6: Basic Renal Processes for Sodium, Chloride, and Water Flashcards
If you give a patient a hypertonic saline bolus, how does this affect its intracellular osmolality?
increases
water will shift from IC space to the EC due to the osmotic pull from the hypertonic saline in the IV space
If your patient has hemorrhagic gastroenteritis will large volume of vomiting and diarrhea, how does this affect its intracellular osmolality
Increases
vomitus and diarrhea is hypotonic - left-over osmoles increase the IV and interstitial osmolality and pull water from the IC space
If you give your patient a D5W infusion, how does this affect its IC volume?
increases - water will distribute evenly through IC and EC space
What percentages of sodium are rabsorbed in the proximal tubule, the loop of Henle and the distal convoluted tubules?
- 65%
- 25%
- 10%
compared to the filtered sodium load, what percentage remains in the final urine?
less than 1%
What are the major anions absorbed with sodium in the tubules to maintain electroneutrality?
- Chloride
- Bicarbonate
Where is most bicarbonate reabsorbed?
In the proximal tubules (90%)
What are the two sources of body water?
- water intake (drinking/eating)
- water production during carbohydrate oxidation
What are the 4 ways of bodily water loss?
- urination
- gastrointestinal losses
- exhalation
- skin evaporation
Is the luminal or basolateral membrane of tubular cells more permeable to water?
basolateral membrane
high number of aquaporines –> cytosolic osmolality close to that of the interstitium
describe the luminal water permeability of tubular cells in the following nephron segments:
* proximal tubules
* loop of Henle
* distal convoluted tubules
* collecting ducts
- proximal tubules - highly water permeable with aquaporines and permeable tight junctions - reabsorption here is isotonic
- descending thin loop of Henle early parts still very permeabel to water
- ascending thick loop of Henle relatively water impermeable - higher Na than water fraction reabsorbed –> tubular fluid leaving here will be hypotonic (osmolality 1/3 of plasma)
- distal convoluted tubules little to no water reabsorption/very low permeability
- collecting ducts permeability is highly variable and adjusted depending on body water status
What does obligatory water loss mean?
the minimum water needed to excrete sufficient amounts of urea, sulfate, phosphate, and other waste products
Why does starvation decrease one’s ability to survive without water?
- starvation leads to a catabolic state –> releases excess solutes and waste products –> increases the obligatory water loss
- If no food intake –> no water production from carbohydrate oxidation
- no protein intake –> not enough urea to achieve sufficient osmolality of the inner medullary interstitium
How is most Na reabsorbed on the apical/tubular side of the poximal tubular cells?
via the NHE-3 antiporter
Sodium-hydrogen-exchanger 3
Name 3 solutes that are reabsorbed in the proximal tubules and are sharing a symporter with Na
- Amino acids
- glucose
- phosphorous
How does Na exit the cell on the basolateral tubular cell membrane?
Na-K-ATPase
Na/HCO3- symporter
Explain how Chloride is reabsorbed in the proximal tubules
- Cl/Base antiporter on luminal membrane and Cl-channel + K-Cl symporters on basolateral membrane
- paracellular through tight junctions
Fill the gaps
Explain how organic bases and H+ protons are recycled in the poximal tubules
Hydrogen ions leave the tubular cells in exchange for Na entering (NHE-3 antiporter)
Base leaves the tubular cell in exchange for a Cl- ion entering (antiporter)
The H+ and base can then unite and are able to diffuse into the cell as Hbase –> will split in the cell and are able to facilitate further Na and Cl absorption
What percentage of water and and NaCl are reabsorbed in the loop of Henle?
25% of filtered NaCl
10% of filtered water
What is the Na concentration of tubular fluid at the end of the loop of Henle?
1/3 of plasma –> ~ 50 mEq/L
What parts of the Loop of Henle expresses aquaporins?
Only the descending limb
How are Cl and Na reabsorbed in the THIN ascending loop of Henle?
tubular fluid has a higher Na and Cl concentration because of water reabsorption in the descending limb –> creates concentration gradient favoring absorption
Cl is absorbed via Cl channels on both apical and basolateral membranes
Na follows paracellularly through tight junctions
How are Cl and Na reabsorbed in the THICK ascending loop of Henle?
- Na-K-ATPase on baselateral side –> creating concentration gradient for Na flux (like everywhere)
- Na-K-2Cl symporter –> apical membrane –> movement into cell
- to prevent K depletion in the tubular fluid - K channel moves K down cc gradient out of the cell back into the lumen (K recycling)
- Cl exits on the basolateral side via Cl channels and K-Cl symporter
- paracellular Na movement achieves electroneutrality (otherwise too much Cl- would be absorbed alone)