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Renal Exam #2 > Etc. Part 1 > Flashcards

Etc. Part 1 Flashcards

1
Q

What us the first step in the counter-current exchange mechanism?

A

NaCl secretion into the interstitium from the ascending limb.

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2
Q

What happens if the rate of blood flow thru the vasa recta is too high?

A

Medullary washout. Dissipates gradient established by counter-current echange.

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3
Q

Why is urea recycling ADH dependent?

What is the effect if ADH is present?

A

It is used as a means to reabsorb water.

If ADH is present, urea is reabsorbed.

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4
Q

What channel does aldosterone act on?

A

ENaC. On luminal side.

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5
Q

Where are AQPs inserted?

A

Apical membrane of PCs.

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6
Q

What does aldosterone do to urine?

A

Concentrate it

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7
Q

What portion of the CD is always permeable to water?

What portion is under hormonal control?

A

CCD

MCD

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8
Q

Normal Osm?

Dehydrated Osm?

A

275-295 mOsm

>300 mOsm

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9
Q

CNDI is caused by:

A

Head injuries, congenital abnormalities, infections.

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10
Q

How is CNDI treated?

Where does it bind?

A

Desmopressin

V2 receptors in DCT and CD.

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11
Q

What further actvates Nephrogenic DI?

A

Li, tetracyclines

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12
Q

What is the fluid shift occurring in SIADH?

A

From ECF to ICF causing water intoxication.

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13
Q

What does SIADH to do Na+ levels?

A

Decreases Na+ as it produces highly concentrated urine

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14
Q

What segment is dilution depending on? Why?

A

TAL of LoH.
It is the only portion where solutes are reabsorbed w/o water. Uses NaKCC2 channel.
It is impermeable to water.

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15
Q

How does Hyponatremia develop?

A

Increased ADH in kidneys and decreased water excretion.

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16
Q

What are the stimuli for hyponatremia?

A

Nonosmotic ones.

Nausea, pain, drugs, exercise, etc.

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17
Q

How does hypernatremia develop?

A

Decreased fluid intake. Usually in elderly and accompanies vol. depletion.

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18
Q

4 main causes of polyuria

A

Increased fluid intake
Increased GFR
Increased solute output
Kidney doesn’t absorb water in DCT well.

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19
Q

Equation for free water clearance

A

= V - (Uosm - V)/Posm

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20
Q

ECV

A

Volume of ECF in arterial system actively perfusing tissues.

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21
Q

How much of ECF is the ECV?

A

5% of ECF and 20 % of plasma

Not measurable

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22
Q

CHF

A

Decreased ECV due to decreased CO.
Pts retain Na and water causing edema.
Pts add to ECF vol but do not change their ECV.

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23
Q

Intrarenal receptors activate:

A

RAAS

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24
Q

When Na+ is low, what hormone is activated? Via what receptors?

A

Aldosterone

Baroreceptors

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25
When water is low, what hormone is activated? Via what receptors?
ADH | Osmoreceptors
26
Effect of activating RAAS
Increased angiotensin and Na+ reabsorption along the nephron. Increased aldosterone. Activation of ADH
27
Effect of activating SNS
Decreased GFR Activated RAAS Increased NaCl reabsorption
28
Effect of activating ANP/BNP/Urodilatin
``` Increased GFR Inhibits RAAS Inhibits aldosterone Inhibits NaCl reabsorption Decreased ADH ```
29
3 Methods of secreting renin
SNS Perfusion pressure decreases Tubuloglomerular feedback
30
Where does fluid shift during hyponatremia?
ECF to ICF. Cells swell.
31
Role of epinephrine in K+ balance
Causes extrarenal cells to increase uptake of K+. | Causes renal cells to secrete more K+.
32
Role of insulin in K+ balance
Activates Na/K ATPase. | Leads to a decrease in K+ levels.
33
What can insulin and Glc treat?
Hyperkalemia
34
Role of aldosterone in K+ balance
Increased K+ secretion by kidney. | Increased K+ secretion into intestines and saliva.
35
B-catecholamine function
Same as insulin. | + Na/K ATPase
36
a-catecholamine function
- Na/K ATPase | Increase serum K+
37
What is the role of Na+ in the Pt in affecting K+ secretion in the DT?
Indirect. | The more Na+ reabsorbed here, the less that is available in the DT for K+ secretion.
38
How is K+ reabsorbed in the PT?
TEPD. Na leaves. Cl leaves. K+ leaves.
39
LoH recycling of K+ pathway
K+ screted into CCD K+ reabsorbed by MCD and enters the interstitium K+ secreted back into the late PT and DL of LoH.
40
What is the point of K+ recycling?
To excrete more K+ during times of increased K+ intake. | Large K+ inhibits NaKCC2, increasing the amount of Na being delivered to the DT. This increases secretion of K+.
41
Where is K+ secreted and/or reabsorbed?
Late DT and CCD due to body's needs.
42
What is the effect of flow rate on K+ secretion? | Why?
Increased tubular flow rate increases K+ secretion. | increases gradient for K+ and increases Na+ delivery to DT.
43
What happens when there is too much K+?
``` + Na/K ATPase Decreases leak of K+ into interstitium + synthesis of K+ channels on luminal membrane + aldosterone Increase flow rate ```
44
Acute alkalosis and K+ Na/K ATPase K+ diffusion into lumen Leads to:
+ Na/K ATPase + K+ diffusion into lumen Leads to: HYPOkalemia
45
Acute acidosis and K+ Na/K ATPase K+ diffusion into lumen Leads to:
- Na/K ATPase - K+ diffusion into lumen Leads to: HYPERkalemia
46
What happens to K+ in chronic acidosis? | How?
+ K+ secretion. | The Na/K ATPase is inhibited at the PT and RAAS is activated.
47
Ca levels during hypoalbuminemia
Increased
48
Ca levels during hyperalbuminemia
Decreased
49
Ca levels during acidosis
Increased plasma Ca as less is bound to albumin
50
Ca levels during alkalosis
Decreased plasma Ca as more is bound to albumin
51
Alkalosis can lead to:
Hypocalcemic tetany
52
Calcitriol function: | How?
Increase Ca and P. Bone: resorption GI: Increased absorption of Ca/P Kidney: Increased reabsorption of Ca/P
53
Calcitonin function: | How?
Decrease Ca and P. Bone: inhibitbone resorption. Kidneys: Increase Ca and P excretion.
54
PTH function: | How?
Increase Ca and decrease P. Bone: increase bone resorption GI: increase Ca absorption via calcitriol Kidneys: increase Ca reabsorption in DT and decrease P reabsorption in PT.
55
Where is the CaSR and what is its function?
Apical membrane of the TAL. | Inhibits NaKCC2, causing a dcrease in Na reabsorption and thus a decrease in Ca reabsorption.
56
How does Ca reabsorption occur in the PT? | How much occurs here?
Mostly paracellularly, but some transcellularly. Passive mainly. 65-70%
57
What 2 transported exist in the PT and aid in Ca movement across the BL membrane?
Ca ATPase | Ca/Na antiporter
58
How does volume expansion affect Ca levels?
Decreases Ca levels (increases secretion).
59
How does volume contraction affect Ca levels?
Increases Ca levels (increases reabsorption).
60
How is Ca reabsorbed in the TAL?
Via TEPD paracellularly
61
What is the effect of loop diuretics on Ca excretion?
Increases Na excretion, thus increases Ca excretion by lowering TEPD. Can treat hypercalcemia.
62
How is Ca reabsorbed in the DT?
Via active transport due to -TEPD. | Uses TRPV5 on luminal side, then NCE.
63
What is the effect of thiazide on Ca reabsorption?
Decreases Na reabsorption and increases Ca reabsorption.
64
Acidemia and Ca balance
Increases Ca excretion by inactivating TRPV5
65
Alkalemia and Ca balance
Decreases Ca excretion by activating TRPV5
66
Activated TRPV5 does what to Ca balance?
Causes Ca reabsorption
67
How is P reabsorbed in the early PT?
The Na-P symporter on luminal side. | P leaves luminal cell via unknown channel and Na leaves via Na/K ATPase
68
FGF-23
Released by bone in response of calcitriol, PTH, hyperohosphaturia to increase P excretion.
69
How is calcitriol activated (which enzyme)?
Renal 1a-hydroxylase
70
What is the effect of CaSR on Renal 1a-hydroxylase?
Inhibits it. | CaSR signals high Ca, so no need to produce calcitriol
71
1,25 (OH)2 D3 causes:
Increased P by intestinal reabsorption.
72
Insulin effect on P balance
Decreases P by moving it into cells to be excreted (same as K+)
73
What is the effect of PTH on Na-P and Na-H transporters in PT cells?
PTH inhibits them
74
Chronic acidosis does what to P excretion?
Increases P excretion
75
Chronic alkalosis does what to P exrcetion?
Decreases P excretion
76
Where is most Mg reabsorbed?
TAL (70%)
77
How is Mg reabsorbed at the PT?
Paracellularly/passively. | Follows Na and water.
78
How is Mg reabsorbed at TAL?
Depends on NaKCC2 and TEPD.
79
How is Mg reabsorbed at DT?
Crosses border via TRPM6 then the BL membrane via unknown channel.
80
Mg levels during vol. expansion? | Contraction?
E: decrease reabsorption C: increase reabsorption
81
Mg levels during acidosis? | Alkalosis?
Acidosis: decrease reabsorption Alkalosis: increase reabsorption

Renal Exam #2 (7 decks)

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