Test 2: Wk8: 2 Integrated control of the cardiovascular-renal system - Puri

Question 1

ECF Na concentration doesn’t change if

Answer 1

ADH work and water access is available

Question 2

Na retention =

Answer 2

water retention

Question 3

Na intake affects plasma Na

Answer 3

only briefly

Question 4

Osmolarity and Na are rapidly restored to normal values if

Answer 4

the pt has free access to water

Question 5

excess dietary Na will lead to

Answer 5

water gain

Question 6

Na deficient diet will lead to

Answer 6

water excretion

Question 7

at steady state Na intake =

Answer 7

Na excretion

Question 8

— to — hrs for kidney to recognize change in Na

Answer 8

48-96hrs

Question 9

Na balance influence (3 things)

Answer 9

ECF Vol

CO

BP

Question 10

— signals adequacy of Na balance

Answer 10

Effective Circulating Volume

Question 11

effective circulating volume cannot be identified anatomically. Rather, it is a — that reflects the extent of tissue perfusion in specific regions

Answer 11

functional blood volume

Question 12

patients with congestive heart failure, nephrotic syndrome, or liver
cirrhosis, total ECF volume is grossly expanded (e.g., edema or ascites). In
contrast, the effective circulating volume is low, resulting in —

Answer 12

Na+ retention

Question 13

Low Circulation ➡ — ➡ — Repeat

Answer 13

Low circulation ➡ More Na ➡ More ECF ➡ repeat

Question 14

Four systems act in concert to regulate Na+ balance

Answer 14

1.Renin Angiotensin Aldosterone
System
2.Sympathetic Nervous System
3.Arginine Vasopressin (ADH)
4.Atrial Natriuretic Peptide

Question 15

ANP responds to

Answer 15

lack of Na

Question 16

Juxtaglomerular Apparatus

has two components

Answer 16

1. Macula Densa in TAL

2. AA Juxtaglomerular cells that secrete renin

Question 17

Renin Synthesis is a Balance of Four Systems

Answer 17

1. NKCC2 in TAL
2. SNS in AA on Beta1 Receptors
3. Ca release from stretching of AA
4. AT1-R on AA

Question 18

↑ Renin Synthesis NKCC2 (5)

Answer 18

1. ↓Blood pressure→ ↓RBF→ ↓GFR→ ↓ Na filtration
2. ↓Dietary Na→ ↓ECF volume→ ↓Renal flow
3. ↓Cardiac output→ ↓RBF→ ↓GFR
4. ↓RBF→ ↓GFR
5. ↑Na resorption in the PCT

Question 19

↑ Renin Synthesis Beta1 Receptor (3)

Answer 19

1.↓Blood pressure→ ↑SNS activity
2.↓Dietary Na→ ↓ECF volume→
↓Blood pressure
3.↓Cardiac output→ ↓Blood pressure

Question 20

↑ Renin Synthesis Ca (1)

Answer 20

1.↓Blood pressure→ ↓Stretch of the

AA

Question 21

— is the rate limiting step in synthesis of ANG II

Answer 21

Renin

Question 22

5 things increase Renin secretion

Answer 22

⬇ Na
⬇ ECF
⬇ MAP
⬇ RPF
⬇ GFR

Question 23

Short Feedback loop

Answer 23

ANG II feedback inhibition on ANGII

Question 24

Long Loop Feedback

Answer 24

increased GFR and NaCl at MD prevent reabsorption of NaCl at MD

Question 25

Renin is released from the A.A in response to a --- diet:

Answer 25

reduced Na

Question 26

Reduced Na has reduced--- that reduces the stretch on the | ---

Answer 26

perfusion pressure; A.A

Question 27

Reduced Na has reduced --- and the filtered load, which then translates to reduced Na reaching the --- as the proximal tubule stills absorbs a constant fraction of N %

Answer 27

GFR; macula densa; 66%

Question 28

Reduced Na and ECF volume has also reduced --- thus increasing filtration fraction. This leads to increased Na reabsorption in the PT and less Na reaching the ---. This stimulates --- release.

Answer 28

renal perfusion, MD, renin

Question 29

Reduced Na has reduced the MAP, which then activates the --- and the --- which then stimulates --- release

Answer 29

baroreflex; SNS; renin

Question 30

Alters TPR (7)

Answer 30

1. Vasoconstriction 2. Increased SNS Activity 3. Reduced NE reuptake 4. Increased peripheral responsiveness 5. Increased CNS discharge 6. Epinephrine from AM 7. Releases AVP (ADH)

Question 31

Alters CV structure (3)

Answer 31

1.Increased proto-oncogenes 2.Increased growth factors and inflammatory cytokines 3.Increased collagen production

Question 32

Alters Renal Fn. (5)

Answer 32

1.Increased NHE in PT 2.Aldosterone release 3.Altered renal hemodynamics 4. Preferential EA constriction = ↑ FF 5 .ADH-mediated water reabsorption

Question 33

RAAS Regulates Na+ in ---, --- & ---

Answer 33

Proximal Tubule, TAL, Cortical Ducts

Question 34

3 Effects of ANGII on kidney

Answer 34

increase resistance of EA and AA increase NHE and NKCC2 increase Aldosterone

Question 35

Atrial natriuretic peptide is synthesized in the cardiac myocyte (L. Atria) in response to an ---.

Answer 35

increase in blood volume

Question 36

Kidneys make dopamine in response to ---

Answer 36

volume expansion

Question 37

--- is the true long term | regulator of arterial pressure

Answer 37

ECF

Question 38

two pathways are directly affected by change in blood pressure

Answer 38

1 Renin angiotensin system | 2 Pressure-natriuresis mechanism

Question 39

Increased MAP leads to ↑ --- in the peritubular capillaries | and ↓ ---

Answer 39

Hydrostatic pressure, solute and water reabsorption

Question 40

to maintain the MAP and to accommodate diet, the P-N is modulated by

Answer 40

by the AngII and ANP