renal pathophysiology (sandoval)

Is Ne/EPI constrict/dilate the arterioles?

constrict

does adenosine constrict/dilate the arterioles?

constrict

Where does NE/EPI act at?

agonist at alpha 1 receptors

Where does NE/EPI act at most: afferent arteriole or efferent arteriole?

afferent

Where does Adenosine act at?

agonist at adenosine receptors (A1)

where does adenosine act at: afferent arteriole or efferent arteriole?

afferent arteriole

Does angiotensin 2 constrict/dilate the arterioles?

constrict

What receptor does angiotensin 2 act at?

AT1 receptor

Where does angiotensin 2 mostly act at: afferent arteriole or efferent arteriole?

efferent

Does prostaglandins constrict/dilate the arterioles?

dilate

What receptor does prostaglandins act at?

EP4 and IP receptor

Where does prostaglandin act at: afferent arteriole or efferent arteriole?

afferent

Describe the effect on P_GC, GFR, and RBF when we vasoconstrict the afferent arteriole

PGC= decreases

GFR= decreases

RBF= decreases

How do NSAIDs cause prerenal AKI?

block COX → less prostaglandins→ less afferent dilation→ less blood enters→ GFR falls

How do ACE/ARBs/renin inhibitors cause prerenal AKI?

block ang. 2 → less efferent constriction → less pressure in glomerulus → GFR falls

What is intrinsic AKI usually due to?

• ischemic acute tubular necrosis (ATN)

• toxic acute tubular necrosis

Describe ischemic acute tubular necrosis

• lack of blood flow and oxygen to kidney → cell damage/ death

• prolong renal vasoconstriction

What exacerbates injury in ischemic ATN?

reperfusion (restoring blood flow)

what is rhabdomyolysis?

massive breakdown of muscle