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HOMEOSTASIS BY THE KIDNEY FLUID AND ELECTROLYTE BALANCE Flashcards

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1
Q

The maintains the volume and composition of extracellular fluid, what dysfunction could arise from this

A

Fluid overload and metabolic derangement

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2
Q

The kidney does the Excretion of endogenous waste products of metabolism, what dysfunction could arise from this?

A

Reduction in renal excretory function (uraemia and acidosis)

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3
Q

The kidneys does excretion of foreign substances and their derivatives e.g. drugs and their metabolites. what dysfunction could arise from this?

A

Drug toxicity

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4
Q

The kidney produce hormones, e.g. renin, erythropoietin, and calcitriol, what dysfunction could arise from this?

A

Hormone function reduced

(anaemia, hypertension, etc)

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5
Q

What are the Functions of the Kidney?

A

+Volume and composition of extracellular fluid
+Excretion of endogenous
+waste products of metabolism
+Excretion of foreign substances and their derivatives e.g. drugs and their metabolites
+Synthesize prostaglandins and kinins that act within the kidney
+Production of hormones, e.g. renin, erythropoietin, and calcitriol

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6
Q

Which system of the body all work very closely together to maintain fluid and acid-base homeostasis (3)

A

The renal system, cardiovascular system and respiratory system

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7
Q

What can the kidney control?

A

Extracellular, specifically plasma, fluid volume- Effective circulating volume (ECV)

Body fluid osmolality by H2O and electrolyte control

The amount of ultrafiltrate produced in the glomeruli

The amount of H2O and electrolytes reabsorbed in the nephron and tubules

Fluid, electrolyte and H+ and HCO3- balance i.e. the amount gained minus the amount lost each day

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8
Q

_________ is formed at the glomerulus

A

Ultrafiltrate

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9
Q

What is the normal filtration rate?

A

80-120 ml/min

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10
Q

Does the Kidney control the extracellular or intracellular fluid volume?

A

Extracellular, specifically plasma, fluid volume- Effective circulating volume (ECV)

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11
Q

How does the kidney control the body fluid osmolality

A

H20 and electrolyte control

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12
Q

How does the kidney control the amount of urine made

A

controlling amount of ultrafiltrate produced in the glomeruli
controlling amount of H2O and electrolytes reabsorbed in the nephron and tubules

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13
Q

How much of the Ultrafiltrate formed at the glomerulus is reabsorbed back into the systemic circulation?

A

> 99%

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14
Q

Nephron controls the osmolality and volume of the urine produced through which mechanism and where?

A

a countercurrent mechanism in the loop of Henle

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15
Q

The descending limb of loop of henle are permeable to _____, but not to solutes

A

water

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16
Q

The ascending limb of loop of Henle is permeable to _____but not to water

A

solutes

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17
Q

______ is a predominantly passive process allows energy efficient ability to produce a dilute or a concentrated urine

A

Countercurrent Mechanism

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18
Q

Changes in ECV trigger which 4 effector pathways that act on the kidney

A

1) Renin Angiotensin Aldosterone System
(2) Sympathetic nervous system
(3) Antidiuretic Hormone (ADH) release

(4) Atrial Natriuretic Peptide (ANP) release which acts to reduce ECV

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19
Q

Apart from ADH, most other pathways (RAAS, SNS, ANP) use changes in ___ excretion to change effective circulating volume

A

Na+

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20
Q

How does the RAAS, Sympathetic stimulation, ADH and ANP acts on the kidneys to control effective circulating

A

change renal haemodynamics and Na+ transport by renal tubule cells.

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21
Q

_____ is group of specialised cells in distal tubule sensing sodium delivery to distal tubule

A

Macula densa

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22
Q

Central vascular receptors are blood volume receptors that detect changes in the ECV. Where are they found?

A

Large systemic veins
Cardiac atria
Pulmonary vasculature

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23
Q

Peripheral stretch receptors are baroreceptors that detect changes in ECV. Where can these be found?

A

Carotid sinus
Aortic arch
Renal afferent arteriole

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24
Q

Where are the other 2 less important baroreceptor sensors that detect changes in the ECV

A

CNS and liver

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25
ADH is released by posterior pituitary gland in response to ___ and ____
hyperosmolality and volume depletion
26
Antidiuretic effect is mediated by _____ by acting on renal collecting ducts
V2 receptors
27
Which part of the Nephron is ADH most active on
Collecting ducts
28
In addition to ADH acting on the renal collecting ducts via V2 receptors It also increases _____ ____ mediated by ___ ___
vascular resistance | V1 receptor
29
Describe the regulation of ECV by ADH
reduced ECV --> peripheral baroreceptors --> hypothalamus --> ADH --> increased water reabsorption --> Increased ECV
30
Actions of ANP are all designed to lower ECV. True or false?
true
31
increased ECV causes atrial stretch which leads to ANP release into circulation, ANP promotes
natriuresis (increased Na+ and H2O excretion from the kidney)
32
What is the overall effect on ANP in ECV regulation
inhibits actions of renin and opposes effects of Ang-II
33
What re the 3 specific ways ANP regulates the ECV
Natriuresis, renal vasodilation, inhibits renin through low Na
34
What is the only active process in the loope of Henle (upper 2/3)
Reabsorption through the NKC2 channel
35
auto regulation in the kidney is within what range of mean arterial pressure
80 and 180mmhg
36
What will be the effect of drop in mean arterial blood pressure below 80mmHg on GFR
reduced
37
_____ is the main solute that governs plasma osmolality (number of solutes in solution)
Sodium
38
What are the 2 things that stimulate renin release form the juxta glomerular cells
reduced arteriolar stretch | reduced NaCl delivery to the macular densa in the distal tubule
39
What are the main functions of angiotensin II in RAAS
aldosterone secretion Renal Na reabsorption increase systemic blood pressure (Vasoconstriction)
40
Plasma osmolality is sensed by ___ ___ which releases ADH to aid water reabsorption in the collecting ducts
Hypothalamic osmoreceptors
41
Which sensors are involved in volume regulation by sensing the circulating/vascular fluid volume
Macula densa | Baroreceptors; Atria, Carotid sinus, central veins, pulmonary vasculature, renal afferent arterioles)
42
Sodium and water are regulated independently Hyponatremia= _______ Hypernatremia=__________
too much water | too little water
43
Does too much or too little sodium have effect on plasma concentration?
minimal or no effects
44
When two liquids are separated by semipermeable membrane such as cell membrane there are two opposing forces at play called _ and _
hydrostatic and osmotic pressure
45
pressure exerted by the volume fluid on the blood vessel that pushes water out is called
Hydrostatic pressure
46
The pressure exerted by the solute i.e. Na within the solution the pulls water to itself is referred to as ___
osmotic pressure
47
_____ is the number of ‘osmotically’ active particles in solution.
Tonicity
48
Larger molecules such as __ and ___ do not significantly contribute to plasma osmotic pressure (cf. plasma Tonicity) as it freely crosses the cell membrane through facilitated diffusion.
Urea and Glucose
49
What is the formula for calculating the plasma osmolality
2(Na + K) + Urea + Glucose
50
Normal Plasma osmolality
280 - 300 mosmol/kg
51
Why calculate difference between measured and calculated plasma osmolality?
Osmolar Gap | Identifies alcohol poisoning that might be ingested by the patient- Ethenol, Methanol, Antifreeze (Ethylene glycol)
52
Osmolar gap
_____ Identifies alcohol poisoning that might be ingested by the patient- Ethenol, Methanol, Antifreeze (Ethylene glycol)
53
_____ is the most abundant compound in the body
Water
54
How much of the water in the body on the ICF and ECF
ICF 2/3 | ECF 1/3
55
If ECF effective osmolality increases, what happens to the cell and ICF?
cells shrinks (ICF↓)
56
If ECF effective osmolality decreases, what happens to the cells and ICF
cells swells (ICF↑)
57
What is the distribution of electrolytes in the intracellular and extracellular compartments
Intracellular - K+, PO4-. and Mg++ | Extra cellular - NA+, Cl-, Ca2++ and HCO3-
58
IF a patients presents with osmolality problems with fluid compartments should we be worried about?
ECV
59
What is the effect is the effect of adding salt on plasma Na concentration, ECF volume, Urine Na concentration and ICF volume
plasma Na concentration - increases ECF volume- increases Urine Na concentration - increases ICF volume - decreases
60
What is the effect of adding water on plasma Na concentration, ECF volume, Urine Na concentration and ICF volume
plasma Na concentration - decreases ECF volume- decreases (increases initially) Urine Na concentration - increases ICF volume - increases
61
What is the effect of adding isotonic saline on plasma Na concentration, ECF volume, Urine Na concentration and ICF volume
plasma Na concentration - the same ECF volume- increases Urine Na concentration - increases ICF volume -the same
62
What is the effect of salt loss on plasma Na concentration, ECF volume, Urine Na concentration and ICF volume
plasma Na concentration - decreases initially the balances out ECF volume- the same initially then falls Urine Na concentration - decreases ICF volume -increases
63
___ is the commonest electrolyte imbalance/abnormality
Hyponatraemia (135-145)
64
What are the some causes of reduced serum osmolality
Gastrointestinal losses- eg. Diarrhoea, Vomiting Burns renal losses e.g. Diuretic therapy, Addison's disease oedematous state - HF, RF, Nephrotic syndrome SIADH Hypothyroidism Psychogenic polydipsia
65
A 32 year old male with 3 day history of watery diarrhoea was admitted with confusion. He was hypotensive with a rapid heart rate. His serum sodium was low at 125 mmol/L (135-145 mmol/L). What is the most common cause of hyponatraemia in clinical settings?
defect in renal water excretion
66
Severe hyponitraemia leads to ____
Cerebral oedema
67
What happens with rapid correction of hypernatremia?
cerebral oedema
68
How is hyponatraemia diagnosed?
Low serum sodium | Simultaneous measurement of plasma and urine osmolality for diagnosis of SIADH
69
How is hyponatraemia treated?
Salt replacement Water restriction Treatment of underlying cause
70
Rapid correction of (chronic) hyponatremia can lead to ________
Central Pontine Myelinosis (intracellular dehydration)
71
In SIADH is plasma and urine osmolality high or low?
plasma osmolality - low | urine osmolality - high
72
What are the causes of hypernatreamia?
Dehydration Certain drugs eg, Lithium Diabetes insipidus- deficiency or renal tubular resistance to ADH

NME (3 decks)

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