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A/P > Lecture 11/18: Renal Physiology Cont'd > Flashcards

Lecture 11/18: Renal Physiology Cont'd Flashcards

Final

1
Q

T/F: MD relaxes both the AA & EA

A

T

Selective to AA though

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2
Q

___% of PAH is left in plasma

A

10%

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3
Q

Describe how a selective vs Nonselective vasoconstrictor/dilator can effect GFR

A

Selective: Will effective either the AA or EA more and we can better gauge how GFR will change

Nonselective: You dont know which one is effected more therefore you cant determine how GFR will be exactly effected

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4
Q

Most pressers/dilators are selective to the _____

A

AA

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5
Q

Describe the Angiotensin II Type 1 Receptors

A

AT1

AT1-R binds to ANGII

-Proximal Tubule
-Apical & Basolateral

Speeds up the cycling of Na/K Atpase pump
-Ultimately results in increased reabsorption of Na+ (and water) and Bicarb by speeding up the NHE pump

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6
Q

Describe the Sodium-Hydrogen Exchanger pump

A

NHE

1 Na+ in (tubular cell)
1 H+ out (urine)

-Important in acid/base regulation
-SECRETES a proton into tubular lumen
-Major role in Na reabsorption

-Proximal Tubule
-Apical

Affected by AT1-R; Speeds up based on Na/K ATPase Na+ gradient on basolateral

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7
Q

Describe the Sodium-Potassium ATPase pump

A

Na+/K+ ATPase

3 Na out (Renal ISF)
2 K in (Tubular cell)

-Proximal Tubule
-Basolateral

-Sped up by AT1-R
-Speeds up the NHE

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8
Q

Describe the Sodium-Bicarb Symporter

A

Co-transporter

1 Na+ & THREE (3) Bicarbs in renal ISF

-Proximal Tubule
-Basolateral

Affected by AT1-R; Sped up by the NHE

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9
Q

What pumps do AT1 affect?

A

This is the ANGII receptor

  1. Na/K ATPase <– primary
  2. NHE
  3. Sodium-Bicarb symporter
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10
Q

What are the routes of reabsorption in the PT?

A
  1. Paracellular pathways via osmosis
  2. Trancellular pathways via transporter/channels in the cell wall
  3. Aquaporins (specialized trancellular pathway for water) via osmosis
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11
Q

Describe water reabsorption in the PT

A
  1. Aquaporins
  2. Transcellular pathway: Na+ influenced
  3. Paracellular: dragged with other ions
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12
Q

Describe how chloride is reabsorbed in the PT

A

Paracellular

This is heavily Na+ influenced

Na+ is reabsorbed via the transcellular route (pumps in the cell wall) and pumps positive charges into the renal ISF. These positive charges attract the negative charges on Cl-

Also increased glucose & amino acids influence Na reabsorption

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13
Q

If you have diabetes, what 2 ions will you see an increased reabsorption in? What will this cause?

A

Increase reabsorption of Na (SGLT) & Cl (paracellular route)

This causes a decrease in Na and Cl at the MD –> thinks GFR is low –> releases renin/ANGII –> EA constricts to increase GFR……. you know this

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14
Q

What is osmosis?

A

Passive movement of water from an area of lower osmolarity to a higher osmolarity to equalize osmolarity

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15
Q

What is bulk flow?

A

The process of reabsorption at the PT cap based on the starling capillary forces

Remember NFP = -10 & NRP = 10
This is a high pressure so lots of reabsorption

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16
Q

What is a big portion of the concentrated renal ISF? What is this?

A

Urea

A waste product that assists in concentrating the renal ISF to assist with reabsorption and osmosis

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17
Q

If you’re dehydrated, you would expect your renal ISF to be _________. Why?

A

Very concentrated

Body is trying very hard to conserve water (prevent body from excreting it)

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18
Q

______ assists with osmosis

A

urea

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19
Q

What is the brush border?

A

Brush-looking structure that increases surface area by 20-fold

Increases room for transporters for reabsorption

Located on the apical/luminal side

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20
Q

T/F: Tubular cells are electrically excitable

A

T

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21
Q

What is the charge in the tubular lumen in the Proximal tubule? What attributes to this?

A

-3 mV

Excess Cl-

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22
Q

T/F: Cl- builds up in the PCT. Why?

A

T

Cl- reabsorption lags behind Na+

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23
Q

What part of the PCT is Cl- most absorbed in?

A

2nd half

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24
Q

What happens when proteins are filtered at the GC?

A

A small amount of SMALL proteins can be filtered
Reabsorbed at the PCT ONLY

-1.8g/day filtered
-1.7g/day reabsorbed via endocytosis (pinocytosis) <– this is the max amount
-0.1g/day excreted (this is normal)

After protein is filtered the brush border grabs the protein –> endocytosis –> degrades to amino acids –> reabsorbs

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25
Q

What is the max amount of protein that can be reabsorbed?

A

1.7g/day

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26
Q

T/F: pinocytosis of proteins can happen in the PCT and DCT

A

F

only in the PCT; if it doesnt happen here the protein will be excreted or stuck in tube causing damage

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27
Q

About how much protein do we filter per day? Excrete?

A

1.8g/day

0.1g/day

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28
Q

What is the driving forces behind Na reabsorption in the PCT?

A
  1. NHE
  2. SGLT
  3. Amino acid/Na cotransporter
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29
Q

What is the enzyme associate with bicarb formation?

A

Carbonic Anhydrase

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30
Q

Describe the bicarb process

A

Proton secreted into tubular lumen from NHE pump –> Bicarb forms with it to make carbonic acid –> carbonic acid (H2CO3) + carbonic anhydrase –> Water + CO2

These can freely diffuse across the cell via osmosis/passive diffusion. Once in the cell:

Water + CO2 + Carbonic Anhydrase –> Carbonic Acid (H2CO3) –> Bicarb + H+

-Bicarb is reabsorbed via the Na-Bicarb Symporter
-H+ is used by the NHE again for the process to start again :)

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31
Q

What happens to bicarb if you decrease Na intake?

A

Decreases

this can cause mild acid/base imbalances –> acidosis

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32
Q

Bicarb formation is dependent on what pump?

A

NHE

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33
Q

Where is CA (carbonic anhydrase) located? What does it do?

A

-Tethered to the walls & in between cells in the PCT
-Breaks down Carbonic Acid H2CO3 to water and CO2

-Tubular cells
-promotes formation of carbonic acid from water and CO2

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34
Q

What happens to protons if there’s no bicard in the tubular lumen?

A

-Protons attach to the excess ammonia in the urine –> forms Ammonium
-Dont want free protons in urine = pain
-Ammonium helps buffer Cl-

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35
Q

Describe how CA inhibitors work

A

Inhibit CA in the PCT –> indirectly slows down the NHE pump (Decrease in protons to spin pump) –> less Na reabsorbed & less bicarb reabsorbed

Results: Diuretic effects
-acidosis

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36
Q

Where is glutamine produced?

A

Liver

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37
Q

What does Glutamine do?

A

PCT
-inside tubular cells

in combination with Proximal Tubular cell … Produces NEW bicarb:
– 2 HCO3 and 2 ammonium

38
Q

What is a common side effect we see in people with liver failure?

A

acid/base imbalances

unable to produce sufficient glutamine –> not able to produce new bicarb or ammonium

39
Q

What are the urinary buffers?

A

-Ammonia/Ammoniun
-NaHPO4- (Sodium phosphate) –> NaH2PO4
-Bicarb

40
Q

Describe the Ammonium pump

A

SECRETES 1 NH4 into tubular lumen for 1 Na reabsorbed into tubular cells

-PCT
-apical

41
Q

How is Calcium reabsorbed in the PCT?

A
  1. Paracellular: dragged with water/ions
  2. Trancellular:
    -Apical: Ca++ ion channel
    -Basolateral: Ca++ ATPase & NCX
42
Q

Explain how Ca++ plays a role in acid/base balance

A

-If you are more acidotic there are more protons in your blood. Those protons will attach to albumin in the blood because they have opposit changes. Causing more free Ca++ to be in the blood. –> More Ca++ able to be filtered

-Alkalotic –> more Ca++ binding to albumin –> less Ca++ filtered

43
Q

What detects low Ca++ levels in the blood?

A

Parathyroid gland

44
Q

How does the parathyroid gland regulate Ca++ levels?

A

They sense Ca++ is low & release
Parathyroid hormone (PTH)

  1. Increases Vit D activation –> increases the amount of Ca++ absorbed from diet
  2. Increases Ca++ reabsorption in kidneys –> increases # of Ca++ channel
  3. Stiumlates bone breakdown via osteoclasts –> uses Ca++ store
  4. Inhibits activity of osteoblasts –> prevents Ca++ being used to build new bone
45
Q

Our long term Ca++ stores are ______ & short term is _______

A

Bone

Sarcoplasmic Reticulim

46
Q

Differentiate between Osteoblast & osteoclasts

A

Blasts = bone builder; increases bone density

clasts = break down bone

47
Q

What is bone made of?

A

Calcium
Phosphate

48
Q

What is a common disorder we see in people who are chronically hypocalcemic? What does this put them at risk of? What is the Tx for this?

A

Osteoporosis

Bone fractures

Tx: Vitamin C with Activated Vitamin D

49
Q

What is an Antiporter?

A

Pump that secretes organic compounds into the Proximal tubule to be excreted

Location: PT only
Apical/Tubular Lumen

50
Q

What are your endogenous Organic Cations?

A

Think neurotransmitters mostly
Ach
Creatine
choline
dopamine
epi
histamine
serotonin
NE

51
Q

What are your exogenous organic cations?

A

Think heart drugs
isoproteranol
atropine
procaine
quinine
tetraethylammonium (TEA)
TEE

52
Q

What are the endogenous organic anions?

A

Bile salts
hippurates
prostaglandins
urate (uric acid)
oxalate

53
Q

What are the exogenous organic anions?

A

Abx & Diuretics
Furosemide
Penicillin
Salicyclates (ASA)
sulfonamides
acetazolamide
chlorothiazide

54
Q

How are Organic cations secreted?

A

An H-Dependent antiporter

-Secreted the organic cation into the PCT
-Reabsorbs a proton

55
Q

Organic Anions antiporters involve ________

A

Alpha-Ketoglutarate

56
Q

How are Organic anions secreted?

A
  1. A pump takes 3 Na+ & 1 AlphaKG into the renal ISF from the PT cap
  2. That is able to spin the pump that brings in 1 organic anion from the PT cap to the Renal ISF & takes out 1 AlphaKG from the renal ISF
  3. Now the antiporter is able to pump the organic anion into the PCT to be excreted
57
Q

How does penicillin stay in the system longer?

A

Adding a synthetic hippurate

This creates competitive inhibition with the antiporters, making penicillin stay in the system longer

58
Q

Explain the history of penicillin

A

Mold was producing PCN and stopping the growth of bacteria

Discovered prior to WWII –> Used during during WWII

PCN was leaving the body rapidly –> added hippurate

59
Q

As a rule of thumb, if we dont know how much of something gets reabsorbed at the PCT, its _____

A

2/3

60
Q

The majority of the loop of henle is _____

A

thin

61
Q

Describe the Thin Descending Limb

A

-Fluid is descending into an area w/ a more concentrated renal ISF
-Tubular fluid is becoming more concentrated as well

Water reabsorption via AQP1 channels
Impermeable to ions

62
Q

Where is the hairpin turn?

A

Between the descending and ascending loop of henle

63
Q

Describe the thin ascending limb in the loop of Henle

A

-Fluid is ascending into an area w/ a more dilute renal ISF
-Tubular fluid is becoming more dilute as well

Na+/Cl- ATPase (reabsorbs 1Na & 1Cl)
Impermeable to water

64
Q

____% of ions filtered are reabsorbed ath the thick ascending loop of henle

A

25%

65
Q

T/F: TAL is permeable to water

A

F

66
Q

What is the charge in the TAL? What causes this charge? What is the result of this charge?

A

+8 mV

cause: Leak K+ causing a positive charge

result: Causes cations to leave the TAL via the paracellular route

67
Q

Which ions are pushed harder via diffusion in the paracellular route? Why?

A

Mg++
Ca++

They both have a double charge and want to leave even more away from the positive charge

68
Q

Where does acid/base balance happen in the nephron?

A

TAL
PCT
Late DCT
Collecting tubule

69
Q

What pumps do the TAL have that are neccesary for acid/base balance?

A

Na/K ATPase
NHE

70
Q

Describe the NKCC2 transporter

A

1 Na+, 1 K+, 2 Cl- cotransporter

TAL
Apical

71
Q

The ______ plays an important role, along with urea, in concentrating the renal ISF

A

TAL

72
Q

Where do loop diuretics work? What is the MOA.

A

TAL

inhibit the NKCC2 pump –> This causes the renal ISF to become less concentrated –> losing the ability to reabsorb water –> excrete more urine

73
Q

T/F: Animals that live in the desert can concentrate their renal ISF higher than 1200

A

T

This allows them to reabsorb more water so their body wont excrete it.

74
Q

T/F: urine can be a little more concentrated than the renal ISF

A

F

Urine can only be as concentrated as the renal ISF, not higher

75
Q

What are 3 examples of loop diuretics?

A

Furosemide
Ethacrynic acid
bumetanide

76
Q

What helps preserve the osmotic gradient in the loop of henle?

A

countercurrent blood flow in allows for exchange of solutes & water with distruption of osmotic gradient

This is the reason why 1 side is impermeable to water and the other is impermeable to ions

77
Q

Where does PTH influence Ca reabsorption ini the nephron?

A

PCT
DCT

78
Q

What are the pumps associated with Ca++ reabsorption in the DCT?

A

apical:
-Ca++ ion channel
-NCC

Basolateral:
Ca++ ATPase
NCX
Na/K ATPase

79
Q

The NCX exchanges ___ Na+ ____ the cell for ____ Ca++ _____ the cell

A

3 Na+ in the cell

1 Ca++ out the cell (renal ISF)

Basolateral

80
Q

PTH increase Ca++ ion channels on the _____ side of the cell

A

Apical

81
Q

What pump drives Na reabsorption in the DCT?

A

NCC (1Na/1Cl)

82
Q

Where do Thiazide diuretics work? What is the MOA.

A

In the DCT

They inhibit the NCC pump –> More Na+ in the tubular lumen & more Ca++ in the renal ISF

Results: More Na+ in the tubular lumen –> less water reabsorption –> more water excreted

–Increased Ca++ reabsorbed into the renal ISF

83
Q

What medication can help osteoporosis or preventing kidney stones? Why?

A

Thiazide diuretics

Increases reabsorption of Ca++ by inhibiting the NCC pump in the DCT

84
Q

T/F: Thiazide diuretics can get rid of kidney stones

A

F

Can only help prevent

85
Q

The DCT is also sensitive to ______ & ________

A

ADH
Aldosterone (Aldo)

86
Q

Aldo =

A

Aldosterone

87
Q

Which cells are sensitive to Aldo?

A

Intercalated & principal cells in the DCT

88
Q

Which cells are sensitive to ADH?

A

Intercalated cells in the DCT

89
Q

How does Aldo-R work in the DCT?

A

Speeds up the Na/K ATPase pump which –>

  1. Increase K+ secretion
  2. Increase Na+ reabsorption
90
Q

Where are Aldo-R located? Why?

A

Inside intercalated and principal cells

Aldo is a cholesterol derivative therefore can cross membranes freely

A/P (33 decks)

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