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Nephrology > Regulation of Sodium Balance and Extracellular Fluid - Rao > Flashcards

Regulation of Sodium Balance and Extracellular Fluid - Rao Flashcards

1
Q

What is ECFV proportional to?

A

Total body Na content

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2
Q

What are the ways that Na is excreted from the body?

A

Renal (80-90%)
Skin (0-20%) - sweat (half isotonic)
GI - (.5-10%) - diarrhea, vomiting (isotonic)

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3
Q

What are common causes of Na imbalance?

A

Diarrhea
Excessive sweating
Diuretics

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4
Q

What are the locations and amounts of renal Na reabsorption?

A

PT - 64% (isotonic)
LoH - 28%
DT / CD - 7%

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5
Q

What are signs of a decrease in ECFV?

A

Hypotension / Orthostatic hypotension

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6
Q

What are signs of an increase in ECFV?

A

Edema
Pulmonary edema (more severe)
Heart sounds (S3)
Jugular vein distension (JVD)

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7
Q

What can cause edema with normal or low ECFV?

A

Hypo-albuminemia

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8
Q

How quickly does the body react to changes in plasma osmolarity?

A

1-2 hours

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9
Q

How quickly does the body react to changes in Na intake?

A

2-4 days

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10
Q

What receptors regulate ECFV, where are they located, and what is their mechanism?

A

Neural stretch receptors - large veins - signals pituitary to regulate AVP/ADH
Atrial stretch receptors - atria - parasympathetic in vagus for AVP secretion - sympathetic firing to kidneys and cardiovascular
Arterial baroreceptors - arteries - signals pituitary to secrete AVP

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11
Q

What mechanisms regulate Na excretion?

A 
GFR
Aldosterone
Natriuretic hormone
Renin-Angiotensin system
Sympathetic nerves
Prostaglandins
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12
Q

How does arterial pressure regulate Na excretion?

A

Pressure natriuresis
Reduced Renin
Reduced Angiotensin II
Reduced Aldosterone

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13
Q

Where does aldosterone act and what are its actions?

A

DCT and CD
Increases Na reabsorption
*Relatively slow effect

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14
Q

Where does natriuretic peptide (ANP) act and what are its actions?

A

Renal tubule - inhibits Na reabsorption
Renal vessel - increase GFR / Na excretion
Adrenal cortex - inhibit aldosterone

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15
Q

Described the renin-angiotensin system (RAS).

A

Stimulation - decreased ECFV, BP or increased sympathetic firing
JG cells - alpha 2 globulin -> AT I
Lungs - AT I -> AT II via Angiotensin converting enzyme
Adrenal cortex - increase Aldosterone
AT II - increase proximal Na:H exchanger

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16
Q

How do sympathetic nerves affect Na reabsorption?

A

Decrease GFR

Increase proximal reabsorption

17
Q

Where are prostaglandins, bradykinin, and dopamine produced and how do they affect Na reabsorption?

A

Kidney

Diuresis / Natriuresis

18
Q

Where is ouabain like factor produced and what is its affect on Na reabsorption?

A

Atrium
Diuresis
Natriuresis

19
Q

What are the hypovolemic hormones?

A

AVP
Renin (->AT II-> Aldosterone)
Norepinephrine

20
Q

What is a stronger stimulus of AVP in severe cases, osmolarity or volume?

A

Volume

Nephrology (18 decks)

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