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Phys exam 5 > Renal 9 > Flashcards

Renal 9 Flashcards

1
Q

____ is a highly regulated ion via:

  • Enzymes
  • Blood clotting
  • Muscle contraction
  • Channels
A

H+

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2
Q

What is the range that is compatible with life for only a short time for pH?

A

pH: 6.8-8.0

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3
Q

The following are way to ____ H+ ions:

  • Generation of H+ from CO2
  • Production of nonvolatile acids from metabolism of proteins and other organic molecules
  • Loss of HCO3 in diarrhea or other nongastric GI fluids
  • Loss of HCO3 in urine
A

Gain H+ ions

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4
Q

The following are way to ____ H+ ions:

  • Utilization of H+ in the metabolism of various organic anions
  • Vomit
  • Urination
  • Hyperventilation
A

Loss of H+ ions

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5
Q

What is the net gain of H+ daily?

A

40-80 mEq/L

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6
Q

______ acids are produced by metabolism of organic molecules

A

Non-volatile acids (Fixed)

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7
Q

Adds ≈ 80 mEq/dayProtein Catabolism – sulfuric acid and HCl
Phospholipid Catabolism – phosphoric acid
Exercise, hypoxia – lactic acid
Post-absorptive state, diabetes mellitus – acetoacetic, β-hydroxy-butyric acids
Nucleoprotein metabolism – uric acid

A

Non-volatile acids (Fixed)

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8
Q

Primary Systems Regulate the [H+] in Body Fluids
_____ system:
Acid-base buffer systems (body fluids)
“instantaneous”

A

Chemical system

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9
Q

Primary Systems Regulate the [H+] in Body Fluids
_____ system:
Regulates the removal of CO2(and acid)

A

Respiratory system

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10
Q

Primary Systems Regulate the [H+] in Body Fluids
_____ system:
Excrete an acidic or alkaline urine

A

Kidneys

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11
Q

What are the 2 buffer systems used in the chemical system to regulate [H+] in body fluids in the ECF?

A

Bicarbonate buffer system and Phosphate buffer system

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12
Q

Most Powerful EC BufferMost Powerful EC Buffer

CO2 and HCO3 regulated by respiratory regulated by respiratory and renal systems and renal systems

A

Bicarbonate buffer system

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13
Q

Not a significant buffer for ECF
Concentration significantly lower than Bicarbonate system
Important for buffering renal tubular fluids and ICF

A

Phosphate buffer system

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14
Q

_____% of the total chemical buffering of the body fluids is inside the cells

A

60-70%

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15
Q

_____ system
Regulates the removal of CO2(and acid)
Change VA
Seconds to minutes (maximal in hours) “fast.”

A

Respiratory system

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16
Q

Three processes facilitate ____ transport:

  • 10% dissolved in plasma
  • 25% binds to amino groups in Hb(carbaminohemoglobin)
  • Remainder converted to H2CO3 by CA in erythrocytes.
A

CO2 transport

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17
Q

In the respiratory system, changes in _____ can function to restore pH following acid/base disturbances

A

Alveolar ventilation

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18
Q

Does hypoventilation increase or decrease pH?

A

Decreases

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19
Q

Does hyperventilation increase or decrease pH?

A

Increases

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20
Q

Does increased AV increase or decrease pH?

A

Increases pH

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21
Q

Does decrease AV increase or decrease pH?

A

Decreases pH

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22
Q

_____ is the most powerful of the acid/base regulatory systems

A

Kidneys

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23
Q

Kidney regulate pH by altering plasma _____

A

[HCO3-]

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24
Q

The ______:
–Secrete H+
–Reabsorb, produce, or excrete HCO3-

A

kidneys

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25
Q

99.9% of ______ is reabsorbed

A

[HCO3-]

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26
Q

______ % of HCO3-absorption - and H+ secretion - occurs in proximal tubule)

A

85%

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27
Q

(85% of HCO3-absorption - and H+ secretion - occurs in what nephron segment?

A

proximal tubule

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28
Q

For each _____ reabsorbed, a H+ must be secreted.

A

HCO3-

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29
Q

For each HCO3- reabsorbed, a ___ must be secreted.

A

H+

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30
Q

Secondary active transport pattern of H+secretion occurs in what segments of the nephron?

A

the proximal tubule, TAL, and the early distal tubule

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31
Q

___% of filtered HCO3-reabsorbed by secondary active transport process and requires 4000 mEq of H+ to be secreted

A

95%

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32
Q

Rate of tubule H+ secretion = _____ mEq/day

A

4400 mEq/day

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33
Q

HCO3-]ECF = _____ mEq/L)

A

24 mEq/L

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34
Q

Excrete _____ mEq/day of non-volatile acid produced by metabolism

A

80 mEq/day

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35
Q

In ______, HCO3-load > H+secretion and excess HCO3- will be excreted

A

Alkalosis

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36
Q

In Alkalosis, HCO3-load > H+secretion and excess ______ will be excreted

A

HCO3-

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37
Q

In _____, H+ secretion > HCO3-load and excess H+ excreted

A

Acidosis

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38
Q

In Acidosis, H+ secretion > HCO3-load and excess ___ excreted

A

H+

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39
Q

Excess H+ Excretion is a function of what part of the nephron?

A

Function of late DT and CD

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40
Q

Responsible for only 5% H+ secretion, but enough to create maximally acidified urine

A

Excess H+ secretion

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41
Q

____ and ______ systems are used for excess H+ excretion (non-volatile acids produced during metabolism).

A

Pi and glutamine/NH4+

42
Q

Abnormal H+ production induces ________ compensation

A

renal compensation

43
Q

Where in the nephron is the phosphate buffer system acting?

A

Early nephron

44
Q

When secreted H+ exceeds filtered load of HCO3-, H+can bind to _______

A

Phosphate buffer

45
Q

Anytime H+ combines with a buffer other than HCO3-, results in new _____ being added to the ECF

A

HCO3-

46
Q

Anytime ____ combines with a buffer other than HCO3-, results in new HCO3-being added to the ECF

A

H+

47
Q

Most filtered ____ reabsorbed so only small amount of this buffer available to interact with H+ in filtrate.

A

Pi

48
Q

In what sections of the nephron, NH4+ is added to filtrate following glutamine metabolism and represents acid secretion

A

PT, TAL and DT

49
Q

In PT, TAL and DT, ____ is added to filtrate following glutamine metabolism and represents acid secretion

A

NH4+

50
Q

In PT, TAL and DT, NH4+ is added to filtrate following ______ metabolism and represents acid secretion

A

glutamine

51
Q

In what segment of nephron is, NH3 is secreted into lumen where it combines with H+ to form NH4+

A

CD

52
Q

In CD, ____ is secreted into lumen where it combines with H+ to form NH4+

A

NH3

53
Q

In CD, NH3 is secreted into lumen where it combines with H+ to form _____

A

NH4+

54
Q

When there is excess H+ buffered and excreted, this results in new _____ being added to the ECF

A

HCO3

55
Q

____ buffer system: Responsible for 50% of the acid excreted and 50% of new HCO3-added to ECF

A

Ammonia Buffer System

56
Q

In PT, TAL and DT, NH4+ is added to filtrate following glutamine metabolism and represents acid secretion
In CD, NH3 is secreted into lumen where it combines with H+ to form NH4+
Results in new HCO3-being added to the ECF
Responsible for 50% of the acid excreted and 50% of new HCO3-added to ECF

A

Ammonia Buffer System

57
Q

_____ secretion by tubular epithelium necessary for:
HCO3- reabsorption
Addition of new HCO3-to ECF
Acid Excretion
Rate of secretion must be carefully controlled to maintain acid-base homeostasis

A

H+ secretion

58
Q

Under Normal Conditions: Acid secretion needs to be enough to do what 2 things?

A

Reabsorb almost all filtered HCO3-

Rid the body of non-volatile acids produced during metabolism

59
Q

During _____: Acid secretion decreased

A

Alkalosis

60
Q

During Alkalosis: Acid secretion _____

A

decreased

61
Q 
During \_\_\_\_\_\_\_:
Not all filtered HCO3-is reabsorbed
HCO3-is excreted
No NH4+ or H2PO4-
   -No non-volatile acid excreted-No new HCO3-
   - added to ECF
A

Alkalosis

62
Q

During _____: Acid secretion is increased

A

Acidosis

63
Q

During Acidosis: Acid secretion is ______

A

increased

64
Q 
During \_\_\_\_\_\_: 
Almost all filtered HCO3-is reabsorbed
NH4+ and H2PO4- generated 
   -Acid excreted
   -New HCO3-added to ECF
A

Acidosis

65
Q

What are the Two Most Important Stimuli that increase H+ secretion by tubules?

A
  1. Increase in PCO2 of ECF

2. Increase [H+]ECF

66
Q

Does an increase or decrease in PCO2 increase H+ secretion and HCO3- reabsorption?

A

Increase

67
Q

Does an increase or decrease in H+ increase H+ secretion and HCO3- reabsorption?

A

Increase

68
Q

Does an increase or decrease in HCO3 increase H+ secretion and HCO3- reabsorption?

A

decrease

69
Q

Does an increase or decrease in Ang II increase H+ secretion and HCO3- reabsorption?

A

Increase

70
Q

Does an increase or decrease in aldosterone increase H+ secretion and HCO3- reabsorption?

A

Increase

71
Q

Does hypokalemia increase or decreaseH+ secretion and HCO3- reabsorption?

A

Increase

72
Q

Does an increase or decrease in aldosterone decrease H+ secretion and HCO3- reabsorption?

A

Decrease

73
Q

Does an increase or decrease in Ang II decrease H+ secretion and HCO3- reabsorption?

A

Decrease

74
Q

Does an increase or decrease in H+ decrease H+ secretion and HCO3- reabsorption?

A

Decrease

75
Q

Does an increase or decrease in HCO3- decrease H+ secretion and HCO3- reabsorption?

A

Increase

76
Q

Does an increase or decrease in PCO2 decrease H+ secretion and HCO3- reabsorption?

A

Decrease

77
Q

Does hyperkalemia increase or decrease H+ secretion and HCO3- reabsorption?

A

Decrease

78
Q

Problems with ventilation or gas exchange
Ex. Hypoventilation, Pulmonary Edema, COPD, Damage to respiratory centers in brain stem
Increased PCO2

A

1.Respiratory Acidosis

79
Q

_______ compensation:
Buffer of body
Renal Compensation
Reabsorb all Filtered HCO3- Reabsorb all Filtered
HCO3-
Secrete Excess H+ and add New HCO33- to ECF
(increased glutamine metabolism and NH metabolism
and NH4+ excretion)

A

Respiratory acidosis

80
Q

All changes in pH not associated with an increase in CO2 levels

  1. Failure of kidney to excrete metabolic acids (Renal Failure, Addison’s Disease)
  2. Formation of excess quantities of metabolic acid (ketoacidosis)
  3. Increased input of of metabolic acids (aspirin and methyl alcohol)
  4. Loss of base from body (Diarrhea)
A

Metabolic Acidosis

81
Q

_____ compensation:
Renal Compensation (Assuming this isn’t the problem)
Reabsorb all Filtered HCO3- Reabsorb all Filtered
HCO3-
Secrete Excess H+ and add New HCO33- to ECF
(increased glutamine metabolism and NH metabolism
and NH4+ excretion)
Respiratory Compensation
Compensatory increase in VA in response to
metabolic acid (hyperventilation)

A

Metabolic Acidosis

82
Q

______
Rare
Excessive ventilation Ex. Hyperventilation
Leads to Decreased PCO2

A

Respiratory Alkalosis

83
Q

______ compensation:

  • Renal Comp
    • Increased HCO3-
    • Decreased H+ excretion
A

Respiratory Alkalosis

84
Q

_______
All changes in pH not associated with a decrease in CO2 levels
1.Diuretics
2.Excess Aldosterone
3.Excessive vomiting
4.Ingestion of Alkaline drugs (ex. NaHCO3-)

A
  1. Metabolic Alkalosis
85
Q

_____ compensation:

  • Respiratory Compensation
    • Compensatory decrease in VA in response to metabolic acid
A

Respiratory Alkalosis

86
Q

The following are responses to ______:

  • Sufficient H+ is secreted to reabsorb all filtered HCO3-
  • Still more H+ is secreted and this contributes new HCO3- to the plasma as the H+ is excreted bound to non bicarbonate urinary buffers such as HPO4-
  • Tubular glutamine metabolism and ammonium excretion are enhanced which also contributes new HCO3- to the plasma
A

Acidosis

87
Q

In acidosis, the urine is highly _____

A

Acidic

88
Q

The following are responses to ______:

  • Rate of hydrogen ion secretion is inadequate to reabsorb all the filtered HCO3- so significant amounts of HCO3- are excreted in the urine, and there is little or no excretion of H+ on non bicarbonate urinary buffers
  • Tubular glutamine metabolism and ammonium excretion are decreased so that little or no new HCO3- is contributed to the plasma from this source
A

Alkalosis

89
Q

In alkalosis, the urine is highly ______

A

Alkaline

90
Q

In which disorder are the following conditions true?

  • Increased H+
  • Increased HCO3-
  • Increased CO2
A

Respiratory acidosis

91
Q

In which disorder are the following conditions true?

  • Decreased H+
  • Decreased HCO3-
  • Decreased CO2
A

Respiratory alkalosis

92
Q

In which disorder are the following conditions true?

  • Increased H+
  • Decreased HCO3-
  • Decreased CO2
A

Metabolic acidosis

93
Q

In which disorder are the following conditions true?

  • Decreased H+
  • Increased HCO3-
  • Increased CO2
A

Metabolic alkalosis

94
Q

If pH is <7.4, HCO3- <24 mEq/L, and PCO2 <40 mm Hg?

A

Metabolic acidosis

95
Q

If pH is <7.4, HCO3- >24 mEq/L, and PCO2 >40 mm Hg?

A

Respiratory acidosis

96
Q

If pH is >7.4, HCO3- <24 mEq/L, and PCO2 <40 mm Hg?

A

Respiratory alkalosis

97
Q

If pH is >7.4, HCO3- >24 mEq/L, and PCO2 >40 mm Hg?

A

Metabolic alkalosis

98
Q

What is the main compensation for metabolic acidosis?

A

Respiratory: Hypervent

99
Q

What is the main compensation for respiratory acidosis?

A

Renal: Increased HCO3 in ECF

100
Q

What is the main compensation for metabolic alkalosis?

A

Respiratory: Hypovent

101
Q

What is the main compensation for respiratory alkalosis?

A

Less H+ excretion; Increased HCO3 secreting

Phys exam 5 (9 decks)

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