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Y2 Urology > Renal regulation of water and acid-base balance > Flashcards

Renal regulation of water and acid-base balance Flashcards

1
Q

Give the equation for osmolarity.

Give the units.

A

Osmolarity = Concentration x No. of dissociated particles
= Osm/L OR mOsm/L

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2
Q

Total fluid volume is ___% of body weight.

A

60

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3
Q
A
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4
Q

Name some unregulated ways that the body can lose water.

A

Sweating
Feces
Vomit
Water evaporation from resp lining and skin

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5
Q

Explain renal regulation in the context of just water and solutes starting from
a) positive water balance
b) negative water balance

A
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6
Q

Where is the majority of water reabsorbed in the nephron?

A

PCT

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7
Q

Explain the loop of Henle and how it works.

A
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8
Q

Name the system that the Loop of Henle uses and how it works.

A
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9
Q

Which channel does urea pass through in the thin descending limb and in what direction?

A
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10
Q

Which urea channels are on apical and basolateral sides of the principal cells on the collecting duct?

Which direction does urea travel?

A

UT-A1 (apical)
UT-A3 (basolateral)

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11
Q

Name the order of channels of which urea travels through and where they are found

A

UT-A2 (urea enters thin descending limb)
UT-A1 (urea enters principal cell from collecting duct)
UT-A3 (urea leaves principal cell into interstitium)
UT-B1 (urea enters vasa recta from interstitium)

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12
Q

What happens if there is a problem with the UT-B1 urea transporter? why?

A

there will less water reabsorbed and urine will be dilute

if function of UT-B1 compromised, urea would flow away and not stay in interstitium (will go to capillaries or cortical region)

thus, UT-B1 transports urea into vasa recta and there are some fenestrations where urea can freely flow out and water can be reabsorbed

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13
Q

How does the UT-B1 transporter work?

A

UT-B1 transports urea into vasa recta and there are some fenestrations where urea can freely flow out and water can be reabsorbed

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14
Q

What effect does vasopressin have on the urea recycling system?

A

boosts UT-A1 and UT-A3 numbers

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15
Q

Why do we need the urea recycling system?

A

so that we can remove urea with as little loss of water and possible

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16
Q

How and why does some urea always stay in the interstitium?

A

urea transported into vasa recta via UT-B1 and there are some fenestrations where urea can freely flow out and water can be reabsorbed

thus, some urea always remains in the interstitium, supporting passive water reabsorption

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16
Q

How and why does some urea always stay in the interstitium?

A

urea transported into vasa recta via UT-B1 and there are some fenestrations where urea can freely flow out and water can be reabsorbed

thus, some urea always remains in the interstitium, supporting passive water reabsorption

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17
Q

How long is ADH amino acids wise?
What is ADH’s main function?
Where is ADH produced?
Where is ADH stored?

A
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18
Q

Where is fluctuation of plasma osmolarity detected?

A

osmoreceptors in hypothalamus

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19
Q

How much change of osmolarity is required for detection by baroreceptors?

Where is this information then transmitted to?

A

5-10%

hypothalamus

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20
Q

What factors other than increased plasma osmolarity and hypovolemia stimulate ADH production? (3)

A

Nausea
Angiotensin II
Nicotine

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21
Q

What factors other than decreased plasma osmolarity and hypervolemia inhibit ADH production?

A

ethanol
atrial natriuretic peptide

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22
Q

Explain the mechanism of action of ADH in detail on the principal cell.

A

ADH is released into the blood circulation
- ADH binds to the V2 receptor
- this binding activates the G-coupled-protein signalling cascade
- this activates protein kinase A
- results in secretion of AQP2 in vesicle form
- vesicle is transported to apical side of principal cell and is inserted into apical cell membrane
- water is reabsorbed thru AQP2
- water travels thru principle and is reabsorbed into the blood via AQP 3/4

23
Q

V2 receptors are on the _____ side of the principal cell.

A

Basolateral

24
Q

ADP up/down regulates the numbers of which AQP channels?

A

AQP 2 and 3

25
Q

How is NaCl reabsorbed on the thick ascending limb of the Loop of Henle?

A
26
Q

How is NaCl reabsorbed in the DCT ?

A
27
Q

How is Na+ reabsorbed in the Principal cells?

A
28
Q

How does ADH also support the reabsorption of Na+

A

(the basolateral side)

29
Q

Name 3 ADH-related clinical disorders.

A

central diabetes insipidus
syndrome of inappropriate ADH secretion
nephrogenic diabetes insipidus

30
Q

Name the cause, clinical features and treatment for central diabetes insipidus

A
31
Q

Name the cause, clinical features and treatment for SIADH

A
32
Q

Name the cause, clinical features and treatment for nephrogenic diabetes insipidus

A
33
Q

What are the role of the kidneys in acid-base balance? (3)

A
34
Q

Give 3 equations of the HCO3- buffer system.

A
35
Q

fill with respiratory and metabolic

A
36
Q

Give the equation which links the lungs and kidneys in relation to respiratory or metabolic acid-base disorders.

A
37
Q

What equation can we used to establish the direct/inverse proportion of HCO3- and PCO2 to pH.

What is the relationship of the 2?

A

high [PCO2] -> high [H+] = (low pH)
high [HCO3-] -> low [H+] = (high pH)

38
Q

What 4 places in the kidney nephron is bicarbonate reabsorbed?

A

PCT
thick ascending limb of LoH
DCT
CD

39
Q

How are bicarbonate ions reabsorbed in the PCT? (process v. similar in ascending loop of henle)

A

-carbon dioxide enters cell via diffusion
- undergoes reaction by carbonic anhydrase and a H+ and HCO3- is produced

  • the proton can be transported back into the tubular fluid via either the Na+/H+ antiporter or the H+/ATPase pump
  • the bicarbonate ion gets reabsorbed thru the use of Na+/HCO3- symporter
40
Q

What % of bicarbonate ions are reabsorbed in the kidney and where in the kidney is the majority reabsorbed?

A

100%

PCT

41
Q

How are bicarbonate ions reabsorbed in the DCT and CD? Thru which cell?

A

a-intercalated cell
- H+ transported back into tubular fluid
- HCO3- ions reabsorbed thru Cl-/HCO3- antiporter

42
Q

When cell in the DCT and CD works to get rid of HCO3- ions? When would this happen?

A

alkalosis

  • thru use of the HCO3-/Cl- antiporter bicarb ions are transported back into tubular fluid and H+ ion is reabsorbed
43
Q

How are new HCO3- ions produced in the PCT?

A

glutamine molecule gives rise to 2 ammonium ions and one divalent anion

the divalent anion gives rise to 2 HCO3- anions which are reabsorbed

the 2 ammonium ions will be transported back into the tubular fluid via the Na+/H+ antiporter or by the conversion of the ammonium ions into gas and it can diffuse into the tubular fluid

44
Q

How are new HCO3- ions produced in the DCT and CD?

A

thru the use of the phosphate buffer system we are able to gain a bicarb ion

the phosphate buffer system neutralises a proton, which means we effectively gain a bicarb ion thru the absorption in the blood

45
Q

What is the name of the Na+/H+ antiporter that transfers the ammonium from the proximal convoluted tubule call back into the tubular fluid?

A

NHE3

46
Q

What is the name of the H+/ATPase on the apical side of the a-intercalated cell?

A

V-ATPase

47
Q

Why is it important that the 2 ammonium ions from the conversion of glutamate in the proximal convoluted tubule are excreted?

A

if they goes to liver, they become 2 urea and 2 protons (which we will have to neutralise w/ 2 bicarb)

so ammonia ion needs to be excreted

48
Q

What acid base imbalances are these?

A
49
Q

What is the compensatory response for a metabolic acidosis?

A

increased ventilation

increased [HCO3-] reabsorption and production

50
Q

What is the compensatory response for a metabolic alkalosis?

A

decreased ventilation

increased [HCO3-] excretion

51
Q

What is an acute compensatory response for a respiratory acidosis?

A

intracellular buffering

  • increased CO2 enters inside the cell and is hydrated by CA producing a H+ and HCO3-.
  • H+ is neutralised by cellular proteins, which gives rise ot just one bicarb ion
52
Q

What is an acute compensatory response for a respiratory alkalosis?

A

intracellular buffering

  • the equation is shifted to the left
  • bicarb ion is employed and produces carbonic acid so there is less bicarb ion in the body
53
Q

What is a chronic compensatory response for a respiratory acidosis?

A

increased [HCO3-] reabsorption and production

54
Q

What is a chronic compensatory response for a respiratory alkalosis?

A

decreased [HCO3-] reabsorption and production

Y2 Urology (7 decks)

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