Renal and Acid-Base Physiology

Question 1

Marker for ECF

Answer 1

Sulfate, inulin, mannitol

Question 2

Interstitial Fluid marker

Answer 2

measured indirectly

ECF-plasma volume

Question 3

Marker for ICF

Answer 3

measured indirectly

TBW-ECF

Question 4

Clearance Equation

Answer 4

CL = (UV)/P
U is urine conc
V is urine vol/time
P is plasma conc

Question 5

Vasoconstriction of renal arterioles on RBF

Answer 5

RBF will decrease

Question 6

Low conc of Ang II

Answer 6

preferentially constricts efferent arterioles and increase GFR

Question 7

ACE-inhibitors on GFR

Answer 7

dilate efferent arterioles thus decreasing GFR

Question 8

Vasodilation of renal arterioles on RBF

Answer 8

increase in RBF, is produced by PGE2 and PGI2, bradykinin, NO and dopamine

Question 9

Macula Densa

Answer 9

increases renal artery pressure leads to increased delivery of fluid to macula densa

increased load causes constriction of nearby afferent arteriole, increasing resistance to maintain constant blood flow

Question 10

Constriction of Afferent Arteriole (sympathetic)

Answer 10

decrease GFR, decrease RPF, no change in FF

Question 11

Constriction of Efferent Arteriole (angII)

Answer 11

increase GFR, decrease RPF, increase FF

Question 12

increased plasma [protein]

Answer 12

decrease GFR, no change in RPF, decrease FF

Question 13

Kidney Stone

Answer 13

decrease GFR, no change in RPF, decrease FF

Question 14

Reabsorption rate

Answer 14

Filtered Load - Excretion Rate

Question 15

Secretion Rate

Answer 15

Excretion Rate - Filtered Load

Question 16

HA form predominates in which type of urine?

Answer 16

acidic urine

Question 17

A- form predominates in which type of urine?

Answer 17

alkaline

Question 18

Reabsorbs 2/3 of 67% of filtered Na and H2O in nephron

Answer 18

Proximal Tubule

Question 19

Isosmotic process in the renal tubules

Answer 19

in Proximal Tubules

Question 20

Carbonic anhydrase inhibitor

Answer 20

diuretic that act in early PT by inhibiting the reabsorption of filtered HCO3-

Question 21

Late Proximal tubules reabsorbs what

Answer 21

Sodium and Chloride

Question 22

Reabsorbs 25% of filtered Na+

Answer 22

Thick Ascending Limb of Henle

Question 23

impermeable to water

Answer 23

Thick ascending limb of henle, early distal tubule

Question 24

Principal Cells

Answer 24

in late distal tubule and collecting duct
Aldosterone - reabsorb Na and H2O & secrete K
ADH - increases H2O permeability

Question 25

alpha-intercalated cells

Answer 25

secrete H+ by H-ATPase, stimulated by aldosterone | reabsorbs potasium by H/K-ATPase

Question 26

Increases the urea permeability of the inner medullary collecting ducts

Answer 26

ADH

Question 27

Low urine flow rate

Answer 27

greater urea reabsorption

Question 28

high urine flow rate

Answer 28

greater urea excretion

Question 29

Phosphate reabsorbed in the PT

Answer 29

85% via Na-Phos Cotransport

Question 30

PTH

Answer 30

inhibits phsophate reabsorption in PT by activating adenylate cyclase increased Calcium reabsorption by activating AC in distal tubule

Question 31

secreted when hyperosmotic plasma and decreased blood volume

Answer 31

ADH | increases H2O permeability in LDT and CD principal cells

Question 32

released when there is a decreased in blood volume and an icnrease in plasma [K]

Answer 32

Aldosterone

Question 33

Actions of Aldosterone

Answer 33

increase sodium reabsorption in DT principal cells increase K secretion in DT principal cells increase H+ secretion in DT alpha-intercalated cells

Question 34

what is release with an increase in atrial pressure and its MoA

Answer 34

ANP, cGMP | used to increase GFR, decrease Na reabsorption

Question 35

MoA of AngII

Answer 35

increases Na/H-exchange and HCO3- reabsorption in proximal tubule

Question 36

Volatile Acid

Answer 36

CO2

Question 37

When are buffers most effective?

Answer 37

within 1pH unit of the pK of buffer

Question 38

Most important extracellular buffer

Answer 38

HCO3-

Question 39

Most important urinary buffer

Answer 39

Phosphate

Question 40

Intracellular Buffers

Answer 40

Organic Phosphates & Proteins like Imidazole and alpha-amino groups and Hb deoxyHb is better buffer than oxyHb

Question 41

Henderson-Hasselbalch Eqtn

Answer 41

pH = pK + loh ([A-]/[HA])

Question 42

Buffer is most effective in what part of a titration curve?

Answer 42

Linear portion

Question 43

Primary reabsorption site for HCO3-

Answer 43

proximal tubule

Question 44

pCO2 and HCO3-

Answer 44

increased pCO2 => increased rates of HCO3- reabsorption, basis for renal compensation for respiratory acidosis decreased pCO2 => decreased rates of HCO3- reabsorption, renal compensation for respiratory alkalosis

Question 45

ECF volume and HCO3-

Answer 45

ECF volume expansion results in decreased HCO3- reabsorption | ECF volume contraction results in increased HCO3 reabsorption

Question 46

Diffusion Trapping

Answer 46

H+ is secreted into lumen via H-ATPase and combines with NH3 to form NH4

Question 47

NH3 and acidosis

Answer 47

in acidosis, adaptive increase in NH3 synthesis occurs thus increasing gradient for NH3 diffusion

Question 48

Inhibits NH3 synthesis

Answer 48

Hyperkalemia

Question 49

Kussmaul Breathing

Answer 49

respiratory compensation for metabolic acidosis

Question 50

Serum Anion Gap

Answer 50

For metabolic Acidosis [Na]-([Cl]+[HCO3]) normal is 12mEq/L

Question 51

Hypoventilation

Answer 51

respiratory compensation for metabolic alkalosis

Question 52

Decerase in respiratory rate and retention of CO2

Answer 52

Respiratory Acidosis | increase in both H+ and HCO3-

Question 53

Winter Formula

Answer 53

PCO2 = (1.5 x HCO3) + 8 ± 2 • If Measured < Expected = Respiratory Alkalosis • If Measured > Expected = Respiratory Acidosis

Question 54

Anion Gap with K+

Answer 54

= ([Na] + [K]) − ([Cl] + [HCO3])

Question 55

Metabolic Acidosis increase anion gap

Answer 55

``` Increase Anion ( >12 ): MUDPILES  Methanol  Uremia  Diabetic Ketoacidosis  Paraldehyde  Iron, Isoniazide  Lactate  Ethylene Glycol  Salicylates, Starvation ```

Question 56

Metabolic Acidosis non-gap

Answer 56

normal is between 5-12: Hypercholemic GI Loss: diarhhea, Sx drain, Fistula, Cholestryamine Renal Loss: Renal tubular acidosis • Proximal RTA – Acetazolamide (Diuretic) • Distal RTA – Inpaired H+ Secretion, Cannot Acidify Urine

Question 57

Nasogastric suction

Answer 57

causes metabolic alkalosis

Question 58

medical procedures that cayse metabolic alkalosis with chloride sensitivity

Answer 58

vomiting, NG suction, diuretics, LR, TPN, Blood

Question 59

Metabolic Acidosis - pH, primary disturbance, compensatory response

Answer 59

decreased pH, decreased HCO3 | compen - decrease pCO2

Question 60

Metabolic Alkalosis - pH, primary disturbance, compensatory response

Answer 60

increased pH, increased HCO3 | compen - increase pCO2

Question 61

Respiratory Acidosis - pH, primary disturbance, compensatory response

Answer 61

decreased pH, increased pCO2 | compen - increase HCO3

Question 62

Respiratory Alkalosis - pH, primary disturbance, compensatory response

Answer 62

increased pH, decreased pCO2 | Compen - decrease HCO3

Question 63

Furosimide, ALbuterol, Na Polysterene Sulfonate

Answer 63

Cause Hypo-K

Question 64

Spironolactone, ACEi, Ibuprofen

Answer 64

Cause Hyper-K

Question 65

Grossest Food Ever?

Answer 65

Onions