Ch.1 Homeostasis, Fluid Vol, Disease Flashcards
Renal Fxn: Homeostasis…What are the two waste products most frequently checked for renal function?
1.BUN-Blood Urea Nitrogen 2.Creatinine
Renal Fxn: Homeostasis…What are the 6 electrolytes that the body regulates?
Na+, K+, Cl-, Ca2+, Mg2+, PO42-
Renal Fxn: Homeostasis…What two ions regulate blood pH?
H+ and HCO3-
SPRING 2015 WELCOME BACK…WHAT ARE THE 8 functions of the Kidney to maintain homeostasis????
1.Excretion of waste 2.Regulate WATER/Electrolyte balance 3. pH 4. ARTERIAL Blood Pressure 5.Erethrocyte Production 6.Vitamin D 7.Gluconeogenesis 8. Peptide Hormone Clearance
What are the two ways in which the kidney regulates arterial bp?
- Regulate Na+ balance 2.Renin-Angiotensin-Aldosterone System
What is the hormone used by the kidney to initiated erythrocyte synthesis? What kicks this system into gear?
Lack of O2 to the kidney stimulates ERYTHROPOIETIN synthesis
Where are the 2 sites of EPO synthesis?
1.PeriTubular Fibroblasts 2.Endothelial Cells
What is the MAIN transcription factor in the regulation mech for EPO synthesis???
HIF-1 (HYPOXIA-inducible factor-1) tough name huh, since low oxygen induces it :)
What is the first step in a low O2 state that catalyzes EPO synthesis?
HIF alpha and HIF beta DIMERIZE
How is the Kidney involved in activation of Vit-D? WHERE does this happen?
Kidney does the 2nd Hydroxylation….Happens in the Proximal tubule cells
Where does GlucoNeoGenic activity happen in the kidney?
Proximal Tubule cells!
What are the TWO most urgent consequences of impaired renal function? (what are their levels?)
Metabolic Acidosis (>7.4pH) and HyperKalemia (>4.0mEg/L)
What is the term for accumulation of JUST Creatinine and Blood Urea Nitrogen?
AZ-o-temia
What happens when the Glomerulus becomes leaky and a plasma protein imbalance occurs?
Edema…lose plasma proteins=loss of water to the ECF (interstitial space)
BOOM: WHAT ARE THE 8 consequences of IMPAIRED RENAL FUNCTION?
1.Metabolic Acidosis 2.Hyperkalemia 3.Uremic Toxicity 4.Sodium/Water Imbalance 5.Ca2+/PO3- Imbalance 6.Plasma Protein Imbalance 7.Anemia 8.Depressed Immune System (WHAAA???)
Why does impaired renal function affect the immune system?
Immune system is like an organ and needs a CONSTANT environment free of uremia
What % of Kidney function can still maintain body fluid homeostasis?
20% kidney function can still maintain homeostasis!! HOLY COW!!!
What % of adults in the US experience some form of kidney disease? What are the two types? Which one is reversible, which one is irreversible?
10%..Acute-Reversable….Chronic-Irreversible
What are the three types of acute renal failure (ARF)?
1.Pre-Renal ARF 2.Intra-Renal ARF 3.Post-Renal ARF
What is the cause of Pre-Renal ARF?
Low blood flow to the kidneys=low GFR
What is the cause of Intra-Renal ARF?
Acute Tubular Necrosis (ATN) (the nephron tube is damaged by Ischemia (lack of oxygen)/toxin-induced (rx drugs)
What is the cause of Post-Renal ARF?
urinary tract obstruction
What are the three main causes of Chronic Renal Failure?
1.Diabetes 2.Hypertension 3.Glomerulonephritis
BELOW what % of renal function are we considered in End-stage renal disease? What is needed?
GFR <10%…Kidney Transplant needed
What are the two types of DIALYSIS? What is the difference?
Hemo (uses an artificial membrane) and Perotineal (uses your own body’s capillaries)
Hemodialysis: What are two items with usually [HIGH] in renal failure that are then combated with in a [LOW] in the dialysate?
High [Creatinine] and High [K+] in the blood….so low in the dialysate
Hemodialysis: What is the [HCO3] in End-Stage Renal Disease (ESRD)?
[HCO3] is LOW in renal diseased blood (we lose our buffer capability) so dialysate [HCO3] is high
Hemodialysis: Is there a high or a low water pressure in the blood?
High water pressure (kidneys can’t move water out of body) so the dialysate has low water pressure
How often is hemodialysis? How long does it last?
3x per week…lasts 3-4hours
How often does fluid have to be exchanged in Chronic Ambulatory Peritoneal Dialysis (CAPD)?
4-6x / day
About how many times per day do the kidneys process the ENTIRE blood plasma?? (thus preventing the dialysis ‘oscillation’)
FREAKING 60X/day!!!
What are the three UNITs we will be talking about for items in the plasma?
1.mEq 2.mmol 3.mg
What are the units for a molar solution?
g/L SO 180g glucose/L=1mol/L a 1 molar solution or 180mg/L=1mM solution
What does a 1 mM solution of NaCl consist of in terms of Equivalance?
1mM NaCl solution = 1 mEq/L of Na+ and 1 mEq/L of Cl-
What % body weight is water in the avg male and female?
male=60%….female=50% (due to the fat and muscle differences
How much of total body water is intracellular?
2/3 (side note: remember ~1/2 of blood is intracellular)
How much of total body water is extracellular?
1/3
What are the 3 sub-categories of ECF?
1.Interstitial Fluid (75%) 2.Plasma (25%) 3. Transcellular fluid
What is the PRIMARY Cation of the ExtraCellularFluid????
Na+ (thanks to Na/K pump)
What is the PRIMARY Cation of the IntraCellularFluid?
K+ (thanks to Na/K pump)
What are the two PRIMARY anions in ECF?
Cl- and HCO3-
What are the two primary anions in ICF?
organic phosphates and proteins
What is the ONLY difference between plasma and interstitial fluid?
There is more PROTEIN and Ca2+/Mg2+ in PLASMA then in the interstitial fluid.
What is the value for BOTH ECF and ICF osmolality?
290 mOsm/L
What are the three ingredients used to find plasma osmolality?
Sodium, Glucose, and BUN (plug them into the formula and BOOM=290mOsm/L
How do you MEASURE the volume of body fluids? Whats the formula???
The Dilution principle! Vol=amount of X added/[ ] @ Eq
When DIRECTLY measuring volume of body fluids, what other volume should be included?
Plasma Volume (the ‘marker’ you use is usually injected into the plasma)
What body fluid volume are these ‘markers’ used for: Radiolabeled Sodium, Sucrose, Mannitol, and Inulin?
Extracellular Volume
What body fluid volume are these ‘markers’ used for: Iodinated albumin and T-1824 (Evans Blue Dye)?
Plasma Volume
What body fluid volume are these ‘markers’ used for: Titrated Water, Heavy Water (radioactive), AntiPyrine?
Total Body Water
What is the key when measuring a body fluid volume?
USE THE SAME MARKER for pre and post treatment for a consistent readout!!!
Since there is no way to taking a sample fluid….how do you measure Interstitial Volume?
Interstitial Volume=ECF Vol-Plasma Vol
Since there is no way to taking a sample fluid….how do you measure Intracellular Volume?
Intracellular Volume=Total Body Water-Extracellular Fluid Volume<–(interstitial + plasma)
What is the movement of H2O across cell membranes? What is the DRIVING FORCE for movement of H2O across cell membranes?
Osmosis…..driving force=Osmotic Pressure
In our osmotic pressure experiment…What is the osmotic pressure EQUAL and OPPOSITE to when we reach equilibrium?
The HYDROSTATIC pressure
Osmolarity is just an alternative expression of ________.
Osmotic Pressure (SO high osmolarity=high [solute]=high osmotic pressure) :)
What is the formula for Osmolarity?
Osmolarity= [ ] (in mmol/L) X # of particles/molecule EXAMPLE:150mmol/L NaCl solution–>osmolarity= 300mOsm/L ([150mmol/L] X 2 particles)
What is the difference between osmolaRity and osmolaLity? Which one is Temperature DEPENDENT?
osmolaRity= # of solute particles/L of solvent (volume) (((TEMPERATURE DEPENDENT–volume can increase with more heat )))….VS…..osmolaLity= # of solute particles / kg of solvent (temp independent) (kg doesn’t change with more or less heat)
What is the Osmolarity of CaCl2 if we have 150mmol/L CaCl2 solution?
Osmolarity CaCl2=150mmol/L X 3 particles = 450mOsm/L
When talking about Tonicity…Osmolality has a directly proportional relationship with what?
Osmolality directly proportional to [Solute]…Ergo–high intracellular [solute]=hypotonic solution=high intracellular Osmolality
What is the key with membrane permeability and tonicity???
We typically talk about tonicity with membranes that are IMPERMEABLE to solutes (just to water)
What is the tonicity of 290mmol/L of UREA? What happens to the Osmolality?
290mmol/L of UREA is a HYPOTONIC solution!!! since Urea is PERMEABLE to the cell membrane, Urea will flow IN and water will FOLLOW, causing the cell to swell. (Osmolality increases when Urea flows into the cell, remember Osmolality=[solute])
When looking at an ‘insult’ to the osmolality/volume are we following water movement or [solute]?
Shifts in osmolality are from WATER MOVEMENT ONLY!
What INITIALLY happens to osmolarity of the ECF when we drink a bunch of water?
Initially osmolarity of the ECF DECREASES (becomes less [solute]
