L07: Urine Concentration Dilution Flashcards

1
Q

Whereabouts in the nephron does water get reabsorbed back into the blood

A

Descending limb of loop of henle

Collecting duct

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2
Q

What is the main determinant hormone of the urine concentration

A

ADH

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3
Q

What is ADH also known as

A

Vasopressin

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4
Q

Where is ADH synthesised

A

Hypothalamus

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5
Q

Where is ADH secreted from

A

Posterior pituitary gland

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6
Q

Where does ADH act on

A

Collecting duct

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7
Q

What does ADH do in term of express channels

A

It expresses aquaporin 2

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8
Q

Describe the process of absorption of water when ADH increases aquaporin 2 in the apical membrane

A

1) water moves in through AQP2 in the apical membrane

2) water then moves out of the cell though the basolateral membrane via aquaporin 3

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9
Q

What receptors do ADH bind to when they are released from the posterior pituitary gland

A

V2 receptors

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10
Q

What happens intracellular when ADH binds to V2 receptors

A

V2 receptors or coupled to Gs proteins
Gs proteins Stimulate adenylyl cyclase to create CAMP (2nd messenger)
CAMP stimulates the nucleus to transcribe AQP2 synthesis
CAMP then stimulate protein kinase A to insert the synthesised AQP2 into the apical membrane

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11
Q

Therefore what is the concentration of the urine like when there is ADH

A

Concentrated

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12
Q

Therefore what is the concentration of urine when there is no ADH

A

Dilute

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13
Q

What happens to the flow rate of urine when there is no ADH

A

High

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14
Q

What happens to the flow rate in the nephron when there is ADH

A

LOW as we are not producing urine

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15
Q

What does urea do in terms of osmolalility

A

Contribute to medullary osmolarity when it gets reabsorbed from the loop of henle

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16
Q

What happens to urine when there is low urea

A

Urine is dilute

17
Q

What results in low urea

A

Protein starvation

18
Q

What hormone regulators the expression of UT-A1 (urea transporter)

19
Q

What receptor does ADH bind to stimulate the expression of UT-A1

A

V2 receptors the basolateral membrane

20
Q

What happens intracellularly when ADH binds to V2 receptors

A

1) Gs is activated which stimulates adenylyl cyclase to produce CAMP
2) CAMP increases transcription and synthesis of UT-A1
3) CAMP stimulates protein kinase A to insert UT-A1 into the apical membrane

21
Q

What is diabetes insipidus

A

Low ADH secretion
Or
Loss of ADH sensitivity due to loss of function of V2 receptors

22
Q

What are the symptoms of diabetes insipidus

A
Polyuria 
Dehydration 
Hypo aloe is 
Polydipsia (drinking too much)
Hypernatreamic
23
Q

Due to the 2 different causes of diabetes insipidus, what are the 2 types of diabetes inspidus

A

Central diabetes insipidus

Nephrogenic diabetes insipidus

24
Q

What is diabetes insipidus due to

A

Lack of secretion of ADH

25
What are the causes of central diabetes insipidus
Head injury Tumours in pituitary gland Infection
26
What is the treatment of central diabetes insipidus
Give ADH analogue called desmopressin to replace ADH
27
What is nephrogenic diabetes insipidus due to
Loss of sensitivity to ADH in V2 receptors
28
What are the causes of nephrogenic diabetes insipidus
Toxicity Hypercalcaemia Genetic mutation to V2 receptors
29
What is the treatment to nephrogenic diabetes insipidus
Thiazides diuretic: increase aquporin expression | Law salt diet
30
What does SIADH stand for
Syndromes inappropriate ADH
31
In terms of SIADH what are the levels of ADH like
High
32
What are the causes of SIADH
Head injury
33
What are the symptoms of SIADH
Concentrated urine | Hyponatremic because water dilutes sodium
34
What is the treatment for SIADH
Fluid restriction | Aquaretic drugs
35
What does aquoretic drugs cause
Water loss without salt loss
36
What is a aquaretic drug
V2 receptor antgonist
37
Where does aquaretic drugs act in the nephron
Late portion of the distal tubule | Collecting duct
38
Why do we administer a low salt diet to someone who has nephrogenic diabetes insipidus
They have a low sodium because they are losing a lot of water To treat hypernatremia we tell them to restrict salt in the diet