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Renal concentrating mechanisms Flashcards

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1
Q

Where is the site of renin synthesis?

A

The juxtaglomerular apparatus.

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2
Q

What are the four components of the JGA?

A
  1. modified smooth muslce cells in afferent arteriole.
  2. Modified smooth muscle cells in the efferent arteriole.
  3. Extraglomerular mesangial cells
  4. Macula densa cells in the distal tubule
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3
Q

What causes angiotensiongen to be cleaved to angiotensin I?

A

Renin

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4
Q

What converts Angiotensin I to angiotensin II?

A

Angiotensin Converting Enzyme

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5
Q

What is the more potent vasoconstrictor in the body?

A

Angiotensin II

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6
Q

Where is angiotensin I converted to angiotensin II?

A

Lungs

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7
Q

What are the 5 actions of Angiotensin II?

A
  1. Vasoconstriction and increased blood pressure.
  2. Increased aldosterone synthesis and release
  3. Increased ADH
  4. Increased thirst
  5. Feedback inhibition of renin release
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8
Q

What does ACE inhibitor do?

A

Inhibits angiotensin I from converting to angiotensin II?

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9
Q

What helps maintain GFR in spite of constrictive effects of Angiotensin II?

A

Prostagladins

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10
Q

Where is aldosterone synthesized in the body?

A

Zona glomerulosa of the adrenal cortex

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11
Q

Chronic ACE inhibitors cause a patient to be refractory to what medications?

A

Epinephrine and neosynephrine and ephedrine

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12
Q

What medication would you use to ACE inhibitor caused refractory hypotension?

A

Vasopressin

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13
Q

What causes aldosterone release and synthesis?

A
  1. Increased K+ levels in the ECF
  2. Angiotensin II
  3. Decreased Na+ levels
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14
Q

Where does aldosterone act on in the nephron?

A

Distal tubule and collecting ducts

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15
Q

What is the net effect of aldosterone?

A

Get rid of K+ and H+

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16
Q

Name a steroid hormone that is synthesized in the zona glomerulosa of the adrenal cortex?

A

Aldosterone

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17
Q

Does aldosterone cause a marked reabsorption of secretion of Na+?

A

Reabsorption

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18
Q

What is exchanged for K+ and H+ by aldosterone?

A

Na+

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19
Q

Where is ADH made?

A

Hypothalamus

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20
Q

Where is ADH released from?

A

Pituitary gland

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21
Q

Atrial natriuretic peptide does what to the nephron?

A
  1. Increases GFR
  2. Decrease Na+ reabsorption
  3. Inhibits release of renin/aldosterone/ADH
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22
Q

What is Conn’s Syndrome?

A

Aldosterone secreting tumor

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23
Q

What three main things does Conn’s Syndrome cause?

Study These Flashcards
A
  1. Hypertension
  2. Hypernatremia
  3. Hypokalemia
24
Q

What symptom of Conn’s Syndrome is most dangerous?

Study These Flashcards
A

Hypokalemia can cause heart/muscle/nerve hyperpolarization

25
What is maximum capable urine concentration?
1200mOsm/L
26
What is the minimum daily urine output?
0.5L/day
27
Where are osmoreceptor cells located?
Anterior hypothalamus
28
What effects does increase in extracellular fluid osmolarity have on osmoreceptor cells?
Causes them to shrink
29
Shrinkage of osmoreceptor cells causes them to fire to the pituitary gland to do what?
Stimulates release of ADH
30
Where does ADH work in the nephron?
Late distal tubules
31
What stimuli cause ADH release?
1. Osmoreceptor stimulation 2. Angiotensin II 3. Fright 4. Nausea 5. Pain 6. Anesthesia 7. Nicotine
32
T/F: Alcohol inhibits ADH release?
True
33
In the presence of dehydration, ADH is released or inhibited?
Release
34
In the presence of overhydration, ADH is released or inhibited?
Inhibited
35
How does ADH work?
1. Increases the permeability of the collecting system of water 2. Increases urea permeability
36
What three things are the basic requirements for forming a concentrated urine?
1. High level of ADH 2. High osmolarity of the renal medullary interstitial fluid 3. Water moving by osmosis into the renal interstitium
37
What is the osmolarity of the interstitial fluid in the medulla of the kidney?
1200-1400 mOsm/L
38
What 4 major factors contribute to the buildup of solute concentration into the renal medulla?
1. Active transport. 2. Active transport 3. Facilitated diffusion 4. Diffusion
39
What is an example of active transport?
Sodium ions and co-transport potassium/chloride/other ions out of the thick portion of the asecnding limb into the medullary interstitium
40
What is an example of active transport?
Ions from the collecting ducts into the medullary interstitium
41
What is an example of facilitated diffusion?
Urea from the inner medullary collecting ducts into the medullary interstitium
42
What is an example of diffusion?
Small amounts of water from medullary tubules into medullary interstitium
43
What is the role of urea?
Byproduct of amino acid metabolism consisting of 2 ammonia molecules.
44
How much Urea is made per day by the liver?
25-30g/day
45
What can high levels of ammonia cause?
Encephalopathy and coma
46
Does the medullary interstitium have a high or low concentration of urea?
High
47
What are the two functions of the vasa recta?
1. Remove reabsorbed fluid from the interstitium. | 2. Minimize solute uptake from the medulla.
48
Why is vasa recta U-shaped?
Act as countercurrent exchangers to minimize solute washout.
49
Where does RAAS system start?
Macula Densa
50
Is urine hyper or hypo osmolar?
Hyper osmolar
51
What is Central Diabeters insipidus?
An inability to produce or release ADH from the posterior pituitary
52
What is treatment of central diabetes insipidus?
Administration of a synthetic analog of ADH (desmopressin)
53
What receptor does demsopressin act on?
V2 receptor
54
What does stimulation of the V2 Receptor cause?
Increase water permeability in the late distal and collecting tubules.
55
What is Nephrogenic diabetes insipidus?
Normal or elevated levels of ADH are present, but the renal tubular segments cannot response appropriately.

Renal (5 decks)

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