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Exam 3 physio > Lecture 3 Renal > Flashcards

Lecture 3 Renal Flashcards

1
Q

normal pH range of body fluids and concentration of HCO3

A

7.35-7.45
HCO3= 24 mM
if pH 7.8 life can not be sustained

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2
Q

the greatest concern of the body is too much acid or base?

A

TOO MUCH ACID. body produces more acid than base

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3
Q

what are volatile acids

A

volatile acids are by products of metabolism that can be exhaled or dissipated by lungs Ex: CO2 bc it produces H in water of body fluids

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4
Q

What are nonvolatile acids

A

non volatile acids arise from metabolism or the diet Ex: phosphoric, lactic, and sulfuric acid and KETONES

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5
Q

how does body handle non volatile acid

A

neutralizes them with HCO3, regulated by renal system

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6
Q

theory says amount of acid in urine should equal the NonVolatile load how is this accomplish

A

the kidney does this by reabsorbing all filtered bicarbonate and then producing enough bicarbonate to neutralize acids produced by body

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7
Q

what is the lowest pH of urine possible? and what does this tell us

A

lowest urine pH can be is 4.4 so body has to excrete more acid than can be held in a solution of pH = 4.4

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8
Q

how does kidney excrete more acid than a pH of 4.4 will allow?

A

BUFFERING!

buffers bind to excess or free H to INC acid carried in urine without decreasing the pH

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9
Q

what molecules serve as buffers

A

HCO3, phosphate and ammonium

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10
Q

phosphate as a buffer

A

phosphate is used first but small supply

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11
Q

ammonium as a buffer

A

ammonium produced within tubular cells eliminates H and produces HCO3 that is reabsorbed

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12
Q

Net acid excretion should remove all non volatile acids what forms are secreted

A

free H
HPO4(-2)
and NH4

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13
Q

what two acids are titratable and what 1 acid is NOT Titratable

A

H and HPO4 (-2) ARE TITRATABLE
NH4 is NOT titratable
URINE has all 3!

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14
Q

under normal conditions what does the kidney do t regulate the acidity of urine

A

regulates HCO3 reabsorption by excreting acid equal to the non volatile load and replenishing the HCO3 lost to the neutralization of the acids

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15
Q

what are the 3 options for renal regulation of body pH that will produce an alkaline urine and acidifies body fluids

A
  1. DEC body pH by not reabsorbing HCO3 this urine is alkaline and body fluids acidic
  2. no effect on body pH by reabsorbing all HCO3, urine is neutral
  3. INC body pH by reabsorbing all and producing more HCO3, produces and acidic urine and basic body fluids
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16
Q

what happens due to the fact that HCO is NOT directly transported from tubular fluid into blood

A

HCO3 production and reabsorption results in H secretion`

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17
Q

what produces H and HCO in the tubular epithelium

A

Carbonic Anhydrase activity

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18
Q

How is H secreted after production by CA

A

H is secreted via Na H antiporter and via H ATPase pump and H/K ATPase pump which secretes H

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19
Q

how is HCO3 reabsorbed

A

HCO3 is reabsorbed/ transported across basolaterial membrane

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20
Q

Where does CA activity take place to produce H and HCO3

A

CA = late distal tubule and Collecting duct

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21
Q

what do intercalated cells doe in the late distal tubule and collecting ducts

A

reverses H and HCO3 transporters to the basolateral and apical membranes, THUS causing reabsorption of H and secretion of HCO3
VEYR LOW activity usually

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22
Q

if body is alkaline what must kidney do

A

produce alkaline urine by INC excretion of HCO3 and not neutralizing all the HCO3 in the tubular fluid

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23
Q

What do cells in the proximal tubule do regarding pH

A

PCT detects intracellular pH and can alter CA activity

24
Q

when does kidney use phosphatase as an additional buffer

A

when body is acidic so it can INC excretion of H

25
Q

after all HCO has been reabsorbed and HPO4 is depleted what will kidney do

A

Kidney produces the 3RD buffer of ammonium to INC H secretion

26
Q

Ammonium must be kept from what

A

NH4 must NOT enter body where it would become urea and produce H

27
Q

where is NH4 produced and by metabolism of what

A

NH4 produced in PCT by metabolism of glutamine

28
Q

what up regulates synthesis of glutamine metabolism enzymes

A

acidosis- but longggg time

29
Q

how is NH4 added to urine

A

by diffusion trapping

30
Q

explain diffusion trapping of NH4

A

NH4 substitutes for K and the NaKCl2 symporter and enters the interstitial fluid- once in the interstitial fluid the polar molecule of NH4 is trapped but NH3 can diffuse into the collecting ducts thus once in the tubule NH3 is protonated by excess H producing NH4 and eliminated with the urine

31
Q

key points of regulation of acid base balance by kidneys

A

respiratory system keeps Pco2 constant and kidneys regulate bicarbonate
urine typically acidic
net acid excretion occurs after all filtered bicarbonate is reabsorbed
additional H must be buffered
new bicarbonate made in PCT by NH4 from glutamine
NH4 produced in PCT facilitates H excretion in collecting duct as a result of diffusion trapping

32
Q

4 ways body gains H ions

A

generation of H from CO2
production of non volatile acids
gain of H from loss of bicarbonate in diarrhea and GI fluids
due to loss of bicarbonate in urine

33
Q

4 ways body loses H ions

A

utilization of H ion in metabolism of organic ions
in vomitus
in urine
from hyperventilation

34
Q

4 disorders of acid base changes

A

respiratory acidosis
respiratory alkalosis
metabolism acidosis
metabolism alkalosis

35
Q

what is respiratory acidosis

A

low pH due to CO2 build up

36
Q

what does respiratory acidosis causes

A

impaired pulmonary function

and a renal compensatory response leading to production of HCO3

37
Q

respiratory acidosis cause example

A

hypoventilation i.e. holding breath

38
Q

respiratory alkalosis?

A

high pH due to low PCO2

39
Q

cause of respiratory alkalosis

A

HYPERventilation, anxiety, altitude, fever, drugs

40
Q

kidney response to respiratory alkalosis

A

excrete HCO3 to lower pH

41
Q

what is metabolic acidosis

A

low pH due to low HCO3

42
Q

what are the compensatory responses to metabolic acidosis

A

HYPERventilation

Renal= produce new HCO3

43
Q

causes of metabolic acidosis

A

diabetic ketosis, diarrhea, renal failur

44
Q

what is metabolic alkalosis

A

high pH due to INC HCO

45
Q

causes of metabolic alkalosis

A

Vomitting, antacids, hemorrhage

46
Q

compensatory responses due to metabolic alkalosis

A

HYPOventilate

renal= excrete HCO3

47
Q

where is Ca found

A

interstitial fluid, extracellular fluid and bone

48
Q

why is it important to regulate Ca

A

hypocalcemia INC Excitability of neural and muscle tissue- tetany

HYPERcalcemia causes cardiac arrhythmias and disorientation can cause death

49
Q

A dec in plasma pH will ____ to the amount of free Ca which can be filtered and excreted so ____ can lead to _____

A

DEC plasma pH INC free Ca

INC free Ca leads to secretion of Ca causing alkalosis and leading to HYPOcalcemia

50
Q

what 3 hormones regulate Ca

A

PTH

Calcitriol (1,25 dihyrdroxyvitain D) and Calcitonin

51
Q

what regulates the 3 Ca regulating hormones and where is it found?

A

Ca sensing receptor (CaSR) found in plasma membrane of cells in parathyroid, thryroid and proximal tubule

52
Q

PTH
release why?
Does what?

A

PTH released in response to hypocalcemia

INC bone resorption and INC renal Ca reabsorption and stimulates calcitriol production

53
Q

Calcitriol (1, 24 dihydroxyvitamin D)
released why?
does what?

A

Calcitriol is made by metabolism of Vit D stimulated by hypocalcemia and hypophosphatemia and stimulated by PTH
action: INC transport mechan for Ca reabsorption in SI and facilitates action of PTH and INC renal Ca transport

54
Q

Calcitonin
released why?
does what?

A

Calcitonin released in response to HYPERcalcemia

INC bone deposition

55
Q

What drugs respond to HYPOcalcemia

A

PTH and Calcitriol

56
Q

what drugs respond to HYPERcalcemia

A

CALCITONIN!

57
Q

describe Ca reabsorption in nephron

A

PCT = paracellular transport and solvent drag
THICk ascending limb- para and transcellular transport
DCT- transcellular reabsorption of Ca regulated by expression of Ca transported regulated by PTH
Collecting duct - not significant for Ca

Exam 3 physio (4 decks)

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