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Maddy - Renal II > Ca2+ > Flashcards

Ca2+ Flashcards

1
Q

what is the effect of hypoalbuminemia on Ca+

A

increases plasma calcium

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2
Q

what is the effect of hyperalbuminemia on Ca+

A

decreases plasma calcium

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3
Q

what happens to calcium in acidosis

A

more H+ binds to albumin to increase the pH so less calcium binds, leading to more free calcium in circulation

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4
Q

what happens to calcium in alkalosis

A

less H+ binds to albumin so more Ca2+ binds, leading to less free Ca2+ in the plasma

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5
Q

why does acute alkalosis mimick hypocalcemia

A

in acute alkalosis, less H+ is bound to albumin to decrease the pH, so more calcium is bound instead leading to less free Ca2+ in the blood which mimicks hypocalcemia, even if there is actually enough Ca2+ in the body

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6
Q

effect of calcitriol (vitamin D) on bone

A

works with PTH to resorb bone and pull Ca2+ from the bone into the blood, increasing plasma Ca2+ levels

bone –> blood

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7
Q

effect of calcitriol in the intestines

A

increases Ca2+ absorption (increasing calcium plasma levels)

lumen of intestines –> blood

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8
Q

effect of calcitriol in the kidney

A

increases calcium reabsorption from the tubule into the blood

tubule –> blood

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9
Q

what receptor is used to resorb, absorb, and reabsorb Ca2+

A

VDR (vitamin D receptor)

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10
Q

effect of calcitonin on bone

A

inhibits osteoclastic mediated bone resorption by decreasing activity and # of osteoclasts
(decreases plasma Ca2+)

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11
Q

effect of calcitonin on kidney

A

promotes calcium excretion

decreases plasma Ca2+

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12
Q

what stimulates calcitonin

A

hypercalcemia

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13
Q

how is calcitonin used pharmacologically

A

osteoporosis
paget’s disease
hypercalcemia

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14
Q

what is the effect of calcitonin on the intestines

A

none

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15
Q

effect of PTH on bone

A

increases osteoclastic resorption

increases plasma Ca2+

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16
Q

effect of PTH on intestines

A

increases Ca2+ absorption indirectly via calcitriol production

17
Q

effect of PTH on kidney

  • on Ca2+
  • on Na+/H+
  • on bicarbonate reabsorption
A

increases Ca2+ reabsorption primarily in DCT

  • also decreases Na+/H+ antiporter
  • decreases bicarbonate reabsorption
18
Q

excess PTH can cause

A

hypercalcemia
hypophosphatemia
hypercholermic metabolic acidosis

19
Q

what senses calcium and how does it work

A

CaSR (calcium sensing receptor)

  • on basolateral membrane
  • inhibits reabsorption of Ca2+ when hypercalcemic by inhibiting the NKCC2 on the apical membrane
20
Q

how to calculate filtered load for calcium

A

FL = GFR x plasma concentration x 0.6

21
Q

where does most of calcium reabsorption take place

and how does it take place

A

proximal tubule 65-70%

  • passively
  • follows Na+ and H2O
  • primarily paracellularly
22
Q

how does Ca2+ get reabsorbed in the thick ascending limb

A

paracellularly from the lumen positive voltage gradient

- stimulated by ADH

23
Q

how does Ca2+ get reabsorbed in the distal tubule

A

8%

  • active transport from the lumen negative voltage gradient
  • via TRPV5
24
Q

what prevents adverse reactions (like apoptosis) from occurring during excessive intracellular Ca2+ concentration

A

calbindin

25
Q

how does volume contraction affect Ca2+ reabsorption

A

increases it

it follows Na+

26
Q

how do loop diuretics affect Ca2+ reabsorption in the TAL

A

loop diuretics like furosemide inhibit the NaK2Cl transporter which blocks calcium reabsorption and increases calcium excretion
- thus can treat hypercalcemia

27
Q

in the DT, how does calcium cross the basolateral membrane and how does it cross the apical membrane

A

basolateral: Na+-Ca2+ exchanger (NCE)
apical: TRPV5

28
Q

what stimulates TRPV5

A

PTH

calcitriol (vitamin D)

29
Q

how do thiazide diuretics affect Ca2+ reabsorption and how do they treat kidney stones

A

they inhibit the Na+-Cl- transporter and increase Ca2+ reabsorption, reducing Ca2+ excretion in the urine
- used to treat kidney stones

30
Q

how does acidemia affect Ca2+ reabsorption

A

decreases reabsorption and increases excretion by inhibiting TRPV5

31
Q

how does alkalemia affect Ca2+ reabsorption

A

increases reabsorption and decreases excretion by stimulating TRPV5

32
Q

how does low ECV affect Ca2+ reabsorption

A

increases it (follows Na+)

Maddy - Renal II (6 decks)

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