PHYSIOLOGY

Renal Physiology
Khts!8
Dr. Francis Paul Jagolino

QUESTION 1 QUESTION 4
In Chronic Renal Failure (CRF), the decline in GFR for This is a usual symptom seen in renal disease
uremia to manifest is below:
• All other choices were eliminated
 According to Harrison
 If you have a patient with uremia ibig sabihin  Metabolic acidosis is a common complication
10% sirang-sira na talaga kidneys niya Acidosis seen in renal disease. Acid-base balance is
 Dialysis na talaga ‘yan maintained by increase in excreted
ammonium per nephron (during times of
20% acidosis).
30%
Hypokalemia • Usually hyperkalemia
40%
Hypotension • Usually hypertension

QUESTION 2 Hypernatremia • Usually hyponatremia

Defined as heavy albuminuria with or without edema

 Nephrotic syndrome describes the onset QUESTION 5

of heavy proteinuria, hypertension,
This is the least likely cause of Hematuria
hypercholesterolemia,
hypoalbuminemia, edema/anasarca, Acute Renal  In acute renal failure there is usually no
Nephrotic and microscopic hematuria; if only large Failure hematuria
Syndrome
amounts of proteinuria are present
Infection  Usually with hematuria
without clinical manifestations, the
condition is sometimes called nephrotic- Sickle Cell  Surely with hematuria
range proteinuria Disease
 If neoplasms occur in the genitourinary tract, it
Chronic Renal • Definitely with edema Neoplasm
Failure usually presents with hematuria.

 Acute GN is defined as sudden onset of  Hematuria also presents with renal casts. Ano ang renal casts?
hematuria, proteinuria, and RBC casts in Nephrolithiasis – stones.
Acute urine often accompanied by
Glomerulonephritis
hypertension, edema, azotemia (GFR),
and salt and water retention. QUESTION 6
Reduced renal perfusion may lead to:
Rapidly  Edema is rare
Progressive Pre-Renal • Look notes below
Glomerulonephritis Failure
Intrinsic
Renal
QUESTION 3 Failure
Sudden onset of hematuria, edema, hypertension, oliguria,
Post Renal
and elevated BUN and creatinine. Failure
 Sabi sa Harrison’s  Anything before the kidney is always pre-renal.
Acute
Glomerulonephritis • See definition above (Question 2)  Causes of acute kidney injury can be divided into three categories:
(1) pre-renal (caused by decreased renal perfusion, often because
 Characterized by only proteins moving
Nephrotic Syndrome of volume depletion); (2) intrinsic renal (caused by a process within
into the urine
the kidneys); (3) postrenal (caused by inadequate drainage of urine
 Characterized by not having proteins distal to kidneys)
Nephritic Syndrome moving into the urine

Rapidly Progressive  Edema is rare REFERENCES

Glomerulonephritis
• Hall JE. 2016. Guyton and Hall Textbook of Medical Physiology,
13/e. Saunders Elsevier
• Harrison’s IM, 19th ed.
• Henry’s Clinical Diagnosis, 23rd ed.
Lecture Title: Kahoots! 8 – Renal Physiology
Transcribed by: MANGABAN and MOLINA
 QUESTION 7 QUESTION 10
33 year old male present with polyuria, polydipsia, and This can cause Renal Tubular Acidosis
hypernatremia. Impression?
 A form of alcohol.
Nephrogenic  All the other choices DOES NOT present  Acetaldehyde gives the symptoms of “lasing”
Diabetes with polyuria. – nababaliw sa isang tabi, ataxia
Insipidus
 Acetaldehyde needs to be broken down into
Urinary Tract  Presents with oliguria or anuria acetate by aldehyde dehydrogenase
Infection
Ethylene (process takes a while)
Acute Renal  Ethylene glycol is also broken down by
Glycol
Failure
aldehyde dehydrogenase to oxalic acid
Nephrotic  Oxalic acid causes damage to the renal
Syndrome
tubules causing renal tubular acidosis
 Sweet-tasting and available in attractive
QUESTION 8 colors  usually mga bata ang nakakainom
This is a possible cause of Post Renal Failure  Hemotherapeutic drug
5-Flurouracil  Used to treat lymphomas
Urinary  Post renal
Tract
Infection Erythromycin  Antibiotic
Diabetes  Intrinsic renal  Alcohol
Mellitus  Our body tolerates ethanol very well
Acute  Pre-renal Ethanol  Body tolerates it because of two enzymes:
Tubular alcohol dehydrogenase and aldehyde
Necrosis
dehydrogenase
Renal
Artery
Stenosis
QUESTION 11
 UTI is more common in females. Short urethra and anatomical
This diuretic inhibits the sodium-potassium-chloride co-
location of urethra and anus.
transporter in the thick ascending limb
 How do males get UTI? Lifestyle. What type of lifestyle? In most
cases of male UTI, it is usually sexually transmitted, it comes Loop • See image below
from females. Diuretics
 I had a patient 5/M with fever of unknown origin, I requested for Thiazides
urinalysis. Pinagalitan ako ng consultant… “bakit ka Aldosteron
nagpaurinalysis? What’s your indication of doing that? Tanga ka e Receptor
ba? Lalaki yan tapos 5-years old, sa tingin mo ba sexually active Antagonist
‘yan?” Osmotic
 Aside from the fact that patient is male, 5-years old lang siya… Diuretics
so the chances of the patient getting UTI is very, very slim.

QUESTION 9
This is a possible cause of Pre-Renal Failure
Diabetes  Pre-renal
Mellitus
Renal
Artery
Stenosis
Acute  Intrarenal (as explained from other numbers)
Tubular
Necrosis
Urinary  Post-renal (as explained from other numbers)
Tract
Infection

Lecture Title: Kahoots 8 – Renal Physiology Page 2 of 3

Transcribed by: MANGABAN and MOLINA
 QUESTION 12 QUESTION 16
This diuretic inhibits the sodium-chloride transporter in A rare inherited defect in the thick ascending limb of the loop
the distal tubule. of Henle.
 Rule of elimination
Thiazide • See image in Question 11 Bartter
 See Question 15 – Gitelmann and Bartter
Diuretics Syndrome
classified as genetic disorders
Loop Nephritic
Diuretics Syndrome
Osmotic Gitelman
Diuretics Syndrome
Carbonic Nephrotic
Anhydrase Syndrome
Inhibitors
QUESTION 17
Proteinuria, Hypoalbuminemia, Hyperlipidemia, and edema
QUESTION 13
are seen in:
Inhibits the transport of bicarbonate out of the PCT into Nephrotic  Proteinuria no hematuria
the interstitium. Syndrome
Carbonic • See image in Question 11 Nephritic  Hematuria no proteinuria
Anhydrase Syndrome
Inhibitors Bartter
Osmotic Syndrome
Diuretics Gitelman
Syndrome
Thiazide
Diuretics
Aldosterone QUESTION 18
Receptor Hemautria, Hypertension, Oliguria, and Azotemia are usually seen in:
Antagonists Nephritic  Hematuria no proteinuria
Syndrome
Bartter
QUESTION 14 Syndrome
This can either be a cause of a consequence of Chronic Nephrotic  Proteinuria no hematuria
Kidney Disease (CKD) Syndrome
Gitelman
 Hypertension can be pre-renal (cause of Syndrome
CKD) or it can be a consequence of CKD
Hypertension because of the loss of function to regulate QUESTION 19
blood pressure.
This is likely a consequence of CKD.
Azotemia  Is the term for GFR  EPO Produced by the Lacis cells  maturation
Anemia
of RBC
Acute Kidney
Hypokalemia • Hyperkalemia
Injury
Hypotension • Hypertension
Diabetes • Cause of CKD but not consequence
Mellitus Hypercalcemia • May or may not be present

QUESTION 20
QUESTION 15
The least likely complication of Hemodialysis
The disorder results in improper function of Na-Cl
symporter located in the DCT of the kidney.  Although the kidney has lost ability to
 Subset of Bartler syndrome. regulate pressure. Pero the mere fact that
Gitelman
 Genetic disorder you are still draining fluids from the patient
Syndrome
Hypertension means na kahit papaano that’s going to
Bartter cause hypertension.
Syndrome  Sodium regulation nadun pa din sa
Nephritic hemodialysis
Syndrome Leukopenia
Nephrotic Access site
Syndrome Sepsis
Loss of Residual
Renal Function

Lecture Title: Kahoots 8 – Renal Physiology Page 3 of 3

Transcribed by: MANGABAN and MOLINA