56. Renal Physiology

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56. Renal Physiology

56. Renal Physiology

 

 

CATEGORY: Medical & Medicine – 500 Courses

COURSE NUMBER: 56

FEES: 555/- INR only

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BOOKS/ MANUALS: Pages

Syllabus

CHAPTER 1
PHYSIOLOGY OF BODY
FLUIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Objectives 1
Physicochemical Properties of Electrolyte
Solutions 1
Molarity and Equivalence 1
Osmosis and Osmotic Pressure 2
Osmolarity and Osmolality 3
Tonicity 3
Oncotic Pressure 4
Specific Gravity 4
Volumes of Body Fluid Compartments 4
Composition of Body Fluid
Compartments 6
Fluid Exchange Between Body Fluid
Compartments 7
Capillary Fluid Exchange 7
Cellular Fluid Exchange 9
Summary 12
Key Words and Concepts 12
Self-Study Problems 12

CHAPTER 2
STRUCTURE AND FUNCTION
OF THE KIDNEYS . . . . . . . . . . . . . . . . . 15
Objectives 15
Structure of the Kidneys 15
Gross Anatomy 15

Ultrastructure of the Nephron 17
Ultrastructure of the Glomerulus 20
Ultrastructure of the Juxtaglomerular
Apparatus 24
Innervation of the Kidneys 24
Summary 25
Key Words and Concepts 25
Self-Study Problems 26

CHAPTER 3
GLOMERULAR FILTRATION AND
RENAL BLOOD FLOW . . . . . . . . . . . 27
Objectives 27
Renal Clearance 27
Glomerular Filtration Rate 29
Glomerular Filtration 31
Determinants of Ultrafiltrate
Composition 31
Dynamics of Ultrafiltration 32
Renal Blood Flow 33
Regulation of Renal Blood Flow and
Glomerular Filtration Rate 36
Sympathetic Nerves 37
Angiotensin II 37
Prostaglandins 37
Nitric Oxide 39
Endothelin 39
Bradykinin 40
Adenosine 40
Natriuretic Peptides 40

Adenosine Triphosphate 40
Glucocorticoids 40
Histamine 40
Dopamine 40
Summary 42
Key Words and Concepts 42
Self-Study Problems 42

CHAPTER 4
RENAL TRANSPORT
MECHANISMS: NaCl AND WATER
ABSORPTION ALONG THE
NEPHRON . . . . . . . . . . . . . . 45
Objectives 45
General Principles of Membrane
Transport 46
General Principles of Transepithelial Solute
and Water Transport 49
NaCl, Solute, and Water Reabsorption Along
the Nephron 50
Proximal Tubule 50
Henle’s Loop 58
Distal Tubule and Collecting Duct 61
Regulation of NaCl and Water
Reabsorption 62
Summary 70
Key Words and Concepts 70
Self-Study Problems 70

CHAPTER 5
REGULATION OF BODY FLUID
OSMOLALITY: REGULATION OF
WATER BALANCE . . . . . . . . . 73
Objectives 73
Arginine Vasopressin 75

Osmotic Control of Arginine Vasopressin
Secretion 76
Hemodynamic Control of Arginine
Vasopressin Secretion 77
Arginine Vasopressin Actions on the
Kidneys 78
Thirst 82
Renal Mechanisms for Dilution and
Concentration of the Urine 82
Role of Urea 87
Vasa Recta Function 88
Assessment of Renal Diluting and
Concentrating Ability 89
Summary 91
Key Words and Concepts 91
Self-Study Problems 92

CHAPTER 6
REGULATION OF
EXTRACELLULAR FLUID VOLUME
AND NaCl BALANCE . . . . . . . . . . . . . 93
Objectives 93
Concept of Effective Circulating Volume 95
Volume-Sensing Systems 96
Volume Sensors in the Low-Pressure
Cardiopulmonary Circuit 96
Volume Sensors in the High-Pressure
Arterial Circuit 97
Hepatic Sensors 97
Central Nervous System Na+ Sensors 98
Volume Sensor Signals 98
Renal Sympathetic Nerves 98
Renin-Angiotensin-Aldosterone
System 99
Natriuretic Peptides 102
Arginine Vasopressin 103
Control of Renal NaCl Excretion During
Euvolemia 103

Mechanisms for Maintaining Constant
Na+ Delivery to the Distal
Tubule 104
Regulation of Distal Tubule and
Collecting Duct Na+
Reabsorption 105
Control of Na+ Excretion with Volume
Expansion 105
Control of Na+ Excretion with Volume
Contraction 107
Edema 109
Alterations in Starling Forces 109
Role of the Kidneys 111
Summary 112
Key Words and Concepts 113
Self-Study Problems 113

CHAPTER 7
REGULATION OF POTASSIUM
BALANCE . . . . . . . . . . . . . . . . . . . . . . . . 115
Objectives 115
Overview of K+ Homeostasis 115
Regulation of Plasma [K+] 117
Epinephrine 118
Insulin 118
Aldosterone 118
Alterations of Plasma [K+] 119
Acid-Base Balance 119
Plasma Osmolality 119
Cell Lysis 120
Exercise 120
K+ Excretion by the Kidneys 120
Cellular Mechanisms of K+ Transport by
Principal Cells and Intercalated Cells in the
Distal Tubule and Collecting Duct 122
Regulation of K+ Secretion by the Distal
Tubule and Collecting Duct 123
Plasma [K+] 123

Aldosterone 124
Arginine Vasopressin 125
Factors that Perturb K+ Excretion 125
Flow of Tubular Fluid 125
Acid-Base Balance 127
Glucocorticoids 129
Summary 130
Key Words and Concepts 130
Self-Study Problems 130

CHAPTER 8
REGULATION OF ACID-BASE
BALANCE . . . . . . . . . . . . . . . . . . . . . . . . 131
Objectives 131
HCO−
3 Buffer System 132
Overview of Acid-Base Balance 132
Renal Net Acid Excretion 134
HCO−
3 Reabsorption Along the
Nephron 135
Regulation of H+ Secretion 138
Formation of New HCO−
3 139
Response to Acid-Base Disorders 143
Extracellular and Intracellular
Buffers 144
Respiratory Compensation 144
Renal Compensation 146
Simple Acid-Base Disorders 146
Metabolic Acidosis 146
Metabolic Alkalosis 147
Respiratory Acidosis 147
Respiratory Alkalosis 148
Analysis of Acid-Base Disorders 148
Summary 150
Key Words and Concepts 150
Self-Study Problems 151

CHAPTER 9
REGULATION OF CALCIUM AND
PHOSPHATE HOMEOSTASIS 153
Objectives 153
Calcium 154
Overview of Ca++ Homeostasis 156
Ca++ Transport Along the Nephron 157
Regulation of Urinary Ca++
Excretion 159
Calcium-Sensing Receptor 160
Phosphate 160
Overview of Pi

Homeostasis 161

Pi
Transport Along the Nephron 162
Regulation of Urinary Pi

Excretion 163
Integrative Review of Parathyroid Hormone
and Calcitrol on Ca++ and Pi
Homeostasis 164
Summary 165
Key Words and Concepts 166
Self-Study Problems 166

CHAPTER 10
PHYSIOLOGY OF DIURETIC
ACTION . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Objectives 167
General Principles of Diuretic Action 168
Sites of Action of Diuretics 168
Response of Other Nephron
Segments 168
Adequate Delivery of Diuretics to Their
Site of Action 169
Volume of the Extracellular Fluid 169
Diuretic Braking Phenomenon 169
Mechanisms of Action of Diuretics 171
Osmotic Diuretics 171

Carbonic Anhydrase Inhibitors 171
Loop Diuretics 172
Thiazide Diuretics 172
K+-Sparing Diuretics 173
Aquaretics 173
Effect of Diuretics on the Excretion of Water
and Solutes 173
Solute-Free Water 174
K+ Excretion 174
HCO−
3 Excretion 175
Ca++ and Pi

Excretion 175

Summary 176
Key Words and Concepts 177
Self-Study Problems 177
ADDITIONAL READING 179

A P P E N D I X A
INTEGRATIVE CASE STUDIES . . . . . . . . 181

A P P E N D I X B
NORMAL LABORATORY VALUES . . . . . . 185

A P P E N D I X C
NEPHRON FUNCTION . . . . . . . . . . . . . 187

A P P E N D I X D
ANSWERS TO SELF-STUDY
PROBLEMS . . . . . . . . . . . . . . . . . . . . . 191

A P P E N D I X E
ANSWERS TO INTEGRATIVE
CASE STUDIES . . . . . . . . . . . . . . . . . . . 205

A P P E N D I X F
REVIEW EXAMINATION . . . . . . . . . . . . 213

INDEX . . . . . . . . . . . . . . . . . . . . . . . . . 227

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