COURSE OBJECTIVES
The objectives of this course are to have students master the following topics and to apply this knowledge to problems and case studies relevant to clinical physiology.
COURSE OUTLINE
INTRODUCTION
- Roles of the Kidney
- Typical composition of plasma and urine
- Urine formation rate
FUNCTIONAL ANATOMY OF THE RENAL SYSTEM
- Role of the ureter, bladder, urethra
- Components of the nephron
RENAL BLOOD FLOW
- Components of the renal circulation
- Rate and distribution of renal blood flow
- Roles
- Control of blood flow:
- Nervous system (essential?)
- Pressure; autoregulation
- Interaction of nervous and autoregulation
GLOMERULAR FILTRATION
- Glomerular filtrate composition
- Mechanism; hydrostatic and osmotic pressures; role of afferent and efferent arterioles
- Glomerular filtration rate; autoregulation of GFR
PROXIMAL TUBULE TRANSPORT
- Role; reabsorption and secretion; transcellular and paracellular transport
- Primary active transport; Na-K-ATPase pump; Na reabsorption
- Secondary active transport; mechanism, glucose, amino acids, etc.
- Passive reabsorption; mechanism, chloride, potassium, urea
- Water reabsorption; forces and consequences for solute transport
- Active secretion
- Rate and composition of fluid leaving the proximal tubule
- Tubular transport maximum; glucosuria
CLEARANCE
- Formula
- Interpretation; relation to filtration and tubular transport
- Significance of creatinine/inulin and PAH clearance
RENAL WATER EXCRETION
- Functional anatomy of cortical and juxtamedullary nephrons
- Permeability and transport in the Loop of Henle and initial distal tubule
- thin descending limb, thin ascending limb, thick ascending limb
- Osmolar concentration in the renal medulla; countercurrent multiplication
- Role of urea
- Role of the vasa recta; countercurrent exchange
- Volume and composition of fluid leaving the Loop of Henle and initial distal tubule
- Water transport and permeability of the later distal tubule and collecting duct
RENAL WATER REGULATION
- ADH synthesis and release
- ADH action
- Control of ADH release and mechanisms
- Plasma osmolality and hypothalamic osmoreceptors
- Blood volume and low pressure baroreceptors
- Systemic arterial pressure and high pressure baroreceptors
- Other influences
- Osmolality of urine and rate of urine excretion
- Defense of body osmolar homeostasis
RENAL ELECTROLYTE TRANSPORT
- Sodium transport: proximal tubule, Loop of Henle, distal tubule and collecting ducts
- Chloride transport: proximal tubule, Loop of Henle, distal tubule and collecting ducts
- Potassium transport: proximal tubule, Loop of Henle, distal tubule and collecting ducts
RENAL ELECTROLYTE REGULATION
- Renin: synthesis and release; control; actions
- Angiotensin: synthesis and release, control; actions
- Aldosterone: synthesis and release; control; actions
- Atrial Natriuretic Peptide (ANP): synthesis and release; control; actions
- Urodilatin
- Summary of control
- Defense of extracellular Na and K composition
EXTRACELLULAR VOLUME REGULATION
- Sodium and extracellular volume
- Role of ADH, Renin-Angiotensin-Aldosterone system, ANP
- Defense of body extracellular volume
ACID-BASE BALANCE
- Introduction: normal pH values; acidosis, alkalosis vs. acidemia, alkalemia; pathophysiology
- Forms and Sources of H+: acid, base definition, metabolic sources, buffers, bicarbonate-CO2 system
- Disturbances of Acid-Base Balance
- Defenses Against pH Disturbance: buffers, respiratory compensation, renal compensation
- Evaluation of Acid-Base Status
- Diagnosis from Blood Values