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BRS YR2 > Renal Regulation of Water and Acid-Base Balance > Flashcards

Renal Regulation of Water and Acid-Base Balance Flashcards

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1
Q

What is the relationship between osmotic pressure and the number of solute particles?

A

proportional

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2
Q

What is osmolarity?

A

concentration x number of dissociated particles (Osm/L, mOsm/L)

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3
Q

Where is the majority of body fluid found?

A

2/3 in the intracellular fluid

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4
Q

Where is the 1/3 of extracellular fluid found?

A

1/4 intravascular (plasma)

3/4 extravascular (95% - interstitial fluid, 5% - transcellular fluid)

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5
Q

What are the different forms of unregulated water loss?

A
  • sweat
  • feces
  • vomit
  • water evaporation from respiratory lining and skin
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6
Q

What are the different forms of regulated water loss?

A

renal regulation (urine production)

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7
Q

What are the 2 different forms of renal regulation?

A

positive and negative water balance

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8
Q

What is positive water balance?

A
  • high water intake
  • increased ECF volume
  • reduced Na+ concentration
  • reduced osmolarity
  • hypoosmotic urine production
  • osmolarity normalises
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9
Q

What is the first compartment of the body where new fluid is put?

A

ECF

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10
Q

What is negative water balance?

A
  • low water intake
  • reduced ECF volume
  • increased [Na+]
  • increased osmolarity
  • hyperosmotic urine production
  • thirst induced
  • osmolarity normalizes
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11
Q

Where is the majority (67%) of water reabsorbed?

A

the DCT

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12
Q

What is absorbed in the ascending limb of the loop of Henle?

A
  • Thin: passive NaCl
  • Thick: active NaCl
    no water
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13
Q

What is absorbed in the descending limb of the loop of Henle?

A
  • passive water

-

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14
Q

Why is water reabsorbed first in the loop of Henle?

A
  • since water is reabsorbed through the passive process of osmosis, a gradient is required
  • the medullary interstitium needs to be hyperosmotic for water reabsorption to occur from LoH and CD
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15
Q

What process causes the gradient in the medullary interstitium?

A

countercurrent multiplication

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16
Q

What transports urea from the collecting duct to the medullary interstitial?

A

UT-A1, UT-A3

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17
Q

What are the 2 possible locations for urea to go to once in the medullary interstitial?

A
  • the descending loop of Henle

- the Vasa-Recta

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18
Q

What transporters allows for the movement of urea into the Vasa Recta?

A

UT-B1

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19
Q

What transporters allows for the movement of urea into descending LoH?

A

UT-A2

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20
Q

What is the purpose fo urea recycling?

A

to increase the interstitial osmolarity

  • causes urine concentration
  • urea excretion needs less water (high concentrations can be excreted)
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21
Q

How is vasopressin involved in urea recycling?

A

boosts UT-A1 and UT-A3 numbers

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22
Q

What is the main function of ADH/vasopressin?

A

promote water reabsorption from the collecting duct

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23
Q

Where is ADH produced?

A
  • hypothalamus

- neurons in the supraoptic and paraventricular nuclei

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24
Q

Where is ADH stored?

A

the posterior pituitary gland

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25
What detects fluctuation in plasma osmolarity?
osmoreceptors in the hypothalamus
26
What factors stimulate ADH production and release?
- increased plasma osmolarity - hypovolemia (reduced BP) - nausea - angiotensin II - nicotine
27
What factors inhibit ADH production and release?
- low plasma osmolarity - hypervolemia (increased BP) - ethanol - ANP,BNP
28
What detects changes in BP?
baroreceptors to the hypothalamus
29
What is required in order for baroreceptors to detect BP changes?
5-10% change
30
What receptor binds ADH?
V2 receptor
31
What happens when ADH binds to a V2 receptor?
- activates the G protein mediated signalling cascade - activating protein kinase A - increasing the secretion of Aquaporin 2 channels that are transporters of water on apical membrane
32
What happens in diuresis?
increased dilute urine secretion (low/no ADH)
33
What is absorbed/excreted in the collecting duct during diuresis?
- NaCl reabsorbed | - water reabsorption in the inner medulla (even with absent ADH)
34
What is the type of fluid that enters the LoH?
Isosmotic
35
What is the type of fluid that enters the DCT?
Hypoosmotic
36
What is reabsorbed in the DCT during diuresis?
- active NaCl | - water channels closed in DCT
37
What is the type of fluid that exits the CD?
hypoosmotic
38
How is sodium reabsorbed in the collecting duct?
- Na+/K+/ATPase Pump | - sodium channels
39
What is antidiuresis?
- concentrated urine in low volume excretion | - high ADH
40
How does ADH increase salt reabsorption in the thick ascending limb?
increased number/action of the Na+/K+/2Cl- symporter
41
How does ADH increase salt reabsorption in the DCT?
increased number/action of the Na+/Cl- symporter
42
How does ADH increase salt reabsorption in the CD?
increased Na+ channels
43
What is reabsorbed in the DCT during antidiuresis?
- active NaCl | - water through AQP2
44
What is reabsorbed in the CD during antidiuresis?
- water reabsorbed increases as passing into the medulla
45
What are some examples of ADH related clinical disorders?
- central diabetes insipidus - syndrome of inapropriate ADH secretion (SIADH) - Nephrogenic Diabetes Insipidus
46
What is the cause of central diabetes insipidus?
decreased/negligent production/release of ADH
47
What are the clinical features of central diabetes insipidus?
- polyuria | - polydipsia
48
What is the treatment given for central diabetes insipidus?
external ADH
49
What is the cause of SIADH?
increased production and release of ADH
50
What are the clinical features of SIADH?
- hyperosmolar urine - hypervolemia - hyponatremia
51
What is the treatment given for SIADH?
Non-peptide inhibitor of ADH receptor | - (conivaptan and tolvaptan)
52
What mechanisms neutralise excess metabolic acids?
- bicarbonate buffering mechanism
53
What is the role of kidneys?
- secretion and excretion of H+ - reabsorption of HCO3- - production of new HCO3-
54
How much of bicarbonate ions are reabsorbed in the PCT?
80%
55
How much of bicarbonate ions are reabsorbed in the ascending LoH?
10%
56
What mechanisms neutralise excess metabolic acids?
- bicarbonate buffering mechanism | - phosphate buffering system
57
How much of bicarbonate ions are reabsorbed in the CD?
4%
58
How is bicarbonate reabsorbed in the PCT?
- CO2 from the tubule enters the cell - reacts with water to form HCO3- - Na/HCO3- symporter into the blood
59
Where are intercalated cells found?
- DCT | - CD
60
What is the role of the alpha-intercalated cells?
- HCO3- reabsorption | - H+ secretion
61
What is the role of the beta-intercalated cells?
- HCO3- secretion | - H+ reabsorption
62
What happens in the alpha-intercalated cell?
- H+ back into tubule via H+ATPase and H+/K+ ATPase | - HCO3- into blood by Cl-/HCO3- antiporter
63
What happens in the beta-intercalated cell?
- HCO3- into tubule by Cl-/HCO3- antiporter | - H+ ATPase pump for H+ into the blood
64
Where are new bicarbonate ions produced
PCT
65
How is new bicarbonate produced?
- glutamine into 2 ammonia and one divalent ion | - 2 HCO3- ions that are reabsorbed
66
What happens if ammonia reaches the blood and eventually back to the liver?
- ammonia = one urea and one H+ | - then uses up another HCO3- for neutralisation
67
How do you prevent ammonia from reentering the blood stream and reaching the liver?
- Na+/H+ antiporter (NH4+ replacing H+) | - Ammonium gas that binds with a H+ to produce ammonia that is excreted
68
What happens to the excess proton when HCO3- is produced (from CO2 in the tubule) in the DCT and CD?
it is neutralised by phosphate in the tubule
69
What are the characteristics of metabolic acidosis?
- low [HCO3-] | - low pH
70
What are the characteristics of metabolic alkalosis?
- high [HCO3-] | - high pH
71
What is the compensatory response to metabolic acidosis?
- increased ventilation | - increased [HCO3-] reabsorption and production
72
What is the compensatory response to metabolic alkalosis?
- hypoventilation | - increased [HCO3-] excretion
73
What are the characteristics of respiratory acidosis?
- high Pco2 | - low pH
74
What is the compensatory response to respiratory acidosis?
acute - intracellular buffering chronic - increase [HCO3-] reabsorption and production
75
What are the characteristics of respiratory alkalosis?
- low Pco2 | - high pH
76
What is the compensatory response to respiratory alkalosis?
acute - intracellular buffering chronic (more carbonic acid production) - increase [HCO3-] excretion and reduced [HCO3-] production

BRS YR2 (70 decks)

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