2015: Biological Systems 1: INTER 131
Body Fluid/Electrolytes and Kidney System - 1 Credit Hour
November 20, 2015 – December 9, 2015
Monday, Wednesday, Friday 9:00 - 11:00 am lectures
Location: Medical Education Bldg, 3rd Floor, Seminar Rm #4
Section Director: Lisa M. Harrison-Bernard, PhD;
Associate Professor, Department of Physiology
Section Co-Director: Daniel R. Kapusta, PhD;
Professor, Department of Pharmacology
Faculty: Joseph B. Delcarpio, PhD;
Professor, Cell Biology and Anatomy
Richard E. Tracy, MD, PhD;
Professor Emeritus, Pathology
Course Schedule
DAY/DATE / TIME am / PROFESSOR / TOPICFri, Nov 20 / 9:00
10:00 / Delcarpio
Harrison-Bernard / Organization of the Urinary System
Body Fluid Compartments, Renal Clearance and Renal Excretion of Drugs
Mon, Nov 23 / 9:00
10:00 / Harrison-Bernard
Harrison-Bernard / Glomerular Filtration
Renal Blood Flow
Wed, Nov 25 / No Class / No Class / No Class
Fri, Nov 27 / HOLIDAY / HOLIDAY / THANKSGIVING HOLIDAY
Mon, Nov 30 / 9:00
10:00 / Harrison-Bernard
Harrison-Bernard / Quiz 1
Renal Problem Set Student Presentations
Transport of Acids and Bases
Wed, Dec 2 / 9:00
10:00 / Kapusta
Kapusta / Transport of Sodium and Chloride
Transport of Urea, Glucose, Organic Solutes, and Potassium
Fri, Dec 4 / 9:00
10:00 / Kapusta
Kapusta / Quiz 2
Urine Concentration and Dilution
Pharmacology of Diuretics
Regulation of Sodium and Water Balance
Mon, Dec 7 / 9:00
10:00 / Tracy
Harrison-Bernard / Quiz 3
Renal Pathology
Renal Failure Patient
Wed, Dec 9 / 9:00-11:00 / EXAM / Body Fluid/Electrolytes and Kidney Systems
Textbook
The recommended text for this course is "Renal Physiology”, 4th or 5th Edition, The Mosby Physiology Monograph Series by Koeppen and Stanton, and is available for purchase in the LSUHSC bookstore. ISBN-13 978-0-323-03447-0
Examination
One examination will be given which will consist of approximately 5 multiple choice questions per lecture hour.
Overall Learning Objectives
1. Describe in sequence the tubular segments through which ultrafiltrate flows after it is formed at Bowman’s capsule to when it enters the renal pelvis. Identify each structure as being located in the renal cortex or renal medulla. Based on the glomerulus location and the length of the loop of Henle, distinguish between cortical and juxtamedullary nephrons.
2. Given the body weight estimate the a) total body water, b) extracellular fluid volume, c) intracellular fluid volume, d) blood volume, and e) plasma volume. Identify normal extracellular fluid (plasma) osmolarity and concentrations of Na+, K+, Cl- and contrast these values with those for intracellular fluids.
3. Using the volumes/compartments identified in objective 2, contrast the movement between intracellular and extracellular compartments caused by increases or decreases in extracellular fluid osmolality.
4. Explain the clearance principle. Use the clearance equation and an appropriate compound to estimate the glomerular filtration rate, renal plasma flow, and renal blood flow.
5. Given the capillary and Bowman’s capsule hydrostatic and oncotic pressures, calculate the net filtration force at the glomerular capillaries. Predict the changes in glomerular filtration caused by increases or decreases in any of those pressures.
6. Describe the relative resistances of the afferent and efferent arterioles and the effects on renal blood flow and GFR of selective changes in each.
7. Describe the contribution of the major nephron segments to the reabsorption of the filtered load of solute and water.
8. Describe the nephron sites and molecular mechanisms of action of the following classes of diuretics (osmotic, carbonic anhydrase inhibitors, loop, thiazide, K+-sparing).
9. Identify the two most powerful stimuli that cause ADH release, and describe the negative feedback control mechanisms for each.
10. Diagram the formation and generation of angiotensin II, beginning with renin. Identify four factors that can promote renin release.
11. Describe the regulation of Na+ reabsorption along the nephron, including the effects of sympathetic nerves, angiotensin II, aldosterone, and atrial natriuretic peptide.
12. Describe net acid excretion by the kidneys, titratable acid, the importance of urinary buffers, and the production and excretion of ammonium. Distinguish between the reclamation of filtered bicarbonate and the formation of new bicarbonate by the kidney.
13. Understand the common symptoms and treatments for patients suffering from chronic renal failure.
Integrative Sciences: Biological Systems B
Body Fluid/Electrolytes and Kidney Systems
Organization of the Urinary System
Lecturer: Joseph B. Delcarpio, PhD
Reading: Chapters 2 in Koeppen & Stanton Renal Physiology (Mosby Physiology Monograph Series)
Learning Objectives:
1. Gain insight into the kidney adaptations to arid environments
2. Know the location of the kidneys, gross anatomic features, and components
3. Know the nephron and tubular nomenclature and the locations within the cortex and medulla
4. Know the components of the renal corpuscle and the cell types located in each component
5. Describe which structures in the glomerulus are filtration barriers to plasma proteins
6. Describe the physiological significance of the juxtaglomerular apparatus
7. Understand the blood supply to the kidneys
Integrative Sciences: Biological Systems B
Body Fluid/Electrolytes and Kidney Systems
Body Fluids Compartments, Renal Clearance and Renal Excretion of Drugs
Lecturer: Lisa M Harrison-Bernard, PhD
Reading: Chapters 1 & 3 in Koeppen & Stanton Renal Physiology (Mosby Physiology Monograph Series)
Learning Objectives:
1. Given the body weight, estimate the a) total body water, b) extracellular water, c) intracellular water, d) blood volume, and e) plasma volume. Identify normal extracellular fluid (plasma) osmolarity and concentrations of Na+, K+, Cl-, HCO3, proteins, creatinine, and contrast these values with those for intracellular fluids.
2. Predict the changes in extracellular fluid volume, extracellular fluid osmolality, intracellular fluid volume, and intracellular fluid osmolality caused by intravenous infusion of three liters of 0.9% NaCl (isotonic), 0.45% NaCl (hypotonic), and 7.5% NaCl (hypertonic).
3. Explain the clearance principle. Use the clearance equation and an appropriate compound to estimate the glomerular filtration rate (GFR), renal plasma flow (RPF), and renal blood flow (RBF).
4. Given the appropriate plasma and urine concentrations and the urine flow, calculate the filtered load, tubular transport, and excretion rate of a given compound. Given the appropriate plasma and urine concentrations and the urine flow, calculate the clearance of inulin, creatinine, para-amino hippuric acid (PAH), and glucose. Predict how changes in filtration, reabsorption, and secretion will affect renal excretion of each compound.
Integrative Sciences: Biological Systems B
Body Fluid/Electrolytes and Kidney Systems
Renal Blood Flow and Glomerular Filtration
Lecturer: Lisa M Harrison-Bernard, PhD
Reading: Chapter 3 in Koeppen & Stanton Renal Physiology (Mosby Physiology Monograph Series)
Learning Objectives:
1. Describe how the Starling hypothesis of capillary exchange applies to the glomerular capillaries and the process of glomerular filtration. Describe typical values of the Starling forces and how changes in them would affect glomerular filtration.
2. Describe how the Starling hypothesis of capillary exchange applies to the peritubular capillaries and the process of fluid reabsorption. Describe typical values of the Starling forces and how changes in them would affect the rate of fluid reabsorption.
3. List the 3 components of the glomerular filtration barrier and describe their relative contribution to the composition of the glomerular filtrate.
4. Define the filtration coefficient at the glomerular capillary and explain its role in determining glomerular filtration rate.
5. Given the capillary and Bowman’s capsule hydrostatic and oncotic pressures, calculate the net filtration force at the glomerular capillaries. Predict the changes in glomerular filtration caused by increases or decreases in any of those pressures.
6. Define renal blood flow, plasma flow, glomerular filtration rate, and filtration fraction.
7. Know the average values for renal blood flow and glomerular filtration rate in adult humans. Compare kidney blood flow and oxygen consumption to that of skeletal muscle.
8. Describe the relative resistances of the afferent and efferent arterioles and the effects on renal blood flow and glomerular filtration rate of selective changes in each.
9. Define and describe autoregulation of renal blood flow and glomerular filtration rate.
10. Define and describe the myogenic and tubuloglomerular feedback mechanisms that mediate the autoregulation of renal blood flow and glomerular filtration rate.
11. Predict the changes in renal blood flow and glomerular filtration caused by: a) increased synthesis of angiotensin II, b) increased release of atrial natriuretic peptide, c) increase in renal sympathetic nerve activity, d) increase secretion of arginine vasopressin, and e) increased prostaglandin formation, f) increased nitric oxide formation.
12. Know the effects of hormones, paracrine factors and autocoids on the resistance of afferent and efferent arterioles.
Renal Physiology Block Page XXX of 17
Integrative Sciences: Biological Systems B
Body Fluid/Electrolytes and Kidney Systems
Problem Set
Complete the Problem Set on Your Own. The key will be posted on June 2.
I. Body Fluid Problems - Shifts of water between compartments
What is the direction of change (↔, , ↓) after equilibration for the following 7 parameters?
1. Volume of Total Body Water (TBW)?
2. Total Body Osmolality?
3. Extracellular Fluid (ECF) Osmolality?
4. Extracellular Fluid (ECF) Volume?
5. Intracellular Fluid (ICF) Volume?
6. Plasma protein concentration (PPC)?
7. Arterial blood pressure (BP)?
A. Infusion of isotonic NaCl (isosmotic volume expansion)
B. Diarrhea - loss of isotonic fluid (isosmotic volume contraction)
C. Excessive NaCl intake - addition of NaCl (hyperosmotic volume expansion)
D. Sweating in a desert - loss of water (hyperosmotic volume contraction)
E. Syndrome of inappropriate antidiuretic hormone (SIADH) - gain of water (hypoosmotic volume expansion)
F. Adrenocortical insufficiency - loss of NaCl (hypoosmotic volume contraction)
TBW(L) / TBW Osmolality
(mosmol/kgH20) / ECF Volume
(L) / ECF Osmolality
(mosmol/kg H20) / ICF Volume
(L) / PPC
(g%) / Blood Pressure
(mmHg)
A
B
C
D
E
F
II. Starling Forces
1. At the afferent arteriolar end of a glomerular capillary, PGC is 45 mmHg, PBS is 10 mmHg, and GC is 27 mmHg.
What are the value and direction of the net ultrafiltration pressure?
III. Renal Clearance, Renal Blood Flow, Glomerular Filtration Rate, etc.
2. To measure GFR:
Infuse inulin intravenously until PIN is stable. Measure urine volume produced in a known period of time (urine flow). Measure PIN and UIN.
Given the following:
PIN = 0.5 mg/ml
UIN = 60 mg/ml
Urine flow = 1.0 ml/min
What is GFR?
3. To measure CPAH:
Infuse PAH. Obtain a timed, complete urine collection and a blood sample.
Measure PPAH, UPAH, and urine flow.
Renal Physiology Block Page XXX of 17
Given the following:
PPAH = 0.05 mg/ml
UPAH = 29.5 mg/ml
Urine flow = 1.0 ml/min
What is CPAH?
4. Calculation of Renal Blood Flow (RBF): RBF = RPF (1–Hct )
Given the following:
Hematocrit = 0.45
RPF calculated in problem #3
What is RBF = ?
5. Calculation of Filtration Fraction (FF): Fraction (%) of renal plasma flow that is filtered (moves across the glomerular capillary walls into the Bowman's space) as blood traverses the kidney. FF = GFR RPF
Given the GFR and RPF calculated in problems #2 and #3, what is FF = ?
6. Creatinine is a substance that is excreted primarily by filtration and is produced by the body at a fairly constant rate. Thus, it can be used to estimate glomerular filtration rate (GFR).
Given the following data:
24 hour urine volume = 1.2 liters
UCr = 144 mg/100 ml
PCr = 2 mg/100 ml
6A. Calculate the GFR.
6B. Is this value below normal, normal, or above normal?
7. In many experimental studies, inulin is used to measure GFR because it is easily measured and only filtered. Also, PAH is used to estimate the plasma flow because the kidney extracts it from plasma very efficiently.
Given the following data:
urine flow = 3 ml/min
PIN = 0.22 mg/ml
UIN = 9.5 mg/ml
PPAH = 0.08 mg/ml
UPAH = 20 mg/ml
7A. Calculate the GFR and PAH clearances.
7B. Calculate the filtration fraction.
7C. If the hematocrit is 0.40, what is the total renal blood flow?
Integrative Sciences: Biological Systems B
Body Fluid/Electrolytes and Kidney Systems
Transport of Sodium Chloride
Lecturer: Daniel R. Kapusta, Ph.D.
Reading: Chapters 4, 7, and 10 in Koeppen & Stanton Renal Physiology (Mosby Physiology Monograph Series)
Learning Objectives:
1. Know the renal processes involved in the formation of urine.
2. Describe the contribution of the major nephron segments to the reabsorption of the filtered load of solute and water.
3. Describe the cellular mechanisms involved in the transport of Na+, Cl- and water by each of the major tubular segments.
4. Describe the pathways involved in the renal tubular reabsorption of filtered bicarbonate and glucose in the proximal tubules.
5. Understand the principle of osmotic diuresis as applies to the drug mannitol and hyperglycemia. Understand the urinary effects caused by inhibition of carbonic anhydrase inhibitor diuretics.
6. Describe the transporter responsible for Na reabsorption in the thick ascending limb and its importance in the action of loop diuretics.
7. Describe the transporter responsible for Na reabsorption in the early distal convoluted tubules and its importance in the action of thiazide diuretics.
8. Describe the transporters responsible for Na reabsorption and potassium secretion in the late distal tubule and how aldosterone can influence transporter activity. Understand how these pathways can be altered by potassium-sparing diuretics.
9. Describe the mechanism by which vasopressin (antidiuretic hormone) alters water transport in the collecting duct and how ‘water diuretics’ alter this process.
Integrative Sciences: Biological Systems B
Body Fluid/Electrolytes and Kidney Systems
Urine Concentration and Dilution
Lecturer: Daniel R. Kapusta, Ph.D.
Reading: Chapters 5 and 6 in Koeppen & Stanton Renal Physiology (Mosby Physiology Monograph Series)
Learning Objectives:
1. Know the renal processes involved in the concentration and dilution of urine.
2. Explain how the transport and permeability characteristics of the descending and ascending segments of the loop of Henle enable the kidneys to produce concentrated urine.
3. Describe how the renal tubular handling of urea contributes to the production of concentrated urine. Know that urea is filtered, reabsorbed and secreted and that urea recycling is responsible for the buildup of high [urea] in the inner medulla.