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Renal Final > 6. Renal Control of Acid-Base > Flashcards

6. Renal Control of Acid-Base Flashcards

1
Q

What are fixed acids?

A

non-carbonic acids generated metabolically like sulfuric and phosphoric acids
Initially neutralized by buffers in body fluids and ultimately excreted in urine

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2
Q

What are the metabolic sources of H?

A

oxidative metabolism of CO2
Fixed: glycolysis (lactic acid), incomplete FA oxidation (ketones), Protein, nucleic acid, phospholipid metabolism (sulfuric, phosphoric, hydrochloric acids)

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3
Q

What is the primary buffer system?

A

bicarb/CO2 buffer

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4
Q

What are the ECF buffer systems?

A

bicarb/CO2
inorganic phosphate (HPO4)
Plasma proteins

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5
Q

What are the ICF buffers?

A 
Cell proteins (hemoglobin)
Organic phosphates (ATP, 2,3 DPG)
Bicarb/CO2
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6
Q

What is the Henderson-Hasselbalch equation?

A

pH = pK + log [A-]/[HA]

A- = HCO3
HA = CO2 or CO2 = (0.03*PCO2)
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7
Q

What are volatile acids?

A

Produced by metabolic processes that can be expired by respiratory tract
Carbonic acid system

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8
Q

What is the renal response to excess acid?

A

all of filtered HCO3 is reabsorbed and additional H is secreted into lumen, excreted primarily as ammonium

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9
Q

What is the renal response to excess base?

A

Incomplete reabsorption of filtered HCO3
Decreased H secretion
secretion of HCO3 in collecting duct

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10
Q

Most H is excreted in combination with urinary buffers. What are the two types?

A

Titratable acid: conjugated bases of metabolic acids accept H in lumen (phosphate, creatinine, urate)

Ammonia: generated by tubular epithelium

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11
Q

H excretion = ?

A

urinary excretion of titratable acid + ammonium - HCO3

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12
Q

HCO3 excretion is equivalent to adding ___ to body fluids

A

acids

*for each mEq of HCO3 lost, a free H is left behind

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13
Q

Where is a major site for the formation of ammonia ?

A

Proximal tubule when glutamine is converted to ammonia

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14
Q

What do alpha - intercalated cells secreted?

A

H by H ATPase pump

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15
Q

What do beta - intercalated cells secrete?

A

HCO3 to eliminate excess base

HCO3/Cl exchanger

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16
Q

The activity of H-ATPase in the alpha-intercalated cells are directly stimulated by what?

A

Aldosterone

17
Q

acid base status of hyperaldosterone patient

A

alkalosis

and hypokalemic

18
Q

Most of the H secreted by the proximal tubule is used to do what?

A

reabsorb filtered HCO3 so luminal pH falls only slightly in this segment

19
Q

Why must all of the filtered HCO3 needs to be reclaimed in normal individuals?

A

because excretion of HCO3 has same effects as gaining H; excretion of even small fraction of filtered HCO3 would acidify body fluids

20
Q

How does HCO3 get across the membrane?

A

it temporarily is converted to CO2

21
Q

80% of the filtered HCO3 is reabsorbed in PT, what is this ultimately dependent on?

A

Na,K ATPase

22
Q

If there is an excess amount of HCO3 in the plasma, what is preventing the bicarb from being reabsorbed?

A

it is a saturable process and the antiporters are filled

23
Q

what is the most important buffer converted to titratable acid?

A

filtered HPO4

24
Q

What is the process of excretion of H as ammonium in the proximal tubule?

A

glutamine in the cells is converted to 2 ammonium. This is converted to ammonia so that it can freely pass through the membrane to the tubular fluid. The Na/H exchanger pushes H out into the tubular fluid and joins NH3 and is excreted as ammonium. Also 2 bicarbs are produced by glutamine oxidation

25
Q

What are the factors controlling renal H secretion?

A 
intracellular pH
Plasma PCO2
CA activity 
Na reabsorption (angiotensin/aldosterone)
Extracellular [K]
aldosterone
26
Q

What is hyperchloremic acidosis?

A

when metabolic acidosis occurs and anion gap is unchanged due to loss of HCO3 is matched by gain of Cl

27
Q

What is normochloremic acidosis?

A

It is a high anion gap that occurs in metabolic acidosis due to HCO3 being replaced by unmeasured anion (lactate, ketoacidosis, poisoning)

28
Q

What are some causes of anion gap?

A 
E. Elm Park
ethanol
ethylene glycol 
lactic acid
methanol 
paraldehyde 
aspirin
renal failure 
ketone bodies 
or MUDPILES
29
Q

What is MUDPILES?

A 
methanol
uremia
diabetic ketoacidosis, starvation or alcoholic ketoacidosis
paraldehyde
iron
lactic acidosis 
ethylene glycol
salicylate

Renal Final (8 decks)

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