A&P Final Lecture 6 Notes Flashcards
What cell is the governing body for potassium homeostasis in the body ?
Principle cell
What cell is the governing body for acid / base homeostasis in the body ?
Intercalated cells
What form does the protons show up in the urine
NH3
What is the most potent diuretic on the market
Loop diurectics
Furosemide
What are the 2 effects that the loop diuretics have on the renal tubules ?
Inhibiting Ion reabsorption
(Na)
Impact the concentration of renal interstitial concentration gradient
True or false, The urine osmolarity of a healthy person in the desert would be 300 ml per osmol
False,
True or false, Normally the kidneys has a concentrated renal interstitial concentration gradient
False, diluted renal interstitial concentration gradient
What is the big component of the renal interstitial concentration?
Urea
what is the charge that attract urea in the interstitial space
positive charge
Why is the urea concentration increased as the filtrate move down the renal tubules ?
Proximal tubules reabsorb some, however since the urea is larger the urea is not reabsorbed at the same rate as water, so the concentration increase has the urea move down the tubular
Most of Urea tends to be reabsorbed in what location of the tubules with the aid of what hormone?
MCD,
ADH (AVP)
Where is ADH release from? what cells does it effect in the kidney?
posterior lobe of the pituitary gland
Principles cells
Intercalated cells
What hormone affects the Aquaporins -2 and Urea Transporters ?
ADH/AVP
What side of the cell wall does ADH moves Urea transporters and Aquaporin -2?
Apical side
What are the 2 main concepts a student need to know regarding Urea ?
- Urea is reabsorbed at the proximal tubules with water but at a slower rate
- The increase in urea permeability in the MCD to allow urea to be reabsorbed
What happen to the blood as it descends the Vasa Recta ?
It becomes more concentrated
What happen to the blood as it ascends the Vasa Recta?
and Why?
It becomes more diulted
the solutes are able to move back into interstitium due to the current of the blood
Does the velocity of the blood plays a role in the amount of solute reabsorbed back in to the interstitium?
Yes, the slower the velocity of the blood the more concentrated the interstitium. it can move out of the peritubular capillaries and into the intersitium
Decrease in GFR = ________ renal blood flow = ________ = urinary output
decrease
decrease
What does the ADH system regulate
our blood osmolarity, excellular fluid
What will happen to the osmoreceptor cell in a hypertonic environment?
How do that effect the release of ADH?
the cell will shrink
increasing the release of ADH from the posterior lobe of the pituitary gland
What will happen to the osmoreceptor cell in a hypotonic environment?
How do that affect the release of ADH?
the cell will swell
decreasing the release of ADH from the posterior lobe of the pituitary gland
How do the osomoreceptor determine the amount of ADH that needs to be release
by selectively reabsorption of water
Which hormone has a direct effect on the fluid in the body?
ADH
What are the names of the 2 neurons where the osomreceptors synapse on that is responsible for the production of ADH?
anterior -superaoptic neuron (nuclei)
posterior - Paraventricular neuron
Where is the osomoreceptor found within the body
anterior portion of the thalamus
How much production of ADH is the Supraoptic neuron responsible for?
5/6
How much production of ADH is the Paraventricular neuron responsible for?
1/6
True or False, Both production of ADH travels separately in the neuro - hypothesis
False, ADH travels together in the neuro - hypothesis
True or False, Very rich vascular beds located near the posterior pituitary lobe
True
What area of the renal tubules where the ADH is most effective
MCD
What effect does ADH have on the renal interstitium in correlation to effecting the serum osmolarity
Changes the renal interstitium space osmolarity
How do changes in the renal interstitium space effect osmolarity in the urine?
it can make out urine more or less concentrated depending on its osmolarity
Under a steady state, what is the minimum osmolarity concentration of filtrate in the loop of henele can be with a decrease release of ADH?
600 mOsm/L
What happens to the urine when there is no release of ADH?
very diluted
What is the maximum osmolarity concentration of the filtrate in the loop of henele with an increase release of ADH?
1200 mOsm/l
What happens to the urine when there is a release of ADH?
Very concentrated
What is the pathway of decreasing water excretion involving ADH?
- Water deficit
- Increase extraceullar Osmolarity
- Osmoreceptors sense a change in the environment
- increase ADH secretion from the posterior pituitary gland
- increase Plasma concentration ADH
- Increase in water permeability in distal tubules and collecting ducts (MCD)
- increase water reabsorption
- Decrease water excretion
What laboratory electrolyte is a reflects the osmolarity concentration in the body
sodium
What does free water clearance means
it gives us an idea on how much free water we are getting rid of
Alot of ADH = __________ water clearance
low amount of ADH = __________ water clearance
low water clearance
high water clearance
What happens to the blood osmolarity if ADH is block?
it becomes irregular, concentrated
True or false a person with diabetes and blocked ADH do not have life threading problems
False, it becomes irregular and unstable
What other sensors around the body that can influence ADH?
Baroreceptor cardiopulmonary receptor
-looking at Blood pressure in the artery
low pressure sensors in the heart and veins
- looking at the blood volume
What is the disease process that inhabits the secretion of ADH?
Diabetes insipidus
Identify and define the 2 types of Diabetes Indipidus?
Central Diabetes insipidus
- lack of release of ADH
Nephorgenic Diabetes insipidus
-failure of kidney to respone normally
What can cause Nephogenic Diabetes insipidus?
infection
drug (high doses of lithium)
inherited diseases
ETOH
What can cause Central Diabetes insipidus
brain damage
trauma
storke
drugs
ETOH (reduce the amount of ADH release from the posterior pituitary gland)
What is the half life of ADH, and why?
20mins, which allows us to rapidly adjust to changing positions
What stimulates the increase in the thirst controllers?
-increase in plasma osmolarity
-decrease blood volume
-decrease blood pressure
-increase Angiotensin II
-Dryness of mouth
-decrease of ADH
What stimulates the decreases in the thirst controllers ?
-decrease in plasma osmolarity
-increase blood volume
-increase blood pressure
-decrease angiotensin II
gastric distention
What are the 2 hormones responsible for thirst control?
ADH
Angiotensin II - something must be driving it
How do a lot of gastric distention affects the thirst controllers?
decrease thrist
Craving to eat salty food is due to a ________ in the thirst control.
Which hormone is affected
increase
Angiotensin II
What cause a decrease in ADH release?
-decrease osmolarity
- increase in blood volume
- increase in blood pressure
-Drugs:
-ETOH
What cause an increase in ADH release?
-increase plasma osmolarity
-decrease blood volume
-decrease blood pressure
-nausea
-hypoxia
-Drugs:
Morphine (not strong)
Nicotine
Cyclophosphamide
Describe how potassium homeostatsis is maintain?
- increase in potassium intake
- increase in potassium concentration
- increase in aldosterone
- increase in potassium secretion out the CCD in the princple cell
- potassium secretion
What is the hormone that affect the potassium plasma concentration
Aldosterone
What will happen if we use aldosterone antagonist or a Na channel blocker
we would have swings in our potassium concentration in the body
True of false, overall in the past we had a large sodium intake
True
Lower potassium diet = _____ potassium secretion
low
What is the disease that is due to an over active adrenal gland, causing excess amount of aldosterone
conn’s disease
What are the hormones that the kidney alternates to maintain balance
some ADH, Angio II and aldosterone
High potassium diet = _______ aldosterone
high
Problems with high Aldosterone
long term decrease production in potassium
What is the disease of lack of adrenal gland function
Addison’s
what affects would addison have on potassium levels
-sustained elevation potassium levels
-acid/ base inbalance
what drug can be given to treat Addison
-potassium sparing diuretic
-non - potassium sparing diuretic
What are ways in handling: sodium Connection?
- increase in sodium intake
- increase in GFR
- decrease reabsorption of Na in proximal tubular will have an effect of increasing Na in distal tubular flow
- decrease Aldosterone and increasing distal tubular flow leads to unchange K excretion
True or false, Blocking aldosterone system or Angio II does not have that much affect on the sodium concentration
True
What does a healthy kidney do in regards to small amount of changes regarding the arteriole blood pressure ?
any increase in pressure will be brought back down by the kidneys,
any decrease pressures long term should be corrected by the kidneys with fluids or electrolytes
True or False, in an acute setting increase BP will increase urine output
True
What does it say about our kidneys: If we have different pressures or blood pressure is sensitive to salt intake.
something is wrong with the kidneys
what is salt induce HTN?
a salt induce increase in blood pressure
it is reversible
depends on the salt inake
What is central HTN?
set point that is a higher number
- reason why is likely kidney problem trying to determine what the actually BP is due to some type of obstruction between blood vessels of the kidney and the heart
-if it is measuring blood pressure on the other side of the obstruction it is going to be low
- kidney will hang on to volume and electrolytes until it thens that the BP is higher
What would cause the kidney to think that the BP was low in central HTN and what hormones are affected?
A stanatic blood vessels
increase in renin
increase in Ang II
What causes HTN
Something at the kidney
True or False, We remove a portion of our ECF when treating HTN with diuresis?
True
How much volume is in the ECF?
14L
How much volume in the ICF?
28L
What affects does the diuretic has on the urine output and ECF on the first day
large urine output
ECF volume is reduce
reduce ECF volume = _________ Plasma volume
reducing
What happens after a couple of days of diurectic thearpy ?
the Patient return to normal with a little less ECF
How do you determine if the diuresis is effective
looking at the BP
If the diuretic is not effective on decreasing the BP what other ways can you improve decreasing BP?
increase dose of diuretic or add more medication
What would happen to a healthy person that drinks a liter of pure water?
blood osmolarity will drop
- water is reabsorb in the small intestine
- small change in the blood osmolarity will cause a decrease in the ADH being release
- urine output increase
What happen to the amount of solutes that we get rid of after drinking pure water?
solute excretion rate does not increase with the water excretion rate, because ADH
What will happen once our body diuresis the water?
it goes back to homeostasis
Renal drugs: Antihypertenisve
Mannitol
- osmotic diuretic
- if it gets filitered into the proximal tubule but not reaborbed
- less osmosis happening
- increasing the fluid in the tubules
Renal drugs: Antihypertenisve
Acetazolamide
- Carbonic Anydrase inhibtor
- interfers with the sodium reasborption that happen
- as we are secreting protons out the NHE pump
- increasing urine output
Renal drugs: Antihypertenisve
ARB’s
- blocks Angiotenins type 2 receptors
Renal drugs: Antihypertenisve
ACEi’s
- reduce the formation of Ang I to Ang II
Renal drugs: Antihypertenisve
K+ Sparing Diuretics
-Anything that interfers with role of aldosertone
-anything that increase the sodiem deliver to the distal tubules
Renal drugs: Antihypertenisve
Renal aterial stenosis
- something that blocks the renal Ango II system
Renal drugs: Antihypertenisve
Loop Diuretics
-powerful diuretic
Renal drugs: Antihypertenisve
Thiazide Diuretics
- they are able to mess with the calicum homostatis
Renal drugs: Antihypertenisve
CCB’s
- Anything that relaxes blood vessles increase renal blood flow, increase UOP
Renal drugs: Antihypertenisve
No Donors
Anything that relaxes blood vessles increase renal blood flow, increasing UOP
Renal drugs: Antihypertenisve
Catecholamine Anatagonist
- Example: beta blocker
-dilates the afferent ateriaoles, which increase renal blood flow and GFR = increasing UOP
MAP, renal blood flow
what outcomes would you see in a disease kidney and normal kidney when given a vasopressor?
- low purfuse kidney due to disease (Chronic low)
- given a pressure will increase purfusion to the kidney ( increasing UOP)
- vasocontriction in the other vessels is what is improving renal blood flow not so much the Afferent arterioles
-giving a pressue to a normal BP you will not see alot of UOP
Which section of the nephrons is less well autoregulated, is most sensitive to the changes in blood flow, and the first to go in kidney damage?
M. Nephrons
True or false, Not having a well manage autoreulation is a key component in the kindey function?
True
-allows us to manage how concetated our renal interstital sapce is
-what kind of change will expect to see in GFR and UOP when we have increase in BP
Which nephons is well autoregulated,
C. Nephrons
How do diabetes affect the nephrons?
excess sugars to bind to everything
causing the immune to destroy stuff
causeing inflammtion
how do diabetes affect the nephron filitration?
filitration change due to uncontrol blood sugar
Where is glucose reasbored with what electroylete
Glucose is reabsorbed in the proximal tubule
with sodium
True or false, If we have more glucose reasborbed we will have more sodium reasorbed
True , due to the 2nd set of transporters
True or false, If more sodium is reabsorbed at the proximal tubules it will affect the concentation at the distial tubules
True
Descibe the pathway that takes place at the Macula Densa with low NaCl due to DM?
- Macula densa senses a decrease in NaCl
- increasing Renin realse
2a. incresing Ang II - increasing Efferent arteriolar resistance and decreaseing afferent arteriolat resistance
- increasing GFR (125ml/min)
What are the 2 problems with DM that cause kidney damage
- inflammatory process
- over worked
Why is a high protein diet has smiliar affects like DM dealing with na
- proteins breaks down to amino acids
- amino acids are co- reabsorb with sodium like high glucose
Postitive feed back cycle
Describe the pathway of renal disease/ failure as describe in lecture
- Primary kidney disease
- decrease in the nephron number
3a. Hypertrophy and vasodilation of survivng nephons
3b. increase in arterial pressures - increase in the Glomerular pressures and or filtration
- Glomerular scierosis
What is the classification of chronic renal failure
< 20 -5% GFR
What is the classification of renal insufficiency
- 50 - 20%
What is the classification of End - Stage Renal Disease (ESRD):
< 5%
At what age do you start loosing nephorns if you are healthy
40 year old
What are 4 thing that must be restricted for a person that is in renalfailure?
Na
Volume
K
Proteins
How do NSAIDs affects the renal function?
- reduce prostoglandins that is need for kidney function
What are some of the problems are you expected to see with renal failure?
Hypernatremia
Hypervolemia
Hyperkalemia
Hypertension
Hypocalcemia
Uremia (Azotemia)
Acidosis
Anemeia
Hyperphosphatemia
Body Fluid Compartments, 70kg
What is the total amount of fluid found in the body
what is the amount in the excellular
what is the amount in the intracellular
amount of fluid 42L
1/3 - ECF (14L)
2/3 - ICF (28L)
Body Fluid Compartments, 70kg
What is the osmolatity between the 2 comparments?
How do is the osmolarity maintain
300 mOsm/L
water will move across the permable membrane to maintain the balance ?
Body Fluid Compartments, 70kg
True or False: Sodium, and Potassium move freely across the cell wall like water
False, Sodium,and Potassium do not move freely across the cell wall
Body Fluid Compartments, 70kg
What would happen to the compartments if we gave an Isotonic solution to a patient?
What is an example of a isotonic solution?
a fluid is similar to the body’s normal balance
-0.9 NaCl
- adding salt and water to the blood should stay in the ECF
Body Fluid Compartments, 70kg
What would happen to the compartments if we give a hypertonic solution to a patient?
What is an example of a hypertonic solution?
a fluid that is a little over the body’s normal balance
3% NaCl
-adding extra salt (disproportional amount) and water to ECF
-increasing the osmolarity of the ECF fluid compartment (making it more salty)
-movement of water form ICF to correct the increase of the salt in the ECF (increasing the ECF volume)
-water shift making the volume balance in each compartment
ECF volume increase
ICF volume decrease
Osmolarity increase
Body Fluid Compartments, 70kg
What would happen to the compartments if we give a hypotonic solution to a patient?
What is an example of a hypotonic solution?
a fluid that is little over the body’s normal balance
- 0.45 NaCl
- adding small amount of salt ( Half the amount of 0.9) and water
- lowering the osmolarity
- shifting water from ECF to the ICF
ICF volume increase
ECF volume decrease
Overally osmolarity of the system to be lower
What is a concern with hyponatremia?
increasing intercranial pressures
What are the tubular Substance Handling
Glucose (g/day)
Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed
Amount Filtered - 180
Amount Reabsorbed -180
% of filtered load Reabsorbed -100%
What are the tubular Substance Handling
Bicarbonate (mEq/day)
Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed
Amount Filtered - 4320
Amount Reabsorbed - 4318
% of filtered load Reabsorbed - >99.9%
What are the tubular Substance Handling
Sodium (mEq/day)
Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed
Amount Filtered - 25,560
Amount Reabsorbed - 25,410
% of filtered load Reabsorbed - 99.4 %
Amount excreatd 150 (increase in intake will excreate more)
What are the tubular Substance Handling
Cloride (mEq/day)
Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed
Amount Filtered - 19,440
Amount Reabsorbed -19260
% of filtered load Reabsorbed -99.1%
for the amount in the blood, we excreate a significant amount
What are the tubular Substance Handling
Potassium (mEq/ day)
Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed
Amount Filtered -756
Amount Reabsorbed- 664
% of filtered load Reabsorbed - 87.8%
get rid of most of the potassium by excreation in the princple cells
What are the tubular Substance Handling
Urea (g/day)
Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed
Amount Filtered - 46.8
Amount Reabsorbed -23.
% of filtered load Reabsorbed - 50%
recycle itself within the kidney to concentrated the intersitium
What are the tubular Substance Handling
Creatinine( g/day)
Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed
Amount Filtered - 1.8
Amount Reabsorbed -0
% of filtered load Reabsorbed -0
Sodium cannot move across the capillaries free at what barrier in the body?
Brain
What problem would concern a CRNA with a patient that is taking ARB’s?
response to the body during hemorrhage
blood loss
low blood presue
RAAS place a big role on the body ability to hang on to fluids, electro., and vasocontricts.
What would happen to a blood pressure after a hemorrhage with an intact RAAS?
They are able to maintain a moderate BP with the blood loss
What would happen to a blood pressure after a hemorrhage without RAAS?
They are not able to maintain a moderate BP with the blood loss
patient is on ARB’s
What life style choice would affect the RAAS?
poor diet, high in Na
suppressing the RAAS system
by suppressing renin release at the MD at the distial tubules
potato chips
