Renal IIIa Flashcards
Maintenance of body fluid is tied to….
regulation of body sodium content
What effect does plasma membrane Na-K ATPase pump on Na and K?
most body Na is retained within ECF
most body K+ is intracellular
Any net increase in total body fluid….
is retained in the ECF and body fluid volume increases
Any net loss of total body Na results in…
decrease in ECF volume
___ is critical in the maintenance of body fluid volume
Regulation of body Na
Increase Na → __ osmolarity → __ H2O
Increase Na → increases osmolarity → increases H2O
Increase Total - Body Sodium → __ EC Volume (Plasma Volume/Interstitial Volume) → __blood volume → __ venous pressure → __ atrial pressure → __ ventricular pressure → __ stroke volume → __ cardiac output → __ arterial blood pressure → effects __ and directly effects __
Increase Total - Body Sodium → ⇡ EC Volume (Plasma Volume/Interstitial Volume) → ⇡ blood volume → ⇡ venous pressure (MV) → ⇡ atrial pressure (MV) → ⇡ ventricular pressure (MV) → ⇡ stroke volume → ⇡ cardiac output → ⇡ arterial blood pressure → effects monitored variables (MV) and directly effects kidneys
Sodium Excretion Equation
Sodium Excretion = Sodium Filtered - Sodium Reabsorbed
= (GFR X PNa) - Sodium reabsorbed
PNa = plasma concentration of Na
It is possible to adjust sodium excretion by…
controlling plasma sodium, GFR, and sodium reabsorption
What regulates GFR and sodium reabsorption?
the kidneys
monitored by alterations in ECF where effectors that regulate ECF simultaneously regulate sodium reabsorption and excretion
Changes in Plasma Sodium
Plasma sodium changes little except to change transiently after ingestion of sodium rich or sodium-free meal/drink
A person is considered in positive Na balance if…
excretion is less than Na ingested
retaining water
A person is in negative Na balance when…
Na excretion is more than Na ingested
net excreting fluid
Factors that control GFR and Sodium reabsorption in response to altered bodily sodium balance are initiated by….
- Extrarenal baroreceptors
- carotid sinuses, in arteries, cardiac chambers, great veins
- Renal Juxtaglomerular (JG) apparatus
- specifically intrarenal baroreceptors and macula densa which control secretion of renin
Extrinsic control of GFR:
- Renal sympathetic nerves
- Renin-angiotensin system
Extrinsic control of GFR: Renal Sympathetic nerves
- increased renal sympathetic nerve activation → increased renal arteriolar constriction → decreased PGC → decreased GFR
- Increases renal sympathetic nerve activation → increased renal arteriolar constriction → decreased renal blood flow → increased average πGC → decreased GFR
Extrinsic control of GFR: Renin-Angiotensin System
increased renin release → increased plasma Ang II → decreased GFR and RBF
Local and Direct regulation of GFR:
- Autoregulation
- Prostaglandins
Local and Direct regulation of GFR: Autoregulation
allows maintenance of a relatively constant GFR over a wide range of perfusion pressures
fine tuning
minute to minute regulation of RBF and GFR in the face of changes in BP
Local and Direct regulation of GFR: Prostaglandins
PGE2 and PGI2
vasodilators
help make sure too much constriction doesn’t occur
Tubular Sodium Reabsorption is mediated by…
- aldosterone
- renal sympathetic nerves
- angiotensin II
- pressure natriuresis
- ANP
- ADH (minor effect)
Where is aldosterone produced?
the adrenal cortex
How does aldosterone work?
Aldosterone exerts its effect by combining with intracellular receptors and stimulating synthesis of mRNA which mediates translation of specific proteins
The proteins increase the number of luminal-membrane sodium channels and basolateral Na-K-ATPase pumps in the cortical collecting duct (principal cells)
3 Major Inputs to the adrenal gland stimulating aldosterone secretion…
- Adrenocorticotropic hormone (ACTH)
- Increased plasma potassium
- Angiotensin II
increase any of these → increase aldosterone secretion
Anything that increases Ang II, ___ aldosterone
increases
Aldosterone acts in the ___ and ___ Na reabsorption
collecting duct; increases
Control of aldosterone secretion
Aldosterone attaches to aldosterone receptor → increases number of sodium channels → increases sodium reabsorption
Tubular effects of renal sympathetic nerves
- stimulates renin secretion via direction action on β1-receptors of granular cells
- directly stimulates sodium reabsorption in proximal tubule cells
- affect peritubular capillary Starling Forces and FF → constriction of arterioles will decrease RBF more than GFR
- results in decreased peritubular capillary hydrostatic pressure and increased peritubular capillary oncotic pressure → increases sodium reabsorption
- decreased GFR and increased Na reabsorption in proximal tubule → decreases sodium delivery to macula dense which in turn increases renin secretion
Increased constriction, ___ Filtration Fraction (FF)
increases
FF increases with sympathetic nervous activity that increases capillary oncotic pressure (driving force of Na reabsorption)
Tubular effects of Ang II: Direct effects
Angiotensin II acts directly on proximal tubule cells to stimulate sodium reabsorption → this is done by stimulating the Na-H+ exchanger in the proximal tubule
Tubular effects of Ang II: Effects on FF and Peritubular Capillary Starling Forces
Increases FF and thus increases Na and water reabsorption in proximal tubule
Tubular effects of Ang II: Aldosterone
increase aldosterone secretion