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PHGY 210 > renal 2 > Flashcards

renal 2 Flashcards

1
Q

what % of K+ is found wthin the ICF? ECF?

A

ICF= 98% of K+

ECF: 2% OF k+

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2
Q

What is the function of the K+ concentration in the ECF?

A

extremely important for the function of excitable tissues (nerve and muscle)

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3
Q

what is the resting potential of tissues directly related to?

A

intracellular and extracellular K concentrations

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4
Q

what is hyperkalemia?

A

high concentration of K in the extracellular fluid (>5 mEq/L)

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5
Q

what is hypokalemia?

A

low concentration of K in the extracellular fluid (<3.5 mEq/L)

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6
Q

what maintains potassium balance?

A

kidneys

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7
Q

from our dietary intake, how much K+ gets excreted and where?

A

90% through urine

10% through feces

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8
Q

how is K+ filtered in the glomerulus?

A

freely filtered

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9
Q

generally is there alot of K+ found in the urine?

A

generally not since most of it gets reabsorbed in the urine

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10
Q

where can K+ be secreted at?

A

at the cortical collecting ducts.

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11
Q

how does secretion of k+ differ from that of sodium and water?

A

because K+ secretion can occur at CCD unlike the 2 others

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12
Q

what are the main factors that will regulate potassium secretion?S

A
  1. Dietary intake of potassium

2. Aldosterone

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13
Q

how is K+regulated by aldosterone and daily intake

A

increase of K+ intake will increase plasma K thus increasing aldosterone secretion which increases aldosetine in plasma causing for an increased amount of k+ secreted in CCD thus increase in K excretion

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14
Q

can the activation of Renin-aldosterone system cause the release of K+ for reasons other than high intake?

A

yes

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15
Q

what is hyperaldosteronism?

A

The conditions in which the adrenal hormone aldosterone

released in excess.

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16
Q

what is the most common cause for hyperaldosteronism?

A

denoma of the adrenal gland which

produces aldosterone autonomously.

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17
Q

what does hyperaldosteronism lead to?

A

fluid volume, hypertension, hypokalemia.

suppressed. Metabolic alkalosis is often seen

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18
Q

why is the H+ ion concentration tightly regulated in the ECF?

A

Metabolic reactions are highly sensitive to the hydrogen ion concentration of the environment.

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19
Q

what is the regulated concentration of H+? pH?

A

pH ~ 7.4

[H+] ~ ~40 nmol/L

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20
Q

what is equivalent to losing a bicarbonate ion in the body?

A

its the equivalent to gaining a h+ ion

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21
Q

what is equivalent to gaining a bicarbonate ion in the body?

A

its the equivalent to losing a h+ ion

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22
Q

what are changes in K+ excretion maily due to?

A

changes in K+ secretion of the CCD

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23
Q

what is k+ secretion in the CCD coupled with?

A

coupled with Na reabsorption

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24
Q

what may the production of non volatile acids due to metabolic reactions cause?

A

gain in h+ ions

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25
Q

what are some non volatile acids?

A

Phosphoric acid
Sulfuric acid
Lactic acid

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26
Q

how much non volatile acids are produced in the average person daily?

A

40-80 mmol of H+ per day

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27
Q

what is a buffer?

A

Any substance that can reversibly bind hydrogen ions

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28
Q

how is pH measured?

A

-log [H+]

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29
Q

what happens if no buffers are present?

A

H+ concentrations would greatly vary

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30
Q

what are some of the major EC buffers?

A

CO2/HCO3- system

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31
Q

what are the major IC buffers?

A

phosphates and proteins

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32
Q

do buffers allow to eliminate H+ ions?

A

no, it will only “lock them up”

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33
Q

what controls the ultimate balance of H+ ions?

A

Respiratory system

kidneys

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34
Q

how will the respiratory system control H+ balance?

A

by controlling CO2

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35
Q

how will the kidneys control the h+ balance?

A

by controling bicarbonate levels

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36
Q

how do the kidneys function under low [H+]?

A

Kidneys excrete HCO3- thus equivalent to a gain of H+

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37
Q

how do the kidneys function under high [H+]?

A

kidneys will produce new bicarbonate ions and add it to the plasma

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38
Q

what state are we in under low [H+]

A

high pH thus alkalosis

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39
Q

what state are we in under high [H+]

A

low pH thus acidosis

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40
Q

what is Ka (dissociation) for CO2/HCO3-

A

0.03 is solubility of CO2 at 37 degrees celsius

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41
Q

what is pH equivalent to?

A

pH = -logKa + log ( [HCO3-] / 0.03[CO2] )

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42
Q

what is bicarbonate excretion equivalent to?

A

HCO3- FILTERED - HCO3- SECRETED -HCO3- REABSORBED

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43
Q

Normally what happens to HCO3-? except?

A

generally the kidneys reabsorb all filtered HCO3-, except in cases of alkalosis

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44
Q

what mediated the transport of H+ from tubular epithelial cell to tubular lumen

A

H+/K+-ATPase Na+/H+ antiporter

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45
Q

what happens to Hco3- once it dissociated in the proximal tubule

A

it gets sent into the ISF

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46
Q

what happens to the end product H+ from H2C03 in the proximal tubule?

A

H+ is secreted in tubule lumen

47
Q

what happens in the tubule lumen when H+ meets HCO3- which has been filtered?

A

forms h2o and co2

48
Q

what % of HCO3- rebasorption occur in the proximal tubule? Tubule apical lumen? CCD?

A 
PT = 80%, 
TAL = 15%, 
CCD = 5%
49
Q

how is the addition of new HCO3- in the plasma achived?

A
  1. by H+ secretion and excretion on nonbicarbonate buffers

2. by glutamine metabolism with NH4+ excretion.

50
Q

both processes of addition of HC03- can be viewed as what?

A

h+ excretion process by the kidneys

51
Q

do the kidneys contribute enough HCO3- to compensate for the h+ ions from non volatile acids?

A

yes

52
Q

when does the addition of HCO3- occur?

A

only after all HCO3- has been reabsorbed and no longer availible in the lumen

53
Q

where does the addiiton of HCO3- occur mainly through glutamine metabolism?

A

in the proximal tubule

54
Q

addition of HCO3- to the plasma is also know as?

A

H+ excretion bound to NH3

55
Q

where does glutamine come from?

A

ISF AND then from the lumen after being filtered

56
Q

what is glutamine broken down into?

A

HCO3- and NH4+

57
Q

what happens to HCO3- and NH4+

A

both get secreted into the lumen

58
Q

in the H+ secretion on nonbicarbonate buffers, where does H+ secreted in the lumen bind to?

A

binds to phophate, hpo4-2

59
Q

what does respiratory alkalosis result from?

A

altered respiration causing for low [H+]

60
Q

what does metabolic alkalosis result from?

A

Other causes leading to low [H+]

61
Q

what does respiratory acidosis result from?

A

altered respiration causing for high [H+]

62
Q

what does metabolic acidosis result from?

A

Other causes leading to high [H+]

63
Q

what happens in the case of respiratory acidosis

A

increase in CO2

64
Q

what happens in the case of metabolic acidosis?

A

decrease of HCO3-

65
Q

what happens in the case of metabolic alkalosis?

A

increase of HCO3-

66
Q

what happens in the case of respiratory alkalosis?

A

decrease in in CO2

67
Q

what is the primary abnormality associated with respiratory disorders?

A

changes in CO2 levels

68
Q

what is the primary abnormality associated with metabolic disorders?

A

changes in HCO3- levels

69
Q

how does the body respond to acidosis?

A
  1. Sufficient H+ are secreted to reabsorb all the filtered HCO3-.
  2. Still more H+ are secreted and this contributes new HCO3- to the plasma as these H+ are excreted bound to non-HCO3- buffer such as HPO42-.
  3. Tubular glutamine metabolism and ammonium excretion are enhanced, which also contributes new HCO3- to the plasma.
70
Q

what is the net effect of the body in response to acidosis?

A

More new HCO3- than usual are added to the plasma, thereby compensating for the acidosis

71
Q

how is the urine in cases of acidosis?

A

acidic

lowest pH ~ 4.4

72
Q

how does the body respond to alkalosis

A
  1. Rate of H+ secretion is inadequate to reabsorb all the filtered HCO3-, so the significant amounts of HCO3- are excreted in the urine.
  2. There is little or no H+ secretion on non-HCO3- urinary buffers.
  3. Tubular glutamine metabolism and ammonium excretion are decreased, so that little or no new HCO3- is contributed to the plasma from this source.
73
Q

what si the net result of the body’s response to alkalosis?

A

Plasma HCO3- will decrease, thereby compensating for the alkalosis.

74
Q

how is the urine during alkalosis?

A

highly alkaline

pH > 7.4

75
Q

how do kidneys compensate to increase CO2 concentration in respiratory acidosis?

A

increasing hco3-

76
Q

how do kidneys compensate to decrease CO2 concentration in respiratory alkalosis?

A

decrease hco3-

77
Q

how does the respiratory system compensate to metabolic acidosis?

A

increase H+, decrease HCO3 and thus decrease of PCO2

78
Q

how does the respiratory system compensate to metabolic alkalosis?

A

increase HCO3, decrease H , thus increases PCO2

79
Q

Give a clinical example of when respiratory acidosis may occur?

A

respiratory failure with CO2 retention, severe asthma

80
Q

Give a clinical example of when respiratory alkalosis may occur?

A

hyperventilation (e.g. high altitude)

81
Q

Give a clinical example of when metabolic alkalosis may occur?

A

vomiting (loss of H+ in vomits), hyperaldosteronism (increased H+ secretion in DCT and CCD)

82
Q

Give a clinical example of when metabolic acidosis may occur?

A

diarrhea (loss of HCO3- in diarrhea), renal failure (accumulation of inorganic acids)

83
Q

what are the drugs used to uncrease the volume of urine excreted?

A

diuretics

84
Q

what do diuretic act on?

A

tubules

85
Q

what is inhibited by diuretics?

A

inhibit reabsorption of Sodium along with Cl, and/or bicarbonate

86
Q

what does the inhibition of ions by diuretics cause?

A

increased excretion of these ions hence increased water excretion

87
Q

what do loop diuretics act on?

A

the thick ascending limb of the loop of Henle.

88
Q

what is inhibited by loop diuretics?

A

Inhibits cotransport of sodium, chloride and potassium

89
Q

what type of diuretic is furosemide?

A

loop diuretic

90
Q

what happens to Na reabsorption when consuming loop diuretic?

A

Diuretics will block reabsorption in the TAL

91
Q

what % of Na reabsorption occurs in TAL?

A

25%

92
Q

what is inhibited by potassium spanning diuretics?

A

Inhibit sodium reabsorption in the CCD, and also inhibits potassium secretion there

93
Q

what happens to the K+ plasma concentration when using potassium spanning diuretics?

A

it will not decrease as it would with other diuretics

94
Q

what gets blocked by potassium spanning diuretics?

A

block the action of aldosterone or block the (aldosterone-regulated) epithelial sodium channel in the CCD.

95
Q

give a few examples of potassium spanning diuretics and their function?

A

amiloride (block sodium channel)

spironolactone (block aldosterone receptor)

96
Q

what happens when alsosterone is blocked?

A

blocks the secretion of K and Na uptake since aldosteron acts on Na/K atpase, K channel and Na channel

97
Q

why can diuretics be used in clinical settings?

A

in cases of renal retention of salt and water leading to edema

98
Q

what happens in cases of congestive heart failure?

A

heart failure lowers CO, which is percieved by baroreceptors as a lack of fluid/Na and sends info to the brain causing kidneys to reabsorb Na and H20 which will accumulate in the lungs

99
Q

what happens in cases of hypertension?

A

renal retention of salt and water may be contributing to high blood pressure

100
Q

what are some common features associated with kidney diseases and renal failure?

A

-proteinuria
-accumulation of waste in blood
high [potassium] –> hyperkalemia
metabolic acidosis
anemia
decreased secretion of vit D3 leading to hypocalcemia

101
Q

what are some of the waste products which may accumulate in blood in cases of renal failure or kidney diseases?

A

urea, creatinine, phosphate, sulfate

102
Q

why is anemia possible in cases of kidney failure?

A

due to decreased secretion of EPO

103
Q

what is involved in renal remplacement therapy?

A
  1. Hemodialysis
  2. Peritoneal dialysis
  3. Kidney transplantation
104
Q

when is a patient subject to renal remplacement therapy?

A

when more than 90 % of nephrons stop working

105
Q

what is hemodialysis?

A

its a blood cleaning treatment

106
Q

how does hemodialysis work>

A

Arterial blood is run through pump, anticoagulant is added, goes through fibers from top to bottom. Dialysis fluid is run bottom to top across a membrane, and molecules are exchanged. Blood is then returned to patient through vein.

107
Q

what is used as a dialysis memebrane?

A

abdominal peritoneum

108
Q

where is dialisis fluid injected?

A

into the cavity via a tube inserted through the abdominal wall.

109
Q

where do solute from a patient diffuse?

A

the solutes from patient blood will diffuse into dialysis fluid

110
Q

can dialysis be done at home

A

yes, requires to be done a few times per day

111
Q

can kidney transplantation be done from both living and decreased donor?

A

yes if compatible.

must be recently deceased

112
Q

what type of treatment must be applied immediately after kidney transplant?

A

anti-rejection treatment

113
Q

can donor functions well with a single kidney?

A

yes

114
Q

are we short on organs?

A

yes, shortage is an issue

PHGY 210 (11 decks)

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