renal regulation of water and acidbase balance Flashcards

1
Q

what is osmotic pressure dependent on

A

total number of solute particles

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2
Q

how can we calculate osmolarity

A

concentration x no. of dissociated particles

osm/l

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3
Q

what are some form of unregulated water loss

A

sweat faeces
vomit
water evaporation from skin

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4
Q

what is regulated water loss

A

renal regulation - urine production

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5
Q

what is positive water balance

A

happens when there is high water intake
causes increase in ecf vol
decreased na+ and decreased osmolarity
.. therefore kidneys produce hyposmotic (dilute) urine production

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6
Q

what is negative water balance

A

happens when low water intake
decreased ecf vol but increased na+ and osmolarity
kidneys produce hyperosmotic urine and triggers thirst

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7
Q

where is 67% of water reabsorbed in kidneys

A

proximal convoluted tubule

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8
Q

what % of water is reabsorbed at thin descending limb

A

15%

no na or cl reabsorbed

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9
Q

is any water reabsorbed at ascending limb

A

no only na and cl reabsorbed

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10
Q

why does medullary interstitium need to be hyperosmotic

A

for water reabsorption to occur from loop of henle and collecting ducts

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11
Q

what are vasa recta

A

series of blood capillaries that surround your nephron mainly in medullary region

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12
Q

how is urea transported out collecting duct into medullary interstitium

A

via uta3 and uta1 transporters

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13
Q

where can urea travel to after leaving the collecting duct

A

into vasa recta via utb1 transporter or into thin ascending limb via uta2 transporter

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14
Q

what is the reason behind why urea increases interstitium osmolarity

A

urine concentration occurs

urea excretion requires less water

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15
Q

what is vassopressins role in urea

A

boosts uta1 and uta3 numbers and increases permeability of collecting duct for urea

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16
Q

what is the main function of adh/vasopressin

A

promote water reabsorption from collecting duct

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17
Q

where is vasopressin/adh produced

A

hypothalamus - neurons in supraoptic and praventricular nuclei

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18
Q

what are some stimulatory factors that influence adh production and release

A
increase in plasma osmolarity
hypovolemia
decrease in blood pressure
nausea
angiotensin 2
nicotine
19
Q

what are some inhibitory factors influencing adh production and release

A
decrease in plasma osmolarity
hypervolemia
increase in blood pressure
ethanol
atrial natriuretic peptide
20
Q

what % change is required for detection by baroreceptors for adh release/inhibition

21
Q

what is the mechanism of adh

A

adh binds to v2 receptor on basolateral membrane of collecting duct
activates g coupled protein mediated signalling cascade
activates protein kinase A
and increases secretion of aqp2 which are inserted into apical membrane

22
Q

what is diuresis

A

increased dilute urine excretion

23
Q

what is antidiuresis

A

concentrated urine in low volume excretion

24
Q

treatment for syndrome of inappropriate adh secretion (siadh)

A

non-peptide inhibitor of adh receptor - conivaptan and tolvaptan

25
what is the treatment of nephrogenic diabetes insipidus
thiazide diuretics and nsaids
26
what is the role of kidneys in acidbase balance
secretion and excretion of h+ reabsorption of hco3- production of new hco3-
27
what is the neutral ecf hco3-
~ 350mEq or 24mEq/L
28
what % of bicarbonate ions are reabsorbed by kidneys
almost 100% around 80% in pct 10% in thick ascending limb
29
how are h+ ions reabsorbed in pct
1. via na+h+ antiporter | 2. h+ atpase pump
30
how are bicarbonate ions reabsorbed into blood
via na+hco3- symporter
31
what are the 2 different cells present in dct and collecting duct
alpha intercalated cell | beta intercalated cell
32
what is role of alpha intercalated cell
hco3- reabsorption and h+ secretion
33
what is the role of beta intercalated cells
hco3- secretion and h+ reabsorption
34
how are new bicarbonate ions produced
in proximal convoluted tubule glutamine is converted into 2 molecules of ammonia and 1 divalent ion which gives rise to 2 hco3- ions which are reabsorbed ammonia re-enters blood circulation reaches liver and gets converted into one urea ion and one proton ion THEREFORE ammonia must be excreted from body via na+h+ antiporter and becoming ammonia gas and binding with proton ion into tubular fluid
35
how are bicarbonate ions produced in dct and collecting duct | alpha intercalated cells
proton ion is neutralised with a phosphate ion hco3- is gained travels into blood via cl-hco3- antiporter
36
what are the characteristics of metabolic acidosis
low hco3- | low ph
37
what is the compensatory response to metabolic acidosis
increased ventilation | increased hco3- reabsorption and production
38
what are the characteristics of metabolic alkalosis
high hco3- and high ph
39
what is the compensatory response to metabolic alkalosis
decreased ventilation | increased hco3- excretion
40
what is respiratory acidosis
high pco2 | low ph
41
what is the compensatory response to respiratory acidosis
acute - intracellular buffering | chronic - increase in hco3- reabsorption and production
42
what is respiratory alkalosis
low pco2 and high ph
43
what is the compensatory response to respiratory alkalosis
acute - intracellular buffering | chronic - decrease in hco3- reabsorption and production