick ascending limb LASIX (loop diuretics)
in the DT water is under the control of _____ ADH or vasopressin
In the DT reabsorption od Na & secretion of K are under the control of ____ aldoesterone
in the DT which hormone increase Ca reabsorption PTH
in the CD what inhibits WATER & NA reabsorption Atrial natiueretic peptide
Juxtaglomerular cell contain ____ and are innervated by SNS (BETA receptors) RENIN
Controls BF ro the GLOMERULUS JG apparatus
_____ stimulates the JG apparatus to secrete tenin Macula densa
Renin-Angiotensinogen System cascasde Renin > Angiotensinogen (liver)> Angiotensin I>ACE (lungs)>Angiotensin II>Aldosterone> ADH
MAP at which GFR ceases 50 mmHG
Increase in Tubular Flow rate ____ GFR and vice versa REDUCE
Increased Serum BUN is caused by ____ & ____ Low GFR & Increased reabsorption
Dehydration, Increased protein input, catabolism, and Decreased GFR can cause _____ increased BUN
Creatinine is caused by ______ breakdown MUSCLE
most useful/sensitive indicator for GFR Creatinine
need 50% reduction in GFR to see ____% increase in CR 100
15:1 ratio is indicative of _____ failure renal
20:1 ratio is indicative of _____ failure pre-renal
10:1 ratio is indicative of _____ renal function NORMAL
in pre-renal failure excretion of Na is ____ and Osmolality is ____ LOW/HIGH
what should be avoided in PRErenal failure r/t its reduction in Prostaglandin synthesis NSAIDS
in RENAL failure exertion of NA is ____ & Osmolality is____ HIGH/LOW
#1 & #2 cause of CHRONIC renal failure DM & HTN
Clinical signs of CHRONIC renal failure are ABSENT until ____% of nephrons are left 40
two methods to classify severity of RENAL injury RIFLE (risk, injury, Failure, Loss, ESRD) criteria & Acute Kidney Injury Network (AKIN)
FDA recommendation for SEVO 1L -> 2 hours then UP to 2L/min
better choice Atracurium or Cisatracurium Cisatracurium
which produces more LAUDANOSINE & histamine (At or Cisat) Atracurium
which muscle relaxant should be avoid with RENAL population PANCURONIUM or SUCC if K >5.5
Reversal agents require dose adjustment in RENAL pts T or F FALSE
Propofol requires dose adjustment in RENAL pts T or F TRUE (increase)
What are good choices for OPIOIDs in RENAL pts r/t not having metabolites FENTANYL, SUFENT, ALFENT, REMIFENT
Vasopressor of choice for RENAL pt r/t constriction of EFFERENT arteriole Vasopressin
AMINO GLYCOSIDES are contraindicated for RENAL pts TRUE (gentamicin, tobramycin, amikacin)
Myoglobin can lead to TUBULAR obstruction in ACIDIC urine & scavenges NITRIC OXIDE –> renal vasoconstriction TREAT with MANNITOL, hydration, UOP >100-150ml/hr and BICARB or Acetazolamide to ALKALIZE urine
Chronic renal failure labs (K, Ca, Mg, Phos) Increased K, Mg, Phos, Decreased Ca
Avoid LR, Hyperventilation, CaCl (1gm) Mgmt of hyperkalemia
acidemia in RENAL its increases _______ , unbound portion of drug so more is available UNIONIZED
blood loss replace the __: __ colloid 1:1
3rd space replace with ____ crystalloid
CYSTINE stones are caused by too much ____ AMINO ACID
URIC stones are created when the body breaks down _____ PURINES
calculi less than ____ in diameter usually pass with intervention 4mm
PREGGO is contraindication for LITHOTRIPSY r/t RADIATION FYI

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