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Renal > Na handling > Flashcards

Na handling Flashcards

1
Q

What is EABV?↓↑→

which limb detects the changes in EABV?

A

effective arterial blood vol
- volume of blood that is detected by volume sensors, located on arterial side of circulation

  • afferent limb has volume receptors for EABV
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2
Q

What is the efferent limb responsible for regulating?

A

regulates the rate of Na+ excretion by the kidney

note the afferent limb is responsible for volume sensing

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3
Q

4 categories of volume sensing in the afferent limb?

A
  1. low P baroreceptors
  2. high P baroreceptors
  3. intrarenal baroreceptors
  4. hepatic and CNS sensors
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4
Q

Low P baroreceptors include

A
  1. cardiac atria receptors
  2. LV receptors
  3. Pulm vascular bed receptors
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5
Q

Which receptors are located on the arterial side of the circulation and protect the body against volume contraction and expansion?

A

the high P recetors:
Carotid sinus body @ bifurcation
aortic body @ arch

*note that the low P receptors are located on the venous side

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6
Q

What happens if EABV is low?

A

If it is low → volume contraction state → signals the brain → ↑ renal SNS

*if really severe volume contraction, NE is released

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7
Q

Tubuloglomerular feedback

A

phenomenon where ↑ NaCl to the macula densa, ↑s afferent arteriolar tone and corrects GFR

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8
Q

Glomerulo-tubular balance

A

fundamental property:

- changes in GFR causes proportional (fractional) change in the rate of PROXIMAL tubular sodium reabsorption

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9
Q

What effects do NO, PGE2, PGI2 have on GFR?

A

It induces vasodilation of aff a → increases GFR (thus maintaining it - keeps it up)

*note that AGII vasoconstricts the efferent arterial to also increase GFR

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10
Q

What effects do NSAIDS, ACE-I, ARBs have on GFR? how

A

NSAIDS decrease GFR by inhibiting the vasodilatory effects of PG

ACE-I and ARBs inhibit AGII vasoconstriction effects on Eff arterioles

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11
Q

During states of volume contraction, which hormones act to induce antinatriuresis?

A

antinatriuresis (increase Na reabsorption)

  • Ag II
  • aldosterone
  • catecholamines
  • vasopressin
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12
Q

During states of volume overload, which hormones act to induce natriuresis?

A

natriuresis (pee more)

  • natriuretic peptide
  • PGs
  • Bradykinin
  • Dopamin
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13
Q

activation of the renal SNS induces what: natriuresis or antinatriuresis?

A

antinatriuresis

SNS is usually stim in state of volume contraction

(stim release of renin → increases AGII → antinatriuresis)

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14
Q

3 ways that Na is reabsorbed into the cell, in the Distal tubule

A
  1. Na channels
  2. NaCl cotranporters
  3. Na/H antiporter
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15
Q

2 ways that Na is reabsorbed, into the cell, in the thick ascending loop of henle

A
  1. NaK2Cl

2. Na/H antiporter

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16
Q

name which receptor these drugs inhibit:

  1. Loop diuretics
  2. thiazide
  3. amilioride
A
  1. NaK2Cl
  2. Na/Cl cotransporter
  3. Na channel
17
Q

two types of cells in cortical collecting duct and their purpose

A
  1. principal cells:
    - exchanges a ton of shiz (Na, K, Cl, HCo3)
  2. intercalated cells
    - H+ secretion
    - HCO3- secretion
18
Q

First clinical signs of mild volume contraction

A
  1. orthostatic HTN

2. tachycardia

19
Q

What happens to BUN levels during states of volume contraction

A

increased BUN

volume contraction → kidney avidly reabsorbs Na+ in prox tubule → urea follows Na+ → ↑ BUN

20
Q

Saline expands ___________ volume acutely.

A

ECF: electrolytes move freely between intravascular and interstitial spaces

21
Q

How does congestive HF result in ECF volume expansion?

A

increased venous P → increases capillary hydrostatic P → Fluid move to interstitial compartment

22
Q

How does nephrotic syndrome result in ECF volume expansion?

A

urinary protein loss → decrease capillary oncotic P → decrease vessel ability to retain water → water moves into interstitial comp

23
Q

How does cirrhosis result in ECF volume expansion?

A
  1. hypoalbuminemia: decrease in capillary oncotic P

2. Increased splanchnic vasodilation (seen in cirrhosis): increase in capillary hydrostatic P

24
Q

Diuretic abuse in pts

A

excessive use of diuretics can worsen kidney fxn by intravascular vol depletion

25
Q

Diuretic acting at Proximal tubule

A

acetazolamide:
- blocks carbonic anhydrase
- causes HCO3- wasting

*uniquely can cause metabolic acidosis

26
Q

Diuretic acting at loop of henle

A

furosemide
bumetanide
torsemide

  • blocks NaKCl cotransporter
27
Q

Diuretic acting at distal convoluted tubules

A

thiazide diuretics

- inhibits Na/Cl transporter

28
Q

Diuretic acting at collecting ducts

A

triamterene
amiloride
- Na channel blockers

spirinolactone
- competitive aldosterone inhibitor

29
Q

Which diuretics are K wasting?

A 
Acetazolamide (prox)
Furosemide
Bumetanide
Torsemide
Thiazides

______
all but the diuretics acting at collecting ducts

Renal (22 decks)

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