Exam #4: Urine Concentration & Dilution Flashcards Preview

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Flashcards in Exam #4: Urine Concentration & Dilution Deck (22):
1

Explain the importance of urea recirculation in the medulla of the kidney.

The recirculation of urea into the medulla of the kidney provides the kidney with roughly half of its ability to concentrate urine

2

Where is urea reabsorbed?

1) 50 % of the filtered urea is reabsorbed in the proximal tubule (BUT, urea is later secreted back into the Loop of Henle)
2) 60% urea is reabsorbed again in the meduallary collecting ducts

*Note that roughly 40% of the filtered urea is excreted

3

Where is urea secreted?

1) Urea is secreted in the medullary thin tubule of the Loop of Henle

4

Explain why a high-protein diet can enable people to concentrate their urine better than people with low protein intake.

Concentrated urine requires two things:
1) ADH
2) Urea

Thus, people that have a high protein diet & more urea, concentrate their urine better. Conversely, the malnourished have difficulty concentrating their urine.

5

Identify the portions of the loop of Henle that reabsorb sodium and chloride.

1) Thick ascending limb reabsorbed Na+/K+/2Cl- by secondary active transport/ cotransport

6

Identify the portions of the loop of Henle that are permeable to water.

1) Proximal convoluted tubule
2) Descending limb--Loop of Henle (via aquaporin-1)

7

Identify the portions of the loop of Henle that are impermeable to water.

1) Thin ascending limb--Loop of Henle
2) Thick ascending limb--Loop of Henle

8

State which part of the nephron is responsible for countercurrent multiplication.

Loop of Henle

9

What is countercurrent multiplication?

Deposition of NaCl into the deeper regions of the kidney via repetition--or multiplication--of single effect & second step.

1) Single effect= Na+-K+-2Cl- reabsorbed WITHOUT water in THICK ASCENDING LIMB-->dilution of TUBULAR FLUID & increased osmolarity of interstitial fluid

2) Second step: tubular flow= descending limb of Loop of Henle IS PERMEABLE to water; thus, water flow INTO ISF to equilibrate osmolarity

10

Identify the kidney structure that performs countercurrent exchange.

Vasa Recta

Note that this is the process that helps MAINTAIN the corticopapillary osmotic gradient that was ESTABLISHED by countercurrent multiplication.

11

State if countercurrent exchange involves essentially passive or active transport.

Countercurrent exchange is purely a PASSIVE process (vs. active and passive processes involved in countercurrent multiplication).

12

How does the process of countercurrent exchange allow medullary blood flow and removal of some medullary interstitial fluid without causing the washout of the concentration gradients in the renal medullary interstitium?

Countercurrent multiplication and urea recycling constantly replace the solute that is carried away with the blood

13

Describe the effect of ADH (vasopressin) concentration on the cortical collecting ducts and the medullary collecting ducts

1) ADH increases the Na+/K+/2Cl- cotransporter in the THICK ASCENDING LIMB, increasing the "single effect" of countercurrent multiplication.

2) ADH increases water permeability in the cortical & outer medullary collecting ducts, BUT it DOES NOT increase UREA PERMEABILITY; water reabsorbed but urea left behind

3) In the inner medullary collecting ducts, BOTH water & urea are reabsorbed by the action of ADH; ADH adds to the corticopapillary osmotic gradient of the inner medulla

14

Which area of the nephron can develop the highest osmolarity in the presence of ADH?

Medullary collecting duct

15

Describe the compensatory responses to dehydration.

- Dehydration causes LOW blood volume and HIGH blood osmolarity, which BOTH increase ADH secretion

1) Decreased ANP
2) Increased sympathetics i.e. renin & angiotensin II
3) Increased osmolarity= decreased ADH

16

Describe the compensatory responses to overhydration.

- Overhydration causes HIGH blood volume and LOW blood osmolarity

1) Increase ANP
2) Decrease sympathetics i.e. renin & angiotensin II
3) Decreased osmolarity= decreased ADH

17

Explain how/why diabetes insipidus can cause the excretion of large amounts of dilute urine.

The patient is unable to use the medullary gradient to remove water from the collecting ducts, either because of a lack of ADH production (central), or from a lack or receptors/aquaporins (nephrogenic)

18

Distinguish between central and nephrogenic diabetes insipidus.

Central diabetes inspidus= patients do not make ADH in the hypothalamus

Nephrogenic diabetes insipidus= no receptors for ADH in the nephron, or no aquaporins to insert into the membrane

*****In both cases, the patient produces large amounts of DILUTE urine

19

Briefly explain why some lung cancers are associated with changes in ADH level and water balance.

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20

What is SIADH?

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21

What is the effect of ethanol on the release of ADH?

Alcohol decreases ADH secretion & makes urine LESS CONCENTRATED

22

What is the effect of morphine on the release of ADH?

Morphine increases ADH secretion & makes urine MORE CONCENTRATED

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