Physiology Part 2 Flashcards
What stimulates Renin?
Decreased BP (JGC)
Decreased Na Delivery (MDC)
Increased sympathetic tone (B1R)
What are all the 6 effects of AngII?
- Acts at AT1 receptors of vascular SM
- Constricts efferent arteriole of glomerulus
- Aldosterone Secretion from Adrenal Gland
- ADH secretion from Post. Pituitary
- Increased PT Na/H activity
- Simulates Hypothalamus
What happens when AngII binds AT1 receptors?
Vasoconstriction–>
Increased BP
What happens when AngII constricts eff. afteriole?
Increased FF to preserve GFR in low-volume states and RBF is low
Aldosterone enhances ______ and ________ excretion, and creates a favorable gradient for ____ and ____ reabsorption
K, H, Na, H2O
ADH does what? This leads to what?
Increases H2O channel insertion in principal cells leading to water reabsorption
Increased PT Na/H activity increases _________ reabsorption
Na, HCO3, and H2O
Increased PT Na/H activity permits
Contraction alkalosis
AngII stimulation hypothalamus does what?
Increased thirst
AngII affects _____, which limits ________
Baroreceptor function
Bradycardia
AngII maintains what?
Blood volume and Blood Pressure
Where is ANP released from?
Atria
What is ANP released in response to?
Increased atrial volume
What does ANP act as?
Check on RAA system
ANP _____ vasc. SMC via ______
relaxes, cGMP
ANP causes _____ GFR and ____ Renin
Increased, decreased
What are the 2 things ADH regulates?
Osmolarity
low blood volume level
Which of ADH’s 2 regulating things takes precedent?
Low Blood Volume
What is Aldosterones primary job?
Regulates blood volume
In low volume states _____ and ______ protect Blood Volume.
ADH, Aldosterone
JGA consists of ______ and ______
JGC and MDC
what are JGC?
Modified smooth muscle of afferent arteriole
What are MDC?
NaCl sensor part of the distal convoluted tubule
JGC secrete ______
Renin
JGC secrete renin in response to what?
Decreased Renal BP
Decreased NaCl delivery to DT
Increased SNS tone (B1R)
JGA defends GFR via what system?
RAA
B-Blockers have what effect on JGA
Decrease BP by inhibiting B1R of the JGA causing decreased renin release
What is Epo released from?
Interstitial cells in the peritubular capillary bed
What is Epo released in response to?
Hypoxia
PT cells convert ________ to _________ via 1-alpha hydroxylase.
25-OH Vit. D, 1,25-(OH)2 Vit. D
What stimulates 1 alpha hydroxylase?
PTH
Paracrine secretion of Prostaglandins does what?
Vasodilates afferent arterioles to maintain GFR
How do NSAIDS negatively effect the kidney?
Inhibit renal production of prostaglandins
ANP causes ______ GFR and ______ Sodium filtration WITH NO compensatory Na reabsorption at the distal nephron.
Increased, increased
What is the net effect of ANP?
Na and volume loss
PTH is secreted in response to…
Decreased plasma Ca
Increased plasma Phosphate
Decreased plasma Vit. D
PTH causes…
Increased Ca reabsorption (DCT)
Decreased Phosphate reabsorption (PCT)
Increased Vitamin D production (PCT)
What additional extrarenal effect does PTH have?
Increased calcium and phosphate absorption from the gut
ATII is synthesized in response to ____ BP
Decreased
When it causes efferent arteriole constriction, it ____GFR and ____ FF WITH compensatory Na reabsorption in the proximal and distal Nephron
Increase, increase
Net effect of ATII is…
- Preserve renal function in low volume states (Increased FF)
- Simultaneous Na resorption (P and D)
both to decrease volume loss
Aldosterone is secreted in response to _______ (via ATII) and _________.
Decreased Blood Volume
Increased plasma K
Aldosterone causes what?
Increased Na reabsorption
Increased K secretion
Increased H secretion
ADH is secreted in response to ______ plasma osmolarity and ________ Blood volume
Increased, Decreased
ADH binds to receptors on principal cells and _______ water channels and increases _______.
Increase number of
H2O reabsorption
What causes hyperkalemia?
DO Insulin LAB:
Digitalis HyperOsmolarity Insulin deficiency Lysis of cells Acidosis Beta antagonists
What causes hypokalemia?
Hypo-osmolarity
Insulin (increases Na/K ATPase)
Alkalosis
Beta agonist
Low serum Na concentration leads to…
Nausea
Malaise
Stupor
Coma
High serum Na concentration leads to…
Irritability
Stupor
Coma
Low serum K concentration leads to what on an ECG?
U waves
Flattened T waves
Low serum K concentration leads to…
Arrhythmias
Muscle weakness
High serum K concentration leads to what on an ECG?
Wide QRS
Peaked T waves
High serum K concentration leads to…
Arrhythmias
Muscle weakness
Low serum Ca concentration leads to…
Tetany
Seizures
High serum Ca concentration leads to…
Stones (renal)
Bones (pain)
Groans (ab pain)
psychiatric Overtones (anxiety, altered mental status)
Low serum Mg concentration leads to…
Tetany
Arrhythmias
High serum Mg concentration leads to…
Decreased DTR Lethargy Bradycardia Hypotension Cardiac Arrest hypocalcemia
Low serum Phosphate leads to…
Bone loss
Osteomalacia
High serum Phosphate leads to…
Renal stones
Metastatic calcifications
hypocalcemia
Metabolic acidosis (pH, Pco2, Hco3)
decreased, decreased, decreased
Metabolic alkalosis (pH, Pco2, Hco3)
increased, increased, increased
Respiratory acidosis (pH, Pco2, Hco3)
Decreased, Increased, increased
Respiratory alkalosis (pH, Pco2, Hco3)
Increased, decreased, decreased
What is the compensation for metabolic acidosis?
Hyperventilation (immediate)
What is the compensation for metabolic alkalosis?
Hypoventilation (immediate)
What is the compensation for respiratory acidosis?
Increased renal HCO3 reabsorption (delayed)
What is the compensation for respiratory alkalosis?
Decreased renal HCO3 reabsorption (delayed)
What is the henderson-Hasselbach equation?
pH=6.1+log(HCO3 conc.)/0.03PCO2
If the measured PCo2 differs significantly from the predicted PCo2, then ________ is likely present
Mixed acid-based disorder
What causes hypoventilation?
Airway obstruction
Acute/chronic lung disease
Opioids/sedatives
Weakening of respiratory muscles
What causes an increased anion gap?
MUDPILES Methanol (formate) Uremia Diabetic Ketoacidosis Propylene glycol Iron tables or INH Lactic Acidosis Ethylene glycol (oxalate) Salicylates (late)
What causes a normal anion gap?
HARD ASS Hyperalimentation Addison's disease Renal tubular acidosis Diarrhea Acetozolamide Spironolactone Saline infusion
What causes respiratory alkalosis?
Hyperventilation (eg. early high altitude exposure)
Salicylates (early)
What causes metabolic alkalosis?
Loop diuretics
Vomitting
Antacid use
hyperaldosteronism
What is type 1 distal RTA?
Defect in CT ability to excrete H
Untreated patients with type 1 distal RTA have a urine pH of _______
> 5.5
Patients with type 1 distal RTA have a ________ risk for _________ as a result of ________ urine pH and ________.
increased
calcium phosphate kidney stones
increased
bone resorption
Type I distal RTA is associated with ________
hypokalemia
What is type 2 proximal RTA?
Defect in PT HCO3 resorption
type 2 proximal RTA can be seen with _______ syndrome
Fanconi’s
Untreated patients with type 2 proximal RTA typically have a urine pH of _________
<5.5
Type 2 proximal RTA is associated with ________, and patients with this are at increased risk for _______
hypokalemia
hypophosphatemic rickets
What is type 4 hyperkalemic RTA?
Hypoaldosteronism or lack of CT response to aldosterone
In type 4 hyperkalemic RTA, the hyperkalemia impairs _____ in the ________, leading to ______ and ______urine pH.
ammoniagenesis
proximal tubule
decreased buffering capacity
decreased
