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ILA > Salt and water balance > Flashcards

Salt and water balance Flashcards

1
Q

How much body sodium exchangeable?
Where located
Where rest?

A

Exchangeable- 70%
Bone crystal- 30%

ECF- 50% body sodium

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2
Q

Draw fluid 70kg man?
Ions

A

IF- K+
ECF- Na+

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3
Q

Main ion IF?
Main ion ECF?

A

IF- K+
ECF- Na+

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4
Q

Define:
Osmolality
Osmolarity
Oncotic pressure
Osmosis

A

Osmolality – concentration of solution expressed as solute particles per kg (OPPOSITE)
Osmolarity – concentration of solution expressed as solute particles per L (OPPOSITE)
Oncotic pressure – pressure exerted by plasma protein on capillary wall
Osmosis – process by which molecules within a solvent pass through a semi-permeable membrane. High conc. To low conc.

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5
Q

Where are osmoreceptors located?

A

Hypothalamus

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6
Q

Function osmoreceptors?

A

Detect low water potential

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7
Q

What occurs when osmoreceptors detect low water potential?

A

1) Osmoreceptors in hypothalamus detect low water potential
2) Loss water reduces osmoreceptors volume
3) Trigger stimulation nerve cells in hypothalamus
4) Trigger ADH to be released from posterior pituitary
5) Act kidneys

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8
Q

What stimulates posterior pituitary to release ADH?

A

Hypothalamus
AP travel down- cause release ADH into blood stream
Act kidneys

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9
Q

Where is urine diluted?
Where is urine concentrated?

A

Diluted- LOH
Concentrated- distal tubules and collecting ducts

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10
Q

What is descending loop in LOH permeable and impermeable to?
What is ascending loop in LOH permeable and impermeable to?

A

Descending- Permeable- water
- Impermeable- NaCl

Ascending- Permeable- NaCl
- Impermeable- water

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11
Q

What occurs in thin descending limb?

A

Highly permeable water- reabsorption- AQP1 channels

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12
Q

What occurs in thin ascending limb?

A

Na reabsorption- Na+ channels
Cl- reabsorption- Cl- channels

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13
Q

What occurs in thick ascending limb?

A

Primary site sodium reabsorption
Impermeable water
Na+/K+ ATPase on the basolateral membrane
Pump Na+ and K+ into cell
Create low intracellular concentration of sodium
Inside of cell becomes negatively charged- creating an electrochemical gradient

Sodium moves into cell (from the tubular lumen) down the electrical and chemical gradient, through the NKCC2 transporter on the apical membrane

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14
Q

How are potassium ions transported back into tubule?

A

Renal outer medullary potassium (ROMK) channels
On apical membrane- prevent toxic build up

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15
Q

Explain counter current multiplication system?

A

Thick ascending limb impermeable water
Interstitium concentrated ions- increase osmolarity
Drive water reabsorption from descending limb- water moves areas low osmolarity to areas high osmolarity

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16
Q

Where does LOH descend?

A

Medulla

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17
Q

Where is glomerulus?

A

Cortex

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18
Q

https://www.youtube.com/watch?v=Vqce2dtg45U

A

https://www.youtube.com/watch?v=Vqce2dtg45U

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19
Q

What occurs ascending limb?

A

Active transport ions out
Allow passive diffusion water in descending into interstitium

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19
Q

What occurs ascending limb?

A

Active transport ions out
Allow passive diffusion water in descending into interstitium

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20
Q

Explain RAAS system?

A

1) Reduced sodium delivery to distal convoluted tubule detected by macula densa cells
2) Reduced blood pressure (decrease perfusion pressure) detected by baroreceptors in afferent arteriole
3) Sympathetic stimulation juxtaglomerular cells via B1 adrenoreceptors
4) Renin cleaves angiotensinogen (liver) to form angiotensin 1
5) Angiotensin 1 converted to angiotensin 2 by angiotensin converting enzyme (ACE- lungs)
6) Angiotensin exert action binding receptors (most AT1)
7) Effect angiotensin:
Arterioles- vasoconstriction
Kidney- stimulate Na+ reabsorption
Adrenal cortex- release aldosterone
Hypothalamus- increase thirst sensation
- stimulate release ADH- AQP1
8) Angiotensin 2 act AT1 receptors in endothelium of arterioles- vasoconstrict- signalling via Gq protein- increase peripheral resistance- increase blood pressure
9) Angiotensin 2 act hypothalamus stimulate thirst- fluid consumption- raise circulating volume- raise bp
Act hypothalamus increase secretion ADH from posterior pituitary- more concentration urine
10) Angiotensin 2 stimulate sympathetic nervous system- increase release noradrenaline- increase CO, vasoconstrict arterioles, release renin

11) Angiotensin 2 act kidney:

1) Renal artery and afferent arteriole-
- Vasoconstriction- increase resistance (less efferent)
- Voltage-gated calcium channels open- influx of calcium ions

2) Efferent arteriole- increase resistance
-Vasoconstriction (greater than afferent arteriole)

3) Mesangial cells- contraction, l
- Decreased filtration area
- Activation of Gq receptors- open voltage-gated calcium
channels

4) Proximal convoluted tubule- Increased Na+ reabsorption
- Increased Na+/H+ antiporter activity

12) Act adrenal cortex stimulate release aldosterone (released
zona glomerulus)
Aldosterone act principal cells of collecting ducts in nephron-
expression apical epithelial Na+ channels (ENaC) to reabsorb urinary sodium- sodium pumped into blood via Na/K pump- K+ moved blood to principle cell- renal tubule- K+ excreted
Aldosterone reduces lvls potassium blood
Activity of the basolateral Na+/K+/ATPase is increased

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21
Q

What inhibits release renin? What stimulates release?

A

Atrial natriuretic peptide (ANP)
Released by stretched atria in response to increase bp

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22
Q

Draw RAAS?

A
23
Q
A
24
Q

What releases renin?

A

Granular cells of the renal juxtaglomerular apparatus

25
Q

What stimulates release renin?

A

1) Macula densa detect reduced sodium delivery to distal convoluted tubule
2) Baroreceptors- reduced BP/perfusion pressure in the afferent arteriole of kidney
3) Sympathetic stimulation of the JGA via β1 adrenoreceptors

26
Q

What is release renin inhibited by? What releases it?

A

Atrial natriuretic peptide (ANP)
Stretched atria- response increase BP

27
Q
A
28
Q

What produces angiotensin?

A

Liver

29
Q

Function angiotensin?

A

Cleave renin to form angiotensin 1

30
Q

What converts angiotensin 1 to angiotensin 2?

A

Angiotensin converting enzyme

31
Q

Where is AACE produced?

A

Lungs

32
Q

What does angiotensin bind to?

A

G protein coupled recepetors
AT1 and AT2

33
Q

Effect angiotensin? (5)

A

1) Vasoconstrict arterioles- Gq coupling- increase resistance and bp
2) Act hypothalamus- thirst
- increase ADH- AqP2
3) Stimulate sympathetic NS increase release noradrenaline
- increase CO, vasoconstriction arterioles, release renin
4) Renal effect
Vasoconstriction
Afferent and efferent ( E more)
Mesangial cells- contraction- decrease filtering area
Proximal convoluted- increase Na+
5) Act adrenal cortex stimulate release aldosterone
Sodium reabsorption- water moves

34
Q

What effect ADH?

A

Increase transcription an idnsertion AQP2 channels to apical membrane of DCT and CD
Water move out- increase blood volume

35
Q

Where is ADH synthesised?
Where stored?

A

Synthesis- hypothalamus
Stored- posterior pituitary

36
Q

What inhibits ADH?

A

ANP

37
Q

What regulates release ADH?

A

Osmoreceptors- lack BBB- detect osmolality blood

38
Q

Fall blood plasma what occurs? (ADH)

A

Increase plasma sodium conc
Osmolarity increase
Water exit cells- osmoreceptors contract
Afferent signals sent from hypothalamus to posterior pituitary- increase release ADH

39
Q

What detects changes blood volume? Where located (2)

A

Baroreceptors
Carotid artery
Aortic arch

40
Q

What occurs baroreceptors detect reduction blood pressure?

A

Relay vagus nerve
Send afferent signals- stimulate release ADH from posterior pituitary

40
Q

What occurs baroreceptors detect reduction blood pressure?

A

Relay vagus nerve
Send afferent signals- stimulate release ADH from posterior pituitary

41
Q

What type of steroid hormone is aldosterone?

A

Mineralcorticoid

42
Q

Where is aldosterone release?

A

Zona glomerulosa of adrenal cortex

43
Q

Effect aldosterone (what cell act on)?

A

Act principal cells collecting duct in nephron
Increase expression apical epithelial Na+ channels (ENaC)
- reabsorb sodium
Increase activity basolateral Na+ K ATPase pump

44
Q

Does aldosterone cause increase or decrease potassium lvls in blood?

A

Decrease
Cause increase expression of apical epithelial Na+ channels (ENAC)- absorb sodium
Pump sodium into blood via sodium/potassium pump
Potassium moved from blood into principle cell
Exit into renal tubule
Excreted urine

45
Q
A
46
Q

Draw RAAS?

A
47
Q
A
48
Q

What inhibits renin? (2)

A

Angiotensin 2 production
ADH production

49
Q

What produces albumin?

A

Liver

50
Q

What is main protein involved in oncotis pressure?

A

Albumin

51
Q

What does low albumin lead to?

A

Oedema
Low oncotic pressure
Fluid move capillaries into interstitium

52
Q

What is fluid movement if low oncotic pressure?

A

Fluid move capillary into interstitium
Albumin
https://www.youtube.com/watch?v=B658Yn3INYc

53
Q

Pressure higher at arterial or venule end capillary?

A

Greater arterial
Less venule
https://www.youtube.com/watch?v=B658Yn3INYc

54
Q

Define insensible water loss? Ex
Define sensible water loss? Ex

A

Insensible- can’t measure
- lung, skin, resp, faeces
Sensible- urine, vomit

55
Q

What is used to measure GFR?
Why?

A

Creatine
Freely filtered not absorbed

ILA (12 decks)

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