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Renal Phys 5: Concentrating and diluting
Pasley 4/26 lecture 1 hr
45
Physiology
Undergraduate 4
04/20/2011

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Term
max: 1200-1400 mOsm/L specific g: 1.030
min: 50-70 mOsm/L specific g: 1.003
Definition
what is the maximal urine concentration? what is the minimum?
Term
directly proportional
Definition
how are urine osmolarity and specific gravity related?
Term
glucose in the urine and protein in the urine
Definition
what influences urine osmolarity/specific gravity?
Term
no, water is separate
Definition
is water excretion the same as solute excretion?
Term
adh will be low if you are well hydrated
urine will be hypotonic (for about 2 hours)
Definition
if you drink a liter of water, what happens to your ADH levels? describe the concentration of your urine
Term
1) absorb electrolytes, but not water
2) decrease ADH, and decrease H2O permeability in DCT/collecting duct
3) high osmolarity in the renal medulla maintained via countercurrent exchange
Definition
how do you form dilute urine?
Term
obligatory urine volume
Definition
the minimum volume in which ingested solutes can be dissolved and excreted
Term
600 mOsm/day / 1200 mOsm/ L = 0.5 L/day
Definition
if the max urine osmolarity is 1200 mOsm/L and 600 mOsm of solute must be excreted to maintain electrolyte balance each day, what is the obligatory urine volume?
Term
the max urine osmolarity the kidneys can produce ex: if you can only concentrate to 300 mOsm/L and you still need to get out 600, the obligatory volume is now 2.0 L/day to get out all the solutes
Definition
what determines the obligatory urine volume?
Term
arginine vasopressin (AVP)
Definition
whats another name for antidiuretic hormone (ADH)
Term
ADH
Definition
what allows for differential control of H2O and solute excretion? (this is important in controlling ECF osmolarity)
Term
1)vasopressin binds to a g protein coupled receptor
2) CAMP caskade -> pKa -> phosphorylation
3) causes immigration of aquaporin 2 channels to the luminal membrane to allow H2O reabsorption
Definition
how does AVP work?
Term
countercurrent exchange (basically the artery and vein are close enough to each other the heat is transferred before the fluid circulates, preventing heat loss & keeping it close to the body, while maintaining flow
Definition
what does thermoregulation in a seagull's leg illustrate?
Term
1) tri-pump active transport to medullary interstitium
2) active transport of ions from medullary collecting ducts to interstitium
3) passive diffusion of urea from medullary collecting ducts to interstitium

4) diffusion of little H2O to medullary interstitium
Definition
how is the medullary concentration increased?
Term
paracellular diffusion in thick ascending limb
Definition
how are Mg and Ca++ reabsorbed?
Term
anatomical relationships of LoH, vasa recta, & collecting ducts
Definition
what does the countercurrent multiplier mechanism depend on?
Term
25%
Definition
how many nephrons are juxtamedullary with long LoH in the medulla?
Term
H2O absorption in descending LoH
Definition
what enhances the high osmolarity of the interstitium in the medulla?
Term
6-8 months of age
Definition
when is the countercurrent gradient established?
Term
PCT
Definition
where does the LoH receive continuous NaCl from?
Term
anywhere there is a pump, but thick ascending limb is important
Definition
where is there continuous resorption of NaCl into the interstitium?
Term
NOT permeable
Definition
describe the ascending limb's permeability to water
Term
NOT permeable
Definition
describe the ascending limb's permeability to water
Term
Na+ and H2O both (plus other junk)
Definition
what is the descending limb permeable to?
Term
H2O reabsorption in DCT
Definition
what helps to dilute the cortical interstitium & maintain the osmolar gradient?
Term
after filtration, helps to re-absorbe H2O in DCT with help of ADH, this concentrates the urine
Definition
when is blood in the vasa recta concentrated? what does this do?
Term
the ascending LoH
Definition
when solute leaves the vasa recta's ascending loop, where is it reabsorbed?
Term
where it passes the descending LoH
Definition
where does high concentrated solute begin to enter the vasa recta?
Term
1-2%
Definition
what percent of renal blood flow do the vasa recta make up?
Term
the vasa recta
Definition
what are the counter current exchangers to the renal tubules?
Term
1) more solute than H2O is added to the renal medulla (solutes are trapped here)

2) fluid in the ascending loop is diluted

3) most of the H2O reabsorption occurs in the cortex (PCT, DCT) not the medulla

3) horizontal gradient of solute concentration established by the active pumping of NaCl is multiplied by the countercurrent flow
Definition
what are the net effects of the countercurrent multiplier?
Term
the proximal tubule
Definition
where is urea passively reabsorbed?
Term
distal and collecting tubules
Definition
where is water resabsorbed in the presence of ADH to concentrate urea?
Term
the medullary collecting tubule (urea diffuses into the interstitium here)
Definition
what tubule is HIGHLY permeable to urea?
Term
increases it
Definition
what does ADH do to urea permeability in the medullary collecting tubule?
Term
50% of filtered urea is reabsorbed in the PCT

then the countercurrent mechanism pumps urea from the collecting tubule back into the thin LoH in the medulla which ends up reconcentrating it at the DCT
Definition
where is 50% of urea reabsorbed? why does the DCT have 100% of the urea back in it?
Term
only 20%, the rest is reabsorbed to help with the concentration gradient
Definition
how much urea is excreted in each pass through the nephron?
Term
1) GFR
2) plasma urea concentration
Definition
what determines rate of urea excretion?
Term
uremia
Definition
abnormal elevation of urea in the plasma
Term
everywhere but the thin limbs

ESPECIALLY in the thick ascending and PCT
Definition
where is sodium actively reabsorbed?
Term
PCT, thin loops(both)
Definition
where is sodium passively reabsorbed?
Term
reabsorbed: PCT, thin descending
NOT: thin ascending, thick ascending
with ADH: DCT, all collecting tubule
Definition
where is water reabsorbed? where is it NOT? where does it depend on ADH?
Term
reabsorbed: PCT, thin loops (both)
+ ADH: medullary collecting tubule
Definition
where is urea reabsorbed? with ADH?
Term
urine flow rate - [(urine osmolarity * urine flow rate) / plasma osmolarity]
Definition
what is the equation for free water clearance (CH2O?)
Term
negative (no clearance)
Definition
what is free water clearance if urine osmolarity is greater than plasma osmolarity?
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