Renal Physiology: Guyton Chapter 28

Question 1

[33-minute video]: Guyton and Hall Medical Physiology (Chapter 28) - Renal Tubular Reabsorption and Secretion

Answer 1

💧

Question 2

What are the two main steps for a substance to be reabsorbed in the kidneys?

Answer 2

(1) Transport across the tubular epithelial membranes into the renal interstitial fluid.
(2) Transport through the peritubular capillary membrane back into the blood.

Question 3

What mechanisms are involved in the reabsorption of water and solutes in the kidneys?

Answer 3

(1) Active or passive transport across the tubular epithelium into the interstitial fluid.
(2) Transcellular route: through cell membranes.
(3) Paracellular route: through spaces between cell junctions.
(4) Transport through peritubular capillary walls into blood by ultrafiltration (bulk flow) mediated by hydrostatic and colloid osmotic forces.

Question 4

How does the Na+-K+ ATPase system function in sodium reabsorption?

Answer 4

It hydrolyzes ATP to transport sodium ions out of the cell into the interstitium and potassium into the cell, maintaining low intracellular sodium and high intracellular potassium concentrations.

Question 5

What creates the electrochemical gradient favoring sodium diffusion into the cell?

Answer 5

The low intracellular sodium concentration (12 mEq/L) and high tubular fluid sodium concentration (140 mEq/L), along with the negative intracellular potential of about -70 millivolts.

Question 6

What role does the brush border on the luminal side of the proximal tubule play in sodium reabsorption?

Answer 6

It multiplies the surface area by about 20-fold and contains carrier proteins that facilitate the diffusion of sodium into the cell.

Question 7

What are the three steps involved in the net reabsorption of sodium ions from the tubular lumen back into the blood?

Answer 7

(1) Sodium diffuses across the luminal membrane into the tubular epithelial cell.

(2) Sodium is transported across the basolateral membrane by the Na+-K+ ATPase pump into the interstitial fluid.

(3) Sodium, water, and other substances are reabsorbed from the interstitial fluid into the peritubular capillaries by active and passive transport mechanisms.

Question 8

What is secondary active transport and how does it work?

Answer 8

In secondary active transport, two or more substances interact with a specific membrane protein (a carrier molecule) and are transported together across the membrane. As one substance (e.g., sodium) diffuses down its electrochemical gradient, the energy released is used to drive another substance (e.g., glucose) against its electrochemical gradient. This process does not require energy directly from ATP but uses the energy from the simultaneous facilitated diffusion of another substance down its own electrochemical gradient.

[1-minute video]: Secondary Active Transport

Question 9

How does the reabsorption of glucose depend on the Na+-K+ ATPase pump?

Answer 9

The reabsorption of glucose depends on the energy expended by the primary active Na+-K+ ATPase pump in the basolateral membrane. This pump maintains an electrochemical gradient for the facilitated diffusion of sodium across the luminal membrane. The downhill diffusion of sodium provides the energy for the simultaneous uphill transport of glucose across the luminal membrane, making this process secondary active transport.

Question 10

What is the transport maximum in the context of renal reabsorption?

Answer 10

The transport maximum is the limit to the rate at which a solute can be actively reabsorbed or secreted, due to the saturation of specific transport systems when the tubular load exceeds the capacity of carrier proteins and enzymes.

Question 11

What happens when the filtered load of glucose exceeds the transport maximum in the proximal tubule?

Answer 11

When the filtered load of glucose exceeds the transport maximum, the excess glucose is not reabsorbed and passes into the urine, leading to urinary excretion of glucose.

Question 12

What is the average transport maximum for glucose in adult humans, and what is the normal filtered load of glucose?

Answer 12

The average transport maximum for glucose in adult humans is about 375 mg/min, while the normal filtered load of glucose is about 125 mg/min. When the filtered load exceeds 375 mg/min, glucose begins to appear in the urine.

Question 13

What is gradient-time transport?

Answer 13

Gradient-time transport refers to the type of active transport where the rate of transport depends on the electrochemical gradient and the time the substance remains in the tubule, rather than reaching a transport maximum.

Question 14

What factors determine the rate of gradient-time transport?

Answer 14

The rate of gradient-time transport is determined by:
(1) the electrochemical gradient for diffusion of the substance across the membrane
(2) the permeability of the membrane for the substance, and
(3) the time that the fluid containing the substance remains within the tubule.

Question 15

How does sodium reabsorption in the proximal tubule demonstrate gradient-time transport?

Answer 15

Sodium reabsorption in the proximal tubule demonstrates gradient-time transport because the maximum transport capacity of the basolateral Na+-K+ ATPase pump is usually far greater than the actual rate of net sodium reabsorption.

Question 16

What happens to solute concentrations and water movement when solutes are transported out of the tubule and into the renal interstitium?

Answer 16

When solutes are transported out of the tubule by primary or secondary active transport, their concentrations decrease inside the tubule and increase in the renal interstitium, creating a concentration difference that causes osmosis of water from the tubular lumen to the renal interstitium.

Question 17

How does water move in the proximal tubules and what is solvent drag?

Answer 17

In the proximal tubules, water moves rapidly through channels known as aquaporins in the cell membranes and through the tight junctions between epithelial cells. Water moving across the tight junctions by osmosis also carries some solutes with it, a process referred to as solvent drag.

Question 18

How does water permeability vary in different parts of the nephron?

Answer 18

💧 In the proximal tubule and descending loop of Henle, water permeability is always high due to the abundant expression of aquaporin-1 (AQP-1).
💧 In the ascending loop of Henle, water permeability is always low.
💧 In the distal tubules, collecting tubules, and collecting ducts, water permeability can be high or low depending on the presence or absence of antidiuretic hormone (ADH).

Question 19

How are chloride ions transported along with sodium during reabsorption in the renal tubules?

Answer 19

💧 When sodium is reabsorbed through the tubular epithelial cell, negative ions such as chloride are transported along with sodium due to electrical potentials. The transport of positively charged sodium ions out of the lumen leaves the inside of the lumen negatively charged, causing chloride ions to diffuse passively through the paracellular pathway.
💧 Additionally, chloride ions are reabsorbed due to a chloride concentration gradient that develops when water is reabsorbed from the tubule by osmosis.
💧 Chloride ions can also be reabsorbed by secondary active transport, primarily through the co-transport of chloride with sodium across the luminal membrane. [The sodium-chloride symporter is found in the DCT.]

Question 20

How is urea reabsorbed in the renal tubules?

Answer 20

Urea is passively reabsorbed from the tubule. As water is reabsorbed from the tubules by osmosis coupled to sodium reabsorption, the urea concentration in the tubular lumen increases, creating a concentration gradient favoring urea reabsorption. However, urea does not permeate the tubule as readily as water, and only about half of the filtered urea is reabsorbed.

Question 21

What facilitates passive urea reabsorption in some parts of the nephron?

Answer 21

In some parts of the nephron, especially the inner medullary collecting duct, passive urea reabsorption is facilitated by specific urea transporters.

Question 22

How is creatinine handled by the renal tubules?

Answer 22

Creatinine is essentially impermeant to the tubular membrane. Therefore, almost none of the creatinine that is filtered is reabsorbed, so virtually all the creatinine filtered by the glomerulus is excreted in the urine.

Question 23

What cellular characteristics of proximal tubule epithelial cells support their high capacity for active and passive reabsorption?

Answer 23

Proximal tubule epithelial cells are highly metabolic with large numbers of mitochondria for active transport. They have an extensive brush border on the luminal side and a labyrinth of intercellular and basal channels, providing a large membrane surface area for rapid transport of sodium ions and other substances.

Question 24

How do protein carrier molecules in the proximal tubule epithelial cells contribute to sodium reabsorption?

Answer 24

💧 Protein carrier molecules in the epithelial brush border transport a large fraction of sodium ions across the luminal membrane via co-transport with organic nutrients like amino acids and glucose.
💧 Sodium is also transported by counter-transport mechanisms that reabsorb sodium while secreting other substances, such as hydrogen ions, into the tubular lumen.

Question 25

What is the difference in sodium reabsorption mechanisms between the early and late portions of the proximal tubule?

Answer 25

💧 In the first half of the proximal tubule, sodium is reabsorbed by **co-transport** with glucose, amino acids, and other solutes. 💧 In the second half, with little glucose and few amino acids remaining, **sodium is mainly reabsorbed with chloride ions**. The higher chloride concentration in the second half favors chloride diffusion from the tubule lumen into the renal interstitial fluid.

Question 26

How do the concentrations of various solutes change along the proximal tubule? [Hints: sodium, organic solutes, creatinine]

Answer 26

💧 Although the amount of sodium in the tubular fluid decreases markedly along the proximal tubule, **sodium concentration (and total osmolarity) remains relatively constant** due to the **high water permeability of the proximal tubules**. 💧 Organic solutes like glucose, amino acids, and bicarbonate are **reabsorbed more avidly [at a faster rate] than water**, leading to a **marked decrease in their concentrations**. 💧 Less permeant solutes like creatinine **increase in concentration along the proximal tubule**. 💧 [**[Diagram](https://media.cheggcdn.com/media/553/55323fbd-4e64-457e-9bf7-505b343667bc/phpKKLWnr.png)**]

Question 27

What are some organic acid and base metabolic waste products secreted at the PCT?

Answer 27

bile salts, oxalate, urate, catecholamines [adrenaline, noradrenaline]

Question 28

List the three functionally distinct segments of the Loop of Henle.

Answer 28

the thin descending segment, thin ascending segment, and thick ascending segment

Question 29

What are the epithelial characteristics of the thin descending and ascending segments of the Loop of Henle?

Answer 29

💧 epithelial cells are squamous 💧 few mitochondria 💧 absence of brush border

Question 30

Compare the descending and ascending loops in terms of permeability to water.

Answer 30

💧 The descending part of the thin segment is **highly permeable to water** [and moderately permeable to most solutes, including urea and sodium]. Its main function is to allow simple diffusion of substances through its walls. About 20% of the filtered water is reabsorbed in the loop of Henle, mostly in the thin descending limb. 💧 The ascending limb is **virtually impermeable to water**, which is important for concentrating the urine.

Question 31

Compare the thick and thin portions of the ascending loop in terms of permeability to solutes.

Answer 31

💧 The thick segment of the loop of Henle, which begins about halfway up the ascending limb, has **thick epithelial cells** that have **high metabolic activity** and are **capable of active reabsorption of sodium, chloride, and potassium**. [About 25% of the filtered loads of sodium, chloride, and potassium are reabsorbed in the loop of Henle, mostly in the thick ascending limb.] Considerable amounts of other ions, such as calcium, bicarbonate, and magnesium, are also reabsorbed in the thick ascending loop of Henle. 💧 The thin segment of the ascending limb has a **much lower reabsorptive capacity** than the thick segment, and the thin descending limb does not reabsorb significant amounts of any of these solutes.

Question 32

What is the role of the Na+-K+ ATPase pump in the epithelial cell basolateral membranes of the thick ascending limb of the loop of Henle?

Answer 32

The Na+-K+ ATPase pump in the epithelial cell basolateral membranes **maintains a low intracellular sodium concentration**, which provides a **favorable gradient for the movement of sodium from the tubular fluid into the cell**. This pump is crucial for the **reabsorption of other solutes** in the thick ascending limb. [The potential energy released by the downhill diffusion of sodium into the cell is used to drive the cotransport of other ions.]

Question 33

Briefly discuss the NKCC2 transporter.

Answer 33

💧 The NKCC2 transporter, also known as the **sodium-potassium-chloride cotransporter 2**, is a crucial transporter **in the thick ascending limb** of the loop of Henle. 💧 It mediates the reabsorption of sodium, potassium and chloride ions from the tubular fluid into the epithelial cells of the thick ascending limb. 💧 It **uses energy released by the downhill diffusion of sodium into the cell** to drive the reabsorption of potassium and chloride against their concentration gradients.

Question 34

Discuss the **regulation** and **clinical relevance** of the NKCC2 transporter.

Answer 34

💧 **Regulation**: NKCC2 is regulated by hormones such as **vasopressin** and **aldosterone** which can increase its activity to enhance sodium reabsorption. 💧 **Clinical relevance**: Inhibitors of the NKCC2 transporter, such as loop diuretics e.g. **furosemide**, **ethacrynic acid**, and **bumetanide** are used to **treat hypertension and edema**. This is because they promote increased excretion of these ions and water, thereby reducing blood volume and pressure. [**[Diagram](https://www.dovepress.com/article/fulltext_file/154000/aW1n/IJNRD_154000_F003.jpg)**]

Question 35

What mechanism in the thick ascending limb mediates sodium reabsorption and hydrogen secretion?

Answer 35

The **sodium-hydrogen counter-transport mechanism** in the luminal cell membrane mediates sodium reabsorption and hydrogen secretion. [**[Diagram](https://www.dovepress.com/article/fulltext_file/154000/aW1n/IJNRD_154000_F003.jpg)**]

Question 36

How does the slight positive charge in the tubular lumen of the thick ascending limb affect cation reabsorption?

Answer 36

The slight positive charge of about +8 millivolts in the tubular lumen, **created by the backleak of potassium ions**, forces cations such as Mg²⁺, Ca²⁺, Na⁺, and K⁺ to **diffuse from the tubular lumen** through the **paracellular space** into the interstitial fluid.

Question 37

With regards to the distal tubules, discuss: (a) parts (b) sodium and chloride (c) water and urea

Answer 37

(a) **_parts_**: ◾ *early distal tubule*: continuous with the thick ascending limb of Henle ◾ *late distal tubule*: continuous with the early distal tubule and leads into the collecting duct (b) **_sodium and chloride_**: The **distal tubule reabsorbs a significant amount of sodium, chloride and other ions**. The early distal tubule contains the **sodium-chloride co-transporter (NCC)**, which moves sodium and chloride from the tubular lumen into the epithelial cells. The Na⁺-K⁺ ATPase pump then transports sodium out of the cells into the interstitial fluid, while chloride diffuses out through chloride channels. (c) **_water and urea_**: the early distal tubule is virtually impermeable to water and urea, which helps in diluting tubular fluid. [It is for this reason that it is often referred to as the "diluting segment".] The late distal tubule has variable permeability to water depending on the presence or absence of ADH.

Question 38

Name two cell types that make up the second half of the distal tubule and subsequent cortical collecting tubule.

Answer 38

(a) principal cells (b) intercalated cells

Question 39

What do principal cells of the late distal convoluted tubule reabsorb and secrete?

Answer 39

principal cells reabsorb sodium and secrete potassium

Question 40

What is the role of the Na+-K+ ATPase pump in principal cells?

Answer 40

The Na+-K+ ATPase pump, located in the basolateral membrane, **maintains a low sodium concentration inside the cell**, **favoring sodium diffusion into the cell** and **facilitating potassium secretion** into the tubular lumen.

Question 41

What are the two steps involved in potassium secretion by principal cells?

Answer 41

💧 Potassium enters the cell due to the Na+-K+ ATPase pump. 💧 Potassium diffuses down its concentration gradient across the luminal membrane into the tubular fluid.

Question 42

What are the primary sites of action for potassium-sparing diuretics?

Answer 42

principal cells

Question 43

(a) Name two mineralocorticoid receptor antagonists that act as potassium-sparing diuretics. (b) Briefly discuss how they cause their effects.

Answer 43

(a) spironolactone, eplerenone (b) They **compete with adolsterone for receptor sites in principal cells**, inhibiting the stimulatory effects of aldosterone on sodium reabsorption and potassium secretion.

Question 44

(a) Name two sodium channel blockers that act as potassium-sparing diuretics. (b) Briefly discuss how they cause their effects.

Answer 44

(a) amiloride, triamterene (b) They directly inhibit the entry of sodium into the sodium channels of the luminal membranes, reducing sodium transport across the basolateral membranes by the Na+-K+ ATPase pump, and decreasing potassium secretion into the tubular fluid.

Question 45

(a) What is the role of intercalated cells found in the late distal convoluted tubule? (b) What are the two types of intercalated cells?

Answer 45

(a) acid-base regulation (b) type A, type B

Question 46

How do type A intercalated cells function?

Answer 46

💧 Type A intercalated cells **secrete hydrogen ions** by a **hydrogen-ATPase transporter** and a **hydrogen-potassium-ATPase transporter**, and they reabsorb bicarbonate ions. 💧 Hydrogen is formed by the action of **carbonic anhydrase** on water and carbon dioxide to form carbonic acid, which then dissociates into hydrogen ions and bicarbonate ions. 💧 The hydrogen ions are then **secreted into the tubular lumen** and, for each hydrogen ion secreted, a **bicarbonate ion becomes available for reabsorption** across the basolateral membrane. [Type A intercalated cells are especially important in eliminating hydrogen ions while reabsorbing bicarbonate in **acidosis**.]

Question 47

How do type B intercalated cells function?

Answer 47

💧 Type B intercalated cells **secrete bicarbonate** into the tubular lumen while **reabsorbing hydrogen** ions in alkalosis. 💧 These cells have a chloride-bicarbonate counter-transporter on the apical membrane of type B cells called **pendrin** [it is different from the chloride-bicarbonate transporter of type A cells]. 💧 Hydrogen ions are actively transported out of the type B intercalated cell on the basolateral side of the cell membrane by **hydrogen-ATPase**, and bicarbonate is secreted in the lumen, thus eliminating excess plasma bicarbonate in alkalosis.

Question 48

Medullary collecting ducts are the final site of processing of urine and therefore play a role in determining the final urine output of water and solutes. **How is the permeability of the medullary collecting duct to water controlled?**

Answer 48

The permeability of the medullary collecting duct to water is controlled by the level of ADH. High levels of ADH increase water reabsorption into the medullary interstitium, reducing urine volume and concentrating solutes in the urine.

Question 49

What is one key difference between the cortical collecting tubule and the medullary collecting duct?

Answer 49

**The medullary collecting duct is permeable to urea**, and there are special **urea transporters** that **facilitate urea diffusion** across the luminal and basolateral membranes.

Question 50

Explain the principle behind the use of inulin to assess water reabsorption by renal tubules.

Answer 50

💧 Inulin is **not reabsorbed or secreted**, thus its concentration in tubular fluid **only changes due to water reabsorption**. As water is reabsorbed along the nephron, the concentration of inulin in the remaining tubular fluid increases. 💧 By **measuring the inulin concentration in the tubular fluid** and **comparing it to the inulin concentration in the plasma**, we can determine the extent of water reabsorption.

Question 51

# *Regulation of tubular reabsorption* What is glomerulotubular balance?

Answer 51

Glomerulotubular balance is the **intrinsic ability of the tubules to increase their reabsorption rate in response to increased tubular load (increased tubular inflow)**, ensuring that the total rate of reabsorption increases as the filtered load increases.

Question 52

# *Regulation of tubular reabsorption* (a) What is the normal rate of peritubular capillary reabsorption? (b) How is reabsorption across the peritubular capillaries calculated?

Answer 52

(a) approximately 124 mL/min (b) Reabsorption = K_f × Net reabsorptive force

Question 53

# *Regulation of tubular reabsorption* The *net reabsorptive force* is used in the calculation of the rate of peritubular capillary reabsorption. It represents the sum of the hydrostatic and colloid osmotic forces that favor or oppose reabsorption across the peritubular capillaries. **List these forces and indicate whether they favor or oppose reabsorption**.

Answer 53

(1) peritubular hydrostatic pressure (P_c), which opposes reabsorption (2) hydrostatic pressure in the renal interstitium (P_if) which favors reabsorption (3) colloid osmotic pressure of the peritubular capillary plasma proteins (π_c), which favors reabsorption (4) colloid osmotic pressure of the proteins in the renal interstitium (π_if), which opposes reabsorption

Question 54

# *Regulation of tubular reabsorption* What are two determinants of peritubular capillary reabsorption that are directly influenced by renal hemodynamic changes?

Answer 54

hydrostatic and colloid osmotic pressures of the peritubular capillaries

Question 55

# *Regulation of tubular reabsorption* Briefly discuss how peritubular capillary hydrostatic pressure is influenced by the **arterial pressure** and **resistances of the afferent and efferent arterioles**.

Answer 55

(1) **Increases** in arterial pressure **tend to raise peritubular capillary hydrostatic pressure and decrease the absorption rate**. **This effect is however buffered to some extent by autoregulatory mechanisms** that maintain relatively constant hydrostatic pressures in the renal blood vessels. (2) An increase in resistance of the afferent or efferent arterioles **reduces peritubular capillary hydrostatic pressure and tends to increase reabsorption rate**. Although constriction of the efferent arterioles increases glomerular capillary hydrostatic pressure, it lowers peritubular capillary hydrostatic pressure.

Question 56

# *Regulation of tubular reabsorption* What determines the colloid osmotic pressure of peritubular capillaries?

Answer 56

(1) the **systemic plasma colloid osmotic pressure**, which increases with higher plasma protein concentration, and (2) the **filtration fraction**, where a **higher filtration fraction increases the concentration of proteins in the remaining plasma**, thus **enhancing reabsorption**. *Further notes:* Renal vasoconstrictors like angiotensin II can increase peritubular capillary reabsorption by decreasing renal plasma flow (RPF) and increasing the filtration fraction.

Question 57

# *Regulation of tubular reabsorption* What are pressure natriuresis and pressure diuresis?

Answer 57

Pressure natriuresis and pressure diuresis are phenomena where small increases in arterial pressure cause marked increases in urinary excretion of sodium and water.

Question 58

# *Regulation of tubular reabsorption* How does increased arterial pressure affect peritubular capillary hydrostatic pressure and renal interstitial fluid hydrostatic pressure?

Answer 58

Increased arterial pressure causes a slight increase in peritubular capillary hydrostatic pressure and renal interstitial fluid hydrostatic pressure, enhancing the backleak of sodium into the tubular lumen and reducing net reabsorption of sodium and water.

Question 59

Which of the following tends to decrease potassium secretion by the cortical collecting tubule? (a) A diuretic that decreases proximal tubule sodium reabsorption (b) Increased plasma potassium concentration (c) A diuretic that inhibits the action of aldosterone (e.g. spironolactone) (d) High sodium intake (e) Acute alkalosis

Answer 59

(c) A diuretic that inhibits the action of aldosterone (e.g., spironolactone) *Explanation:* Aldosterone plays a key role in increasing potassium secretion by the principal cells of the cortical collecting tubule.

Question 60

Sodium reabsorption in the renal tubules ________. (a) is mainly via facilitated diffusion (b) in the ascending loop of Henle is associated with K⁺ secretion (c) in descending limb of the loop of Henle is active and is not accompanied with water reabsorption (d) at the basal border of the cell is along both concentration and electric gradients (e) from the tubule fluid to inside the cells of the proximal convoluted tubule occurs through facilitated diffusion

Answer 60

(d) at the basal border of the cell is along both concentration and electric gradients

Question 61

Reabsorption of filtered HCO₃^- ________. (a) acidifies tubular fluid to pH 4.6 (b) takes place in the collecting duct under physiological conditions (c) can occur normally in the presence of carbonic anhydrase inhibitor (d) is inhibited by a decrease in arterial PCO₂ (e) represents 60% of the filtered load when plasma concentration is 25 mEq/L.

Answer 61

(d) is inhibited by a decrease in arterial PCO₂

Question 62

All of the following comparisons between the distal nephron and the proximal tubule are correct **except** (a) the distal nephron is less permeable to hydrogen ions than the proximal tubule (b) the distal nephron is more responsive to aldosterone than is the proximal tubule (c) the distal nephron has a more negative intraluminal potential than does the proximal tubule (d) the distal nephron secretes more potassium than does the proximal tubule (e) the distal nephron secretes more hydrogen ions than does the proximal tubule

Answer 62

(c) the distal nephron has a more negative intraluminal potential than does the proximal tubule *Explanation:* **Regarding choice (a)**: The proximal tubule is where the bulk of bicarbonate reabsorption occurs, requiring significant hydrogen ion secretion. The distal nephron's role in acid-base balance is more finely tuned and involves less overall hydrogen ion movement. Therefore, it's less permeable to H⁺. **Regarding choice (d)**: Potassium secretion is primarily regulated in the distal nephron, under the influence of aldosterone. While some potassium is reabsorbed in the proximal tubule, the net secretion of potassium occurs predominantly in the distal segments.

Question 63

Which of the following is **true** of the tubular fluid that passes through the lumen of the early distal tubule in the region of the macula densa? (a) It is usually isotonic (b) It is usually hypotonic (c) It is usually hypertonic (d) It is hypertonic in antidiuresis (e) It is hypertonic when the filtration rate of its own nephron decreases to 50% below normal

Answer 63

(b) It is usually hypotonic

Question 64

The greatest amount of hydrogen ions secreted by the proximal tubule is associated with ________. (a) excretion of potassium ions (b) excretion of hydrogen ions (c) reabsorption of calcium ions (d) reabsorption of bicarbonate ions (e) reabsorption of phosphate ions

Answer 64

(d) reabsorption of bicarbonate ions

Question 65

(1) The tubular fluid is iso-osmotic at the end of the ________. (a) proximal tubule (b) ascending limb of the loop of Henle (c) descending limb of the loop of Henle (d) distal tubule (e) medullary collecting tubule (2) Explain your answer.

Answer 65

(1) (a) proximal tubule (2) In the proximal tubule, a significant amount of water and solutes are reabsorbed, **but the reabsorption is proportional**, maintaining the osmolarity of the tubular fluid similar to that of the plasma.

Question 66

In the presence of ADH, the distal nephron is least permeable to ________. (a) urea (b) ammonia (c) water (d) sodium (e) carbon dioxide

Answer 66

(b) ammonia

Question 67

Most of the filtered water is reabsorbed in the ________. (a) proximal convoluted tubule (b) descending loop of Henle (c) ascending loop of Henle (d) distal convoluted tubule (e) collecting duct

Answer 67

(a) proximal convoluted tubule

Question 68

Which of the following statements is **false**? (a) The thick ascending limb of the loop of Henle has Na/K/Cl active transport. (b) The thin descending limb of the loop of Henle is highly permeable to water. (c) Osmolality is greatest at the tip of the loop of Henle. (d) Water diffuses out of blood vessels from the ascending limb of vasa recta into its descending limb. (e) Thin ascending limb of the loop of Henle is impermeable to water.

Answer 68

(d) Water diffuses out of blood vessels from the ascending limb of vasa recta into its descending limb. Explanation: **Regarding choice (c)**: The tip of the loop of Henle extends deep into the inner medulla, where the concentration of solutes is the highest. This high osmolality is crucial for the kidney's ability to produce concentrated urine. **Regarding choice (e)**: The thin ascending limb is permeable to ions but impermeable to water. This allows for the continued removal of NaCl without water, further diluting the tubular fluid.

Question 69

The ascending limb of the loop of Henle is ________. (a) impermeable to water (b) involved in active transport of K⁺ into the lumen (c) involved in active transport of Cl^- into the lumen (d) involved in active transport of Ca²⁺ into lumen (e) involved in active transport of urea out of the lumen

Answer 69

(a) impermeable to water

Question 70

The ascending limb of the loop of Henle is ________. (a) isotonic at the end (b) hypertonic at the beginning (c) hypotonic at the beginning (d) isotonic at the beginning (e) hypertonic throughout its length

Answer 70

(d) isotonic at the beginning *Explanation:* **Regarding choice (a)**: The fluid is hypotonic at the end of the ascending limb. **Regarding choice (b)**: The fluid is isotonic at the beginning, not hypertonic. **Regarding choice (c)**: The fluid is isotonic at the beginning. It only becomes hypotonic as it travels up the ascending limb.

Question 71

In acidosis, most of the hydrogen ions secreted by the proximal tubule are associated with which of the following processes? (a) reabsorption of phosphate ions (b) reabsorption of bicarbonate ions (c) reabsorption of postassium ions (d) excretion of NH4⁺ ions (e) excretion of hydrogen ions

Answer 71

(b) reabsorption of bicarbonate ions *Explanation:* ✔ Hydrogen ions are secreted into the tubular lumen by the proximal tubule cells. ✔ In the tubular lumen, hydrogen ions combine with filtered bicarbonate ions to form carbonic acid. ✔ Carbonic acid dissociates into water and carbon dioxide, catalysed by the enzyme carbonic anhydrase [which is present within the proximal tubule cells and on the brush border of the tubule cells]. ✔ The CO₂ diffuses back into the proximal tubule cells, where it is converted back into bicarbonate ions and reabsorbed into the bloodstream.

Question 72

Concerning the renal handling of water (a) about 60% is reabsorbed at the proximal convoluted tubule (b) the descending loop is impermeable to water (c) most of the water is reabsorbed at the collecting ducts (d) ordinarily the collecting ducts are permeable to water (e) about 180 ml of water is filtered at the glomerulus in a day

Answer 72

(a) about 60% is reabsorbed at the proximal convoluted tubule

Question 73

Which has the greatest renal clearance? (a) Urea (b) PAH (c) Glucose (d) Water (e) Inulin

Answer 73

(b) PAH *Explanation:* Para-aminohippuric acid is almost completely cleared by the kidneys during a single pass through the renal circulation, making it a useful substance for measuring renal plasma flow.