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GIR Test 4 > B5-041 Renal Physiology IV > Flashcards

B5-041 Renal Physiology IV Flashcards

(80 cards)

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1
Q

what receptor does ADH bind to to cause vasocontriction?

A

V1

triggers Ca2+ release –> actin-myosin coupling –> vasoconstriction

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2
Q

do V1 or V2 receptors have a higher affinity for ADH?

A

V2 has higher affinity

thats why osmolarity causes big changes in ADH and pressure only small

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3
Q

small cell lung carcinoma and lung infections can cause

A

SIADH

secretes peptides similar to ADH, too much ADH

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4
Q

central Diabetes insipidus causes water diuresis because

A

hypothalmus does not secrete ADH

decreased water absorption, urine dilution

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5
Q

nephrogenic diabetes insipidus causes water diuresis due to

A

mutation in V2 (lithium ingestion)

decreased water reabsorption, urine dilution

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6
Q

diabetes mellitus causes […] diuresis

solute or water

A

solute

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7
Q

how does a normal individual react to a water restriction test?

A

osmolarity increases, volume decreases

primary polydipsia would be similar

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8
Q

how does an individual with central diabetes insipidus react to a water restriction test?

A
  • very little change in volume/osmolarity until ADH is added
  • then, osmolarity will go up and volume wil go down
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9
Q

how does an individual with nephrogenic diabetes insipidus react to a water restriction test?

A

kidneys do not respond to ADH

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10
Q

treatment for diabetes insipidus

A

ADH analog
(desmopressin)

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11
Q

treatment of SIADH

A

treat underlying cause or inhibit V2 receptors

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12
Q

4 main effector pathways regulating salt and water excretion

A
  1. ADH
  2. natriuretic peptides
  3. RAAS
  4. sympathetic nervous system
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13
Q

stimulus for release of ANP

A

increased heart volume

released from atria

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14
Q

stiumulus for release of BNP

A

increased heart volume

released from ventricle

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15
Q

stimulus for release of CNP

A

increased intravascular volume

released from brain

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16
Q

stimulus for release of urodilatin

A

increased volume and Na+ load

released from kidney

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17
Q

describe the mechanism of action of natriuretic peptides

A
  • bind to NPR on vascular smooth muscle cells
  • diminish calcium
  • cause vasodilation
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18
Q

inhibits ENac in the collecting duct causing less sodium reabsorption

more dilute urine

A

urodilatin

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19
Q

how does sympathetic nervous activity regulate GFR?

A

produces vasoconstriction

constrict vessels –> less volume in afferent arteriole –> low GFR

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20
Q

sensors that regulate ECF volume

2

A

baroreceptors
volume receptors

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21
Q

sensors that regulate ECF osmolarity

A

hypothalmic osmoreceptors

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22
Q

effector pathways for regulation of ECF volume

4

A
  • ADH
  • ANP
  • RAAS
  • SNS
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23
Q

effector pathways that regulate ECF osmolarity

2

A
  • ADH
  • thirst
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24
Q

all transport in the proximal tubules is associated with

A

Na+

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25
the proximal tubule gets rid of bicarb through
bicarb-sodium transporter in basolateral membrane
26
what cells in the distal and collecting tubules regulate pH?
a intercalated
27
how do cells a intercalated cells get rid of H+?
H+ active transporters on the apical side of cells | require ATP
28
for every proton that comes out, one [...] comes in
bicarbonate
29
what cells are very important for getting rid of H+ and protect from acidosis?
a intercalated cells
30
what cells are very important for getting rid of bicarbonate and protecting from alkalosis?
b intercalated cells
31
transporter on apical side of b intercalated cells
HCO3/Cl- exchanger | basolateral in a- intercalated cells
32
transporter on basolateral side of b-intercalated cells
active H+ transport pump | apical in a-intercalated cells
33
what part of the tubule reabsorbs 80% of bicarb through Na/HCO3 transporter in the basolateral membrane?
proximal tubule
34
how does the kidney buffer urine?
* combine H+ with HPO4 to make phosphoric acid * combine H+ with HCO3 to make carbonic acid | urine acidification
35
how does the kidney produce ammonium?
* glutamine --> glutamate = a-ketoglutarate + NH3 * NH3 combines with H+ to make ammonium (NH4)
36
how to calculate urine anion gap
(Na + K) - Cl | should be a negative number
37
urine anion gap is an indicator of the ability of the kidney to
* produce ammonium * get rid of protons
38
if the UAG is negative, what does this mean? | urine anion gap
normal kidneys are producing ammonium and eliminating H+ appropriately
39
equation for plasma anion gap
Na - (Cl + HCO3)
40
normal anion gap
8-16
41
what does a normal anion gap indicate?
kidneys are eliminated excess fixed acids
42
plasma anion gap [...] as pH is reduced
increases
43
what cells work to compensate for alkalosis?
b- intercalated cells
44
if PCO2 rises, proton secretion becomes dominant and the kidney excretes [...]
acid | raises blood pH
45
if HCO3 in plasma rise, HCO3 filtration increases and the kidney excretes [...]
alkali | reducing blood pH
46
how does the kidney respond to respiratory acidosis?
1. excretes protons in the proximal and distal portions of the nephron 1. reabsorbs bicarb (bicarb raised in plasma) 1. pH normalizes
47
how will the kidneys respond to respiratory alkalosis?
excrete bicarb (through saturation and b- intercalated cells)
48
causes of metabolic acidosis with normal PAG
* bicarb loss (diarrhea, proximal renal tubular acidosis) * decreased acid secretion/bicarb consumption (distal renal tubular acidosis, aldosterone deficiency)
49
causes of metabolic acidosis with high PAG
* high acid input (keto acidosis, lactic acidosis, salicylate, methanol, ethylene glycol) * low acid input (renal failure)
50
* decreased distal acidification * low plasma bicarb * normal PAG * low serum K * urine pH > 5.5
type I distal RTA
51
* decreased bicarbonate reabsorption * very low plasma bicarb * normal PAG * low serum K+ * normal/low urine pH
type II proximal RTA
52
* decreased aldosterone * low plasma bicarb * normal PAG * high serum K+ * normal/low urine pH
type IV distal hyperkalemic RTA
53
with more aldosterone, you have more [...] secretion
hydrogen
54
if you have hyperaldosteronism, will cause
alkalosis
55
if you have high aldosterone, the patient will become
alkalotic
56
in a patient who is hypoventilating due to chronic lung disease, the kidneys will respond by
increasing net secretion of acid | H2PO4, CO3H2, NH4+
57
in a patient who is hypoventilating, the PCO2 will
increase
58
an increase in PCO2 will activate [...] in the kidney
mechanism involved in acid secretion
59
PCO2 is an important regulator of the activity of [...] in intercalated cells
H-ATPase
60
actively secretes protons into the tubular lumen
H-ATPase
61
for each proton excreted, one [...] is reabsorbed
bicarbonate
62
when excretion of NH4+ is adequate, the UAG is
negative
63
patients with type I distal renal tubular acidosis have an inability to secrete
protons | reduces amount of NH4+, UAG positive
64
what 2 molecules are low in urine in RTA?
bicarb ammonium
65
bicarb reabsorption in the proximal tubule is tightly coupled to
secretion of protons by Na-H exchanger
66
a positive urine anion gap indicates
inappropriate excretion of ammonium
67
secreted by JG cells in response to decreased renal perfusion pressure
renin
68
increases renal sympathetic discharge (B1 effect) and decreases NaCl delivery to macula densa cells
renin
69
catalyzes conversion of angiotensin I to angiotensin II
ACE
70
produced by vascular endothelial cells in the lung
ACE
71
helps maintain blood pressure and blood volume
angiotensin II
72
affects baroreceptor function; limits reflex bradycardia which would normally accompany its pressor effects
angiotensin II
73
released from atria and ventricles in response to increased volume
ANP, BNP
74
* inhibits RAAS system * relaxes vascular smooth muscle via cGMP to increase GFR and decrease renin * dilates afferent arteriole
ANP, BNP
75
primarily regulates serum osmolality
ADH
76
stimulates reabsorption of water in collecting ducts
ADH
77
stimulates reabsorption of urea in collecting ducts to maximize corticopapillary osmotic gradient
ADH
78
primarily regulates ECF volume and Na+ content
aldosterone
79
* release is increased in hypovolumic states * responds to hyperkalemia by increasing K+ excretion
aldosterone
80
how to beta blockers inhibit renin release?
inhibit B1 receptors in JG cells causing decreased renin release

GIR Test 4 (18 decks)

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