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Renal Exam 2 > Regulation of Sodium and Water Balance > Flashcards

Regulation of Sodium and Water Balance Flashcards

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1
Q

Major body fluid compartments

-Main substances exerting osmotic pressure in compartments-Cells?

A

Potassium

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2
Q

Major body fluid compartments

-Main substances exerting osmotic pressure in compartments-Interstitial fluid?

A

Sodium

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3
Q

Major body fluid compartments

-Main substances exerting osmotic pressure in compartments-plasma?

A

Protein (usually albumin)

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4
Q

Electrolyte composition of ECF (compared to ICF)?

A

High-Na, Cl, Ca, bicarb, pH

-Low-K, phosphate

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5
Q

ECF volume is determined by?

A

Total body Na

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6
Q

Why are water and Na balance regulated independently?

A

To prevent large changes in plasma osmolality

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7
Q

Effects of increased Na in the body?

-Can be compensatory for?

A
  • Increased ECF volume and ECV

- Can be compensatory for hypovolemia

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8
Q

Sodium balance

  • Total body sodium compared to plasma sodium
  • Plasma Na (and therefore osmolarity) is primarily regulated by?
  • Major cause of hyponatriemia?
A
  • Total body sodium is different from plasma sodium:
    • Plasma sodium is affected by water balance
  • Major cause of hyponatriemia is too much water (not low sodium)
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9
Q

Total body Na content=?

A

dietary intake-urinary Na excretion

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10
Q

Dietary Na intake

A
  • Not regulated in humans

- Kidneys control body Na content by adjusting urinary excretion

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11
Q

Increased ECF volume activates mechanisms that have what effect?

A

-Increase Na excretion

decreased ECF causes Na to be conserved

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12
Q

Reabsorption of filtered Na load

  • Bulk of reabsorption occurs in?
  • Fine tuning occurs in?
A
  • Bulk of reabsorption of filtered Na in proximal tubule, loop of Henle
  • Fine tuning occurs in the distal nephron
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13
Q

Neurohormonal factors controlling renal Na handling

-Factors that promote Na reabsorption?

A
  • Activation of renal sympathetic nerves
  • Activation of renin/angiotensin system
  • Secretion of aldosterone
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14
Q

Neurohormonal factors controlling renal Na handling

-Factors that promote Na excretion?

A
  • Release of ANP and BNP (brain natriuretic peptide)
  • Release of urodilatin
  • Intrarenal prostaglandins
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15
Q

Increased activity of renal sympathetic nerves has what effects:

  • on GFR?
  • reabsorption of water and sodium?
  • granular cells?
A
  • Decreased GFR
  • Increased proximal reabsorption of Na and H2O
  • Direct stimulation of granular cells (beta-adrenergic receptors)
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16
Q

Increased activity of renal sympathetic nerves has what effects
-Decreased GFR and increased proximal reabsorption of Na and H2O lead to?

A

Decreased rate of fluid delivery to the macula densa

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17
Q

Increased activity of renal sympathetic nerves has what effects
-Decreased rate of fluid delivery to the macula densa and direct stimulation of granular cells (beta-adrenergic receptors) lead to?

A

Increased renin secretion

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18
Q

Factors that promote renin secretion?

A
  • Renal sympathetic stimulation
  • Tubuloglomerular feedback
  • Intrarenal baroreceptor afferent arteriolar vasoconstriction
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19
Q

Factors that promote renin secretion

  • Renal sympathetic stimulation
    • Due to?
    • Directly stimulates?
A
  • Renal sympathetic stimulation (due to decreased perfusion pressure through the cardiopulmonary baroreceptors)
  • Directly stimulates renin secretion via beta-1 receptor activation in the JG apparatus
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20
Q

Factors that promote renin secretion

-Tubuloglomerular feedback stimulated by?

A

-Decreased NaCl delivery to macula densa causing increased renin secretion

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21
Q

Factors that promote renin secretion

-Intrarenal baroreceptor afferent arteriolar vasoconstriction stimulated by?

A

Decreased pressure at granular cells causing increased renin secretion

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22
Q

Loop diuretics MOA?

A

Inhibit the Na-K-2Cl pump

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23
Q

What effect would loop diuretics have on renin secretion?

A

They would increase renin secretion

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24
Q

Angiotensin II stimulates?

A
  • Systemic arteriolar constriction
  • Renal arteriolar constriction
  • Na reabsorption
  • Thirst
  • ADH and aldosterone secretion
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25
Angiotensin II stimulates - Renal arteriolar constriction - Afferent compared to efferent? - How would this affect GFR? - How would this affect RBF?
- Efferent > afferent - Maintain or slightly increase GFR - Decrease RBF-stopping flow and backing up pressure
26
Angiotensin II stimulates | -Na reabsorption occurs in? Via?
-Na reabsorption in the PCT (via increased Na-H exchanger activity) > TAL, CCD (cortical collecting duct?)
27
Where is ADH secreted from?
Posterior pituitary
28
Where is aldosterone secreted from?
Adrenal cortex
29
Renal effects of angiotensin II?
- Decreased renal blood flow - Proportionately increased efferent arteriolar resistance - Glomerular mesangial cell contraction - Decreased medullary blood flow - Increased tubular sodium reabsorption-->sodium retention
30
Renal effects of angiotensin II | -Proportionately increased efferent arteriolar resistance-->?
-Proportionately increased efferent arteriolar resistance-->increased glomerular capillary hydrostatic pressure-->increased filtration
31
Renal effects of angiotensin II | -Glomerular mesangial cell contraction-->?
-Glomerular mesangial cell contraction-->Decreased glomerular capillary surface area available for filtration-->decreased filtration (offsets increased filtration)
32
Slide 17/18
flow charts
33
Where do aldosterone's actions take place? | -What are the cells called?
Late DCT and CD (principal cells)
34
Aldosterone stimulates sodium reabsorption resulting in?
lumen negative potential difference
35
Aldosterone stimulates sodium reabsorption | -Electroneutrality maintained by?
Passive Cl-reabsorption and K+/H+ secretion
36
Aldosterone - Potassium is secreted by what type of cell? - In what part of the nephron?
Principal cells of the DT and the CCD
37
Aldosterone - Hydrogen is secreted by what type of cell? - In what part of the nephron?
H+ ATPase activity in intercalated cells of CCD
38
What would happen to K and H secretion in a patient with hyperaldosteronism?
Increased secretion of K and H-hypokalemic and metabolic alkalosis
39
Factors that stimulate aldosterone secretion?
- Increased plasma K concentration - Increased plasma ACTH - Volume depletion-->ANG II conc
40
Feedback control of aldosterone secretion | -Aldosterone-->decreased Na and water excretion leads to?
-Increased ECF volume-->increased renal arterial mean pressure, decreased discharge of renal nerves-->inhibits renin
41
ANP-How does it affect: - Na, H2O excretion? - GFR? - Na reabsorption? - Renin, aldosterone, ADH? - Overall effect?
- Increases Na, H2O excretion - Increases GFR - Inhibits Na reabsorption - Suppresses renin, aldosterone, and ADH secretion - Systemic vasodilator
42
ANP response to increased ECF volume flow chart | -ANP is released in response to?
- ANP is released in response to an increased right atrial pressure - Slide 22 and 23
43
Urodilatin | -What is it?
Endogenous renal natriuretic peptide
44
Urodilatin - Secreted by? - Secreted in response to? - Suppresses?
- DCT and CD in response to increased arterial pressure and ECF volume - Suppresses Na and water reabsorption by medullary CD
45
Urodilatin | -Difference between urodilatin and ANP/BNP?
Urodilatin has NO EFFECT on systemic circulation
46
Prostaglandins | -Compare their effects to those of sympathetics
Prostaglandins oppose sympathetics
47
Effect of intrarenal prostaglandins - on Na excretion/Na reabsorption? - GFR?
- Intrarenal prostaglandins increase Na excretion and suppress Na reabsorption - Increase GFR
48
Effect of intrarenal prostaglandins | -How do they increase GFR?
By dilating renal arterioles
49
Effect of intrarenal prostaglandins | -Where is the Na reabsorption suppressed?
thick ascending limb and cortical CD
50
What effect will intrarenal prostaglandins have on the solute concentration in the renal medullary tissue?
Decreased osmolarity, won't concentrate urine as you would normally
51
Major regulatory hormones of each segment of the nephron | -PCT?
Ang II, norepi, epi, dopamine
52
Major regulatory hormones of each segment of the nephron | -Loop of Henle and DCT?
Aldosterone and Ang II
53
Highest percentage of NaCl is reabsorbed in what portion of the nephron?
PCT
54
Mechanisms of Na entry across apical membrane? | -PCT
Na-H antiporter, Na symporter with aa, Na-H-Cl antiporter, paracellular
55
Mechanisms of Na entry across apical membrane? | -Loop of henle?
Na-K-2Cl symporter
56
Mechanisms of Na entry across apical membrane? | -DCT?
NaCl symporter
57
Mechanisms of Na entry across apical membrane? | -Late DCT and CD?
epithelial sodium channel
58
Major regulatory hormones of each segment of the nephron | -Late distal tubule and CD?
Aldosterone, ANP/BNP, urodilatin, Ang II
59
2 types of receptors that control ADH secretion?
Osmoreceptors (hypothalamic > hepatic) and baroreceptors
60
Two major stimuli for ADH release?
- Hyperosmolarity - Volume depletion - These two arms are separate but they interact
61
Plasma AVP vs osmolality (graphs)
- Normal plasma osmolality corresponds to maximum ADH | - Need thirst and resulting hydration to overcome any extra osmolarity
62
Plasma AVP vs blood volume (graphs)
Volume receptors not as sensitive but once they are activated they are powerful
63
Changes in blood volume modulate osmolality-dependent changes in plasma AVP
- Volume depletion potentiates ADH response to hyperosmolality - Volume depletion prevents inhibition of ADH release normally induced by a fall in plasma osmolality - VOLUME ALWAYS TRUMPS OSMOLARITY
64
Renal response to increased NaCl intake flow chart
Slide 33
65
Integrated response to volume expansion flow chart
Slide 34
66
Clinical manifestations of impaired regulation | -Too much water?
Hyponatriemia (low plasma Na)
67
Clinical manifestations of impaired regulation | -Too little water?
Hypernatriemia (high plasma Na)
68
Clinical manifestations of impaired regulation | -Too much Na?
Edema
69
Clinical manifestations of impaired regulation | -Too little Na?
Volume depletion
70
Activation of Ang II in response to hemorrhage flow charts
slide 36, 37, 38
71
Integrated response to volume contraction flow chart
slide 39
72
Increased renal tubular Na reabsorption in response to volume contraction
slide 40
73
***Summary table*** Sensors and effectors of osmoregulation and volume regulation -Osmoregulation-What is sensed?
Plasma osmolarity
74
- Osmoregulation | - sensors?
Hypothalamic osmoreceptors
75
- Osmoregulation | - Effectors?
ADH and thirst
76
- Osmoregulation | - What is affected?
Urine osmolarity and water intake
77
Volume regulation | -What is sensed?
Adequate tissue perfusion
78
Volume regulation | -Sensors?
Macula densa, afferent arterioles, atria, carotid sinus
79
Volume regulation | -Effectors?
RAAS, ANP, NE, ADH
80
Volume regulation | -What is affected?
Urinary sodium and thirst

Renal Exam 2 (6 decks)

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