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RENAL PHYSIOLOGY > ECF Regulation 2 > Flashcards

ECF Regulation 2 Flashcards

1
Q

What promotes Na excretion?

A

ANP

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2
Q

What is the function of ANP?

A

Regulate Na excretion

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3
Q

Aldosterone promotes what?

A

Na+ reabsorption

K+ secretion

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4
Q

How does aldosterone increase weight?

A

Retention of water following ↑Na+

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5
Q

How does increased volume cause Na+ excretion?

A

↑Na+ = ↑water
↑water = ↑volume
↑volume triggers ANP from atrial cells
↑ANP = Natriuresis

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6
Q

Aldosterone acts where?

A

Distal tubule

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7
Q

What is Conn’s syndrome?

A

Primary hyperaldosteronism due to tumour of adrenal cortex

Too much ANP

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8
Q

How does Conn’s syndrome present?

A

Hypokalemia

NO hypernatraemia

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9
Q

ANP is secreted in response to what?

A

Expansion of ECF volume

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10
Q

What is the action of ANP?

A

Inhibit renin

Oppose actions of angiotensin II

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11
Q

What is the effect of ANP on the hypothalamus?

A

Reduced ADH release

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12
Q

What is the effect of ANP on the kidney?

A

Decreased renin
Increased GFR
(more salt and water excretion)

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13
Q

What is the effect of ANP on the adrenal cortex?

A

Less aldosterone

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14
Q

What is the effect of ANP on the medulla oblongata?

A

Decreased blood pressure

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15
Q

Why does excess glucose in the collecting duct cause diuresis?

A

Glucose in the tubule has an osmotic effect and H2O is retained

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16
Q

The osmotic effect in the proximal tubule has what effect on sodium?

A

Dilution - reducing the driving force of Na into the cell (the gradient)

17
Q

Why does excess glucose in the proximal tubule cause reduced Na reabsorption?

A

Main driver of reabsorption is the gradient, excess glucose means excess water which means ↓ [Na]

18
Q

How does reduced Na reabsorption effect glucose?

A

Na+ and Glucose share a symport

If Na+ isnt taken up, glucose isnt either

19
Q

How does uncontrolled diabetes effect the descending limb?

A

Excess glucose and Na+ in the descending loop exerts an osmotic effect - retaining H2D

Fluid in descending limb is not as concentrated

20
Q

How does uncontrolled diabetes effect the ascending limb?

A

Fluid arriving is less concentrated

NaCl pumps are gradient limited, so it stays in the tubule

21
Q

What is the effect of uncontrolled diabetes on the interstitium?

A

Similar to loop diuretic - loss of interstitial gradient

22
Q

In uncontrolled diabetes, what happens at the distal tubule?

A

Large volumes of NaCl and H2O are delivered

23
Q

Large volumes of NaCl and H2O in the distal tubule have what pathological effect?

A

Macula Densa detects high levels of NaCl, so it will inhibit secretion of renin

24
Q

What is the net effect of uncontrolled diabetes on the loop of henle?

A

Loss of interstitial gradient

Very little NaCl or H2O is reabsorbed

25
Q

What should the osmolarity of the distal tubule be?

A

100mOsM

26
Q

What does the Macula densa do when detecting a high rate of NaCl delivery?

A

Supress renin secretion

Leading to reduced Na+ reabsorption at distal tubules

27
Q

How much NaCl and H2O is reabsorbed at the proximal tubule?

A

65-75%

28
Q

How much NaCl and H2O is reabsorbed at the distal tubule/collecting duct?

A

15-20%

29
Q

How much NaCl and H2O is reabsorbed at the loop of Henle?

A

5-20%

30
Q

What is the most important factor controlling reabsorption of NaCl and H2O in the proximal tubule?

A

Oncotic pressure

31
Q

How does diabetes affect the collecting duct?

A

Abolishing the interstitial gradient means water no longer flows down that gradient into the vasa recta from the lumen of the collecting duct

32
Q

What sort of urine will be excreted in uncontrolled diabetes?

A

Large volume of nearly isotonic urine

33
Q

What will the net effect of large volumes of nearly isotonic urine being excreted be?

A

Decreased plasma volume

Severe salt and water depletion

34
Q

Uncontrolled DM can produce urine up to what volumes?

A

6-8L/day

35
Q

What is the cause of hyperglycaemic coma?

A

Inadequate brain perfusion due to hypotension

36
Q

What is the cause of hypoglycaemic coma?

A

Inadequate glucose for the brain

37
Q

Why does baroreceptor activation in uncontrolled diabetes not cause a reduction in diuresis?

A

↓baroreceptor = ↑ADH, but there is no interstitium gradient for water to follow

38
Q

Why is over-excretion of glucose not self-limiting in uncontrolled diabetes?

A

Liver - glycogenolysis/gluconeogenesis

39
Q

How do Loop diuretics cause K+ wasting?

A

Active transport mechanism on luminal surface is Na-K-2Cl-cotransporter
Blocking Na absorption also blocks K+ ion absorption

RENAL PHYSIOLOGY (10 decks)

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