A353 Clinical Chemistry Problem 4 Functioning? Worksheet 1.

The picture below shows nephrons (found in the kidneys), which are involved in the following processes: a. Glomerular Filtration (Ultrafiltration) b. Tubular Reabsorption c. Tubular Secretion

a. Identify where in the nephron each of the processes occurs. Nephron- basic structional and functional unit of the kidney.

Bowman's capsule. Located at the closed end, the wall of the nephron is pushed in forming a double-walled chamber. Glomerulus. A capillary network within the Bowman's capsule. Blood leaving the glomerulus passes into a second capillary network surrounding the Proximal convoluted tubule. Coiled and lined with cells carpeted with microvilli and stuffed with mitochondria. Loop of Henle. It makes a hairpin turn and returns to the Distal convoluted tubule, which is also highly coiled and surrounded by capillaries. Collecting duct. It leads to the pelvis of the kidney from where urine flows to the bladder and, periodically, on to the outside world

What takes place in each of the three processes? Match the processes to the list on the right. Glomerular Filtration (Ultrafiltration) Tubular Reabsorption About 99% of the filtrate is reabsorbed H+ ions are actively transported into the proximal tubule Movement of materials across the glomerulus in to the Bowmans capsule

Tubular Secretion

2. Electrolytes reflect the amount of ions in the body fluids. Proper electrolyte balance within the fluid compartments is essential to normal cellular functions. The bodys fluids are compartmentalized accordingly: intracellular fluid (ICF) and extracellular fluid (ECF). The water content in these compartments is dependent upon the compartments osmotic contents. Any change in solute content of a

compartment creates a shift of water, which restores isotonicity. a. Which electrolytes are important in maintaining fluid balance?
b.

Which electrolyte is the major contributor to the osmolality of the ECF? Sodium, potassium, chloride, bicarbonate

Sodium. Soidum influence the water content and blood pressure. c. Which electrolyte is in highest concentration in the ICF? Sodium. d. What is the importance of potassium in the body? Potassium which is in the exracellular fluid help to remove sodium in the intracellular fluid due to osmolity difference. e. Which electrolyte is important in pH balance? H+. IF there is too much hydrogen which means to acidic. To increase the PH, more hydrogen is secreted. If the PH is too acidic less hydrogen is secreted. To secrete H+, the hydrogen react with ammonia and form ammonium which move out of the kidnay and it revert back to ammonia and hydrogen which hydrogen is secreted, 3. The amount of electrolytes is distributed between the ICF and ECF. Highlight in the diagram below to illustrate the electrolyte distribution.
Intracellular space Extracellular space (plasma/intercellular space) Sodium: High / Low Potassium: High / Low Chloride: High / Low Bicarbonate: High / Low

Sodium: High / Low Potassium: High / Low Chloride: High / Low Bicarbonate: High / Low

4. Electrolyte imbalance occurs when serum concentration of an electrolyte is either too high or too low, affecting all organs and systems in body. Homeostatic mechanisms regulate the distribution of fluid and electrolytes within various body compartments, as well as their excretion. (http://kidney.niddk.nih.gov/Kudiseases/pubs/yourkid neys/) (http://www.anytestkits.com/kidney-functionsregulating-of-it.htm) (http://mcb.berkeley.edu/courses/mcb135e/kidneyflui d.html) a. What are the hormones involved in water and salt regulation by the kidneys? Anti-diuretic hormone (ADH) - to limit the amount of water being lost in urine Aldosterone hormone - to increase re-absorption of sodium and the secretion of potassium b. What are the organs responsible in producing these regulatory hormones? ADH pituitary gland in the brain Aldosterone - kidney c. The hormones target different parts of the kidneys. What effect do these hormones have on the kidneys and which parts of the kidneys do the hormones target to conduct regulation?
Aldosterone - The kidneys sense low blood pressure (which results in lower filtration rates and lower flow

through the tubule). This triggers a complex response to raise blood pressure and conserve volume. Specialized cells (juxtaglomerular cells) in the afferent and efferent arterioles produce renin, a peptide hormone that initiates a hormonal cascade that ultimately produces angiotensin II. Angiotensin II stimulates the adrenal cortex to produce aldosterone. ADH binds to receptors on cells in the collecting ducts of the kidney and promotes reabsorption of water back into the circulation. ADH plays a role in lowering osmolarity (reducing sodium concentration) by increasing water reabsorption in the kidneys, thus helping to dilute bodily fluids. The DCT reacts to the amount of ADH in the blood. The more ADH is present in the blood, the more water is re-absorbed into it. This happens because the presence of ADH in the blood causes the cells in the last section of the DCT (and associated tubules and collecting ducts) to become more permeable to water, therefore they allow more water to pass from the tubular fluid back into the blood. This results in more concentrated urine.

Parathyroid hormone (PTH) is responsible for the endocrine regulation of calcium and phosphate. When blood levels of calcium decrease it stimulates the production of PTH, which has three physiological effects, one having a direct bearing on the kidneys. In the kidneys the parathyroid hormone increases calcium reabsorption in the renal tubules, while phosphates are not really affected.

d. Examine how the electrolytes are regulated. Blood Plas compone ma nts level s Sodium Low Possible Causes Regulation mechanism

Severe diarrhoea Acidosis

Sodium reabsorption: 1. 70% reabsorbed in the proximal

Decrease aldosterone secretion Renal disease (poor ion exchange)

tubule by isoosmotic reabsorption (linked to Cl- to maintain electrical neutrality) 2. Na+ reabsorbed in exchange for H+ (reaction linked to HCO3-) 3. Aldosterone secretion induces Na+ reabsorption in exchange for K+ in distal tubules
ADH causes the insertion of water channels into the membranes of cells lining the collecting ducts, allowing water reabsorption to occur. ADH plays a role in lowering osmolarity (reducing sodium concentration) by increasing water reabsorption in the kidneys, thus helping to dilute bodily fluids.

Sodium

High

Hypernatremia Water reabsorption Dehydration Too little ADH Diabetes insipidus

Potassium Low

Excessive loss due to vomiting, diarrhoea, or use of diuretics Increased aldosterone

Active reabsorption in the proximal tubule Exchange with Na+ is stimulated by aldosterone

Decreased K intake Potassium High Hyperkalemia Sodium level goes down Decreased aldosterone Increased K intake Chloride Low Excessive loss due to vomiting, diabetic ketoacidosis, aldosterone deficiency Reabsorbed by passive transport in the proximal tubule Exchange with Na+ is stimulated by aldosterone

Chloride

High

Loss of Active reabsorption body in proximal tubule fluids from prolonge d vomiting, diarrhea, sweating or high fever (dehydra tion). Severe constipat ion High levels of blood sodium.

 Kidney failure, or kidney disorders Diabetes insipidus or diabetic coma

Phosphat e

Low

-poor -Regulation of PTH absorption vitamin D help to of uptake of calcium phosphate - lacking in vitaminD increased loss of bicarbonat e from urine

Phosphat e

High

Cellular breakdown

Reabsorption inhibited by PTH (Excretion is by calcitonin) ADH acts on the Loop of Henle and collecting ducts enabling water reabsorption Aldosterone need to increase reabsorption of

Water

Low

Dehydration

Water

High

Severe diarrhoea

sodium
5.

Urea and creatinine are waste materials in the blood that are excreted out by the kidneys. a. What is the relationship between urea and creatinine?

(urea on a blood urea nitrogen=BUN) Elevation of BUN out of proportion to the level of serum creatinine Shows that they have gastrointestinal bleed (increased urea production)/ urinary tract obstruction (reabsorption of urea)/ steroid therapy Ratio of BUN to creatinine is usually between 10:1 and 20:1.

b. What does an increase in urea concentration in the blood indicate?

High BUN high level of urea Means kidney function is impaired Could also be due to excess production of urea in your body or decreased blood flow to the kidneys

6.

How do all these analytes (electrolytes, urea and creatinine) influence the movement of water?

Electrolytes: Sodium -> chief cation of ECF and ionized potassium -> chief cation of ICF. Na and K controls the amount of water retained in any given compartment. Usual bases for shifts in water from one compartment to another are ECF changes in concentration of these electrolytes. It causes a shift of water into or out of the cell to maintain balance/homeostasis.

Creatine An osmotically active compound, it draws water into the cells where creatine is stored. Thus the body moves water inside the muscle cells, increasing cell volume and giving your muscles that postworkout pumped look

Urea

-> a small hydrophilic solute, also a denaturant for proteins.

It act as a structure breaker of water, promoting the formation of a dense, disordered liquid structure.

Going Further: 7. What is the relationship between the kidneys and the analytes measured? - The End -