Notes in 001 Eddies M2 Lecture Decks::4A Renal::GFR and HemoDynamics

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Published	10/07/2024	If drugs are bound to {{c1::albummin}} they will NOT be renal excreted
Published	10/07/2024	{{c1::Ca+}} ions commonly bound to albumin so not excreted
Published	10/07/2024	As blood travels along caps and is filtered the oncotic pressure {{c1::rises}} and counters hydrostatic pressure {{c1::more::more/less}} so there is {…
Published	10/07/2024	•This filtration fraction is relatively {{c1::fixed}}•FF = {{c2::GFR/RPF::eqn}} ⇒ so GPF and RPF must inc/dec in {{c1::unison}}
Published	10/07/2024	•Reduction in surface area available in glomerulonephritis →  {{c1::decreased}} GFR
Published	10/07/2024	•Increased Pbs in obstruction →  {{c1::decreased}} GFR
Published	10/07/2024	•Increased πp in volume depletion →  {{c1::decreased}} GFR
Published	10/07/2024	•Increased πp in multiple myeloma (high levels of Ig light chains) -> {{c1::decreased}} GFR
Published	10/07/2024	•Decreased  πp in nephrotic syndrome -> {{c1::increased}} GFR
Published	10/07/2024	•IntraGlomerular {{c3::HTN}} (hyper{{c3::Filtration}}): •Starts with {{c1::nephron}} loss (due to any kidney disease) •Compensatory {{c1::r…
Published	10/07/2024	Glomerular hemodynamics and CKD⇒ •ACEI/ARB treats by reducing Ang II effects⇒ •{{c1::SGLT2i}} treats by blocking {{c2::sodium glucose transporter}}
Published	10/07/2024	•SGLT2i treats by blocking sodium glucose transporter⇒ Sends sodium to the {{c1::macula densa}}⇒ {{c1::TGF}} results in increased {{c2::a}}fferen…
Published	10/07/2024	Theoretically, creatinine should vary {{c1::inversely}} (exponential) with GFR*but over estimates the GFR
Published	10/07/2024	•Urine {{c2::creatinine}} clearance tends to {{c1::OVER}}estimate GFR⇒ •{{c2::Creatinine}} {{c1::secreted}} by the tubules•Urine {{c2::urea}} cle…
Published	10/07/2024	GFR estimate eqns work better when the ptn operating at {{c1::low::high/low}} GFR levels
Published	10/07/2024	In the nephron, where do substances too large for Glomerulus go?{{c1::PeriTubular Capillaries::struct}}
Published	10/07/2024	The main function of PeriTubular Capillaries is {{c1::re-absorption}} of water/electrolytes and {{c1::excretion}} of molecules we do not need
Published	10/07/2024	Renal Blood Flow ⇒ Amount of {{c1::blood}} delivered to {{c1::both::single/both}} kidneys per unit time
Published	10/07/2024	Renal Blood Flow = RBF = {{c1::RPF / (1 - Hct)::formula}}Normal RBF = {{c2::1.2::value}} L/min
Published	10/07/2024	RPF = Renal Plasma FlowNormal RPF = {{c1::625}} mL/min
Published	10/07/2024	Glomerular Filtration Rate = GFR = {{c1::flow}} rate of {{c1::filtered fluid}} through the kidneys
Published	10/08/2024	What measures the amount of blood that reaches the kidneys?{{c1::RBF}}What measures the amount of fluid filtered by the kidneys?{{c1::GFR}}
Published	10/07/2024	What Hemodynamic variable is used to assess kidney health?{{c1::GFR}}
Published	10/07/2024	Normal GFR = {{c1::125::value}} mL/min
Published	10/07/2024	{{c2::Filtration Fraction}} = {{c1::GFR / RPF::formula}}
Published	10/07/2024	What hemodynamic term is used to estimate GFR?{{c1::Clearance}}
Published	10/07/2024	Clearance = the amount of {{c1::plasma}} that is cleared of a {{c1::substance}} per unit time
Published	10/07/2024	Clearance of {{c1::inulin::substance}} is the gold std for estimating GFR
Published	10/07/2024	Clearance = Cx = {{c1::(Ux * F) / Px ::formula}} = {{c1::(Ux * Uvolume) / (Px * time)::formula}} Cx = {{c1::(U…
Published	10/07/2024	Calculate the clearance if:{{c1::UV/P = 120 (1.3) / 2.3= 67 ml/min}}
Published	10/07/2024	Calculate the clearance if:{{c1::UV/(P*t) = 200(2100) / 25 (1440)= 11.7 ml/min}}
Published	10/07/2024	0daf812a80124f62a599eae2b3f54477-oa-1
Published	10/07/2024	Clearance is NOT exactly = to GFR bc a substance can be {{c1::re-absorbed}} or {{c1::excreted}}
Published	10/07/2024	If a substance x is {{c2::Reabsorbed}} then Cx {{c1::<::</>/=}} GFR
Published	10/07/2024	If a substance x is {{c2::Secreted}} then Cx {{c1::>::</>/=}} GFR
Published	10/07/2024	Inulin is gold std for measuring GFR bc it is "{{c1::Freely Filtered}}"
Published	10/07/2024	if Cx / Cinulin {{c1::>::</>/=}} 1 then X is {{c2::Secreted}}
Published	10/07/2024	if Cx / Cinulin {{c1::<::</>/=}} 1 then X is {{c2::ReAbsorbed}}, or {{c2::Not Filtered (i.e. Albumin)}}
Published	10/07/2024	{{c2::PAH::substance}} is the gold std for estimating {{c1::Renal Plasma Flow (RPF)}}
Published	10/07/2024	{{c2::Effective Renal Plasma Flow (ERPF)}} = C{{c1::PAH}} = {{c1::(UPAH * Flow) / PPAH }}
Published	10/07/2024	True RPF = {{c1::CPAH / 0.9}}
Published	10/07/2024	RBF = RPF / (1-Hct)RBF can also be estimated by doing {{c1::CO *25%}}
Published	10/07/2024	{{c1::Constriction::constr/dilate}} of Arterioles causes an {{c2::decrease::inc/dec}} in RPF
Published	10/07/2024	Constriction of {{c1::A}}fferent Arteriole causes Dec RPF and {{c2::Dec::inc/dec}} GFR
Published	10/07/2024	Constriction of {{c1::E}}fferent Arteriole causes Dec RPF and {{c2::Inc::inc/dec}} GFR
Published	10/07/2024	What are the 3 systems that regulate Arteriole Constriction and GFR?{{c1::RAAS}}{{c1::AutoRegulation}}{{c1::TubuloGlomeular Feedback}}
Published	10/07/2024	The {{c1::A}}fferent Arterioles have {{c1::JuxtoGlomerular (JG)}} Cells that can release {{c1::Renin}} to regulate the RAAS
Published	10/07/2024	Stimuli for {{c1::Renin}} release from JG cells:{{c2::(HypoPerfulsion) Volume}} DepletionDecreased {{c2::NaCl}} delivery to {{c2::Macula Densa}}Increa…
Published	10/09/2024	Once Renin is released it converts {{c1::Angiotensinogen}} into {{c1::(AT1) Angiotensin 1}};⇒ {{c1::AT1}} is then converted to {{c1::Angiotensin 2}} b…
Published	10/07/2024	Renin w/ ACE created AT{{c1::2}} → AT{{c1::2}} causes:increased {{c2::Aldosterone}} Secretionincreased {{c2::Na+}} absorptionincreased {{c2::systolic …
Published	10/07/2024	How does AT2 affect the Afferent & Efferent Arterioles?{{c1::Constricts both afferent and efferent}}
Published	10/07/2024	AT2 causes {{c1::decrease::inc/dec}} of RPF and {{c1::maintaince::inc/dec}} of GFR
Published	10/07/2024	Prostaglandins will cause Vaso{{c1::Dilation}} of glomerular arterioles
Published	10/07/2024	Prostaglandins preferentially {{c1::dilate}} the {{c1::a}}fferent arteriole
Published	10/09/2024	{{c1::NSAIDs::drug class}} can cause {{c2::ischemia}} of nephron if given to patients w/ high levels of {{c2::AT2}} bc these drugs block {{c2::ProstaG…
Published	10/07/2024	{{c1::AutoRegulation::term}} is using {{c3::Myogenic Stretch}} receptors on the {{c3::A}}fferent Arteriole to Constrict/Dilate {{c3::A}}fferent Arteri…
Published	10/07/2024	AutoRegulation causes Vaso{{c1::Dilation}} if perfusion is {{c2::Low}}
Published	10/07/2024	1e467786ce5e4180badfd686e22031b4-ao-1
Published	10/07/2024	1e467786ce5e4180badfd686e22031b4-ao-2
Published	10/07/2024	{{c2::TubuloGlomerular Feedback (TGF)}} is done by {{c1::Macula Densa}} cells which sense {{c1::NaCl}} levels
Published	10/07/2024	TubuloGlomerular Feedback (TGF) is done by Macula Densa cells which sense NaCl levels{{c2::high::low/high}} NaCl → {{c1::decreased::inc/dec}} GFR thro…
Published	10/07/2024	GFR determined by the Glomerular Barrier → has 3 layers:1. {{c1::Fenestrated Endothelial}} cell layer2. {{c2::Glomerular Basement Membrane (GBM)}} lay…
Published	10/07/2024	Epithelial layer attached to GBM by {{c1::Foot Proccesses}} → between these are pores called {{c2::slit}} pores which are close by a {{c2::slit diaphr…
Published	10/07/2024	GBM is {{c1::negatively}} charged → causes {{c1::(positive) Cat}}ions to be preferentially filtered
Published	10/07/2024	GFR Pressure Eqn:GFR ={{c1::Kf (Pgc – Pbs – πp)}}
Published	10/07/2024	Oncotic Pressure in the Bowmans Space = {{c1::0}} bc it contains {{c1::no proteins}}
Published	10/09/2024	If afferent is constrictied and efferent is dilated causes {{c1::Decreased}} RPF and {{c1::Decreased}} GFR
Published	10/07/2024	What GFR determining variable increases as blood moves through glomerular capillary?{{c1::Capillary Oncotic Pressure (πp)}}
Published	10/07/2024	Removing 1 Kidney causes a {{c1::50}}% drop of GFR if it happened Acute (i.e. kidney donor)Losing 1 Kidney over time (chronic) causes a {{c1::20-30}}%…
Published	10/07/2024	In 24hr urine collection if Creatinine is < {{c1::20-25}} mg/kg/d you know the patient forgot to collect some pee
Published	10/07/2024	An easy way to measure GFR more accurately is to do Creatinine Clearance and give patient {{c1::Cimetedine (H2 block)::drug}} to prevent {{c1::tubular…
Published	10/07/2024	Best way to use GFR Estimate Equations is by measuring Creatinine and {{c1::Cystatic C}}⇒ especially for patients w/ low {{c1::muscle mass}}
Published	10/07/2024	The GFR Estimate Equations do not account for race⇒ tend to {{c1::Under}}Estimate GFR in African Americans → {{c1::more::more/less}} ptns diagnosed w/…
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