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PSL301 > PSL301: Water 4 > Flashcards

PSL301: Water 4 Flashcards

Sodium balance

0
Q

Early humans evolved in a ___ sodium environment

A

Low

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1
Q

sodium is required for…

A

normal blood volume, BP, organ perfusion

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2
Q

Inadequate sodium results in…

A
  • shock
  • low ECF volume
  • low BP
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3
Q

Human kidneys are designed to ____ sodium

A

retain

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4
Q

what happens when the kidneys retain sodium?

A

keep blood volume high / constant

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5
Q

Why is high blood pressure such a common problem nowadays?

A

Kidneys are designed to retain sodium, so now that we are getting a lot of Na in the diet, it leads to problems like hypertension

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6
Q

Possible ways to lose Na

A
  • diarrhea
  • sweating
  • diuretics
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7
Q

We retain Na in conditions like…

A

heart failure

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8
Q

What happens if we have too much Na?

A
  • edema / pulmonary edema
  • weight gain
  • breathing problems
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9
Q

Data for some populations suggest that low Na+ increases risk for…

A

deaths from cardio events

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10
Q

Which ethnicity is famous for high Na diet?

A

Japanese

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11
Q

Relationship between Na intake and risk of fatal stroke

A

Higher intake = higher risk for stroke

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12
Q

Where does dietary salt come from?

A
  • 75% from processed foods
  • bread, cheese, soup, sauces, restaurants
  • very little from home cooking
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13
Q

Normally, urine sodium =

A

dietary intake of sodium

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14
Q

Urine sodium decreases if…

A

there is Na lost from gut (diarrhea) or skin (sweating)

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15
Q

Urine sodium decreases to 0 when…

A

there is severe loss from the gut or skin

e.g. cholera

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16
Q

What can be used to estimate Na intake?

A

24h urine collection

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17
Q

How long does it take for the kidneys to adjust to increase Na in the diet?

A

several days is needed to form a new steady state

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18
Q

what happens if there is a sudden increase in Na from the diet?

A

ECF volume is large for a few days until kidneys adjust

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19
Q

what happens if there is a sudden decrease in Na from the diet?

A

ECF volume is small for a few days until kidneys adjust

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20
Q

Dietary sodium is a high risk factor for…

A
  • high BP
  • stroke
  • heart disease
  • kidney disease
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21
Q

reducing Na intake is used as a form of treatment for…

A
  • CHF
  • cirrhosis with ascites
  • kidney diseases
  • diseases that result in edema (all of above)
  • hypertension
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22
Q

What sends the kidney signals to increase / decrease Na exretion?

A

Signals from the vascular system

  • intravascular volume
  • effective circulating volume
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23
Q

What does not signal the kidneys to adjust Na levels?

A

serum [Na] concentration

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24
Q

What does serum [Na] affect?

A
  • water balance
  • ADH
    ??
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25
Q

What is effective circulating volume?

A

How well cardiac output fills the arterial system

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26
Q

When is effective circulating volume low?

A
  • low intravascular volume
  • poor heart function
  • excessive arterial vasodilation
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27
Q

What is low effective circulating volume sensed by?

A

cardiovascular receptors

  • arterial baroreceptors
  • juxtaglomerular apparatus
  • atrial stretch receptors
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28
Q

What are possible causes of low intravascular volume?

A
  • diarrhea
  • sweating
  • hemorrhage
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29
Q

What are possible causes of poor heart function?

A

congestive heart failure

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30
Q

What are possible causes of excessive arterial vasodilation?

A

liver cirrhosis (advanced liver disease)

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31
Q

The glomerulus is enclosed by…

A

Bowman’s capsule

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32
Q

Cells that make up the Bowman’s capsule

A

granular cells

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33
Q

What goes out of the Bowman’s capsule?

A

proximal tubule

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34
Q

What goes in and out of the glomerulus?

A

in: afferent arteriole
out: efferent arteriole

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35
Q

What lies beside the arterioles of the glomerulus?

A

ascending limb of Henle

36
Q

What is the purpose of having the ascending limb beside the glomerulus?

A

allow glomerulus to sense things inside the ascending limb

  • feedback regulation
  • affect filtration rate, Na retention, etc. of glomerulus
37
Q

What cells make up the ascending limb that lie next to the glomerulus arterioles?

A

macula densa cells

39
Q

what are macula densa cells?

A
  • reabsorptive cells that sense NaCl levels
  • sends signals to the glomerulus
  • regulates GFR
40
Q

purpose of renin

A

angiotensinogen -> angiotensin I

41
Q

what is the rate limiting step of the RAAS?

A

renin

42
Q

angiotensin I

A

small, inactive AA

43
Q

where can ACE be found?

A

on endothelial lining of pulmonary capillaries

44
Q

ANG II has what effect?

A
  • increase BP
  • increase blood volume
  • maintain osmolarity
45
Q

ANG II: what does it do to cause increased BP?

A
  • peripheral arterioles (efferent arteriole) vasoconstrict
  • cardiovascular control center in medulla tells cardiovascular system to increase BP
  • increased volume
46
Q

where does ANG II affect?

A
  • arterioles
  • cardiovascular center in medulla
  • hypothalamus
  • adrenal cortex
47
Q

effect of ANG II on hypothalamus

A
  • release vasopressin (ADH)
  • thirst
    Overall: more fluid in vessels
48
Q

effect of ANG II on adrenal cortex

A

release aldosterone

49
Q

effect of aldosterone

A

increase Na+ reabsorption (used to maintain osmolarity)

50
Q

ANG II stimulates Na+ reabsorption in…

A
  • proximal tubule
  • distal convoluted tubule
  • collecting duct
51
Q

How does the body make sure only the efferent arteriole is constricted by ANG II?

A

AT1 receptors are only present on efferent arterioles

52
Q

what increases renin secretion?

A
  • low afferent arteriole BP
  • active SNS
  • low dietary NA
  • upright posture = more renin
  • reduced ECF volume: diuretic therapy, diarrhea, sweating, blood loss
  • reduced effective circulating volume (heart failure, liver cirrhosis)
53
Q

what senses afferent arterole pressure?

A
  • afferent arteriolar stretch

- macula densa

54
Q

What senses pressure in the SNS?

A

baroreceptors

55
Q

the RAAS has what effect on cardiac myocytes, arteries, mesangium?

A

release growth factor, which reduces compliance in arteries and kidneys

56
Q

Mesangium

A

structure that can be found between the afferent & efferent arterioles.

surrounded by capillaries but outside of capillary lumen.

57
Q

where is aldosterone secreted?

A

zona glomerulosa of adrenal cortex

58
Q

aldosterone is a ___ hormone

A

steroid

59
Q

receptor for aldosterone

A

mineralocorticoid receptor

60
Q

where can the receptor for aldosterone be found?

A

cortical collecting duct (intracellular receptor)

61
Q

mechanism of aldosterone

A

Changes protein synthesis

  • increase Na channels (ENaC)
  • increase opening of already present channels
62
Q

effect of aldosterone

A
  • Na reabsorption
  • K excretion
  • H excretion
63
Q

ANP is secreted by… in response to…

A 
atrial myocytes
atrial stretch (high BP)
64
Q

function of ANP

A
  • inhibits collecting duct Na reabsorption

- increase GFR

65
Q

what does ANP inhibit?

A
  • aldosterone
  • SNS
  • vasopressin
    overall: inhibits collecting duct Na reabsorption
66
Q

Factors that affect Na excretion

A
  1. reduced GFR (small effect)
  2. ANG II
  3. aldosterone
  4. ANP
    and others not known yet
67
Q

what causes decreased ECF volume?

A
  1. sweating
  2. diarrhea
  3. vomiting
  4. osmotic diuresis
  5. diuretics
  6. blood loss
68
Q

how much Na is lost per L of sweat?

A

35 mmol/L

69
Q

how much Na is lost per L of diarrhea?

A

100 - 120 mmol/L

70
Q

bicarbonaturia

A

excretion of excessive amounts of bicarbonates in the urine

71
Q

how much Na is in gastric fluid?

A

10 mM

72
Q

Na loss in the urine is driven by…

A

bicarbonaturia

??

73
Q

what states can be seen when there is an excess of sodium?

A
  1. congestive heart failure
  2. cirrhosis with ascites
  3. kidney disease
74
Q

congestive heart failure

A

low CO

75
Q

why might congestive heart failure cause Na retension

A

low CO (low BP) stimulates Na retention

76
Q

why might cirrhosis with ascites cause Na retension

A

low arterial resistance lowers effective circulating volume -> stimulates Na retension

77
Q

ascites

A

the accumulation of fluid in the peritoneal cavity, causing abdominal swelling

78
Q

side effects of congestive heart failures

A

edema, pulmonary edema

79
Q

What effect does high Na have on the heart?

A

aggravates heart failure

  • fibrosis
  • oxygen demand
  • reduces peripheral perfusion
80
Q

What drugs can be used to treat heart failure caused by high Na?

A
  • ACE inhibitors
  • angiotension receptor blockers
  • aldosterone blocker
81
Q

ACE inhibitor drug

A

ramipril (-pril)

82
Q

angiotension receptor blockers drug

A

losartan (-artan)

83
Q

aldosterone blocker drug

A

spironolactone

84
Q

ramipril, losartan, and spironolactone can be used to treat…

A
  • congestive heart failure
  • hypertension
  • slow progression of chronic kidney disease
  • reduce protein loss in CKD
85
Q

How to treat someone who has extremely low ECF due to high Na loss?

A
  • IV sodium and water
  • isotonic saline
  • give something to drink: has salt, glucose, K, alkali
86
Q

isotonic saline is…

A

150 mmol/L of Na in water

87
Q

What does the WHO have to treat those who have severe diarrhea?

A

oral rehydration fluid:

  • NaCl
  • glucose
  • KCl
  • sodium citrate
88
Q

why is glucose included in oral rehydration fluid?

A

Na is absorbed through SGLT 1 with glucose

89
Q

antagonizing RAAS has major benefits in…

A

cardiovascular and kidney disease

PSL301 (29 decks)

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