Control of Plasma Volume Flashcards

1
Q

What fluid do you add to increase the ECF volume - explain why this works

A

Add isosmotic fluid

Isosmotic fluid will not penetrate into the ICF as it has the same osmolality as the plasma -> will only distribute itself amongst the ECF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is pressure natriuresis and pressure diuresis. What do they cause

A

Pressure natriuresis - increased Na excretion

Pressure diuresis - increased water excretion

They cause the ECF volume to decrease -> decrease BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the types of reabsportion and secretion

A

Paracellular - solutes go through gap junctions which are loose enough to allow solutes through

Transcellular - solutes travel through the cells lining the lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the functions of tight junctions

A

Prevent movement of ions out of the interstitium into the lumen

Maintain cell polarity by preventing movement of ion channels from the apical to basolateral membrane and vice versa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are aquaporins and what aquaporins are found where

A

AQP - protein channels that allow the movement of water into and out of cells

AQP1 - found in PCT and descending loop of Henle. Is always expressed

AQP2,3,4 - found in the collecting duct. Can be recruited if more water needs to absorbed -> can add or remove these AQP depending on ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is Na reabsorbed in the nephron - name some of the channels/tranporters used and what transporter drives Na reabsorption

A

Na is reabsorbed transcellulary and is driven by basolateral N-K-ATPase which creates a concentration gradient in the cell

Transporters:

  • Na-H antiporter
  • Na-glucose symporter
  • Na-AA co-transporter
  • NKCC2 symporter
  • NaCl symporter
  • ENaC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What two presures drive water movement from the interstitium into the capillaries

A

Hydrostatic pressure - generated by water in the interstitium. Hydrostatic pressure is high -> drives water into capillaries

Oncotic pressure - generated by proteins in capillaries and assists the movement of water into capillaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the movement of solutes from the PCT (not Na)

A
  1. Glucose, AA and lactate are removed first from the PCT
  2. Bicarbonate removed next
  3. Then phosphate removed
  4. Finally Cl is removed down its concentration gradient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What channels and structures are found in the S1 part of the PCT

A

Basolateral N-K-ATPase

Na-H exchanger

Na-glucose/AA/phosphate/carboxylic acid co-transporters

Aquaporin 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What channels and structures are found in S2-3 parts of the PCT

A

Basolateral N-K-ATPase

Na-H exchanger

Aquaporins

Cl transport is via transcellular and paracellular reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the structure of the descending limb of the loop of Henle

A

Descending limb is formed of squamous epithelium

Has lots of aquaporins -> very permeable to water

Few transporters -> no reabsorption of Na -> concentrated filtrate forms as water leaves but solutes don’t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the structure of the ascending limb of the loop of Henle

A

Ascending limb is cuboidal epithelium

Split into thick and thin AL with thick AL having lots of transporters to move ions from the filtrate into the capillaires

Cells in thick AL have lots of mitochondria for active transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the transporters found in the thick AL

A

NKCC2 transporters

N-K-ATPase

ROMK - allows NKCC2 transporters to continue to function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does Na reabsorption in the thick and thin AL differ

A

Na reabsorption in the thin AL is passive as water absorption in DL creates gradient for passive Na reabsorption

Na reabsorption in thick AL is active - requires transporters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the differences between DCT1 and DCT2

A

DCT1 only has NCC transporters on its apical membrane

DCT 2 has both NCC transporters and ENaC on its apical membrane

Greater amount of Cl reabsorbed in DCT2 as the ENaC are not electroneutral and cause the filtrate to become negatively charged -> drives paracellular Cl reuptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What diuretic blocks NCC transporters and what diuretic blocks ENaC

A

Thiazide blocks NCC

Amiloride blocks ENaC

17
Q

What two cell types are found in the collecting duct

A

Principle cells

Intercalated cells - type A and type B

18
Q

What is the function of principle cells in the collecting duct

A

Reabsorb Na via ENaC

This drives Cl uptake as it causes the lumen to become negatively charged

19
Q

What are the functions of intercalated cells

A

Type A - secretes H+ -> acid secreting. Aids in regulating acidity and alkalinity of plasma. Express H+-ATPase and H-K-ATPase

Type B - secretes HCO3- -> bicarbonate secreting -> regulates alkalinity. Express Cl-HCO3--ATPase

20
Q

What physiological mechanisms occur during hypotension to increase the BP to normal

A

Stroke volume is increased via dopamine - increases contractility of the heart

Vasoconstriction of arterioles in the body increases the TPR

RAAS

SNS stimulates mechanisms to increase the BP

ADH release - inserts AQP into the membranes of DCT and collecting ducts to increase water retention

21
Q

What does the SNS stimulate during hypotension

A

Increased SV

Renin release/RAAS activation

Na reabsorption

Vasoconstriction

Vascular hypertrophy

22
Q

What are the effects of the RAAS system

A

Increase SNS activity

Tubular Na, Cl reabsorption, K excretion and water retention

Aldosterone secretion

Arteriolar vasoconstriction

ADH secretion

23
Q

What does aldosterone stimulate

A

Upregulates N-K-ATPase in DCT cells

Upregulates Na channels in CD and colon

Stimulates K secretion into tubule

Stimulates H+ secretion into CD

Upregulates Na/Cl co-transporters in DCT

Stimulates Na and water retention in the gut, salivary and sweat glands

24
Q

How does stimulation of RAAS result in generalised oedema - what loop is created

A

Positive feedback loop is created

Renin release is stimulated by decreased renal perfusion

Angiotensin II causes increased SNS activity

Increased SNS activity cuases increased vasoconstriction resulting in decreased renal perfusion

Decreased renal perfusion results in more renin release

25
Q

What is the pressure-natriuresis curve

A

Curve that shows the threshold pressure required for Na excretion

In hypertension, baroreceptors reset themselves to a higher pressure -> need higher BP to excrete same amount of Na

26
Q

Name some causes of hypertension

A

Liver disease

Underlying hypertension

Fear - white coat effect

Kidney disease

CVS disease

Pain

Hyperaldosteronism

Sleep deprivation

Fluid overload

Diet - high salt diet

Drug effect