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Renal Final > Regulation of Sodium and Water Balance > Flashcards

Regulation of Sodium and Water Balance Flashcards

1
Q

What happens to Na excretion and Na retention when ECF volume is low?

A

Na excretion will be low and Na retention will be high

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2
Q

What happens to Na excretion and Na retention when ECF volume is high?

A

Na excretion will be high and Na retention will be low

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3
Q

Which of the following has a negative effect on Na excretion?

A. Dopamine
B. Natriuretic peptides
C. Sympathetic stimulation
D. ECF volume

A

C. Sympathetic stim

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4
Q

What are the 3 main things that promote renin secretion?

A

Sympathetic stim directly via B1 receptor activation in JG apparatus

Decreased NaCl delivery to macula densa

Afferent arteriolar vasoconstriction leading to decreased pressure at granular cells

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5
Q

What effects do increased afferent arterolar pressure or ADH have on renin secretion?

A

Inhibits it

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6
Q

Aldosterone increases the synthesis of Na/K ATPase in the basolateral membrane of the distal tubule - what is the overall effect?

A

Increase in Na reabsorption and increase in K excretion

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7
Q

What is the aldosterone receptor?

A

MR

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8
Q

2 main actions of aldosterone in terms of membrane channels

A

Increases synthesis and activity of Na/K ATPase in basolateral membrane of DT

Increased synthesis and activity of ENaC channels in apical membrane

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9
Q

3 main actions of aldosterone in terms of ion reabsorption/secretion

A

Increases Na reabsorption

Increases K+ secretion

Increases H+ secretion

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10
Q

What 2 physiological changes is ADH secreted in response to and which one is it more sensitive to?

A

Hyperosmolarity (most sensitive)

Volume depletion

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11
Q

ADH is released in conditions of hyperosmolarity and volume depletion, what receptors detect these changes

A

Osmoreceptors in the hypothalamus and liver

Baroreceptors in aorta and carotid sinus

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12
Q

3 main actions of ADH in kidney tubules

A

Increases water permeability of principal cells of collecting duct via insertion of aquaporins into luminal membrane

Increases urea permeability in inner medullary CD’s

Increases activity of Na/K/2Cl cotransporter in TAL

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13
Q

ADH receptor

A

V2 receptor

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14
Q

Which aquaporin is inserted into the luminal membrane in response to ADH? What happens when ADH decreases again?

A

Aquaporin 2

When ADH decreases, aquaporin 2 is endocytosed

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15
Q

What are the 2 main osmoreceptor areas that respond to ADH, and what is unique about them

A

OVLT and SFO; they extend outside the BBB

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16
Q

Osmoreceptors are located in the OVLT and SFO, 2 areas that breech the BBB. A second neuron carries the signal to the hypothalamus. The osmosensitive ________ neurons project to large diameter neurons in the supraoptic and paraventricular nuclei of the _________. ADH is carried along the axon to posterior pituitary where it is released to circulation

A

Magnocellular; hypothalamus

17
Q

Which of the following inhibits ADH secretion?

A. Nausea
B. Angiotensin II
C. Nicotine
D. Ethanol

A

D. Ethanol

[ANP also inhibits ADH]

18
Q

Action/source of ANP/BNP

A

ANP from heart atria
BNP from heart ventricles

Promotes NaCl and water secretion; elevates GFR; systemic vasodilator

19
Q

What is urodilatin

A

Locally produced in the kidney; promotes NaCl secretion

20
Q

T/F: Natriuretic peptides generally oppose RAAS, SNS, and ADH

A

True

21
Q

Effect of natriuretic peptides on GFR

A

Increases GFR by afferent vasodilation and efferent vasoconstriction

22
Q

Increased activity of the RAAS is the first of four parallel pathways that correct a low ECV. What are the other 3 pathways?

A

Sympathetic stimulation

Posterior pituitary activation and ADH release

ANP activity inhibited

23
Q

Integrated response to volume expansion:

_______ in GFR

________ in reabsorption of Na in the proximal tubule and LOH

_______ of water

A

Increase

Decrease

Excretion

24
Q

Integrated response to decreased ECV involves renin release. What stimulates renin release?

_______ BP

________ NaCl delivery to macula densa

_________ renal perfusion pressure

A

Decrease

Decrease

Decrease

25
Q

Integrated response to decreased ECV: actions of angiotensin II:

______ aldosterone

________ efferent arteriole

_________ Na-H exchange

________ thirst and ADH release

A

Increase

Vasoconstrict

Enhance

Stimulate

26
Q

Integrated response to decreased ECV: effect of sympathetics:

______ renal vascular resistance

_______ Na reabsorption

________ renin release via JG cells

A

Increase

Increase

Enhance

27
Q

In the integrated response to decreased ECV, ANP activity is _______

A

Inhibited

28
Q

Ingtegrated response to volume contraction:

______ in GFR

_______ in Na reabsorption by PT and LOH

_______ water reabsorption

A

Decrease

Increase

Enhanced

29
Q

Disorders of ECF volume are usually the result of disturbances in _____ balance, and disorders of sodium concentration are usually the result of disturbances in ______ balance

A

Sodium

Water

30
Q

T/F: you can depend on serum sodium concentration to tell you about the state of fluids in the vascular compartment

A

False

You also have to consider whether RAAS has had time to elicit effects, as well as the person’s access to water/hydration status

31
Q

Effect of primary polydipsia on serum ADH, serum osmolarity, urine osmolarity, urine flow rate, and C(H2O)

A

Serum ADH decrease

Serum osmolarity decrease

Urine = hyposmotic

Urine flow rate = high

C(H2O) = positive

32
Q

Effect of central diabetes insipidus on serum ADH, serum osmolarity, urine osmolarity, urine flow rate, and C(H2O)

A

Serum ADH decrease

Serum osmolarity increased

Urine osmolarity = hyposmotic

Urine flow rate =high

C(H2O) = positive

33
Q

Effect of nephrogenic diabetes insipidus on serum ADH, serum osmolarity, urine osmolarity, urine flow rate, and C(H2O)

A

Serum ADH increased

Serum osmolarity increased

Urine osmolarity = hyposmotic

Urine flow rate = high

C(H2O) = positive

34
Q

Effect of water deprivation on serum ADH, serum osmolarity, urine osmolarity, urine flow rate, and C(H2O)

A

Serum ADH increased

Serum osmolarity high-normal

Urine osmolarity = hyperosmotic

Urine flow rate = low

C(H2O) = negative

35
Q

Effect of SIADH on serum ADH, serum osmolarity, urine osmolarity, urine flow rate, and C(H2O)

A

Serum ADH INCREASED

Serum osmolarity decreased

Urine osmolarity = hyperosmotic

Urine flow rate = low

C(H2O) = negative

Renal Final (10 decks)

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