Renal 6 Flashcards

1
Q

Normal function requires ECF Osmolarity =

A

300

mOsm

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2
Q

H2O and Na+ input via diet:

A

– Too much

– Not enough.

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3
Q

H2O and Na+ loss: (4)

A

– Insensible
– Sweat
– Feces
– Urine - To a large extent, kidneys balance the
books by adjusting water reabsorption and
excretion.

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4
Q

Mechanisms to eliminate excess water by excreting a

A

dilute urine;

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5
Q

Mechanisms to conserve water by excreting a

A

concentrated urine;

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6
Q

Renal feedback mechanisms that control the

A

extracellular fluid sodium concentration and osmolarity

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7
Q

Thirst and salt appetite mechanisms that determine the
intakes of (2), which also help to control
extracellular fluid volume, osmolarity, and sodium
concentration

A

water and salt

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8
Q
Concentration and Dilution of the Urine
Accomplished 
independently of major 
changes in solute 
excretion:
– Maximal urine concen-
tration:
– Minimal urine concen-
tration:
A
1200 mOsm (specific 
gravity ~ 1.030).
50 mOsm  (specific 
gravity ~ 1.003).
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9
Q

Filtrate is — in proximal tubule.

A

isosmotic

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10
Q
Filtrate is isosmotic in proximal tubule.
 Becomes hyperosmotic as passes 
through tDL (2)
A

– Water reabsorption

– No solute reabsorption.

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11
Q

Becomes hyposmotic as passes

through TAL and early distal tubule (2)

A

– Solute reabsorption

– No water reabsorption.

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12
Q

Osmolarity of fluid will vary as pass
through distal tubule and collecting
duct (2)

A

– Stays hyposmotic in absence of
ADH (dilute urine)
– Dilute Urine (as low as 50 mOsm/L)

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13
Q

Urine Formed With ADH is Concentrated (4)

A
 ADH increases H2O permeability 
of distal tubule and collecting 
duct.
 Large volume of H2O diffuses 
into interstitium.
 Enters capillaries of Vasa Recta 
and removed.
 Creates concentrated urine (as 
high as 1200 mOsm/L)
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14
Q

Obligatory Urine Volume

A

 The maximal concentration ability of the
kidney dictates how much urine volume
must be excreted each day to rid the body of
metabolic waste products and ions that are
ingested.

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15
Q

Adult must excrete — mosmol daily
(solutes ingested and [mainly] produced by
metabolism).

A

600

(600 mosmol/day)/(1200 mosmol/L) = 0.5
L/day.

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16
Q

(600 mosmol/day)/(1200 mosmol/L) = 0.5
L/day.
– Adds to

A

other sources of H2O loss (skin,

lungs, GI).

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17
Q

Renal disease impairs — ability:

A

concentrating

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18
Q

Requirements for Excreting a Concentrated

Urine (2)

A
  1. High levels of ADH

2. Hyperosmotic medullary interstitial fluid

19
Q

Hyperosmotic medullary interstitial fluid (4)

A

Surrounds collecting duct
Sets gradient for water reabsorption
Requires Counter Current Multiplier Mechanism
Function of Juxtamedullary nephrons

20
Q

Function of Juxtamedullary nephrons (3)

A
  • Long Loop of Henle
  • Vasa Recta
  • Slow flow rate
21
Q

High Interstitial fluid Osmolarity a result of: (4)

A
  • Active transport of Na+ and other ions by ascending limb of LOH
  • Active transport of ions from collecting duct into interstitium
  • Facilitated diffusion of Urea by Inner medullary collecting ducts
  • Movement of only small amounts of water into medullary
    interstitium
22
Q

Continuous delivery of NaCl from proximal convoluted tubule into

A

loop of Henle

23
Q

Concentration of filtrate by H2O reabsorption by

A

Descending Limb of Henle

24
Q

Continuous reabsorption of solute into interstitium by

A

thick ascending limb

25
Q

Na+-K+ pumps in CD pump Na+ into interstitium to

A

↑ osmolarity (to ≈1,200 mOsm/l) => formation of interstitial osmolar gradient

26
Q

In Absence of ADH (2)

A

 Reabsorb solute

 Little to no water reabsorption

27
Q

n Presence of ADH (3)

A
 Distal tubule and collecting 
ducts become highly 
permeable to water and 
reabsorb much water into 
cortical interstitium
 Medullary collecting duct cells 
reabsorb water but overall 
amounts much lower (keeps 
medullary interstitium from 
being diluted).
 Reabsorbed water carried 
away by Vasa Recta
28
Q

Role of Urea in Concentrating Urine

A

Waste product of protein metabolism; produced continuously by
liver.

29
Q

urea:

Normally excrete –% of filtered load

A

20-50

30
Q

urea:
Non—, but constitutes an osmotic load that must be —
(mw = 60 g/mol; plasma level 5 mM).

A

toxic

excreted

31
Q

urea:
Contributes —% of medullary interstitial osmolarity (500-600
mOsm/L)

A

40-50

32
Q

Reabsorbed passively by — collecting duct cells

A

medullary

33
Q

Secreted into descending limb and thin ascending limb of Loop of
Henle - Requires: ADH (2)

A

Concentrates urea in filtrate (water reabsorption in cortical and
medullary collecting ducts)
Activates carriers (UT-A1; UT-A3) for the facilitated diffusion of
urea by medullary collecting duct cells

34
Q

Countercurrent Multiplier Mechanism

 Depends on anatomical relationships of (3)

A

loop of Henle, vasa recta, & collecting ducts.

35
Q

~25% of nephrons are —, with long loops of Henle that extend into renal medulla parallel to vasa recta & collecting ducts.

A

juxtamedullary

36
Q

Filtrate in descending & ascending limbs of loop of Henle flows in opposite directions of blood flow in

A

Vasa Recta

37
Q

Clears Reabsorbed water so does not dilute

A

medullary interstitial fluid

38
Q

Blood flow only –%
of total but sufficient
for O2 supply and
CO2 removal

A

2

39
Q

Tubule Segment: Proximal Tubule
% H2O Reabsorbed
Filtrate Osmolarity

A

70

Isosmotic

40
Q

Tubule Segment: Descending LOH
% H2O Reabsorbed
Filtrate Osmolarity

A

20

Hyperosmotic

41
Q

Tubule Segment Ascending limb of LOH
% H2O Reabsorbed
Filtrate Osmolarity

A

0

hyposmotic

42
Q

Tubule Segment: Late DT and CCD
% H2O Reabsorbed
Filtrate Osmolarity

A

variable (adh)

variable

43
Q

Tubule Segment: MCD
% H2O Reabsorbed
Filtrate Osmolarity

A

variable (ADH)

variable