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Physiology > Acid/Base & Renal System > Flashcards

Acid/Base & Renal System Flashcards

1
Q

give the normal pH, acidosis pH, and alkalosis pH

A

normal 7.4
acidosis < 7.4
alkalosis > 7.4

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2
Q

what are the three types of buffers

A
  1. bicarbonate
  2. phosphate
  3. ammonia
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3
Q

what are the 3 ways to regulate acid/base? which one is the fastest? slowest?

A
  1. buffers (fastest)
  2. respiratory
  3. kidney (slowest)
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4
Q

what is the reaction for bicarbonate? what enzyme does it use? what does it act as? what does it buffer?

A

CO2 + H2O <–> H2CO3 <–> H + HCO3
carbonic anhydrase
act as weak acid or weak base
buffers both acid/bases and the blood

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5
Q

what are H ions in the RBC buffered by

A

intracellular proteins and phosphate

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6
Q

how is bicarbonate transported outside of a RBC

A

it is exchanged with extracellular Cl by Band 3 membrane transporter

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7
Q

where in the kidney does the majority of bicarbonate reabsorption occur

A

80% in proximal tubule
15% thick ascending limb
5% collecting duct

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8
Q

what does phosphate do as a buffer

A

buffers acid and bases
bone mineralization
usually an intracellular fluid buffer

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9
Q

where is ammonia made? excreted? what does it do?
when does ammonia excretion increase?

A

made in proximal tubule
excreted in distal tubule
allows kidney to expel acid during acidosis
when pH falls (more acidic)

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10
Q

how is ammonia produced?

A
  1. glutamine metabolized to ammonium by phosphate dependent glutaminase (PDG)
  2. ammonium decomposes into NH3 and H so NH3 can diffuse into proximal tubule or NH4+ can be exchanged with Na
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11
Q

how does bicarbonate get reabsorbed in the proximal tubule

A
  1. lumen (filtrate) –> cell via diffusion of CO2
  2. cell –> blood via cotransport with Na
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12
Q

how does bicarbonate get reabsorbed in the collecting duct

A

type A cells use AE1 to exchange HCO3 for Cl
type B cells use AE4 to exchange HCO3 for Na

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13
Q

what is the importance for the anion gap?
what does it consist of?
what is it useful for diagnosing?

A
  • unmeasured anions to make cations = anions
  • contains albumin, phosphate, sulfate, and other anions
  • metabolic acidosis (either titrational or loss of HCO3)
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14
Q

describe the respiratory and metabolic origin for acidosis

A

respiratory: increase CO2
metabolic: decrease HCO3

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15
Q

describe the respiratory and metabolic origin for alkalosis

A

respiratory: decreased CO2
metabolic: increase HCO3

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16
Q

what is the concentration of Na and K extracellularly vs intracellularly

A

intracellular Na: 15mM
extracellular Na: 140 mM
intracellular K: 140 mM
extracellular K: 4mM

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17
Q

what is edema? how does it develop?

A

edema: excess fluid in extracellular compartment of interstitial space/body tissues
1. increased capillary hydrostatic pressure
2. decreased plasma oncotic pressure/plasma protein
3. decreased lymphatic return
4. inflammation/increased capillary permeability

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18
Q

what are the different body fluid compartments and their osmolarity and primary electrolyte

A

all 290mOsm
extracellular fluid 40% Na, Cl
1. plasma 7%
2. transcellular 2-3%
3. interstitial fluid 12%
intracellular 60% K, PO4, proteins

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19
Q

describe relative changes in size of intracellular and extracellular fluid compartments after IV infusion of isotonic, hypertonic, hypotonic saline

A

isotonic (300mOsm)
IC volume: none
EC volume: increased
hypertonic (500mOsm)
IC volume: decrease
EC volume: increase
hypotonic (100 mOsm)
IC volume: increase
EC volume: increase

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20
Q

why would an animal with hypoproteinemia have a reduction in plasma volume in spite of normal or increased ECF volume?

A

hypoproteinemia: loss of plasma proteins (decreased plasma ontic pressure)
- plasma volume would decrease because fluid would be leaking into interstitial space which could lead to edema

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21
Q

what are the functions of the kidney

A
  1. filter toxic substances
  2. regulate water, electrolytes, and acid-base
  3. endocrine organ (erythropoiesis, calcium homeostasis, and blood pressure)
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22
Q

how does renal control acid-base

A
  1. retains/eliminates HCO3
  2. secretes H+
  3. secretes NH3 with H+ as NH4+
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23
Q

how much cardiac output do the kidneys receive

A

20% CO

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24
Q

contrast the two types of nephrons

which one is the majority

what does it depend on

A
  1. cortical nephrons ( loop of henle in cortex)
  2. juxtamedullary (loop of henle in medulla); capillar termed vasa recta
    majority cortical
    species dependent
25
Q

what are the fundamental processes of the kidney

A
  1. filtration
  2. reabsorption
  3. secretion
26
Q

what is the glomerulus? what types of cells does it have and their function?

A

capillary between two arterioles with high pressure
1. capillary endothelium fenestrations - filtration
2. podocytes - foot processes for filtration
3. (-) charged basement membrane - repels (-) charged proteins

27
Q

what are the 4 factors that determine net filtration

A
  1. hydrostatic capillary pressure Pc
  2. oncotic capillary pressure Ppi
  3. hydrostatic bowman space pressure Pbs
  4. oncotic bowman space pressure Ppibs
28
Q

what is the equation for net filtration

A

net filtration = Pc - Ppi - Pbs

29
Q

what are the determinants of GFR

A
  1. filtration membrane permeability
  2. surface area availability
  3. net filtration pressure
30
Q

what controls GFR

A
  1. renal blood flow (e.g. increase blood pressure increase GFR)
  2. arteriole resistance
    a. constriction of afferent arteriole decreases GFR
    b. constriction of efferent arteriole increases GFR but eventually decreases
31
Q

what are the 4 types of regulation of GFR

A
  1. autoregulation
  2. renin-angiotensin-aldosterone system
  3. sympathetic NS
  4. atrial natriuretic peptides
32
Q

what is the myogenic effect

A

afferent arteriole responding to stretch by constricting to decrease GFR

33
Q

what is tubuloglomerular feedback

A
  1. macula densa sense increase osmolarity in tubules and release vasoconstrictors on afferent arteriole to decrease GFR
34
Q

describe the renin-angiotensin aldosterone system

A

in response to low BP/BV
1. angiotensinogen (liver) –> angiotensin 1 via renin
2. ANG1 –> ANG2 via ACE
3. ANG2
a. system vasoconstriction to increase BP
b. constrict afferent/efferent arteriole to decrease GFR
c. increase aldosterone to increase Na/water reabsorption to increase BV

35
Q

how does the sympathetic NS regulate GFR

A

release of NE to constrict afferent/efferent arterioles to decrease GFR

36
Q

how do ANP regulate GFR

A

atrial myocytes respond to stretch (increase BV/BP) by releasing ANP
ANP will dilate afferent arteriole/ constrict efferent arteriole to increase GFR

37
Q

what is renal clearance and its formula

A

renal clearance: rate of disappearance from plasma and appearance in urine

clearance = excretion rate (mg/min) / plasma conc. (mg/ml)

38
Q

what things are freely filtered

A

inulin, creatinine, amino acids, glucose, and water

39
Q

why do serum creatinine and BUN increase with significant reduction in glomerular filtration rate?

A

amount excreted doesn’t change so if there is an decrease in GFR the body needs to increase the amount in the blood to get the same amount secreted

40
Q

give an example of paracellular transport and transcellular transport

A

paracellular: between cells, like Na/K/Ca/Mg in thick ascending limb
transcellular: passes through both membranes of cell, like bicarbonate transport

41
Q

why is glucosuria seen in animals with uncontrolled diabetes mellitus? how does this contribute to polyuria?

A

glucosuria: glucose in the urine; seen in animals with uncontrolled diabetes because body is having to excrete excess glucose that is not reabsorbed
polyuria: frequent urination because excess glucose increase filtrate osmolarity –> more water in filtrate –> increased urination

42
Q

what is reabsorbed in the proximal tubules

A

Na, Cl, HCO3, K, glucose, amino acids, water

43
Q

how is Na reabsorbed in the proximal tubule

how is Cl reabsorbed in proximal tubule

how is HCO3 reabsorbed in proximal tubule

A

Na/K ATPase Pump

Cl paracellular transport

Na co-transport

44
Q

what is secreted in the proximal tubules

A

H+, toxins/drugs (penicillin, morphine), organic acids and bases, creatine/bile acids

45
Q

what is the major force for reabsorption of Na, Cl, and water in the proximal tubule

A

Na/K ATPase Pump

46
Q

what is the loop of henle

A

countercurrent multiplier that establishes a hyperosmotic gradient for water reabsorption

47
Q

what is primarily occuring in the descending limb?
what type of transport?

A

reabsorption of water impermeable to ions)
passive

48
Q

what is the effect on volume and osmolarity in the proximal tubule

A

volume 70% decreased
osmolarity same 300mOsm (isotonic)

49
Q

what is primarily occurring in the thick ascending limb?
what type of transport?

A

reabsorption of Na,K, Cl
active - Na/K/2Cl transporter

50
Q

where and what is the target for loop diuretics?
what do they do?

A

Na/K/2Cl transporter in the thick ascending limb of LOH
loop diuretics: inhibit the transporter to prevent solute reabsorption to allow increase excretion of water

51
Q

what is primarily occurring in the distal tubule?
what type of transport?

A

reabsorption of Na via Na/Cl transporter
impermeable to water

52
Q

what is primarily occurring in the collecting duct?
what cells are located in this region?

A

water reabsorption (ADH/VP)
Na+ reabsorption (aldosterone)
K secretion (aldosterone)
principle cells & intercalated cells

53
Q

what is the function of principle cells

A

reabsorb Na and secrete K, controlled by aldosterone

54
Q

what is the function of intercalated cells (A and B)

A

type A during acidosis secrete H+
type B during alkalosis secrete HCO3

55
Q

where is urea reabsorbed?
secreted?
why is it a major contributor to the medullary gradient?
where does it come from?

A

reabsorbed in proximal tubule and collecting duct
secreted in thin ascending limb of loop of henle
drives water reabsorption
liver

56
Q

describe species differences regarding the loop of henle

A

long loop of henle in species that need a lot of water reabsorption (kangaroo rats) and short in animals with access to water (beavers)

57
Q

why were there a number of flies attracted to the urine of dogs that had their pancreas removed?

A

pancreas produces insulin, without insulin glucose levels cannot be lowered causing excess to be excreted in the urine making it “sweet”

58
Q

how does acetazolamide work?
how is it a diuretic?
does it lead to acidosis or alkalosis?

A

inhibits carbonic anhydrase = no bicarbonate reabsorption
leads to acidosis
diuretic because it leads to excess water excretion

Physiology (5 decks)

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