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Acid/Base & Renal System Flashcards

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1
Q

give the normal pH, acidosis pH, and alkalosis pH

A

normal 7.4
acidosis < 7.4
alkalosis > 7.4

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2
Q

what are the three types of buffers

A
  1. bicarbonate
  2. phosphate
  3. ammonia
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3
Q

what are the 3 ways to regulate acid/base? which one is the fastest? slowest?

A
  1. buffers (fastest)
  2. respiratory
  3. kidney (slowest)
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4
Q

what is the reaction for bicarbonate? what enzyme does it use? what does it act as? what does it buffer?

A

CO2 + H2O <–> H2CO3 <–> H + HCO3
carbonic anhydrase
act as weak acid or weak base
buffers both acid/bases and the blood

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5
Q

what are H ions in the RBC buffered by

A

intracellular proteins and phosphate

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6
Q

how is bicarbonate transported outside of a RBC

A

it is exchanged with extracellular Cl by Band 3 membrane transporter

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7
Q

where in the kidney does the majority of bicarbonate reabsorption occur

A

80% in proximal tubule
15% thick ascending limb
5% collecting duct

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8
Q

what does phosphate do as a buffer

A

buffers acid and bases
bone mineralization
usually an intracellular fluid buffer

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9
Q

where is ammonia made? excreted? what does it do?
when does ammonia excretion increase?

A

made in proximal tubule
excreted in distal tubule
allows kidney to expel acid during acidosis
when pH falls (more acidic)

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10
Q

how is ammonia produced?

A
  1. glutamine metabolized to ammonium by phosphate dependent glutaminase (PDG)
  2. ammonium decomposes into NH3 and H so NH3 can diffuse into proximal tubule or NH4+ can be exchanged with Na
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11
Q

how does bicarbonate get reabsorbed in the proximal tubule

A
  1. lumen (filtrate) –> cell via diffusion of CO2
  2. cell –> blood via cotransport with Na
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12
Q

how does bicarbonate get reabsorbed in the collecting duct

A

type A cells use AE1 to exchange HCO3 for Cl
type B cells use AE4 to exchange HCO3 for Na

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13
Q

what is the importance for the anion gap?
what does it consist of?
what is it useful for diagnosing?

A
  • unmeasured anions to make cations = anions
  • contains albumin, phosphate, sulfate, and other anions
  • metabolic acidosis (either titrational or loss of HCO3)
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14
Q

describe the respiratory and metabolic origin for acidosis

A

respiratory: increase CO2
metabolic: decrease HCO3

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15
Q

describe the respiratory and metabolic origin for alkalosis

A

respiratory: decreased CO2
metabolic: increase HCO3

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16
Q

what is the concentration of Na and K extracellularly vs intracellularly

A

intracellular Na: 15mM
extracellular Na: 140 mM
intracellular K: 140 mM
extracellular K: 4mM

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17
Q

what is edema? how does it develop?

A

edema: excess fluid in extracellular compartment of interstitial space/body tissues
1. increased capillary hydrostatic pressure
2. decreased plasma oncotic pressure/plasma protein
3. decreased lymphatic return
4. inflammation/increased capillary permeability

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18
Q

what are the different body fluid compartments and their osmolarity and primary electrolyte

A

all 290mOsm
extracellular fluid 40% Na, Cl
1. plasma 7%
2. transcellular 2-3%
3. interstitial fluid 12%
intracellular 60% K, PO4, proteins

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19
Q

describe relative changes in size of intracellular and extracellular fluid compartments after IV infusion of isotonic, hypertonic, hypotonic saline

A

isotonic (300mOsm)
IC volume: none
EC volume: increased
hypertonic (500mOsm)
IC volume: decrease
EC volume: increase
hypotonic (100 mOsm)
IC volume: increase
EC volume: increase

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20
Q

why would an animal with hypoproteinemia have a reduction in plasma volume in spite of normal or increased ECF volume?

A

hypoproteinemia: loss of plasma proteins (decreased plasma ontic pressure)
- plasma volume would decrease because fluid would be leaking into interstitial space which could lead to edema

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21
Q

what are the functions of the kidney

A
  1. filter toxic substances
  2. regulate water, electrolytes, and acid-base
  3. endocrine organ (erythropoiesis, calcium homeostasis, and blood pressure)
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22
Q

how does renal control acid-base

A
  1. retains/eliminates HCO3
  2. secretes H+
  3. secretes NH3 with H+ as NH4+
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23
Q

how much cardiac output do the kidneys receive

A

20% CO

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24
Q

contrast the two types of nephrons

which one is the majority

what does it depend on

Study These Flashcards
A
  1. cortical nephrons ( loop of henle in cortex)
  2. juxtamedullary (loop of henle in medulla); capillar termed vasa recta
    majority cortical
    species dependent
25
what are the fundamental processes of the kidney
1. filtration 2. reabsorption 3. secretion
26
what is the glomerulus? what types of cells does it have and their function?
capillary between two arterioles with high pressure 1. capillary endothelium fenestrations - filtration 2. podocytes - foot processes for filtration 3. (-) charged basement membrane - repels (-) charged proteins
27
what are the 4 factors that determine net filtration
1. hydrostatic capillary pressure Pc 2. oncotic capillary pressure Ppi 3. hydrostatic bowman space pressure Pbs 4. oncotic bowman space pressure Ppibs
28
what is the equation for net filtration
net filtration = Pc - Ppi - Pbs
29
what are the determinants of GFR
1. filtration membrane permeability 2. surface area availability 3. net filtration pressure
30
what controls GFR
1. renal blood flow (e.g. increase blood pressure increase GFR) 2. arteriole resistance a. constriction of afferent arteriole decreases GFR b. constriction of efferent arteriole increases GFR but eventually decreases
31
what are the 4 types of regulation of GFR
1. autoregulation 2. renin-angiotensin-aldosterone system 3. sympathetic NS 4. atrial natriuretic peptides
32
what is the myogenic effect
afferent arteriole responding to stretch by constricting to decrease GFR
33
what is tubuloglomerular feedback
1. macula densa sense increase osmolarity in tubules and release vasoconstrictors on afferent arteriole to decrease GFR
34
describe the renin-angiotensin aldosterone system
in response to low BP/BV 1. angiotensinogen (liver) --> angiotensin 1 via renin 2. ANG1 --> ANG2 via ACE 3. ANG2 a. system vasoconstriction to increase BP b. constrict afferent/efferent arteriole to decrease GFR c. increase aldosterone to increase Na/water reabsorption to increase BV
35
how does the sympathetic NS regulate GFR
release of NE to constrict afferent/efferent arterioles to decrease GFR
36
how do ANP regulate GFR
atrial myocytes respond to stretch (increase BV/BP) by releasing ANP ANP will dilate afferent arteriole/ constrict efferent arteriole to increase GFR
37
what is renal clearance and its formula
renal clearance: rate of disappearance from plasma and appearance in urine clearance = excretion rate (mg/min) / plasma conc. (mg/ml)
38
what things are freely filtered
inulin, creatinine, amino acids, glucose, and water
39
why do serum creatinine and BUN increase with significant reduction in glomerular filtration rate?
amount excreted doesn't change so if there is an decrease in GFR the body needs to increase the amount in the blood to get the same amount secreted
40
give an example of paracellular transport and transcellular transport
paracellular: between cells, like Na/K/Ca/Mg in thick ascending limb transcellular: passes through both membranes of cell, like bicarbonate transport
41
why is glucosuria seen in animals with uncontrolled diabetes mellitus? how does this contribute to polyuria?
glucosuria: glucose in the urine; seen in animals with uncontrolled diabetes because body is having to excrete excess glucose that is not reabsorbed polyuria: frequent urination because excess glucose increase filtrate osmolarity --> more water in filtrate --> increased urination
42
what is reabsorbed in the proximal tubules
Na, Cl, HCO3, K, glucose, amino acids, water
43
how is Na reabsorbed in the proximal tubule how is Cl reabsorbed in proximal tubule how is HCO3 reabsorbed in proximal tubule
Na/K ATPase Pump Cl paracellular transport Na co-transport
44
what is secreted in the proximal tubules
H+, toxins/drugs (penicillin, morphine), organic acids and bases, creatine/bile acids
45
what is the major force for reabsorption of Na, Cl, and water in the proximal tubule
Na/K ATPase Pump
46
what is the loop of henle
countercurrent multiplier that establishes a hyperosmotic gradient for water reabsorption
47
what is primarily occuring in the descending limb? what type of transport?
reabsorption of water impermeable to ions) passive
48
what is the effect on volume and osmolarity in the proximal tubule
volume 70% decreased osmolarity same 300mOsm (isotonic)
49
what is primarily occurring in the thick ascending limb? what type of transport?
reabsorption of Na,K, Cl active - Na/K/2Cl transporter
50
where and what is the target for loop diuretics? what do they do?
Na/K/2Cl transporter in the thick ascending limb of LOH loop diuretics: inhibit the transporter to prevent solute reabsorption to allow increase excretion of water
51
what is primarily occurring in the distal tubule? what type of transport?
reabsorption of Na via Na/Cl transporter impermeable to water
52
what is primarily occurring in the collecting duct? what cells are located in this region?
water reabsorption (ADH/VP) Na+ reabsorption (aldosterone) K secretion (aldosterone) principle cells & intercalated cells
53
what is the function of principle cells
reabsorb Na and secrete K, controlled by aldosterone
54
what is the function of intercalated cells (A and B)
type A during acidosis secrete H+ type B during alkalosis secrete HCO3
55
where is urea reabsorbed? secreted? why is it a major contributor to the medullary gradient? where does it come from?
reabsorbed in proximal tubule and collecting duct secreted in thin ascending limb of loop of henle drives water reabsorption liver
56
describe species differences regarding the loop of henle
long loop of henle in species that need a lot of water reabsorption (kangaroo rats) and short in animals with access to water (beavers)
57
why were there a number of flies attracted to the urine of dogs that had their pancreas removed?
pancreas produces insulin, without insulin glucose levels cannot be lowered causing excess to be excreted in the urine making it "sweet"
58
how does acetazolamide work? how is it a diuretic? does it lead to acidosis or alkalosis?
inhibits carbonic anhydrase = no bicarbonate reabsorption leads to acidosis diuretic because it leads to excess water excretion

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