Renal System Normal Function Flashcards

1
Q

Renal-Relates to the Kidney

Kidney is part of the Urinary System

Two sets of organs

  • Urine forming organs (1)
  • Organs that store or carry urine out of the body (3)
A
  • Kidneys
  • Ureter, Bladder, Urethra
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2
Q

Outline of Topics

  1. Nephrons and steps in Urine Formation
    1. Glomerular Filtration - mechanism and _____
    2. Tubular Reabsorption - importance of ___ reabsorption
    3. Tubular Secretion - __, ___, role for ______, Organic ____
  2. Hydration State and varying the concentration of urine
    1. Medullary osmotic _____
    2. Anti____ Hormone
    3. Variable ___ reabsorption at the distal tubule and CD
  3. Long Term Control of Blood Pressure through the _____ System
A
  1. Nephrons and steps in urine formation
    1. control
    2. Na+ reabsorption
    3. H+, K+, Aldosterone, ions
  2. Hydration state and varying concentration of urine
    1. gradient
    2. ADH
    3. H20
  3. Long term B control - RAAS system
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3
Q

Parts of the Urinary System

Kidneys: major filtering organ of our body

  1. Filters _____ by taking blood and filter excess fluid, excess electrolytes to be removed from body
  2. D____ elimination

Renal Blood Flow: (1) branches off abdominal aorta and supplies blood to kidneys -> kidney filters that blood then leaves through (1) -> drains to (1) back into heart

A
  1. waste
  2. drugs

Renal Artery -> Renal Vein -> Abdominal Vena Cava -> heart

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4
Q

Parts of the Kidney

(1): outer, lighter region

(1): inner darker region

(1): set of tubules where urine collects and drains into renal pelvis

(1): center of kidneys where urine collects and exits through ureter

A

Renal Cortex

Renal Medulla

Renal Pyramid

Renal Pelvis

Urine is formed in cortex and medulla then drains into renal pelvis

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5
Q

Structure of the Kidneys

Kidneys function as (3) types of organs

Each kidney is composed of about 1 million microscopic functional units called ______:

(2) components

A

Filtering, Endocrine, Metabolic

Nephrons

Vascular, Tubular Component

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6
Q

Kidney Functions (notes)

We are going to focus on the kidneys filtering function however they also..

Kidneys as Endocrine organs: (1) hormone that acts on bone marrow to stimulate RBC production

Kidneys as Metabolic organs: (1) produces new glucose from substrates such as lactic acid and amino acids (is a main function of liver but kidneys contribute to this)

A

Erythropoietin (EPO)

Gluconeogenesis

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7
Q

Tubular Components

(1): yellow claw like structure that wraps around the Glomerulus

(1): tuft of capillairies where urine formation _____- plasma within capillaries filters across membrane into bowman’s capsule then down tubules

Flow of Urine

(1): first portion of tubule closest to glomerulus

(1): first down descending arm then up ascending arm

(1)

(1): physically attached to about 9-12 nephrons (located in renal pyramid) -> renal _____ -> _____

A

Bowman’s Capsule

Glomerulus

Proximal Tubule

Loop of Henle

Distal Tubule

Collecting Duct -> renal pelvis -> ureters

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8
Q

Vascular Components

Flow of Blood

  1. (1)
  2. (1): blood moving into Glomerulus
  3. (1): blood that doesn’t get filtered in glomerulus moves out through this
  4. (1): network of capillaries (purple net) that surrounds the nephron
    • Exchange of substances back and forth between capillaries and tubules adjusts _____ of urine
  5. (1): then into vena cava
A
  1. Renal Artery
  2. Afferent Arteriole
  3. Efferent Arteriole
  4. Peritubular Capillaries
    • ​​composition
  5. Renal Vein
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9
Q

Juxtaglomerular Apparatus

**Importance** =

  • juxta-glomerular = right ____ to glomerulus
  • Portion of ____ tubule sits close and in between (2) -invaginate (form a V) -> regulates ____ of filtration
A

REGULATES KIDNEY FUNCTION

  • next to glomerulus
  • distal, sits between afferenta and efferent arteriole -> regulates rate of filtration
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10
Q

Regional Differences Among Nephrons

  • All nephrons originate in the _____ of the Kidney
    • Differ in location of _____ within cortex
      • ​(1) nephrons: glomeruli where?
      • (1) nephrons: glomeruli where?
A
  • cortex
    • glomeruli
      • (Superficial) Cortical Nephrons: outer cortex
      • Juxtamedullary Nephrons: inner cortex
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11
Q

3 Anatomical Differences of Nephrons

  1. ____ of glomeruli
  2. _____ of loop of henle
  3. Juxtamedullary has ___ ____

Juxtamedullary Nephron

  • Glomeruli near ____
  • ____ loops of henle
  • (1): starts with single vessel that parallels the loop of henle and then exits medulla, peritubular capillaries only really wrap around tubular parts in the cortex

Cortical Nephron

  • Glomeruli sit near ____ edge of cortex
  • ____ loops of henle
  • Peritubular capillaries wrap around _____ tubule
A
  1. Location
  2. Lengths
  3. Vasa Recta

Juxtamedullary Nephron

  • medulla (outer cortex)
  • Long
  • Vasa Recta

Cortical Nephron

  • outer
  • Short
  • entire
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12
Q

Functional Differences Between Nephrons

Juxtamedullary Nephrons important function =

  • High proportion of juxtamedullary nephrons in what type of animals?
  • High proportion of cortical nephrons in what type of animals?

Humans: ___% Juxtamedullary, __% Cortical

A

Important in kidney conservation of water by allowing kidneys at certain times produce very concentrated urine

  • dry climates
  • wet climates

20% juxta, 80% cortical

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13
Q

Basic Renal Processes

(3)

What percent of plasma that enters glomerulus gets filtered into bowman’s capsule?

A

Glomerular Filtration (first stage of urine production)

Tubular Reabsorption (tubule -> capillary)

Tubular Secretion (capillary -> tubule)

20%

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14
Q

Glomerular Filtration

Renal Corpuscule =

(3) Layers of Glomerular Membrane

  • GF is a completely ______** and nonselective process
A

Glomerulus + Bowman’s Capsule

  1. Wall of Glomerular Capillaries
  2. Basement Membrane
  3. Inner Layer of Bowman’s Capsule
  • passive**
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15
Q

Glomerular Membrane (Notes)

  1. _____ cells compose the capillary wall
  2. White outline = ______ membrane
  3. (1) make up inner membrane of bowman’s capsule is the spaces in between these processes

Function of Glomerular membrane =

  • Fluid that enters Bowman’s capsule (filtrate) _____ in composition of plasma minus (2)
A
  1. Endothelial cells
  2. Basement Membrane
  3. Podocytes: podo meaning feet, foot processes wrap around capillaries

Prevent plasma proteins and cells from getting out of capillaries

  • filtrate identical to plasma minus protein and cells
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16
Q

Forces Involved in Glomerular Filtration

(3)

Which forces OPPOSE glomerular filtration?

Net Filtration Pressure =

A

Capillary Blood Pressure (55) pushing pressure

Plasma Colloid Osmotic Pressure (30) pulling pressure

Bowman’s Capsule Hydrostatic Pressure (15) pushing pressure from bowman’s

Plasma Colloid + Bowman’s Hydrostatic pressures OPPOSE -> only Cap BP promotes GF

10

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17
Q

The Rate of Glomerular Filtration

Depends on (3)

Filtration Coefficient Kf = ___ x ___

GFR = ___ x ___

A

Net filtration pressure

Surface Area available

Permeability of Glomerular Membrane

SA x Permeability

Kf x net filtration pressure

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18
Q

Rate of Glomerular Filtration (Notes)

  • GFR: volume of fluid filtered at glomerulus per ____, measure of renal ___ and ____ of kidneys
    • SA = how many functional ____ you have
    • Permeability - if membrane gets ____, perm will go down
  • Filtration Coefficient Kf should be ____ in a normal healthy person -> if it is then GFR is entirely dependent on (1) AKA capillary blood pressure
A
  • minute, function, health
    • nephrons
    • injured/scarred
  • constant - net filtration pressure
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19
Q

Two Major Mechanisms Control GFR

(2)

Each with Different Goals/Priorities?

A

Autoregulation

Goal = maintain GFR in the face of normal fluctuations in BP ie. diff positions, stress (intrinsic control, prevents spontaneous changes in GFR whenever arterial BP changes)

Extrinsic Sympathetic Control

Goal = alter GFR in an attempt to control blood volume and BP ie) if BP drops, GFR is going to drop to conserve fluid

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20
Q

Autoregulation

(Goal = maintain GFR in face of normal fluctuations in BP)

  • Kidneys maintain steady Glomerular blood flow and a stable GFR by altering the _____ of the _____ _____ by constriction or dilation of ____ ____ lining of the vessels wall

What happens if arterial blood pressure increases?

What happens if arterial blood pressure decreases?

A
  • diameter, afferent arteriole, smooth muscle

Vasoconstriction of Afferent Arteriole to decrease blood flow into glomerulus

Vasodilation of Afferent Arteriole to increase blood flow into glomerulus

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21
Q

What is the Mechanism for Autoregulation?

(1)

A

Tubuloglomerular Feedback Mechanism Involving the Juxtaglomerular Apparatus

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22
Q

Cells Involved in Autoregulation

(1): located on afferent arteriole and constantly regulates ___

(1): located on distal tubule and constantly regulates ___

BOTH CELLS CAN RELEASE ______ and ______ ONTO AFFERENT ARTERIOLE

A

Granular Cells - BP

Macula Densa Cells - rate of fluid through distal tubule

VASOCONSTRICTORS, VASODILATORS

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23
Q

Extrinsic (Sympathetic) Control of GFR

(Goal = alter GFR in an attempt to control blood volume and BP)

Sympathetic input can ______ the autoregulatory responses

The smooth muscle cells of the afferent and efferent arterioles contain many (1) receptors that are sensitive to (2)

  • Renal nerve releases norepinephrine - ______ arterioles
  • Glomerular capillary BP and GFR then ______
A

Override

alpha adrenergic receptors -> Epinephrine and norepinephrine

  • vasoconstricts
  • GFR decreases

Through innervation of smooth muscle cells of afferent and efferent arterioles by sympathetic nerves -> releases epi onto alpha adrenergic receptors to cause vasoconstriction -> decrease GFR

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24
Q

Case of Hemorrhage

Example of where Extrinsic Control Kicks in

A
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25
Tubular Reabsorption and the Importance of Sodum Reabsorption ## Footnote **\_\_\_%** of plasma that enters glomerulus is filtered * Since GF is a ____ process, a lot filters out that we want to take back, Tubular reabsorption helps us do that * **Tubular Reabsorption**: can be a ____ or ____ process depending on the substance but it is **always \_\_\_\_\_**
**20%** * passive, we want to take alot back * passive OR active, but **always selective**
26
Tubular Reabsorption ## Footnote **\_\_% of water filtered is reabsorbed** **\_\_\_% of sugar filtered is reabsorbed** **\_\_\_% of salt filtered is reabsorbed** Pretty much we reabsorb \_\_\_\_\_
**99%** **100%** **99.5%** ALOT IS REABSORBED
27
Spaces that need to be crossed to be Reabsorbed ## Footnote * Tubular Lumen is made up of (2) 1. **\_\_\_\_\_\_ Membrane** 2. **\_\_\_\_\_ of Cell** 3. **\_\_\_\_\_\_ Membrane** 4. **\_\_\_\_\_\_ fluid space** 5. **\_\_\_\_\_\_ wall**
* epithelial cells and tight junctions 1. **Luminal** 2. **Interior of Cell** 3. **Basolateral** 4. **Interstitial** 5. **Capillary Wall**
28
Reabsorption of Na+ ## Footnote **\*Sodium is reabsorbed at any point in the nephron except?\*** * Na+ is _____ reabsorbed * 80% of energy requirement of the kidneys used for Na+ ____ (99.5% of Na+ filtered is reabsorbed) * Plays important role throughout tubule: not just an end, but also a \_\_\_\_
**Descending Loop of Henle** * actively * Transport * means (to transport many other substances- is why Na+ reabsorption takes up so many energy)
29
Reabsorption of Na+ ## Footnote Coupled with what other substances/roles in the 1. *Proximal Tubule* 2. *Ascending Limb of Loop of Henle* 3. *Distal tubule and Collecting Duct*
1. Glucose, Amino acids, Water, Urea 2. Plays an important role in kidneys ability to _concentrate_ urine and _conserve_ water 3. Under _hormonal_ control and plays a role in regulating _ECF volume_ and _blood pressure_
30
General Pattern for Sodium Reabsorption ## Footnote Na+ travels across Luminal membrane either through (2) Na+ travels across Basolateral membrane through (1)
**Passive Channel** or **Secondary _Active_ Cotransporter** **Sodium Potassium ATP pumps** (this is what takes a lot of energy) and remember sodium has a huge driving force to get into cells (so very easy to do just through channels)
31
Na+ Reabsorption in the Proximal Tubule ## Footnote _In the Luminal Membrane_ * _​_Na+ diffuses through _____ (uses energy) with (3) _In the Basolateral Membrane_: * Na+ diffuses through (1) * Glucose, Amino Acids, Water soluble vitamins diffuses through (1)
* **Cotransporter** w glucose, amino acids, water soluble vitamins * **ATP pumps** * **Facilitated diffusion**
32
Tubular Maximum = * Ex) Glucose is 100% reabsorbed in proximal tubule, but for DM (hyperglycemia) - can start seeing glucose in urine -\> therefore there is a ____ to how much glucose can get reabsorbed dt limited ____ cotransporters
**Maximal rate of reabsorption limited by available cotransporters** * **​**limit in available cotransporters
33
Sodium Reabsorption and Glucose (Proximal Tubule) ## Footnote * Normal (plasma) of glucose are \_\_\_\_/100ml of plasma * Amount of glucose filtered per min = (plasma) of glucose x \_\_\_ * 100mg/100ml x 125ml/min = \_\_\_mg/min * **Filtered Load =** * **Tubular Maximum (Tm) -** point of _____ (**is a \_\_\_)** * **Tm** for glucose is \_\_\_\_mg/min
* 100mg/100ml * GFR * 125mg/min * **amount of substance filtered by kidneys per minute** * **saturation (is a rate)** * **​**375mg/min
34
Sodium Reabsorption and Glucose (Proximal Tubule) ## Footnote Usually \_\_\_% of glucose is reabsorbed in the proximal tubule and returned to the blood stream If the filtered load for glucose increased beyond 375mg/min, begin to find glucose excreted in \_\_\_\_ **Renal Threshold =** maximal _____ concentration any of these organic nutrients can reach before it starts to appear in \_\_\_\_\_ * Renal threshold for glucose = * RT (1) x GFR (1) = TM (1)
100% urine **RT =** maximal plasma concentration before appears in urine * 300mg/ml * 300mg/ml x 125ml/min = 375mg/min
35
Renal Threshold (Notes) ## Footnote * If our tubular maximum is 375mg/min, what amount of plasma is needed to reach that maximum? -\> this term is called **(1)** * **RT = \_\_\_\_\_/100ml plasma** * **​**Anything above 300 -\> glucose will appear in urine -\> so you know that when you see glucose in urine their plasma glucose is at least ___ normal
* **Renal threshold** * **RT = 300mg** * **​**3x normal before appearing in urine
36
Sodium Reabsorption in the Ascending Loop of Henle ## Footnote Same as in proximal tubule but cotransporter with what substances?
**K+, Cl-**
37
Sodium Reabsorption in the Distal Tubule ## Footnote Same as in proximal tubule and ascending loop but cotransporter with what substances?
Cl-
38
Sodium Reabsorption in the Collecting Duct =
Most simple ## Footnote **Na+ through passive channel then ATP pump**
39
Sodium Reabsorption Coupled to Passive Water Reabsorption ## Footnote Throughout the tubule, water is reabsorbed via _____ which requires (1) provided by \_\_\_ 80% is reabsorbed in (2) parts of the nephron **Two mechanisms (2)**
Osmosis, osmotic gradient, Na+ (water follows sodium) Proximal tubule and Loop of Henle **1) Paracellular Route** (in between epithelial cells) **2) Transcellular Route** (through epithelial cells)
40
Paracellular Route ## Footnote Explain how this mechanism works?
In certain areas the tight junctions between epithelial cells are leaky (mostly in proximal tubule) As Na+ gets pumped out of lateral membrane -\> **clumps in area creating high osmolarity** - that moves water into interstitial fluid and to capillary
41
Transcellular Route ## Footnote How does water move through this Route? **(1)** * Abundance of these channels on _____ membrane * Luminal Aquaporins only available in what areas? **Osmotic Gradient** in transcellular route is created by?
**Aquaporins** = water channels on both membranes * abundance on basolateral membrane * luminal aquaporins only in proximal tubule, descending loop of henle Created by high osmolarity of Na+ in interstitial space
42
Water Reabsorption Takeaways (Notes) ## Footnote Only place where water reabsorption does not occur? _Things needed for water reabsorption_ 1. _____ \_\_\_\_\_ created by Na+ 2. Permeability through (2)
**Ascending Loop of Henle** (super tight junctions and no aquaporins) 1. Osmotic Gradient 2. Permeability through leaky tight junctions or luminal aquaporins
43
Sodium Reabsorption Coupled to Passive Chloride Reabsorption Following Water Reabsorption ## Footnote _Passive Reabsorption of Cl, Urea, K_ * Once Na and water move out, it increases concentration of everything left ___ (Cl, Urea, K) * _____ creates a concentration gradient for those substances to also move out through (1)
* behind * Natural osmotic gradient -\> leaky tight junctions
44
Regulated Reabsorption of PO43- and Ca2+ ## Footnote The reabsorption of some substances helps regulate ____ levels of those substances (1) for that substance equals normal plasma levels Our diets are normally rich in \_\_\_\_\_, it ___ gets filtered Renal threshold for phosphate reabsorption is set at ____ plasma phosphate, excess is ____ through urine
plasma Renal threshold = plasma lvls phosphate, all gets filtered RT set at normal plasma levels, excess excreted through urine
45
What does not get reabsorbed? ## Footnote * ____ products (2) except for \_\_\_\_ * Even though they do get concentrated, like chloride and urea, tubule is **\_\_\_\_\_\_ to these waste products**
We do not reabsorb waste products (phenols, creatinine) except for urea **Tubule is impermeable to waste products** We only reabsorb urea bc helps make amino acids
46
Summary of Reabsorption ## Footnote 1. **Proximal Tubule:** huge amount of (2) reabsorbed 2. **Loop of Henle** 1. \***Descending Loop of Henle:** 2. **\*Ascending Loop of Henle** 3. **Distal Tubule** and **Collecting Duct:** Na and Water reabsorption _____ and under _____ control
1. huge amount of Na and H20 2. Loop of Henle 1. Yes H20, No Na+ 2. Yes Na+, No H20 3. variable, hormonal
47
Tubular Secretion ## Footnote **Selective movement of substances from (1) into (1)** **(3)** important substances to be secreted
**Peritubular Capillaries -\> Tubular Lumen** 1. **Hydrogen ions** 2. **Potassium ions** 3. **Organic Cations and Anions** (usually foreign to the body-drugs, environmental pollutants)
48
Hydrogen ion secretion ## Footnote Plays an important role in \_\_\_/\_\_\_ balance in the body Occurs primarily in what parts of the nephron (2)...and minor amounts in (1)
acid/base proximal tubule and collecting duct, ascending loop of henle
49
Hydrogen Ion Secretion ## Footnote How does H+ cross the Basolateral membrane? How does H+ cross the Luminal membrane in the 1. Proximal Tubule = 2. Collecting Duct and Loop of Henle =
ATPase pump 1. Na/H+ antiporter (coupled with Na+ reabsorption) 2. Facilitated diffusion
50
Potassium Secretion ## Footnote Potassium undergoes both _____ and \_\_\_\_\_\_ * In the _proximal tubule_, potassium is _____ in via passive diffusion is much the same way as ___ and ___ following water reabsorption. * Potassium is also _____ secreted in the (2) parts of the nephron * Potassium reabsorption is \_\_\_\_\_, while potassium secretion is \_\_\_\_\_ * If plasma (K) is low -\> secretion is \_\_\_\_\_ * If plasma (K) is high -\> secretion/excretion is \_\_\_\_\_
Reabsorption AND Secretion * reabsorbed, Cl- and Urea * actively, distal tubule and collecting duct * unregulated, regulated * minimal * enhanced K reabsorption is passive and unregulated, K secretion is actively secreted and regulated
51
Mechanism for K+ Secretion ## Footnote Distal Tubule and Collecting Duct * K crosses basolateral membrane through (1) * K crosses luminal membrane through (1)
* Na/K ATP pump * Passive diffusion
52
Why isn't K secreted throughout the tubule when sodium is reabsorbed? ## Footnote Dt _____ of K+ channels * In proximal tubule and loop of henle, K+ channels on _____ membrane therefore? * In distal tubule and collecting duct, K+ channels on _____ membrane therefore?
Location of K+ channels * basolateral membrane -\> cannot enter tubular lumen (just diffuses right back through into interstital space) * luminal membrane -\> allowed to enter tubular lumen
53
Summarizing Reabsorption Events ## Footnote * Remember when summarizing reabsorption: Na+ and Cl- ____ in distal tubule and collecting duct through **\_\_\_\_\_ control** **(1)**
Variable **Hormonal control - Aldosterone** (mineralcorticoid that controls Na+ reabsorption and K loss) therefore aldosterone simultaneously controls **potassium secretion**
54
Aldosterone Control of Sodium Reabsorption and Potassium Secretion ## Footnote **Aldosterone functions (2)**
1) Opens Luminal Na+ Channels 2) Increases Na/K ATPase expression
55
Organic Anion and Cation Secretion ## Footnote Ways to secrete anion and cations in proximal tubule **(2) secretory pathways** * Involve anion and cation \_\_\_\_\_ * Includes blood born chemical messengers like \_\_\_\_\_\_ * Some are foregin compounds like ____ additives, environmental \_\_\_\_\_, and d\_\_\_ Reasons there must be a secretory pathway **(2)**
**Organic Anion pathway, Organic Cation pathway** * receptors * hormones * food additives, environmental pollutants, drugs **1) Some ions can be bound to plasma proteins and are never filtered by glomeruli** **2) Increases speed of elimination** 2 pathways both involve the use of energy and coupled with Na reabsorption
56
Ch 6 Urine Concentration: The Medullary Countercurrent System ## Footnote * Kidneys can produce urine that ranges in osmolarity (concentration) from \_\_\_\_mOsm to \_\_\_mOsm dependent on body's need to ____ water * Perfect balance of hydration = \_ml/min or _____ urine (\_\_\_mOsm) * Overhydrated = \_\_ml/min or ____ urine (\_\_\_mOsm) * Dehydrated = \_\_ml/min or _____ urine (\_\_\_mOsm)
* 100mOsm to 1200mOsm, conserve * 1ml/min, Isotonic Urine 300mOsm * 25ml/min, Hypotonic Urine 100mOsm * 0.3ml/min, Hypertonic Urine 1200mOsm
57
**Obligatory Water Loss** **=** Bc of this, the kidneys deal with persistent _____ way better than persistent \_\_\_\_\_
**Minimal water loss** bc we can't eliminate crystals so no matter how dehydrated we are we have to produce and excrete urine overhydration, dehydration
58
Medullary Countercurrent System ## Footnote The medullary osmotic gradient plays a key role in the kidneys ability to produce urine of varied \_\_\_\_\_\_ This osmotic gradient is created by a unique _____ arrangement **Medullary Countercurrent System =**
concentrations anatomical **Anatomical parts that create this gradient and the ones that use it to produce urine of varied concentration are collectively called this system**
59
Osmotic Gradient of the Renal Medulla ## Footnote Cortex = \_\_\_tonic Medulla interstitial space has an osmotic gradient -\> _____ as you get closer to the ____ \_\_\_\_ This gradient is what allows us to vary how water is reabsorbed and produce urine of varying \_\_\_\_\_
Isotonic increases closer to renal pelvis concentration
60
2 Parts of Countercurrent System**​** ## Footnote **1)** **What part _creates the osmotic gradient?_** **2)** **What part _uses the gradient to vary concentration of urine?_**
1. **Long Loops of Henle of Juxtamedullary nephrons** 2. **Collecting ducts of all nephrons**
61
How Long Loops of Henle Create Osmotic Gradient ## Footnote Descending Loop = Ascending Loop =
Permeable to water, Impermeable to Na+ Permeable to Na+, Impermeable to water (ascending loop actively pumps sodium out)
62
ADH ## Footnote How does ADH determine how much water is reabsorbed in the distal tubule and collecting duct? Urine osmolarity that travels up ascending loop of henle gets ____ and exits with an osmolarity of \_\_\_\_mOsm * **100mOsm** = __ water reabsorption in distal tubule and collecting duct * **1200mOsm** = ___ water reabsorption in distal tubule and collecting duct * **300mOsm** = body is ______ hydrated
By determining **degree of permeability** of tubule/collecting duct smaller and smaller -\> exits with 100mOsm * NO * MAXIMAL * perfectly hydrated -\> which means 300 is the mOsm of distal tubule when normal
63
Vasopressin (ADH) ## Footnote = Hormone producted by (1) and released by (1) **How do we regulate ADH?**
Hypothalamus, Posterior Pituitary **Sensing plasma osmolarity changes in the brain**
64
Vasopressin (ADH) Function ## Footnote **Increases _____ of _____ membrane to H20 by inserting new water \_\_\_\_\_\_** * travels through bloodstream and binds to tubular _____ cells -\> acts through second messenger system and binds to its _____ -\> elevates _____ -\> increasing insertion of \_\_\_\_\_\_ ​Keep in mind: ADH just effects water, NOT sodium
**Permeability, luminal, channels** * epithelial, receptors, cAMP -\> increased insertion of aquaporins
65
Control of Sodium and Water Excretion: Regulation of Plasma Volume and Osmolarity ## Footnote * There are two separate but closely ______ control systems that regulate ECF ____ and ECF \_\_\_\_\_ * ECF volume and ECF Osmolarity have different effects on \_\_\_\_\_\_ * Regulation of **ECF Volume maintains (1)** therefore blood supply to \_\_\_\_\_ * Regulation of **ECF Osmolarity helps maintain (1)** * The _____ play a major role in both of these control systems
* interrelated, volume, osmolarity * homeostasis * **blood pressure -\>** blood supply to tissue * **cell volume** * **​**kidneys
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Sodium Balance and ECF Volume ## Footnote * The body regulates ECF volume by regulating what? * Sodium is the main ______ constituent of the ECF volume * ECF osmolarity is tightly maintained so when _____ moves, _____ must move with it - Sodium _____ in the kidney is always followed by water _____ (wherever permeable) * So any sodium gains or losses in the body are asctd with a corresponding gain or loss in \_\_\_\_
* total body salt content * osmotic * sodium moves, water moves -\> sodium reabsorption, water reabsorption * water
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Sodium Balance ## Footnote Balance between gains and losses What sources 1. Gains = 2. Losses = Sodium balance if: ____ NaCl intake = ____ NaCl output + ____ NaCl output
1. Ingested Sodium absorbed through GI tract 2. Renal Excretion, Nonrenal loss (sweat, feces) usually low except for cases like diarrhea and profuse sweating Oral = Renal + Nonrenal loss
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How are Changes in ECF Volume Sensed? ## Footnote Body actually monitors\_\_\_\_\_ volume, not total ECF volume Changes in plasma volume are sensed by monitoring ___ \_\_\_\_ Specialized sensory receptors called **\_\_\_\_\_\_\_\_** **(3)** **Unlike the first two =**
plasma blood pressure **baroreceptors** 1. **Aortica Arch baroreceptors** 2. **Carotid Sinus barorecetors** 3. **Renal baroreceptors** **Renal Baroreceptors** unlike first two do not change by momentary changes in BP, responsible for **long term regulation of BP**
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Renal Baroreceptors Location =
**Renal Baroreceptors ARE the Glomerular Cells in the Glomerular Apparatus** ## Footnote Can sense arterial pressure in afferent arteriole-but DOES NOT adapt
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Baroreceptors and RAAS ## Footnote Decrease in Plasma Volume -\> Decrease in Blood Pressure -\> Sensed by JGA Granular Cell Baroreceptors stimulates release of enzyme * **(1)** into bloodstream and converts peptide prohormone * **(1)** found in bloodstream and produced by liver into * **(1)** which enters organs like the lungs that have * **(1)** which is an enzyme that interacts with it to form active hormone * **(1)** : strong hormone that increases plasma volume and BP
* **Renin** * **Angiotensinogen** * **Angiotensin I** * **ACE** * **Angiotensin II**
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Actions of Angiotensin II (5) _Increases Sodium reabsorption (and water reabsorption)_ _Decreasing GFR_ _Increased Water consumption and reabsorption_
_Increase Sodium Reabsorption (and Water Reabsorption)_ 1. **Aldosterone Release** 2. **Na/H+ exchanger** in proximal tubule _Decreasing GFR_ 1. **Direct vasoconstriction of afferent arterioles** 2. **Enhancing Tubuloglomerular feedback system** _Increased Water consumption and Reabsorption_ 1. **Stimulates thirst and ADH secretion**
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Angiotensin II Action #1 ## Footnote **Angiotensin II** acts on (1) to stimulate release of (1) -\> that acts on (2) parts of the nephron to increase (1)
Adrenal Cortex -\> Aldosterone -\> Distal tubule, collecting duct -\> sodium reabsorption
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Angiotensin II Action #2 ## Footnote Ang II stimulates the **(1)** in the _____ tubule to increase **(1)** (water follows sodium) * Directly stimulates sodium reabsorption through mechanism thats coupled with (1) -\> so ang II directly and indirectly through \_\_\_\_
**Na/H exchangers** -\> proximal tubule -\> **sodium reabsorption** * H+ secretion (so simultaneusly secretes H+) -\> so ang II directly and indirectly stimulates sodium reabsorption through aldosterone
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Angiotensin II Action #3 **(1)** Reduces capillary blood flow and GFR -\> limit urine production -\> minimize fluid loss
**Vasoconstriction of Afferent Arteriole and Systemic Blood Vessels**
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Angiotensin II Action #4 (1) Tricks this system into thinking that GFR has gotten too high -\> enhances sensitivity and net effect is drop in GFR
**Tricks Tubuloglomerular Feedback System** -\> **macula densa cells respond more quickly -\> vasoconstrict afferent arteriole -\> decrease GFR**
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Angiotensin II Action #5 (1) All acts on the hypothalamus to increase the sensation of?
**Release of ADH to increase sensation of Thirst** ## Footnote Thirst increases water consumption, ADH increases water reabsorption in distal tubule and collecting ducts
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Short Term Plasma/BP Regulation = These receptors sense drops in BP when it first happens and then stimulates what?
Aortic Arch and Carotid Sinus Baroreceptors **Increases Sympathetic Actiity** to body including kidneys
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Increased Sympathetic Nerve Activity Actions (3)
1. Sympathetic Nerve innervates **Afferent Arteriole to vasoconstrict** and decrease GFR 2. Sympathetic Nerve innervates **Juxtaglomerular Apparatus to stimulate Granular cells to release Renin** 3. **Stimulates ADH secretion**
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Summary of Control of Plasma Volume and Total Body Sodium ## Footnote All in all =
Aortic and Carotid baroreceptors adapt after a few minutes so only a few minutes of sympathetic nerve activity but is enough to get the ball rolling bc renal baroreceptros will take over
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Ch 7: Control of Fluid Osmolarity by ADH Thirst System ## Footnote Water balance and ECF osmolarity * ECF osmolarity is regulated by maintaining _____ balance * Total body osmolarity is defined as the ratio of (1):(1) * Total body osmoles is primarily determined by ECF ____ content * Water balance depends on equality between total body water ____ and total body water \_\_\_\_
* water * total body osmoles: total body water * sodium * gains, loss We want to control osmolarity to control **cell volume** -\> hypotonic ECF -\> cell swelling -\> impaired function/injury to cells Regulated by maintaining water balance to match whatever concentration of solues we have to make it isotonic
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Water Balance ## Footnote Body water is **gained** from two primary sources = Body water is primarily **lost** through three routes =
Consumed alone or in food or liberated from metabolic processes Lost through Urine, Feces, Sweat
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Water Balance and ECF osmolarity ## Footnote Two elements that control total body water and therefore osmolarity 1. the ____ control water excretion 2. the _____ mechanism that controls oral intake of water Both effector mechanisms are part of a _____ feedback loop that starts in the _____ of the brain Regulation of ECF osmolarity involves the detection of ____ osmolarity
1. kidneys 2. thirst negative feedback loop, hypothalamus plasma
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Central Osmoreceptors = (2) Increased plasma osmolarity sensed by these and stimulate _____ -\> ______ -\> \_\_\_\_\_\_\_
**Circumventricular Organs** that sense changes in osmolarity of plasma **SFO** **OVLT** Hypothalamus -\> Posterior Pituitary -\> release of ADH
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Sensitivity of ADH release ## Footnote OVC's very \_\_\_\_ In healthy individuals, plasma osmolarity is about 290mOsm * The threshold for AVP (arginine vasopressin) release is actually a bit lower about _____ mOsm * Increases by as little as \_% in plasma osmolarity can produce a large increase in plasma \_\_\_ * ADH then acts on the (2) to increase water reabsorption
sensitive * 280 * 1%, ADH * distal tubule and collecting duct
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Central Osmoreceptors: Functions of SFO/OVLT ## Footnote When SFO and OVLT sense increased osmolarity and release ADH, also stimulates what?
**Thirst**
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Where does the system that controls plasma osmolarity intersect with the system that controls plasma volume?
Ang II receptors on SFO and OLVT -\> stimulate thirst and hypothalmic release of vasopressin Part of brainstem that controls SNS activity also stimulates thirst and hypothalmic release of vasopressin + ang II also stimulates SFO/OVLT to sitmulate thirst Thirst and ADH release stimulated under conditions where plasma osmolarity rises OR when plasma volume and BP drop -\> goals are both fluid consumption and water retention
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Other Factors Affecting Plasma (ADH) and Plasma Osmolarity ## Footnote and how? 1. Rate of ADH _____ by \_\_\_\_\_ 2. P\_\_\_, F\_\_\_, and T\_\_\_\_ 3. A\_\_\_\_\_
1. ADH breakdown by Liver * liver impairment -\> decreased breakdown -\> increased plasma 2. Pain, Fear, Trauma * increased sympathetic activation increases plasma ADH (ie post surgical SIADH, temporary) 3. Alcohol * Alcohol suppreses ADH secretion -\> inappropriate water loss (why we pee so much when we're drunk) -\> more vulnerable to dehydration