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Physiology Renal ABS 2018 > Renal Regulation Acid Base Balance > Flashcards

Renal Regulation Acid Base Balance Flashcards

1
Q

How do we intake acids? get rid of them ?

A
  1. In our diet and metabolism

2. loss of acids and bases in the GI tract + urine (depending on the needs of the body )

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2
Q

What do we ingest more in our diet ? Acids or Bases?Why?

A
  1. Acids
  2. Processed or fatty foods
    We usually rake in more than we need in the body- so we will most likely excrete acids.
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3
Q

What is a buffer?

A

Molecule that helps maintain normal pH levels when there are addition of acids or bases.

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4
Q

Main buffer in our body fluids?

A

HCO3-

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5
Q

Main buffer?Where? Equation?Depends on what?

A

CO2 and HCO3 buffer system; ECF
- REVERSIBLE Equation !
Depends on Concentration of substate and enzymes.
CO2 + H2O H2CO3 HCO3- + H+

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6
Q

What buffers ICF fluids?

A

More buffering is done here because we have more fluid in ICF vs. ECF.

  1. Proteins
  2. Phosphates
  3. K+/H+ exchanger
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7
Q

What buffer system is our first line of defense? Why?

A

ECF - because that is where the fluid goes first (ingestion of acids)

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8
Q

How do we move fluids from ECF to ICF?

A

K+/H+ exchanger- these are transporters located on our cells.
A K+ will be exchanged for H+ if there is more H+ OUTSIDE the cell.
- cause H+ to enter cell and cause ACIDOSIS

GET ALKALOSIS:
when there is too much H+ in cell- it will move out of the cell and K will move into the cell.

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9
Q

What system is CO2 dependent on? Examples?

A

The Respiratory system

  1. Holding breath causes an increase in CO2 (acid buildup)–> decreases pH
  2. Hyperventilation causes decreased CO2 levels (alkalosis)–> increases pH
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10
Q

What happens to HCO3- in the body?

A
  1. Normally reabsorbed (about 100%)
  2. Freely filtered
  3. Normal levels = 24 mEq/L (24 mmol/L)
  4. 4320 mmol/L = FL of Bicarb if normal daily GFR is 180l/day.
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11
Q

What 2 places in the nephron do we see acid base balance ?

A
  1. Proximal Tubule

2. Distal Tubule

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12
Q

What happens in the PT?

A
  1. Reabsorption of HCO3-

2. If necessary- we will secrete acids (in the form of NH4+)

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13
Q

What happens in the DT?

A
  1. May finish reabsorbing
  2. Excrete bases (in the form of HCO3-)
  3. Excrete acids (in the form of H+)
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14
Q

Where does reabsorption of HCO3- take place? What percentage?

A
  1. PT- 85 %
  2. Thick Ascending Limb- 10%
  3. DT and Collecting Duct- 5 %
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15
Q

How do we reabsorb HCO3- in PT?

A

A different HCO3 molecule from the apical membrane than in the blood
NO NET CHANGE in HCO3- in blood

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16
Q

CO2 + H2O forms what in the cell?

A

H2CO3 (Carbonic acid)

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17
Q

H2CO3 (Carbonic acid) breaks down into what in the cell? With what enzyme?

A
  1. HCO3- and H+

2. Enzyme is Carbonic Anhydrase

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18
Q

When H+ is in the cell, how do we get it into the lumen?

A

By using the Na+/H+ exchanger (countertransporter) which is on the apical membrane

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19
Q

What hormone increases Na/H transporters located on the apical membrane of the PT?

A

Angiotensin II

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20
Q

What happens in the lumen when Na/H pumps H+ into the lumen?

A

H+ (is secreted and) binds with a HCO3- that has been filtered already.. will then form Carbonic acid–> these will break up into–> CO2 and H2O

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21
Q

What happens to your filtered HCO3- in the lumen?

A

It is gone - because it binds with secreted H+ to form –> H2CO3–> CO2+ H2O

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22
Q

What happens to the HCO3- molecule made inside the cell?

A

It will get pumped across the BLM by a Na/ HCO3 symporter – now we get a new HCO3- molecule into the blood.

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23
Q

What are 2 transporters used on the BLM of proximal Tubule for Acid base regulation?

A
  1. Na/ HCO3 symporter

2. Cl/ HCO3 antiporter

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24
Q

Explain Type a - Distal Tubule Mechanism for Acid base balance.

A
  1. Begins in the cell with CO2 and H2O
  2. Carbonic anhydrase converts H2CO3 to HCO3 and H+
  3. Apical membrane transporters are different - need energy (primary active transport)!! - so we use K+/H+ ATPase OR H+ ATPase pump.
  4. The pumped out H+ will bind with filtered HCO3 to form H2CO3–> CO2 and H2O.
  5. The HCO3 made in the cell will be pumped out using HCO3/Cl exchanger on the BLM
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25
Q

What transporters do we use on the Apical membrane for the PT? BLM?

A
  1. Na/H exchanger for Apical membrane
    BLM have both
  2. Na/HCO3 symporter
  3. Cl/HCO3 antiporter
26
Q

What transporters do we use on the Apical membrane for the DT(Intercalated cells- type A- alpha)? BLM?

A

BOTH ON APICAL M require energy! (Primary active transport)

  1. K+/H+ ATPase pump
  2. H+ ATPase pump
  3. ONLY have HCO3/Cl exchanger on BLM
27
Q

What is the difference between alpha and beta intercalated cells of the Distal tubule? when will we have each one?

A

Same exact transporters but they are located on opposite membranes.
Alpha cells- reabsorption of HCO3- when we are in need of it
Beta cells- secretion of HCO3- high HCO3(BASE LOAD)/ low acids (ALKALOSIS)

28
Q

How do we get rid of too much acid?

A
  1. High intake of acids
  2. Acids enter ECF (no pH change because of our buffer system- HCO3)
  3. HCO3 decreases in ECF because it buffers with H+
  4. We need to bring HCO3 back up - make more HCO3
  5. Kidneys need to make new HCO3
29
Q

What 2 ways do we make new HCO3?

A
  1. Secrete ions and combine it with another filtered ion (that is not HCO3-)
  2. Excrete NH4+
30
Q

Explain how we make new HCO3 and get rid of acid.

A
  1. If we have no more filtered HCO3
  2. H+ can combine with other buffers in our blood ( Titratable acids,PO43-, etc)
  3. no pH change
  4. new HCO3 we made in cell can be pumped out with HCO3/Cl exchanger
  5. We made a new HCO3 in the blood
31
Q

When we measure titratable acids in the urine (excreted) what are we really measuring?

A

The number of new HCO3 molecules created in the blood.

32
Q

What is important to note about titratable acids?

A

There is a finite amount.

Only a certain number we can do because it depends on the number of titratable acids that are filtered.

33
Q

*******What happens when there is not a titratabale acid for the secreted H+ to bind to ?

A

****Through the creation of NH4+

34
Q

**Where are titratable acids created?

A

****1. In the distal tubule

35
Q

*****Where is NH4+ excreted?

A

*****in the proximal tubule

36
Q

What is the basis for creating NH4+ ?

A

Glutamine

37
Q

What is glutamine? How is it taken up?How long?

A
  1. An AA
  2. Taken up by the PROXIMAL Tubule
  3. Glutamine is converted to HCO3 and NH4+ molecule after many enzymatic reactions.
  4. HCO3- is moved into blood (NEW)
  5. NH4+ is secreted into lumen
  6. THIS PROCESS IS A DELAY!! – great and unlimited way to get rid of acids– but it takes time
38
Q

What acid-base function occur in the PT?

A
  1. Reabsorb bicarb

2. produce ammonium (if there is too much acid)

39
Q

What acid-base function occur in the Ascending Loop of Henle

A
  1. reabsorb bicarb
40
Q

What acid-base function occur in the DT?

A
  1. Reabsorb bicarb

2. secrete bicarb

41
Q

What is Net Acid Excretion ?

A

Tells how much of a role the kidneys played in acid excretion- by
1. Titratable acids excreted
2. NH4+ made
& both of these ways we make a new Bicarb molecule

42
Q

What is the equation for Net Acid Excretion?

A

NAE= (TA + NH4+) - HCO3-

43
Q

What is our NAE when we have excess acid?Excess base? 3 factors for each.

A
  1. Excess acid
    a. HUGE AMOUNT of NH4
    b. NO HCO3
    c. High NAE
  2. Excess base
    a. Small amount of NH4 excreted- because it is delayed process
    b. NO titratable acids- you want to keep them
    c. NEgative NAE
44
Q

What are the 2 main causes of Acidosis we see in the body?

A
  1. Gain of acids

2. Loss of base

45
Q

How do we have an acid gain?

A
  1. Decreased respiration (hypoventilation?)- drugs, airway obstruction, emphysema, chronic bronchitis
  2. Ketoacids- used as a fuel source when others aren’t available- but they are acids! (Seen in Diabetes)
  3. Renal failure- acids levels can rise in the body if they are not excreted by the kidneys
46
Q

How do we have base loss?

A
  1. Diarrhea- common cause of acidosis
47
Q

Why is the anion gap (AG) important?What is it used for?

A

When we have a patient in the state of acidosis, the anion gap helps us determine whether it is due to
1. Acid gain
OR
2. Base loss

48
Q

How do we calculate Anion Gap ?

A

AG= Na - (Cl + HCO3)

major cation minus major anions

49
Q

If we have a normal Anion gap during acidosis– tells us…

A

We have a base loss– When we lose bicarb, Cl actually replaces it so the anion gap stays normal even though you have less base/ bicarb!

50
Q

What is the anion gap? Normal value?

A
  1. The space between Na and Cl

2. 8 - 12

51
Q

What are acids labeled as in terms of the Anion Gap?

A

When we have an acid it the body- they are ANIONS so they go in the unmeasured anon group– which will increase the Anion Gap. AG grows the more acid in the body.

52
Q

How do we lose acid?

A
  1. Vomiting- because there’s a lot of it in the stomach- stomach acids
  2. Hyperventilation
53
Q

How do we gain bicarb?

A
  1. Bicarb overdose- TUMS (Anti-acids)

2. Chronic diuretic usage-

54
Q

Recurrent pylonephritis

A

chronic inflammation of kidney

55
Q

Azotemia

A

increased Nitrogen in blood

56
Q

What is a normal respiration rate?

A

16 breaths/min

57
Q

What is marked cyanosis?

A

turning blue

58
Q

What is a loud strider?

A

Loud whistle sound heard while breathing

59
Q

When we have alkalosis, where do we move K+ ions?

A

Into the cell

60
Q

What are the normal levels for

  1. Na
  2. K
  3. HCO3
  4. Creatinine?
A
  1. 135-145
  2. 4
  3. 24
  4. 1

Physiology Renal ABS 2018 (7 decks)

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