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Renal-1 > Renal Control of Acid-Base Balance > Flashcards

Renal Control of Acid-Base Balance Flashcards

1
Q

How does an increase in aldosterone affect acid-base balance?

A decrease?

A

increase in aldosterone –> increase in H+ secretion in the collecting duct

decrease in aldosterone –> decrease in H+ secretion

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2
Q

What can happen in severe metabolic alkalosis?

A

increased binding of Ca to albumin –> hypocalcemia –> get symptoms of hypocalcemia

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3
Q

What are causes of acute respiratory acidosis?

A

CANS

CNS depression

airway obstruction

neuromuscular disorders

severe pneumonia, embolism, edema

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4
Q

Where is bicarbonate reabsorbed in the nephron?

A

85% PCT

10% TAL

4.9% CD

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5
Q

What are the major symptoms letting you know there is renal tubular acidosis?

A

Acidemia + normal anion gap + normal serum creatinine + NO diarrhea

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6
Q

What are the causes of High anion gap metabolic acidosis?

A

MUDPILERS

methanol

uremia

DKA/Alcoholic KA

Paraldehyde

Isoniazid

lactic acidosis

EtOH/Ethylene glycol

Rhabdo/Renal failure

Salicylates

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7
Q

What is normal HCO3-?

A

22-26 mEq/L

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8
Q

What are the causes of metabolic alkalosis?

A

CLEVER PD

Contraction

Licorice

Endocrine

Vomiting

Excess Alkali

refeeding alkalosis

Post-hypercapnia

Diuretics

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9
Q

How do you know if a pH disturbance is respiratory?

A

CO2 and pH will change in opposite directions

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10
Q

What is normal pCO2?

A

35-45 mm Hg

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11
Q

What constitutes Chloride responsive metabolic alkalosis?

A

if you see metabolic alkalosis and urine chloride is <20 mEq/L

if > 20 mEq/L = chloride unresponsive

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12
Q

What do alpha-intercalated cells do?

A

Secrete H+ into urine

Regenerate and reabsorb HCO3-

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13
Q

What occurs to K+ levels if alkalemia occurs?

A

ICF donates H+ and takes in K+ –> K+ goes into cells

plasma K+ levels decrease

K is lo

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14
Q

What is the henderson-hasselbach equation for blood?

A

pH = 6.1 + log([HCO3-]/[H2CO3])

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15
Q

Why is the body’s buffer system “open”?

A

bc HCO3- (base) is controlled by kidneys = slow with large capacity

CO2 (acid) is controlled by lungs = fast, with limited capacity

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16
Q

What do Beta intercalated cells do?

A

reabsorb H+ into the blood

secrete HCO3- into urine

17
Q

What is type 4 RTA?

A

deficiency of aldosterone –> get hyperkalemia –> decreased NH3 synthesis by PT

18
Q

What are causes of respiratory alkalosis?

A

CHAMPS

CNS disease

Hypoxia

Anxiety

Mechanical Ventilators

Progesterone

Salicylates/Sepsis

19
Q

What is type 1 RTA?

A

H+ secretion by alpha-intercalated cells is somehow impaired

can’t make new HCO3- to reabsorb

20
Q

How does an increase in angiotensin II affect acid-base balance?

A decrease?

A

increase in Angiotensin II –> increased Na-H exchange –> causes increased H+ secretion in PT and increased HCO3- resorption

Decrease –> decreased H+ secretion

21
Q

What are fixed acids?

A

those that don’t turn into HCO3-

lactate

cysteine –> sulfate

phosphoprotein –> phosphate

22
Q

What is normal blood pH?

A

7.35-7.45

23
Q

What is ammonia synthesized from?

What is its function?

A

made from glutamine

acts as a buffer and is easily made = 2/3 of net acid excretion

24
Q

How does hypokalemia affect acid-base balance in the nephron?

Hyperkalemia?

A

hypokalemia –> increased H+ secretion in PCT

hyperkalemia –> decreased H+ secretion in PCT

25
Q

How do you know if a pH disturbance is metabolic?

A

If HCO3- and pH change in same direction

26
Q

What is the major titratable acid used by the kidneys?

A

Phosphate

27
Q

What is the path of ammonia in the nephron?

A

made from glutamine in the PCT –> secreted into lumen –> in TAL, transported by NKCC in place of K+ into the IF –> diffuses into CD lumen = ion trapped and used as a buffer for H+, excreted in urine

28
Q

What are the 2 major goals of renal acid-base regulation?

A
  1. reabsorb/generate bicarb
  2. excrete H+
29
Q

What are volatile acids?

A

those that contain CO2 –> HCO3-

from anaerobic metabolism of glucose and fat

30
Q

Why must extracellular pH remain at 7.4?

A

pH changes alter protein structure/function

need stable pH for them to work properly

31
Q

What does your [HCO3-]/[H2CO3] value need to be to make HH equation = normal pH?

A

20

(bc 6.1 + log(20) = 7.4)

32
Q

What occurs to K levels if acidemia occurs?

A

ICF takes H+ –> K+ transported out of the cell

Plasma K levels increase

33
Q

What are causes of chronic respiratory acidosis?

A

COPD

anything chronic that leads to impaired ventilation

34
Q

What are the causes of non-anion gap acidosis?

A

HARDUPS

Hyperalimentation

Acetazolamide

Renal Tubular Acidosis

Diarrhea

Uretero-Pelvic Shunt

Post-Hypocapnia

Spironolactone

35
Q

What is type 2 RTA?

A

HCO3- reabsorption is impaired in PT

see hypokalemia

36
Q

What does the pKa of a buffer represent conceptually?

A

pH at which the buffer has absorbed half of the H+ it can hold

Renal-1 (14 decks)

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