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Burt's Renal Final > Regulation of Sodium and Water Balance > Flashcards

Regulation of Sodium and Water Balance Flashcards

1
Q

What are the low pressure CP circuit components

A

Cardiac atria and pulmonary vasculature

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2
Q

What are the high pressure arterial circuit components

A

Carotid sinus, aortic arch, JG apparatus

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3
Q

Total body sodium equals what

A

Dietary Na - urinary excretion

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4
Q

When ECF is low, what is Na excretion and retention?

A

Decreased; increased

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5
Q

When ECF volume is high, what is Na retention and excretion?

A

Decreased; increased

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6
Q

What factors serve to increase Na excretion

A
  • dopamine
  • ECF [Na] increase
  • ECF volume increase
  • Natriuretic peptides
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7
Q

What factors contribute to decrease Na excretion

A
  • RAAS
  • sympathetics
  • ADH
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8
Q

What are the main functions of RAAS

A

Retain water
Retain Na
Kick K

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9
Q

What activates renal sympathetics

A
  • constriction of afferent arterioles (decrease in GFR)
  • increased tubular reabsorption of water and salt
  • activated RAAS
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10
Q

What promotes renin secretion

A
  • symp stim of JG by β1
  • decreased NaCl delivery to macula densa
  • afferent arteriole vasoconstriction
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11
Q

What inhibits renin secretion

A
  • increased Na Cl reabsorption at macula densa
  • increased afferent arteriole pressure
  • ADH
  • Ang II (negative feed back)
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12
Q

What does ang II stimulate

A
  • efferent constriction more than afferent
  • Na reabsorption in the PT (via NaH exchanger)
  • increased thirst
  • increased ADH secretion from post pit
  • increased aldosterone secretion from adrenal cortex
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13
Q

What does Ang II do for reabsorption of Na in the LoH

A

Increases it

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14
Q

What does aldosterone cause at the DT

A

Increased Na reabsorption and increased K secretion

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15
Q

What intracellular receptor does aldosterone bind to

A

MR (mineralocorticoid receptor)

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16
Q

What transporter is produced in greater numbers in response to aldosterone

A

NaK ATPase and ENaC

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17
Q

How does aldosterone have the overall result of an increase in Na reabsorption and increase in K excretion

A

Increased synthesis and activity of NaK ATPase

Increased synthesis and activity of ENaC in apical membrane

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18
Q

What cells in the late DT and CD are responsible for increased Na and H2O reasborption and K secretion

A

Principal cells

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19
Q

What are the 3 ions affected by aldosterone

A

Na (increased reabsorption)

K and H (increased secretion)

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20
Q

Where are the most sensitive osmolality receptors

A

Hypothalamus and liver

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21
Q

What is ADH secretion more sensitive to

A

Increases in osmolality

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22
Q

What two things does ADH secretion rely on

A

Hyperosmolality and volume depletion

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23
Q

Where are the baroreceptors

A

Aorta and carotid sinus

24
Q

What 3 main actions does ADH do

A
  1. Increases water permeability of principal cells by inserting more aquaporins
  2. Increases urea permeability in the inner medullary collecting ducts
  3. Increased the activity of the NKCC in the TAL
25
Q

What does ADH bind to extracellularly

A

V2 receptor and functions through Gαs

26
Q

What happens after ADH binds to its receptor

A

AQP2 (aquaporin) is inserted into the apical membrane

27
Q

What happens when ADH levels decrease

A

AQP2 is endocytosed and recycled

28
Q

Which AQP are unaffected by ADH levels? Where are they

A

3 and 4; they are on the basolateral membrane

29
Q

Where are the osmoreceptors in the hypothalamus

A

OVLT and SFO

30
Q

What is special about the OVLT and SFO

A

They are outside the BBB

31
Q

What carries the signal from the brain osmoreceptors to the hypothalamus

A

Magnocellular neurons

32
Q

Where is ADH released into circulation

A

Posterior pituitary

33
Q

What things stimulate ADH secretion

A

Nausea, ang II, nicotine

34
Q

What inhibits ADH secretion

A

ANP and EtOH

35
Q

What are prostaglandins protective of

A

RBF

36
Q

What buffers the vasoconstrictive effects of SNS/RAAS

A

Prostaglandins

37
Q

What do NSAIDs lead to a retention of

A

Na because PGE2 is interfered with

38
Q

What pts would we want to be careful when administering NSAIDs

A

HTN, renal stenosis, pts on diuretics

39
Q

What increases ADH

A
  • increased plasma osmolality
  • decreased BP
  • decreased BV
  • nicotine
40
Q

What decreases ADH

A
  • decreased plasma osmolality
  • increased BP
  • increased BV
  • EtOH
41
Q

What increases thirst

A
  • increased plasma osmolality
  • decreased BP
  • decreased BV
  • increased Ang II
  • mouth dryness
42
Q

What decreases thirst

A
  • decreased plasma osmolality
  • increased BP
  • increaesd BV
  • decreased Ang II
  • gastric distension
43
Q

Where do ANP/BNP come from? What are they secreted in response to?

A

Atria and ventricles; increased stretch of cardiomyocytes

44
Q

What does ANP/BNP do for Na and water

A

Promotes NaCl and water excretion

45
Q

What change does ANP/BNP cause in GFR

A

Elevated

46
Q

What action does ANP/BNP have on vessels

A

Systemic vasodilator

47
Q

Where is urodilatin produced and what does it do

A

Kidney

Promotes NaCl secretion and have no effect on systemic vasoactivity

48
Q

What do naturietic peptides generally oppose

A

RAAS, sympathetic NS, and ADH

49
Q

What actions do natriuretic peptides cause on the kidneys

A

increased GFR, decreased renin, decreased aldosterone, decreased Na and H2O reabs in CD, decresed ADH

50
Q

What stimulates secretion of ADH

A
  • increased plasma osmolality
  • decreased BV
  • decreased BP
51
Q

What stimulates secretion of PTH

A
  • decreased plasma [Ca]
  • increased plasma [PO4]
  • decreased plasma [calcitriol]
52
Q

What stimulates aldosterone secretion

A
  • decreased BP
  • decreased BV
  • increased plasma [K]
53
Q

What 4 responses does increased Na intake cause

A
  • decreased sympathetic activity
  • increased ANP
  • decreased πc
  • decreased RAAS
54
Q

What does decreased Na intake cause

A
  • increased sympathetic activity
  • decreased ANP
  • increased πc
  • increased RAAS
55
Q

What is the hemorrhage response

A
  • RAAS activation
  • sympathetic activation
  • ADH release
  • decreased Pa and baroreceptor response
  • altered blood gases (chemoreceptor reflex)
56
Q

Where is the JG apparatus

A

Distal convoluted tubule

Burt's Renal Final (7 decks)

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