Renal Acid/Base

Question 1

What is the physiological range that is compatible for life?

Answer 1

6.8 - 7.8

Question 2

What are the extracellular buffers?

Answer 2

1. Bicarbonate
2. Plasma proteins
3. Phosphate

Question 3

What are the types of channels on an alpha intercalated cell that relate to pH?

Answer 3

Basolateral:

• HCO3-/Cl- antiporter
• Cl- Pump

Apical:

• K+/H+ Antiporter
• H+ pump

Question 4

What are the common associations of pH and K+ balance?

Answer 4

Acidosis —> Hyperkalemia

Alkalosis —> Hypokalemia

Question 5

How does phosphate operate as a urinary buffer?

Answer 5

• Dibasic phosphate enters tubular lumen

- Na/H+ exchanger on apical surface —> Na pumped across and phosphate binds H+

Question 6

How does Ammonia act as a buffer in the kidneys?

Answer 6

NH3 binds free H+ in the tubule and is excreted as NH4+

Question 7

Describe Type I Renal acidosis.

Answer 7

• Sjogren’s; Autoimmune damage to alpha intercalated cells;
• Hypokalemic
• Distal tubule

Question 8

Describe Type II Renal acidosis

Answer 8

• Fanconi syndrome
• Proximal tubule
• Hypokalemic
• No Solvent drag

Question 9

Describe Type III Renal acidosis

Answer 9

Mixture of Type I/II

Question 10

Describe Type IV renal acidosis

Answer 10

• Distal tubule
• Hyperkalemic
• Hypoaldosteronism
• No ATPase function —> No K+ exchange —> No H+ Reabsorption

Question 11

How is Anion Gap calculated? Normal value?

Answer 11

AG = [Na] - {[Cl-] + [HCO3-]}

= [Other anions] - [other cations]

8-16 mEq/L

Question 12

What is associated with increased anion Gap? What is the exception?

Answer 12

• Increased organic acids
• Decrease in plasma HCO3- offset by increase in unmeasured organic anions

**Some forms of metabolic acidosis, no organic anions are accumulated. The decrease in plasma HCO3- is offset by an increase in Cl-

A.K.A. Hyperchloremic metabolic acidosis

Question 13

What are the causes of High Anion Gap?

Answer 13

GOLD MARK

Glycols
Oxyproline
L-Lactate
D-Lactate
Methanol
Aspirin
Renal Uremic Failure
Ketones (SAD)

Question 14

Why do Cholinergic drugs help empty the bladder in conditions of urinary retention?

Answer 14

Parasympathetic response controls the destructor muscle —> Emptying of bladder

Question 15

Why do alpha Adrenergic stimulators help to avoid uncontrolled urine leakage (Incontinence)?

Answer 15

Tighten the internal sphincter (Sympathetically controlled)

Question 16

How do anticholinergic drugs relax the bladder and decrease urge for frequent urination?

Answer 16

Anticholinergc drugs relax the bladder so it can hold more urine