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Renal Flashcards

1
Q

Extracellular

A

Na
Cl
HCO3
Ca

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2
Q

Intracellular

A

K
Organic anions
Proteins
Mg

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3
Q

Protein (albumin) levels are highest in the _ and _ compartments

A

ICF

Vascular

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4
Q

Are membranes permeable to proteins

A

No

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5
Q

Oncotic (colloid osmotic) pressure

A

Pressure generated by large molecules (like proteins) in solution that are impermeable to membranes

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6
Q

How are ICF and ISF measured

A

Indirectly

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7
Q

ECF

A

Inulin, Na, thiosulfate

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8
Q

ICF

A

TBW-ECF=ICF

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9
Q

TBW

A

H2O

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10
Q

Plasma volume

A

I-albumin, Evans blue dye

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11
Q

Interstitial fluids

A

ECF-plasma=ISF

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12
Q

What drives ECF osmolality

A

Na and Cl

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13
Q

Na vasculature __ Na interstitial fluid ___ Na due to action of NaKATPase

A

> >

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14
Q

What causes increased ICF (Na)

A

Disrupted pump activity (hypoxia

Where Na goes water follows

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15
Q

ICF osmolality is driven by

A

K

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16
Q

ECF osmolality controls _ volume

A

ICF

Water enters of leaves ECF rapidly to balance osmolality of ECF and ICF

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17
Q

Osmotic equilibrium

A

Movement of water across cell membranes from higher to lower concentration as a result of osmotic pressure differences across that membrane

Osmotic presssure exerted across a membrane by a substance is also due to that membrane being impermeable to that substance

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18
Q

Mean forces tend to move fluid __

A

Outward

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19
Q

Total outward force

A

Plasma colloid osmotic pressure (28mmHg)

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20
Q

Total inward force

A

Outward (28.3)

Inward (28

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21
Q

What are the pressures

A

Mean capillary pressure (17.3)
Negative interstitial free fluid pressure (3)
Interstitial fluid colloid osmotic pressure (8)

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22
Q

How is ECF a reservoir

A

All water an solutes must pass through the ECF first

First calculate ECF then ICF

All solutes and water that enter or leave the body do so via ECF
ICF and ECF are in osmotic equilibrium
Equilibration occurs primarily by shifts of water, not solutes

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23
Q

Hypernatremia

A

> 146

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24
Q

Hyponatremia

A

<136

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25
Hyper and hyponatremia is a __ problem
Water
26
What maintains the fluid distribution between plasma and ISF
Balance of hydrostatic and osmotic forces across capillaries
27
What determines ECF and ICF fluid distribution
Osmotic effect of small solutes across cell membranes
28
Isosmotic
Solutions that have the same osmolality as the ECF When added to ECF, osmolality does not change , only the volume
29
Hyperosmotic
Osmolality greater than the ECF When added to the ECF , osmolality increases and pulls water from the ICF into the ECF, resulting in an increase in ECF volume and a decrease in ICF volume
30
Hypoosmotic
Osmolality less than ECF When added to ECF, osmolality decreases and water moved out of the ECF and into the ICF to equilibration. ECF and ICF volumes both increase
31
What give if want to dilute ECF and rehydrate cells
Hypotonic .45 salient
32
What administer if want to replace fluid loss and expand intravascular volume
Isotonic solution normal saline
33
What administer to treat severe hyponatremia
Hypertonic solution | 3% saline
34
Prostagladins are protective of __
RBF
35
Prostagladins as buffers
Vasoconstriction effects of SNS/RAAS (the built in safety mechanism)
36
How do prostagladins with
Inhibits K channels in TAL, increasing Cl, impeding turnover of Na K 2 Cl channels, reducing NaCl reabsorption
37
NSAIDS and prostagladins
Interfere with PGE2 action, leading to Na retention
38
What kind of patient careful to give NSAIDS
Hypertensive patients, renal stenosis, patients on diuretics
39
Angiotensin II effect on RBF
Decrease | Decrease
40
ANP effect on RBF and GFR
Increase increase
41
Prostagladins effect on RBF and GFR
Increase increase
42
Sympathetic stimulation leads to what
Na K ATPase increase Na reabsorption at tubular epithelial cells RAAS juxtaglomerular granular cells*mainly Powerful vasoconstriction : afferent>efferent arteriole a1 adrenoceptors INCREASED BP
43
Immediate effects of sympathetic stimulation
Stimulates renin secretion by the granular cells Angiotensin II exerts thirst Angiotensin II restores systemic blood pressure via vasoconstriction Angiotensin II preferentially acts on efferent arteriolar Stimulates Na reabsorption in PCT and DCT GFR is stabilized Systemic blood pressure is raised
44
Eventually sympathetic stimulation
Decreased urinary output Decreased urinary Na excretion Increased water intake
45
Acute Sympathetic activation effect on RBF, GFR, renin, Na reabsorption in proximal tubule
Ok
46
Chronic effect of sympathetic activation RBF, GFR, renin, Na reabsorption in proximal tubule
Ok
47
``` Afferent arteriole-vasodilation Prostagladins Bradykinin NO Dopamine ANP ``` RBF, GFR, peritubular capillary hydrostatic pressure
Increase increase increase
48
Afferent arteriole vasoconstriction RBF, gfr, peritubular capillary hydrostatic pressure
Decrease, decrease, decrease
49
Efferent arteriole vasodilation RBF, gfr, peritubular capillary hydrostatic pressure
Increase, decrease, increase
50
Efferent arteriole vasoconstriction Angiotensin II RBF GFR peritubular capillary hydrostatic pressure
Decrease Increase (sideways) Decrease
51
What promotes renin secretion
Renal sympathetic stimulation directly stimulate renin via B1 receptor activation in JG apparatus Decrease NaCl delivery to the macula densa stimulates renin Afferent arteriolar vasoconstriction leads to decreased pressure at the granular cells, which stimulates renin secretion
52
What inhibits renin secretion
Increase Na and Cl reabsorption across the macula densa Increased afferent arteriolar pressure ADH Angiotensin II(neg feedback)
53
What does angiotensin II stimulate
Renal arteriolar constriction (efferent>afferent) Na reabsorption in PT (via Na H exchanger)> TAL and CCD Thirst ADH secretion from posterior pituitary Aldosterone secretion from adrenal cortex
54
Angiotensin II causes what
Vasoconstriction, increased thirst, increased aldosterone secretion
55
What does vasoconstriction lead to
Increased peripheral resistance and increase in systolic and diastolic bp
56
What does increased thirst lead to
Increased water intake, increased blood volumes, increased CVP, increased CO and increase in systolic and diastolic blood pressure
57
What does increase in aldosterone cause
``` Increased renal retention of salt and water Increased in blood volume Increase in CVP Increase in CO Increase in systolic blood pressure ```
58
Angiotensin II preferentially ____ the efferent arteriole, but __ the afferent arteriolar
Vasoconstriction Constricts
59
Angiotensin II effect on arterioles
Increase afferent and efferent arteriolar resistance | Afferent
60
What does increase afferent and efferent arteriolar resistsance cause
Decrease renal blood flow Increased filtration fraction Decreased capillary hydrostaticpressure
61
What does increased filtration fraction lead to
Increased peritubular capillary colloid osmotic pressure
62
What does increased peritubular capillary colloid osmotic pressure and decreased peritubular capillary hydrostatic pressure
Increased proximal Na reabsorption —>decreased excretion and H2O
63
What does decreased casa recta flow lead to
Decreased washout of urea from medullary interstitial->increased urea, decreased Na in medullary interstitial->increased gradient for passive NaCl reabsorption by the thin ascending limb of henna->increased loop of henna Na reabsorption->decreased Na excretion and H2O excretion
64
Action of aldosterone
Increases the synthesis of Na K ATPase in the basolateral membrane of the distal tubal Overall result is an increase in Na reabsorption and an increase in K excretion
65
Steps of aldosterone
1. combines with a cytoplasmic receptor 2. hormone receptor complex initiates transcription in the nucleus 3. Translation and protein synthesis makes new protein channels and pumps 4. Aldosterone induced proteins modulate existing channels and pumps 5. Results is increased Na reabsorption and K secretion
66
Actions of aldosterone
Increases the synthesis and activity NaK ATPase in the basolateral membrane of the distal tubule Increases synthesis and activity of epithelial Na channels in apical membrane Overall Na reabsorption and K excretion
67
Aldosterone also stimulates tubular secretion of H
The apical membrane of a intercalated cells contain two transporters that secrete H into the tubular fluid: HATPase HK ATPase Increase Na reabsorption Increase K secretion Increase H secretion
68
Increased activity of __ is the first of four parallel pathways that correct a low effective circulating volume
RAAS
69
Filtered load of Na=
(GFR)(plasmaNa) =180L/day(14-mEq/L) =25200 mEq/day Want a consent amount of Na to be delivered to the distal tubules Distal tubule fine tunes concentration to match dietary intake
70
Na reabsorption in late DT and CD
Principal cells-Na and H20 reabsorption and K secretion Responsible for fine adjustments in tubular fluid Na concentration
71
Early proximal tubule-Na reabsorption
Na uptake across the apical membrane is coupled with movement of another molecule -reabsorbed primarily with HCO3(not Cl), glucose, aa, Pa and lactate Or Reabsorbed in exchange for H or organic solutes
72
Peritubular capillary symporters
Na glucose Na aa Na Pi Na HCO3 Na into peritubular capillary
73
Peritubular capillary antiporters
Na H Na organic solutes Na into peritubular capillary
74
Reabsorption of Na in proximal tubule is driven by
NaK ATPase
75
Early proximal tubules Na reabsorption
NaK ATPase pumps Na into the ISF outside basolateral membrane and is absorbed into the peritubular capillary
76
Late proximal tubules Na reabsorption
Na uptake across the apical membrane is coupled with Cl -reabsorbed primarily with Cl (transcellular) -required operation of parallel transports happening simultaneously -NaH antiporter -Cl-base antiporter Bases=formate oxalate and bicarbonate Driven by NaK ATPase
77
Late proximal tubules Na reabsorption
NaKAPTase pumps Na into the ISF outside basolateral membrane and is absorbed into the peritubular capillary. Cl crosses basolateral membrane via Cl channels Reabsorption still driven by NaK ATPase
78
Loop of Henley thin descending segment
Water permeable NaCl remains in tubules-concentrates during descent
79
Loop of Henley ascending limb
Thin and thick segment Water impermeable NaCl is reabsorbed in tubule Dilutes during ascent
80
Thick ascending limb
NaKATPase maintains low intracellular Favors movement of Na from lumen into cell via NaK2Cl co transporter and NaH countertransporter Luminal electrochemical gradient favors movement of other positively charged ions out of the tubule Passive leakage of K and Cl
81
Distal tubules early segment
Continuation of TAL Juxtaglomerular apparatus Reabsorbs Na Cl and Ca Water impermeable
82
Distal tubule late segment
Principal cells(Na reabsorption, K secretion...water reabsorption) Intercalated cells (acid base balance) Continues into collecting duct
83
Early segment DT
NaKATPase maintains low intracelllular, favoring movement of Na into cell via NaCl cotransporter Cl leaks out Impermeable to water
84
Late segment DT principle cells
NaKATPase maintains low intracellularNa, moving K into the cell Na K and Cl diffuse down their concentration gradients
85
Aldosterone antagonsits DT
Spironolactone Eplerenone (Eplerenone more specific than spironolactone) Stop renal interstitial
86
Na channel blockers DT
Amiloride Triamterene Stop luminal Na in
87
PT water
67% filtered that’s reabsorbed Passive osmosis No hormones that regulate water permeability
88
LOH water
15% filtered that’s reabsorbed Passive osmosis (descending thin) No hormones
89
Early distal tubules water
0% filtered that’s reabsorbed
90
Late distal tubule and collecting duct water
8-17% filtered that’s reabsorbed Passive osmosis ADH, ANP, BNP
91
Water transport is __-
Passive
92
Proximal tubules Na
67% filtered that’s reabsorbed Primary and active transport
93
LOH Na
35% filtered that’s reabsorbed Secondary active transport
94
DT Na
5% filtered that’s reabsorbed Primary and secondary active transport
95
Collecting duct Na
3% filtered that’s reabsorbed Primary active transport ADH, ANP, BNP
96
Water and chloride __ sodium
Follow
97
What increases ADH
Increase plasma osmolality Decrease bp Decrease blood volume Nicotine
98
What decreases ADH
Decrease plasma osmolality Increase bp Increase blood volume Ethanol
99
What increases thirst
Increased plasma osmolality Decrease bp Decrease bv Increase angiotensin II Dryness of mouth
100
What decreases thirst
Decreased plasma osmolality Increase bp Increase bv Decrease angiotensin II Gastric distension
101
Integrated response to volume expansion
GFR increases Reabsorption of Na decreases int he proximal tubule and loop of henle Na reabsorption decreases in the distal tubule and collecting duct Water excretion follows Hours->days
102
What stimulates renin release in integrated response to ECV
Decreased bp (JGA) Decreased NaCl delivery to the macula densa (NaCl sensor) Decreased renal perfusion pressure (renal baroreceptors)
103
Actions of angiotensin II in integrated response to decreased ECV
Increase aldosterone Vasoconstriction efferent arteriole Enhances NaH exchange (promotes Na reabsorption Stimulates thirst and ADH release
104
Sympathetic in integrated response to decreased ECV
Increase renal vascular resistance Increased Na reabsorption Enhances renin release (via JG cells)
105
Major factor controlling ADH release in plasma osmolality
1% decrease in plasma osmolarity | 5-10% decrease in ECV
106
ANP is __ in integrated response to decreased ECV
Inhibited
107
Integrated response to decreased ECV
GFR decreases Na reabsorption by the proximal tubule and loop of henle is increased Na reabsorption by the distal tubule and collecting duct is enhanced Water reabsorption

Physiology (7 decks)

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