Fluid and Renal Physiology Flashcards
What are the 2 largest compartments of ECF?
- Interstitial Fluid
2. Plasma
What electrolytes are in ECF?
LOTS of Na and Chloride, small amount of Mg, K, P, Ca, organic acids
What electrolytes are in ICF?
Lots of K and phosphate, moderate amount of Mg, sulfate
What is osmolality?
Number of osmoles per kg of water
What is osmolarity?
Number of osmoles per liter of water
Causes of hyponatremia = hypoosmotic dehydration
Primary hyponatremia; Adrenal insufficiency - Addison’s dz; overuse of diuretics
Causes of hyponatremia = hypoosmotic overhydration
Excess water diluting Na; Excess ADH (Syndrome of inapporpirate ADH) = Kidney absorbs more water
Causes of hypernatremia = hyperosmotic dehydration
Due to loss of water; Dehydration (most common); Inability to secrete ADH (Diabetes insipidus)
Causes of hypernatremia = hyperosmotic overhydration
Due to gain of Na; Excessive secretion of Na retaining hormone = Aldosterone
What happens with hyponatremia?
Hyponatremia = Cell Swelling → Osmotic mediated demyelination of neurons
What happens with hypernatremia?
Hyponatremia = Cell Shrinking → Stimulating thirst mechanism in hypothalamus
What are the 4 major causes of Extracellular Edema?
- Increased Capillary pressure (excessive kidney retention of salt and water, high venous pressure and venous constriction, decreased arteriole resistance)
- Decreased plasma proteins (Loss of proteins in urine, loss of proteins from denuded skin (burns), failure to produce proteins (liver failure))
- Increased capillary permeability (Immune rxn = histamine, toxins, bacterial infections, Vitamin def (esp Vit C), prolonged ischemia, burns)
- Blockage of Lymph Return (cancer, infections, sx, congenital/lymphatic abnormality)
What is intracellular edema?
Swelling in the cell itself; caused by hyponatremia, decreased cellular metabolic activity or nutrient delivery
What are the 4 safety factors that normally prevent edema?
o Low interstitial compliance: normal interstitial pressure is subatmospheric = low compliance; when interstitial fluid is present, this increase in interstitial hydrostatic pressure deters capillary filtration; when pressure is zero or positive, increased compliance occurs = more fluid contributes less to hydrostatic pressure = allows more water accumulation
o Interstitial gel: most water in the interstitium is in the form of a gel (bound to proteoglycans) = provides the low compliance at negative pressures; as the pressure increases and the increased compliance allows for more water accumulation, it becomes free (not bound to proteoglycans) = “pitting edema”; in edema, excess fluid forms channels through proteoglycans = fluid can flow to gravity-dependent regions
o Increased lymph flow: can increase 10-50 X normal
o Washdown of the interstitial fluid protein: as the interstitial fluid pressure increases, the lymph flow also increases and removes proteins at a more rapid pace.
Name 7 functions of the kidenys in homeostasis.
o Regulation of water and electrolyte balance
o Excretion of metabolic waste products (urea, creatinine, uric acid, bilirubin)
o Regulation of arterial blood pressure (via renin)
o Regulation of acid-base balance
o Produces 1,25 cholecalciferol (active VitD, calcitriol - Ca deposition in bone, Ca reabsoprtion in GIT)
o Produces EPO from the peritubular endothelial cells
o Glucose synthesis (rivals liver in some situations)
Why is the renal circulation unique?
Two capillary beds separated by efferent arteriole; afferent arterioles →glomerular capillaries →efferent arteriole →peritubular capillaries →venous system
How do the 2 capillary beds in the kidney work?
Glomerulus (high pressure) = Filtration Peritubular caps (low pressure) = Reabsorption
How does the kideny regulate hydrostatic pressure?
By adjusting resistance in afferent and efferent arterioles - Kidney can regulate hydrostatic pressure in both capillary beds (glomerular and peritubular) to change the rate of glomerular filtration and tubular reabsorption, or both
Each nephron contains….
- Glomerulus
2. Long tubule
Name the order to tubular segments of the nephron.
Glomerular capillaries surrounded by Bowman’s capsule = proximal tubule = Loop of Henle (descending thin, ascending thin, ascending thick) = distal tubule = cortical collecting tubule = cortical collecting ducts
What is the macula densa?
At end of the thick ascending limb; Plaque of specialized epithelial cells (aids in controlling nephron function)
What are the regional differences in nephron structure?
- Cortical nephrons are located in the cortex and have short loops of Henle
• Have peritubular capillaries - Juxtamedullary nephrons are adjacent to the medulla and have long loops of Henle
• Have vasa recta which originate as efferent arterioles that form an extensive capillary network around the Loop of Henle, return to the cortex and enter into cortical veins
What is the name of the reflex that results in urine in bladder being propelled backwards?
Vesicoureteral Reflex
Name the 3 major nerves involved in bladder innveration and their function.
- Pelvic nerve (PNS)
• Sensory fibers detect the degree of stretch
• Motor fibers facilitate detrusor contraction - Pudendal nerve (skeletal): innervates the external urethral sphincter
- Hypogastric nerve (SNS, from L1-L4):
• B-adrenergic = detrusor relaxation
• A-adrenergic = internal urethral sphincter contraction
Describe the storage phase of micturition.
Storage phase: under SNS tone via hypogastric nerve
• b-adrenergic: detrusor relaxation
• α-adrenergic: contract IUS
• Somatic: contract external urethral sphincter
Describe the micturition reflex.
Micturition reflex = causes the transition from storage to voiding phase
• Afferent limb: stretch receptors in bladder wall → impulses via pelvic nerve → micturition center in brainstem → reach threshold for reflex
• Efferent limb: motor discharges to the sacral PNS nuclei initiate the voiding phase
Describe the voiding phase of micturition.
Voiding phase: under PNS tone via the pelvic nerve
• PNS stimulation → detrusor contraction
• Inhibition of SNS activity → relaxation of IUS
• Urine flow should be sustained until emptying is complete
Why is the glomerular capillary bed unique?
It has 3 membranes (instead of two)
What are the 3 layers of the glomerular capillary membrane?
- Capillary endothelium: contains fenestrations, large enough to allow protein passage
- Glomerular basement membrane: negatively charged proteoglycans that effectively prevent the passage of plasma proteins
- Epithelial cells (podocytes) surrounding the outer layer of the basement membrane = contain slit-pores with some filtration restriction
What is the main barrier to filtration of plasma proteins in glomerulus?
Basement membrane
What determines the filterability in the glomerulus?
- Solute size
2. Electrical Charge (negatively charged proteoglycans prevent passage of plasma proteins)
How can albumin not get through glomerulus?
Albumin is small enough to fit through the pores but the negative charge is what prevents its passage
What are the equation for GFR?
GFR = Kf x net filtration
Kf: capillary filtration coefficient = product of the permeability and surface area of the capillaries
What is the major factor for altering GFR?
Glomerular hydrostatic pressure
What are the 3 factors that an influence glomerular hydrostatic pressure?
- Increased arteriole pressure: increase GFR, but is regulated by autoregulatory systems
- Constriction of the afferent arteriole decreases hydrostatic pressure and decreases GFR
- Constriction of the efferent arteriole will increases resistance to outflow of the capillaries and raises the hydrostatic pressure → increases GFR
• However, if the efferent arteriolar constriction is too much, it will decrease the renal blood flow and significantly increase the capillary COP = decreases GFR
• Moderate efferent arteriolar constriction will increase GFR, severe constriction will decrease GFR
How does autoregulation work in the kidney?
Autoregulation will maintain renal blood flow within an arterial pressure range of 80-170 mm Hg, despite what systemic blood pressure is - needed to maintain relatively constant GRF and excretion of water and solutes
How does the SNS control GFR?
NE, epi, endothelin = decreases GFR and RBF (constricts afferent and efferent arterioles)
How does angiotensin II control GFR?
Constricts the efferent arterioles
Raises glomerular hydrostatic pressure while reducing RBF → increases GFR
The decreased RBF through the peritubular capillaries causes increased resorption of sodium and water
How does endothelial-dervied NO control GFR?
decreases renal vascular resistance and increases GFR
Functions to prevent excessive vasoconstriction of the renal vessels
How do renal vasodilators control GFR?
Prostaglandins: especially PGE2 and PGI2; function to maintain GFR and RBF during volume depletion
Bradykinin
What is glomerulotubular balance?
Adaptive mechanism in renal tubules that allow them to increase reaborption rate when GFR rises
What is tubuloglomerular feedback?
Feedback in autoregulation of GFR = to ensures constant delivery of NaCl to the distal tubule at macula densa
What are the 2 major components of the juxtaglomerular complex?
- Macula densa cells in the initial portion of the distal tubule (close contact with afferent and efferent arterioles) → detects NaCl levels
- Juxtaglomerular cells in the walls of the afferent and efferent arterioles
What happens when there is a decreased in BP in the glomerulus?
Decreased BP →decreased RBF → increased resorption of NaCl in the Loop of Henle →decreased delivery of NaCl to the macula densa
What are the 2 main effects of decreased macula densa [NaCl]?
- Dilation of afferent arterioles → raises glomerular hydrostatic pressure → increase GFR
- Increases renin release from the JG cells → AgII → constricts efferent arterioles
How do ACEi affect GFR?
ACEi block the action of Ang II = decreased GFR (inability to constrict efferent arteriole) = decreased renal perfusion in the face of systemic hypotension = can lead to ARF
How is Na reabsorbed in the proximal tubules?
- Na diffuses across luminal membrane (apical membrane) into cell down electrochemical gradient established by Na-K-ATPase pump (basolateral side of cell)
- Na transported across basolateral membrane AGAINST electrochemical gradient by Na-K ATPase
- Na, water, and others reabsorbed from interstitial fluid into peritubualr capillaries by ultrafiltration (passive process driven by hydrostatic and colloid osmotic pressure)
What are the 4 major transporters of glucose in the proximal tubules and where are they located?
- Sodium Glucose Co-Transporters (SGLT2 and SGLT1): Carry glucose
• 90% filtered glucose is reabsorbed by SGLT2 in early part of proximal tubule (S1segment)
• 10% transported by SGLT1 in later proximal tubular segments - Glucose Transporters (GLUT2 and GLUT1): Glucose diffuse out of cells into interstitial space
• GLUT2: S1 segment
• GLUT1: S3 segment (later portion)
How is glucose reaborbed in the proximal tubules?
Secondary Active transport at apical membrane (via SGLT), passive facilitated diffusion at basolateral membrane (GLUT), and passive uptake by bulk flow at peritubular capillaries
How is water passively resorbed in tubules?
- Concentrations within renal interstitium HIGH = osmosis of water from tubular lumen into renal interstitium
o Proximal tubule is HIGH permeability to water (also permeable to Na, Cl, K, Ca, Mg) - Osmosis through tight junctions btwn cells and through cells
- As water moves through tight junctions (osmosis) it carries solutes = solvent drag
- Changes in Na reabsorption significantly influence water reabsorption (plus other solutes)
Describe the permeability of water in the tubular segments?
- Proximal tubule: HIGH water permeability
- Ascending Loop of Henle: LOW water permeability (despite large osmostic gradient)
- Distal tubules, collecting tubules, and collecting ducts: Can be HIGH or LOW (depends on ADH)
What organ makes aldosterone?
Zona glomerulosa cells (adrenal cortex)
Where is the site of action of aldosterone?
Principle cells of cortical collecting tubules = Stimulate Na-K ATPase pump (basolateral) and ↑ Na permeability on luminal side
What is the sitmulus for aldosterone secretion?
↑ Extracellular K and ↑ Angiotensin II (dt low Na or blood pressure)
What occurs with absent or excess aldosterone?
o Absence of Aldosterone (Addison’s): Marked loss of Na and accumulation of K
o Excess of Aldosterone (Conn’s): Na retention and ↓ K
What is the most powerful Na retainer?
Angiotensin II, caused by low BP, ECF volume (hemorrhage, vomiting, dehydration)
What are the 3 effects of angiotensin II?
- Stimulates aldosterone (↑ Na reabsoprtion)
- Constricts Efferent Arteriole: ↓ Peritubular capillary hydrostatic pressure (↑ net tubular reabsorption in PT) and ↓ renal blood flow = ↑ filtration fraction in glomerulus and ↑ concentration of proteins/colloid osmotic pressure in capillaries → ↑ Net reabsorptive force (more Na and water reabsorbed)
Helps to maintain excretion of waste products (urea and creatinine)
3. Directly stimulates Na reabsorption in PT, Loop of Henle, distal tubules and collecting tubules via Na-K ATPase (basolateral), Na-H exchanger (luminal, PT), and Na-bicarbonate co-transporter (basolateral)