renal system Flashcards

1
Q

Describe renal hormones

A
The kidney as an endocrine organ
– Renin (RAS)
– Erythropoietin
– Calcitriol
• The kidney as a target organ for hormones
– Antidiuretic hormone (AVP, pituitary)
– Aldosterone (RAAS, adrenal gland)
– Cardiac hormones
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2
Q

renin, where is it produced, what is stumuli for release

A

• Produced in the cells juxtaglomerular
apparatus (JGA)
• Stimuli for release:
– Low blood pressure (detected by baroreceptors)
– Decrease in Na (detected at the macular densa)
– Stimulation of the renal sympathetic nerves

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3
Q

Erythropoietin

A

• Kidney is the major site of production –
interstitial cells
• Also produced in the liver - perisinusoidal cells
• Glycoprotein hormone
• Half life ~5 hours
• Binds to EpoR (located in bone marrow, CNS)
and activates JAK2 signalling cascade

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4
Q

Roles of epo?

A

Classical -> stimulate production of red cells

Wound healing
Cardioprotection
Angionesesis
Neuroprotectnat in premmie baboes
Renal and retinal protecion
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5
Q

Simulation and actions of EPo and erthropoiesis

A

Hypoxia detected (decreased O2 bc low RBC)-> epo prodction -> stimulates erythroppoiesis in bone marrow->erythroppoiesis increase RBC -> blood o2 return to normal

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6
Q

what stimulates epo?

A

How much oxygen can be delivered to tissue, -> tissue will detect -> will induce HIF and stim epo:

Low tissue oxygenation can be bc not enough hemoglobin -> iron defficient , or hemorrhage

Or if not enough o2 attached to hemo e.g high altitude

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7
Q

epo production baby and adult

A

In liver as baby and in kidney as adult

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8
Q

how you get rbc from red blood cell?

A

In bone marrow, stem cells turn into BFU-E then CFU-E then erythroblasts then reticulocytes then red cell mass

EPO acts on BFU-E AND CFU-E

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9
Q

What are the Actions of Epo on the bone marrow

A

cts on red blood cell progenitors and precursors
(in the bone marrow)
• Protects these cells from apoptosis.
• Targets
– Burst forming units (BFU-E)
– colony forming units (CFU-E)
• cooperates with various other growth factors
(e.g., glucocortioicds, IL-6).
• Precursors of red cells, the proerythroblasts and
basophilic erythroblasts also express Epo-R.

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10
Q

describe Erythropoietin receptor

A
- Located on erythroid
progenitors
- Cytokine receptor
- Signals through JAK2-STAT
pathway
- Increased Epo production
in people with mutations
in the Epo-R –increased
hematocrit.

CAN ACTIVATE MULTIPLE SECONDARY MESSENGER SYSTEMS TO HAVE DIFFERENT TARGET

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11
Q

What is gold medal mutation?

A
- Point mutation in the
Epo-R causes Primary
familial polycythaemia
- Increased hematocrit
esp good for endurance sports
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12
Q

Altered Epo production

?

A

Low Epo production in kidney failure
• Anemia (multiple causes)
• Early sign of renal failure is tiredness due to
lack of Epo production

epo can be therapteutic for aneamia

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13
Q

what are some Non-haemopoietic effects of EPO

A

Actions of Epo in wound healing:

1) improves mobility of cells and increases migration
rate, particularly in keratinocytes and fibroblasts,
resulting in an overall quicker wound closure.

2)(2) reduces inflammatory reaction.

(3) Increased angiogenic response, accelerated
microvascular network formation, and improved
maturation are associated with improved nutrition and
metabolism of the wound

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14
Q

Epo as a performance enhancing drug

A
Widely used by endurance athletes,
particularly cyclists
• Increased hematocrit to >55%
• Increased blood viscosity
• Strokes! Cardiac events!
• Death!!!
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15
Q

summary of Calcitriol

A

Steroid hormone
• Produced in the cells of the proximal tubule
• 1,25-dihydroxyvitamin D3
• Hormonally active metabolite of vitamin D
• Calcitriol increases the level of calcium (Ca2+)
in the blood by increasing the uptake of
calcium from the gut and stop loss from urine

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16
Q

Calcitriol receptor?

A

Is in nucleus

Transcriptually regulates does whole range of things

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17
Q

Calcitriol receptor?

A

Is in nucleus

Transcriptually regulates does whole range of things

18
Q

classical and novel actions of D3

A

May act on breast colon and prostate -> inhibial clonal proliferation

In vascular cells reduces inflammation

Increases insulin secretion in pancreas

DRAW AND READ UP ON SMOE MORE

19
Q

Clinical uses:

A

Hypocalcemia
• Rickets (infants, children),
• Chronic kidney disease
• Osteoporosis

20
Q

Hormones
acting on the
kidney:

A

theres big ass graph draw it out, understand it

21
Q

Arginine vasopressin ADH

A

• Antidiuretic hormone
• Peptide hormone
• Produced in hypothalamus and stored in the
posterior pituitary
• Inhibited by alcohol
• Stimuli for release:
– Low blood pressure (detected by baroreceptors)
– Low blood volume (eg hemorrhage or dehydration)

22
Q

Vasopressin controls?

A

active water reabsorption

Vasopressin secretion is stimulated by
water deficit. 
This is detected by osmoreceptors in the
hypothalamus (major mechanism) and
volume receptors in the left atria.
Vasopressin secretion is thus triggered
by an increase in ECF osmolarity or a
large loss in ECF volume
Low ECF osmolarity and elevated ECF
volume suppress vasopressin secretion.
Stimuli for vasopressin secretion also
cause thirst
23
Q

Vasopressin controls?

A

active water reabsorption

Vasopressin secretion is stimulated by
water deficit. 
This is detected by osmoreceptors in the
hypothalamus (major mechanism) and
volume receptors in the left atria.
Vasopressin secretion is thus triggered
by an increase in ECF osmolarity or a
large loss in ECF volume
Low ECF osmolarity and elevated ECF
volume suppress vasopressin secretion.
Stimuli for vasopressin secretion also
cause thirst
24
Q

How does it work?

A
  • Increases water
    permeability in the distal
    tubule and collecting duct
    (AVP ACTS TO CHANGE HOW MUCH H20 IS ABSORBED)
  • Results in concentrated
    urine
25
Q

AVP (receptor binding and signalling)

A

• Vasopressin binds to V2
receptors on the basolateral
membrane of epithelial cells in the distal
tubule/collecting duct.
• V2
is a GPCR that couples to Gs
, thus elevating cAMP.
• Increased cAMP induces trafficking of aquaporin 2
(AQP-2) water channels to the luminal membrane.
• Increased insertion of AQP-2 into the luminal
membrane increases free water reabsorption

26
Q

Abnormalities in AVP secretion

Abnormalities in AVP secretion

A
  • AVP secretion may decrease with aging
    -Diurnal secretion may be altered
    -Decreased renal sensitivity to AVP
    Diabetes insipidus
  • Excrete large amounts of urine
  • excessive thirst
  • Central or nephrogenic
27
Q

how can test for diabetes insipisdues with vaeopresson

A

administer it exogenously and see how they respond

IS it nephrogenic
Aquaroprin issues

kidney in origin hard to trear

28
Q

Other actions of AVP

A

clasically -> last 10% fluid balance

but has evidence avp can be involved in emotional and social behaviour
Cognition
Circadian ryhthym

29
Q

Aldosterone produced?

A

Produced in adrenal gland, =zona glomerulosa

30
Q

Aldosterone summary

A
  • Aldosterone is a steroid hormone (mineralocorticoid)
  • Produced in the adrenal cortex (Zona glomerulosa)
  • It binds to the mineralocorticoid receptor (MR)
  • Increases the transcription of ENaC and Na-K pumps
    in the collecting tubule epithelia.
  • This increases Na+
    reabsorption and K+
    secretion -> into urine
31
Q

Actions of Aldosterone

A

binds to MR in kidney duct epithelial cell -? goes to nuclues -? changes structure of channels

32
Q

Stimulation of aldosterone

A

Theres a graph, draw it!

33
Q

what are Actions of Aldosterone on K+

A

Aldosterone is the major hormonal regulator of K+
secretion.
• Increased plasma K+ directly stimulates aldosterone
release from the adrenal cortex, whilst decreases in
plasma K+
suppress aldosterone secretion.
• Tight control of body K+
levels is vital as even small
changes in plasma K+ can have detrimental effects,
particularly on the heart

34
Q

Tubular secretion of K+

A

draw this

K
\+
secretion is coupled to Na+
reabsorption in the distal region
of the nephron.
The basolateral Na+
/K+
-ATPase
that actively reabsorbs Na+ also
pumps K+
into epithelial cells.
K
\+ can then diffuse into the lumen
via ‘leak’ channels on the luminal
membrane
35
Q

what conditions do you have Altered Aldosterone production

A

Conns -> inc aldosterone, results in hypertension and hypokalemia

secondary Hypersaldosteronism -> inc aldo and renin -> results in hypertension and hypokalemia

Cushings -? musce wasting, hypertension

Addisons -? dec cortisol and aldosterone -> results in hypoglycaenia, fatigue, hypotension, dehydration,

36
Q

Primary aldosteronism (Conn’s syndrome)

A

Renin-independent increase in the secretion of aldosterone.
~ 99% of cases due either to anadenoma or due to idiopathic
hyperaldosteronism (IHA), which accounts for around 60% of cases
(almost all of which are bilateral).

CAUSE : ANADENOMA

37
Q

Secondary hyperaldosteronism

A

A diverse group of disorders - activation of the RAAS – high renin
Secondary hyperaldosteronism can be divided into 2 categories,
– hypertension - includes renovascular hypertension, which results from
renal ischemia and hypoperfusion leading to activation of the R-A-A
axis.
– absence of hypertension - occurs as a result of homeostatic attempts
to maintain the sodium concentration or circulatory volume or to
reduce the potassium concentration.

38
Q

describe Low Aldosterone production

A

bc whole adreno functioning bad
• Addison’s disease (Both low Aldo and Cort)
• Fatigue, weight loss, hypotension
• Treatment – hormone replacement

39
Q

what are the Cardiac hormones on the kidney

A

Atrial Natruietic peptic (ANP)

natriuseis -> NA excretion

Stimulated by INCREASED BLOOD VOLUME

Receptors in heart detect change in BV

can act in brain-> hypo, medulla oblongata, and adrneal cortex -> inhibit avp and aldosterone

kidney to increase GFR to result in fluid and electroltye excretion

40
Q

distinguish what works on kidney or made BY kidney

A

summarise!