Renal 16 Ecf

Front 1

what are the 2 main regulators of the ECF oms and volume

Back 1

1. ADH: reabs water, respond to changes in OSM and Volume of ECF

2. ALDO: Na regulation, used to maintain BP and BV, increased Na reabs causes water reabs

Front 2

the 3 main hormones for ECF volume and OSM are..

Back 2

1. ADH
2. ALDO
3. ANP (anti aldo, aldo does Na reabs to increase BV)

Front 3

what 2 things can cause ALDO release

Back 3

1. increase ANG II
2. plasma K

**this causes Na reabs in late DCT (principal cells). also causes K secretion

Front 4

whats the deal with Na reabs and K?

Back 4

when Na is reabs its at the expense of K

**increased K is one of the sidnals for ALDO to reabs Na, its also a way to decrease K when needed

Front 5

how much filtered Na is under the control of ALDO

Back 5

2%, but we have LOTS of Na filtered so it works out to be about 30g

Front 6

increased k and ANg II cause what

Back 6

ALDO release, Na reabs increase in BV, K secretion

Front 7

what are 4 things ang II does?

Back 7

1. Stim Aldo release (aldo then Na reabs at principal DCT cells)

2. Vasoconstrict

3. Stim Na/H in PCT

4. increase NaCl retention and increase BP

Front 8

so ANG II increases ALDO, what increases ANG II

Back 8

renin

**JGA (1. intrarenal baroreceptors 2. macula densa 3. renal symp nerves)

Front 9

is renin released when BP is high

Back 9

no way! renin is released 3 ways 1. intrarenal baroreceptors 2. macula densa 3. renal symp nerves

Na is secreted with no renin

Front 10

what role do the intrarenal barareceptors play in maintaing volume

Back 10

granular cells in JGA respond to stretch

when affernt arterioles have increased Pressure (stretch) less renin is released

**no Na reabs

Front 11

what happens when pressure in the afferent arteriole is LOW

Back 11

granular cells in teh JGA act as intrarenal baroreceptors and renin is stim

**renin release and pressure in afferent art are INVERSELY related

Front 12

how is renin release and pressure in the afferent arteriole related

Back 12

inversely,

when pressure is high the granular cells in the JGA sence it and decrease renin release. this acts to not increase BV

Front 13

what is a mech similiar to that in the intrarenal baroreceptors?

Back 13

in the bara when pressure in high in teh afferent art renein is NOT released

**the macula senses flow to DCT, when its high Renin is NTO released

Front 14

the intrarenal cells sense...
the macula densa sense...

Back 14

pressure in affrent art
flow in DCT

**BOTH with increase renin when flow is decreased and stop renin when flow is high

Front 15

how do synpathetic renal fibers act on renin

Back 15

they are near the granular (intrarenal baroreceptors) and when b sympathetic fibers are stim they release renin

Front 16

what is the fastest of the 3 ways renin is relased

Back 16

SNS

*8when BP falls the renal SNS fibers sense it and release renin immediatly to restore blood volume via Na reabs

Front 17

is renin stim or inhibited in hemmorage

Back 17

stim

1. macula densa 9flow in DCT_
2. SNS
3. Granular intrarenal baroreceptors (afferent art)

renin --> ang II --> ALDO --> na reabs

Front 18

list in order aldo and renin

Back 18

1 macula densa decrease flow
2. granular decrese pressure in afferent
3. SNS is activated

all 3 --> renin --> ang ii --> ALDO --> na reabs--> increase BV

Front 19

what releases ANP? when

Back 19

atria, when pressure is high

**thsi is the anti ALDO, promotes water loss

Front 20

whaht does ANP do to the afferent/efferent art?

Back 20

dilates afferent
constricts efferent

**this increases GFR so we can filter more NaCL

Front 21

what increases NaCl filtration at the glomerulus ADH ALDO ANP

Back 21

ANP

**causes afferent dilation adn effernt constriction

Front 22

what causes the afferent art to dilate nad efferent art to constrict. what effect does this have

Back 22

ANP

**increase GFR and NaCl filtered load

**released whn pres in atri ais high, works to decrease Bv

Front 23

so ANP will increase filtered load of NaCl by increasing GFR by messing with the arterioles. will the NaCl be excreted or reabs. how

Back 23

1. excreted! prevent reabs by...

**inhibiting ADH ALDO
**inhibit Na uptake at CD

Front 24

how does ANP prevent Na reabs

Back 24

1. block ADH and ALDO
2. Block tansport of Na directly at CD

Front 25

what is the most important hormone regulating water balance

Back 25

ADH

Front 26

what cauess ADH release

Back 26

1. increase in plasma osm
2. plasma volume decreases

Front 27

does ADH affect NaCl secretion

Back 27

NOPE!
**the independent regulation of Na and H2O is important

Front 28

where does ADH act

Back 28

it is released from teh peritubular capillay and binds to a basoleteral receptor in the CD cells.

this binding causes cAMP increase and aquaporins bind to apical side nad let water into the collecting duct for rebs

Front 29

what does putting aquaporins on the apical membrane do

Back 29

allows water to enter the CD cells so that is can be abs

**ADH (released when plasma osm increases or volume decreases)

Front 30

we said that changes in plasm osm or volume wil lincrease the release of what horomoe? what are the specific things that happen

Back 30

1. osmoreceptors in hypothalamus sense plasma osm

2, arterial baroreceptros sense changes in volume. (LARGE volume change required for activation)

Front 31

what are the 3 things that happen when ADH is secreted

Back 31

1. increase aquaporins on Cd to let H2O in for reabs

1. Na/K/2Cl transporters in the ascending thick limb LOH increase the corticomedullary grad


3. let urea pass through CD to also increase the corticomedullary gradient

Front 32

what does ADH do to the corticomedullary gradiant? how? why?

Back 32

increase hte gradient by...
1. stim the Na/K2Cl in ascending LOH
2. increase perm for urea in CD for recycle

**if we increase the gradient we can ?????????????

Front 33

is ADH more or less sensitive to changes in OSM or volume

Back 33

more sensiteive to OSM

Needs a LARGE change in volume to stim

Front 34

normal OSM is ____ when OSM is 450 what hormone is abundant

Back 34

290

**ADH, supersensitive to changes in OSM

Front 35

can ADH help in hemmorage

Back 35

sure thing! resonds well to LARGE changes in volume like a hemmorage

ADH will increase water retention in Cd, also will increase countercurrent multiplier by 1. increase Na/K/2Cl nad 2. increase urae recycling by increaseig perm of CD to urea

Front 36

if you drink a TON of pure H2o will ADH be secreted

Back 36

no!

**you are diluting the OSM nad ADH responds to increases in OSM

**also the bV is increasing adn ADh responds to decreased BV

**by NOT reabs water at Cd we incerase H2O excretion

Front 37

do ADH and ALDO usually work togeter or seperate

Back 37

usually together, both work to icnrease BV

Front 38

a decrease in plasma volume leads to what?
an increase in plasma osm leads to what

Back 38

Volume: ALDO
OSM: ADH

Front 39

what is clearance? what is OSM clearanve?

Back 39

its the ml/min of a substance cleared from plasma

Its the number of osmotically active particles cleared from blood ml/min (usually 1-2)

C= UV/P

Front 40

what is the osm clearance

P 285
U 650
V 0.8

Back 40

650 x 0.8/285

1.82 ml/min

**almost 2 ml of plasma is cleared from the blood every min

**normal is 1-2

Front 41

what is a normal rate for OSM clearance

Back 41

usually about 1-2 ml of plasma is cleared of osmotically active substances in a minute

C= UV/P

Front 42

what does it mean if OSM clearance is less than 1

Back 42

you arent clearing as many osmotically active substances, water is going to be drawn into the blood. ie edema

**caused by decreased GFR, increased ALDO

Front 43

if OSM clearance is decreased (less than 1) what is going on with GFR and ADH

Back 43

GFR decreased
ALDO increased

**osmotically active substances arent being cleared nad they are drawing water into the blood

Edema
less than 1

Front 44

what is the value of OMS clearance if water is being taken from the blood

Back 44

more than 2, LTOS of OSM actively substances are being secreted and water follows those substances out

**decreased ALDO, diuretics,

Front 45

what effect does increased ALDO, decreased ALDO, diuretics, and decreased GFR have on OSM clearnace

Back 45

1. increased ALDO decreased OSM cl
2. decreased ALDO, increased OSM Cl
3. diuretics, increase OSM
4. decreased GFR, decrease OSM cl

Front 46

what does it mean to have an increased OSM clearance

Back 46

lots of OSM are being excreted nad water is following

**loose ECF fluid

**increased decreased ALDO, diuretics

Front 47

what does aldosterone do to OSM clearance

Back 47

increase aldo will decrease OSM clearance

decreased ALDO will increase OSM clearance

Front 48

what does it mean when urine flow and OSM clearance are equal

Back 48

urine is isotonic

*C = UV/P

when C=V urine and plasma are also isotonic

Front 49

if urine flow rate (V) is the same as OSM clearance?

V more than Clearance
V less than clearance

Back 49

same: iso

V is higher, water is lost from the body and urine is hypotonic

V is lower, water is added to the body and urine is hypertonic

Front 50

when Urine flow is higher than the clearance of osmotically active substances what happens to the water being returned to the body and the tonicity of urine

Back 50

whater leave the body, hypotonic

Front 51

when urine flow is LOWER than the clearance of osmotically actice substances what happens to water returned from the body, tonicity of utine

Back 51

water is returned to the body, hypertonic

Front 52

formula for free water clearance

Back 52

CH20= V - Cosm

Front 53

what is clearance of free water

Back 53

the amt of solute free water that is being cleared by the kidney in a minuet

Ch2o = V - Cosm

Front 54

what does it mean when there is free water clearance of more than one

Back 54

dilute urine

'solute free water is lost from the body"

Ch20= V - C osm

Front 55

what does it mean when free water clearance is negative

Back 55

that water is being retained, the urine is concentrated

Front 56

to make a dilute urine what does free water clearance need to be? conc?

Back 56

dilute: + free water clearance
conc: - free water clearance

Front 57

What is free water clearance? what is teh tonicity of the urine
P osm 300
U osm 300
V 2

Back 57

1, find clearance of OSM

C= UV/P
C=300x2/300
C=2

Cho2 = V- Cosm

**the flow and C osm are the same, ISOTONIC

Front 58

determine the OSM clearance and determine if the urine is conc or dilute

Posm 300
Uosm 150
V 4

Back 58

C= UV/P
C=150x4/300
C= 2

2. Determine the Free water clearance

CH20 = V- Cosm
C= 4-2
+ free water clearance, this means water is lost and urine is dilute

Front 59

if clearance is - is NOT being CLEARED, duh, think about the terms

Back 59

water is conserved, urine is conc

when free water clearance is + it means free water is being cleared adn uriune is dilute

Front 60

what is the free water clearance

Cosm 1.5
V 2

Back 60

CH20 = 2- 1.5

0.5

+ water clearance, water is LOST from the body

Front 61

is water being lost or retained

Cosm 1.8
V 0.6

Back 61

0.6-1.8
-1.3

free water clearance is negative, water is NOT being cleared. water is retained, Conc urine

Front 62

when ther is a hyperosmotic distrubance what does this mean

Back 62

hyperosmotic relative to the ECF

Front 63

volume expansion/contraction refers to an addition/substraction of water from where

Back 63

the ECF

**terms like hyperosmotic also refer to the ECF as baseline

Front 64

what is a hyperosmotic volume contraction?

Back 64

dehydration

*loose fluid, OSM of ECF increases

**can happen with DM incipidious

Front 65

when you are dehydrated what happnes

Back 65

hyperosmotic volume contraction

*loose fluid, become hyper osmotic

**DM incipidous

Front 66

what does DM incipidous do? what is ADH like?

Back 66

ADH is low, so not lots of water being reabs

**we have HYPERosmotic plasma, and dilute urine

**ADH can be low bc it cant be secreted (neurogenic,central, DM incip) or bc the kidney doesnt respiond (plasma ASH is high)

Front 67

tell me about central Diabeted incipidous? homrome, tonicity of p adn u

Back 67

example of hyperosmotic volume contraction. "dehydration' water is lost and the ECF concentrates

**ADH isnt secreted (head trauma) and so water isnt reabs.

**urine is dilute and plasma is conc

Front 68

tell me about nephrogenic Diabetes incipidous? hormone? tonicity of P and U

Back 68

hyperosmotic, volume contraction (ECF is hyperosmotic, volume is lost from ECF) "dehydration"

**the Kidney wont respond to ADH so water is not reabs.

*ADH levels are high, plasma is conc, urine is dilute

Front 69

what is it called when you cant secrete adh, what about if your kidney wont respond to adh

Back 69

secretion: central diabetes incipidous

response: nephrogenic diabetes incipidous

*in both cases there is a hyperosmotic volumic contraction (dehydration) no h2o enters the ECF so its conc and all of the water leaves as pee so urine is dilute

Front 70

what will an Na load do to ECF osm and volume

Back 70

Hyperosmotic, Volume Expansion

**teh increase in volume leads to increase ANP, increase MAP, and decrease SNS. this all causes Na to be lost and volume to decrease

Front 71

what 3 things happen when there is an increase in plasma volume due to Na reabs

Back 71

1. increase ANP (anti aldo)
2. increase MAP; increase GFR
3. decrease SNS, decreaserenin and ALDO

ALL lead to Na loss

Front 72

when Na is taken in plasma volume ____. The ___ in plasma volume will cause loss of ______. The loss of ____ in return will do what to plasma volume ____

Back 72

increases
increase
Na
Na
decrease

Front 73

what does decrease SNS do in the kidney? is this the only way?

Back 73

decrease Renin and ALDO release

total of 3 ways to alter renin
1. macula densa
2. intrarenal baroreceptors
3. SNS

Front 74

what does ANP do

Back 74

released from atria when increased pressure

**increases GFR to increase Na filtered load. Dilates the afferent art and constricts the efferent art

Front 75

an acute water load can be called what? what happens

Back 75

hyposmotic volume expansion

Excess free water --> decrease plasma osm --> decrease ADH --> decrease h2o perm at CD --> diuresis

Front 76

when you drink pure water what happens to plasma and what hormone is affected

Back 76

plasma osm decreases
ADH decreases
no water is reabs at CD
diuresis (pee dilute)

Front 77

hypoosmotic volume expansion can be caused by what 2 things

Back 77

1. drinking pure water
2. SIADH, inappropriate ADH. EXCESSIVE ADH

Front 78

what is SIADH

Back 78

inappropriate ADH

**EXCESSIVE ADH release,

**always have hypoosmotic volume expansion

Front 79

SIADH causes chronic volume expansion of ECF what things result

Back 79

well we are always having lots of volume with decreased OSM

**ALDO will be low bc we dont need any more water in the blood, so Na is lost. Hyponaturemia

**ISF eventually expands nad dilutes

Front 80

so diabetes incipidious did what to ADH, what does the opposite

Back 80

non repsonsive to ADH, (hyperosmotic volume contraction)

**SIADH, LOTS of ADH and the body responds (hypoospotic volume expansion)

Front 81

low Na is seen in what disorder

Back 81

SIADH

**the increased ECF volume then decreases ALDO which caises MORE Na loss

Front 82

name 3 things that result from increased water abs. this is seen in what disorder, what hormone

Back 82

SIADH, high AHD levels

1. increased volume (-->decreased ALDO)
2. decreased OSM
3. Low Na

Front 83

why is Na so important

Back 83

1. major cation in ECF (135)
2. Determines volume of ECF

Front 84

are changes in [Na] in ECF due to changes in Na or changes in water

Back 84

Water

(Bv depletion, water retention, water addition)

**na loss is normally isotonic

Front 85

what is considered naturemia

Back 85

less than 135

Front 86

what 3 thigns can cause hyponaturemia

Back 86

we know it hapens when con is less than 135, and its usually due to changes in water, not na

1. Loss of blood Volume: loose the blood and the Na, this stim ADH to increase H2O but Na reamins low

2. Free water conservation (SIADH)

3. Drinking TONS of water

Front 87

why does a decrease in BV lead to decreased Na

Back 87

we loose Na along with the blood

**then ADH comes and increases H2O but doensnt help with Na so Na is further diluted

**hyponaturemia is Na less than 135

Front 88

what is hypernaturemia? what causes it? will it persist?

Back 88

high Na (more than 145)
*water loss (diabetes insipidious)
* na intake

**increased Na stim thirst so we drink and dilute it down

Front 89

what does Diabetes incipidious do to Na

Back 89

cant abs H2O so we increase na, nyponaturemia (more than 145)

Front 90

dehydration
Diabetes incipidious
Na intake lead to what

Back 90

hypernaturemia

**more than 145
**stim thirst to dilute it fst

Front 91

when Na intake increases what 3 things happen

Back 91

1. SNS decreases: decrease renin, increase GFR
2. ANP increases (increase GFR and filtered load)
3. Renin & ALDO decreases (decrease reabs)

Front 92

what happens when Na intake decreases

Back 92

1. SNS increases, increase FR
2. Decrease ANP
3. Increase renin, ALDO

Front 93

how does urine enter the bladder

Back 93

renal caylex and pelvis get full of pee and they stretch

stretch stim inherint pacemaker of SM

SM contracts it into the bladder

Front 94

what role does the SNS play in peeing

Back 94

1. Relaxes Detrusor
2. Contracts Internal Sphincter

**SNS inhibits peeing

Front 95

what role does the PNS play in peeing

Back 95

1. Contract detrusor
2. Relax internal sphincter

**PNS helps ya pee

Front 96

what part of the ANS is active during bladder filling, emptying?

Back 96

Filling: SNS
Emptying: PNS