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3 REN > 11 Volume Regulation > Flashcards

11 Volume Regulation Flashcards

1
Q

What does the kidney use to measure body volume?

A

effective circulating volume

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2
Q

When might effective ciculating volume and actual volume change independently?

A

heart failure

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3
Q

What is the structure of the juxtaglomerular apparatus?

A

the late distal tube comes into contact with the afferent arteriole

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4
Q

What secretes renin?

A

granular cells of the afferent arteriole

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5
Q

What is the thickening in the distal tubule called?

A

macula densa

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6
Q

What does the macula densa detect?

A

low Na+ in the distal tubule

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7
Q

What do juxtaglomerular cells do?

A

release renin

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8
Q

What does renin do?

A

converts angiotensinogen into angiotensin 1

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9
Q

Where is angiotensinogen formed?

A

liver

adipose tissues

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10
Q

What happens to angiotensin 1?

A

converted to angiotensin II by angiotensin converting enzyme (ACE) in the lungs

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11
Q

What does angiotensin II do?

A

efferent arteriole vasocontristion

stimulates aldosterone release

increases sodium reabsorption

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12
Q

What are the 2 main triggers for aldsoterone?

A

ATII

Hyperkalaemia

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13
Q

What does aldosterone do in the collecting ducts?

A

reabsorbs sodium, and drives potassium excretion

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14
Q

What broad effect does inhibiting the renin angiotensin system do?

A

reduces blood pressure, acting as an antihypertensive

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15
Q

Name 4 types of antihypertensives associated with the renin angiotensin system

A

ACE inhibitors
AT(1) receptor antagonists
aldosterone receptor antagonsits
renin inhibition

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16
Q

Name 2 types of ACE inhibitors?

A

captopril

enalopril

17
Q

What is the problem with using ACE inhibitors?

How is this avoided?

A

ACE has other functions, like breaking down bradykinin, an inflammatory marker

people hence get a dry cough

we just put them on something else lol, that acts downstream of ATII

18
Q

What is the familial pharmaceutical name for AT(1) receptor antagonists?

A

sartans

19
Q

What is the agonist for AT(1)?

A

ATII

20
Q

Name a type of aldosterone receptor antagonist

A

spironolactone

21
Q

Name a type of renin inhibitor

A

aliskiren

22
Q

what do AT(1) receptors do?

A

Gq linked so vasoconstriction in efferent arteriole

23
Q

How does angiotensin II increase circulating volume?

A

increases Na / H+ exhcnage in proximal tubule and hence proximal Na+ absorption
increase in aldosterone release
causes ADH release
causes thirst

24
Q

How does Haemorrhage lead to increased renin release

A

…. decreased circulating volume, decreasing blood pressure and increasing sympathetic activity
sympathetics act on granule cells

25
Q

What are the 3 key sympathetic effects on the afferent arteriole?

A

vasoconstriction upstream of granule cells (amplifies apparent fall in volume)

direct stimulation of renin release from granule cells

afferent arteriole vasoconstriction to lower GFR

26
Q

What does noradrenaline binding to alpha 1 adrenoreceptors cause?

A

vasoconstriction

27
Q

what does noradrenaline binding to beta 1 adrenoreceptors cause?
why is this unusual?

A

on granule cells to regulate renin release

these receptors are usually found in the heart!

28
Q

What are the 3 key stimuli to renin release?

A

intrinsic renal mechanisms because of less Na+
sympathetic mediated release
decrease in venous pressure

29
Q

How does decreasing venous pressure stimulate renin release?

A

it is transmitted to vesa recta capillaries, decreasing hydrostatic pressure
this increases uptake of fluid from renal interstitial space, increasing water reabsorption
this decreases sodium delivery to the distal tubules

30
Q

what stimulates ADH release?

A

change in osmolality

change in volume a lil bit

31
Q

how does changing volume affect ADH?

A

decreased cardiac output, decreased activation of baroreceptor reflex
AtII increases ADH release following haemorrhage (increases water reabsorption, lowering osmolality, this mechanism does not retain Na+)

32
Q

What will the acute response to haemorrhage be?

A

hyponatraemia

33
Q

Why does beer cause diuresis?

A

it increases water load and also inhibits ADH

34
Q

Why do spirits dehyrdrate you?

A

you aren’t really taking in enough water to facilitate that loss

35
Q

What is ANP and what does it do?

A

Atrial Natriuretic Peptide
atrial stretch in volume overload cuases its’ release
travels to the kidney acting on ANP receptors increasing cGMP

this increases renal Na+ excretion

36
Q

Name a peptide similar to ANP produced in the kidney

A

Urodilatin

37
Q

What do prostaglandins do?

A

PGE2 and PGI2 increase Na+ excretion

38
Q

Why do we have to watch out when giving renally compromised people NSAID’s?

A

they have problems with volume retention anyway, and NSAID’s tend to be nephrotoxic on top of this

39
Q

What does dopamine do?

A

angonist to D1 receptors, increasing cAMP, decreasing activity of Na+ / H+ exchanger in the proximal tubule

this increases Na+ excretion

3 REN (21 decks)

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