L28 - Kidney - Urine pH And Drug Excretion Flashcards

1
Q

What are the key functions of the nephron in the kidney? (3)

A
  • glomelular filtration
  • tubular secretion
  • tubular reabsorption
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2
Q

What are the possible routes for substances entering nephron? (3)

A
  • parital filtering, mostly secreted, fully excreted
  • partial filtering, partial reabsorbed, partially excreted
  • partial filtering, fully reabsorbed, not excreted
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3
Q

How do you calculate amount excreted?

A

Amount excreted = amount filtered + amount secreted - amount reabsorbed

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4
Q

What are not excreted by kidneys?

A

Whole proteins and protein based drugs

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5
Q

What is proteinuria?

A

high levels of protein in urine

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6
Q

What does carbonic anhydrase do?

A

Key enzyme in acid-base homeostasis

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7
Q

What does adding/subtracting carbonate (HCO3-) do?

A

Lower/raises H+ by influencing this equation

CO2 + H2O <-> H2CO3 <-> HCO3- + H+

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8
Q

What does the kidney regulate in terms of body pH?

A

HCO3-
- thereby pH

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9
Q

What is the carbonate reabsorption? (4)

A
  • cabonic acid in tubular cell breaks down into H+ and HCO3-
  • H+ to tubules, combines with HCO3-
  • HCO3- transported into body
  • filtered HCO3- disappears, HCO3- generated inside cell enters the body
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10
Q

What is the net result of carbonate reabsorption?

A

no loss of HCO3-

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11
Q

What is the carbonate generation - H+ secretion? (3)

A
  • carbonic acid generated in tubular cells
  • H+ combines with filters HPO42- = excreted
  • HCO3- transported into body
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12
Q

What is the net result of carbonate generation - H+ secretion?

A

Gain of HCO3-

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13
Q

What is the carbonate generation - glutamine metabolism? (4)

A
  • glutamine enters tubule cells (filtrate or blood plasma)
  • metabolised inside cells to ammonia (NH4+) and HCO3-
  • NH4+ secreted into tubules and excreted
  • HCO3- transported into body
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14
Q

What is the net result of carbonate generation - glutamine metabolism?

A

Gain of HCO3-

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15
Q

What is akalosis?

A

When the body loses H+, pH increases becoming more alkali

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16
Q

What is acidosis?

A

When the body gains H+, pH decreases becoming more acidic

17
Q

What is the body’s response to acidosis? (2)

A
  • H+ secreted into tubules (all filtered HCO3- reabsorbed, additional HCO3- absorbed, H+ excreted bound to phosphate)
  • glutamine metabolism enhanced = more HCO3-
18
Q

What is the body’s response to alkalosis? (2)

A
  • H+ secretion into tubules, cannot keep up with filtered HCO3- (excess excreted)
  • glutamine metabolism decreased = reduced HCO3- gen
19
Q

What drugs are ionised in alkaline urine?

A

Acidic drugs are ionised

20
Q

What drugs are ionised in acidic urine?

A

alkaline drugs are ionised

21
Q

What drugs are less likely to be reabsorbed in the kidney?

A

ionised drugs
- increased excretion

22
Q

What happens in aspirin poisoning? (2)

A

aspirin needs to be quickly removed from the body
- IV indusion of sodium bicarbonate
- enters urine, raises pH

23
Q

What happens to aspirin’s active metabolite? (2)

A

salicylic acid becomes ionised
- reducing its absorption
- aspirin excreted quicker = lowers plasma conc