Lecture 12: Renal Physiology (Rogers) Flashcards

1
Q

In the body, how is water distributed?

A

⅔ of water in ICF

⅓ of water in ECF

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2
Q

In the ECF how, is water distributed?

A

80% interstitial fluid

20% plasma (capillary wall)

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3
Q

What is the 60-40-20 rule?

A

60% of body weight is body water
40% of body weight is body water in ICF
20% of body weight is body water in ECF

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4
Q

How do constituents between the ICF and external world interact with each other?

A

Through ECF

-water always enters ECF compartment first and fluid leaves body via ECF

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5
Q

Describe “third spacing”

A

Most fluids should be in intravascular, intracellular, or interstitial spaces

  • However, fluid can shift into nonfunctional areas of cells: b/t tissues and organs of abdomen, ascites, areas around pulmonary edema
  • problematic
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6
Q

Why must ECF volume be closely regulated?

A

To maintain blood pressure

  • salt balance
  • prevent shrinking and swelling of cells
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7
Q

What ions are in higher concentration in the ECF?

A

Sodium
Chloride
Bicarbonate

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8
Q

What ions are in higher concentration in the ICF?

A

Potassium

Phosphate

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9
Q

What is an electrolyte?

A

Solutes that dissociate into ions

  • have higher osmotic power
  • greater ability to cause fluid shift
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10
Q

What can cause polyuria?

A

Increased intake of fluids
Increased GFR
Increased output of solutes
Inability of kidney to reabsorb water

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11
Q

Regarding polyuria, what is the difference between water and solute diuresis?

A

Water diuresis: increased water excretion w/o corresponding increase in salt excretion

Solute diuresis: increased water excretion with corresponding increase in salt excretion

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12
Q

What can cause oliguria?

A

Dehydration
Blood loss
Diarrhea
Kidney disease

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13
Q

What can cause anuria?

A

Kidney failure

Obstruction

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14
Q

How do you calculate free water clearance?

A

Clearance = Urine Flow Rate - [(Urine Osmolarity x Urine Flow Rate) / Plasma Osmolarity]

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15
Q

What does it mean if free water clearance is positive?

A

Dilute urine

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16
Q

What does it mean if free water clearance is negative?

A

Concentrated urine

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17
Q

How is plasma (serum) osmolarity measured?

A

Osmolarity = (Sodium x 2) + (Glucose/18) + (BUN/2.8)

Rough Calculation: 2 x plasma Sodium

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18
Q

Describe the Gibbs-Donnan Effect.

A

Unequal distribution of permeant charged ions on either side of a semipermeable membrane

  • favors movement of water into cell
  • only ions can move into cell not proteins
19
Q

What counteracts the Gibbs-Donnan Effect?

A

Na/K+ ATPase pumps

20
Q

What promotes plasma colloid osmotic pressure?

A

Albumin in blood vessels

21
Q

What causes edema?

A

1) Increased net filtration: fluid moving from vascular space to interstitium)
2) Expansion of ECF volume

22
Q

What happens to cells placed in hypertonic solution?

A

Cells will shrink

-water moves out of cell into concentrated solution

23
Q

What happens to cells placed in hypotonic solution?

A

Cells will swell

-water moves into cell from dilute solution

24
Q

Describe crystalloid replacement therapy.

A

Does not cross plasma membrane (in ECF)

  • distributed evenly in ECF
  • common solutes: glucose and NaCl
25
Describe colloid replacement therapy.
Large molecules that don't pass semipermeable membranes - remain in intravascular compartment - expand intravascular volume by drawing fluids from extravascular spaces via oncotic pressure
26
Describe hypotonic/hyponatremic dehydration.
More sodium is lost than water in ECF - ICF has greater sodium concentration so water shifts from ECF to ICF (cellular swelling) - low serum sodium and serum osmolality
27
Describe hypertonic/hypernatremic dehydration.
More water is lost than sodium in ICF - ECF has greater sodium concentration so water shifts from ICF to ECF (cellular shrinking) - high serum sodium and serum osmolality
28
Describe isosmotic volume contraction.
ECF volume: Decrease ICF volume: Stays same Osmolality: Stays same
29
What causes isosmotic volume contraction?
Hemorrhage Diarrhea Vomiting
30
Describe hyperosmotic volume contraction.
ECF volume: Decrease ICF volume: Decreases Osmolality: Increases
31
What causes hyperosmotic volume contraction?
``` Dehydration Diabetes Insipidus Alcoholism Sweating Fever ```
32
Describe hyposmotic volume contraction.
ECF volume: Decrease ICF volume: Increases Osmolality: Decreases
33
What causes hyposmotic volume contraction?
Adrenal insufficiency due to loss of aldosterone | -excessive loss of NaCl in urine
34
Describe isosmotic volume expansion.
ECF volume: Increase ICF volume: Stays same Osmolality: Stays same
35
What causes isosmotic volume expansion?
Isotonic saline injection of NaCl
36
Describe hyperosmotic volume expansion.
ECF volume: Increase ICF volume: Decrease Osmolality: Increases
37
What causes hyperosmotic volume expansion?
High NaCl intake
38
Describe hyposmotic volume expansion.
ECF volume: Increase ICF volume: Increase Osmolality: Decreases
39
What causes hyposmotic volume expansion?
Excessive water-drinking | SIADH
40
People with congestive heart failure retain sodium, ______ ECF volume.
People with congestive heart failure retain sodium, INCREASING ECF volume.
41
IF ECF volume is _____, renal NaCl and water excretion are increased.
IF ECF volume is EXPANDED, renal NaCl and water excretion are increased.
42
IF ECF volume is _____, renal NaCl and water excretion are reduced.
IF ECF volume is CONTRACTED, renal NaCl and water excretion are reduced.
43
Renin is stimulated by ____ blood pressure and by ______ receptor activation.
Renin is stimulated by DECREASED blood pressure and by BETA-1 ADRENERGIC receptor activation.