Renal Physiology

Bruce Koeppen, founding dean of the Frank H. Netter MD School of Medicine at Quinnipiac, recently received two prestigious awards: honored by the Patient is U Foundation - a nonprofit that aims to encourage human communication in health care and support both patients and providers and the (LCME) Liaison Committee on Medical Education's 2019 Distinguished Service Award. Bruce Stanton received the Unsung Hero Award in 2019 from the Cystic Fibrosis Foundation. He played a key role in the development of Vertex modulators and is connected with sparking the creation of a Patient Registry which has had an enormous impact on the length and quality of lives in CF patients.

INTRODUCTION

CHAPTER 1

PHYSIOLOGY OF BODY FLUIDS

Objectives

Concept of Steady-State Balance

Physicochemical Properties of Electrolyte Solutions

Molarity and Equivalence

Osmosis and Osmotic Pressure

Osmolarity and Osmolality

Tonicity

Oncotic Pressure

Specific Gravity

Volumes of Body Fluid Compartments

Composition of Body Fluid Compartments

Fluid Exchange between Body Fluid Compartments

Capillary Fluid Exchange

Cellular Fluid Exchange

Summary

Key Words and Concepts

Self-Study Problems

CHAPTER 2

STRUCTURE AND FUNCTION OF THE KIDNEYS

Objectives

Structure of the Kidneys

Gross Anatomy

Ultrastructure of the Nephron

Ultrastructure of the Glomerulus

Ultrastructure of the Juxtaglomerular Apparatus

Innervation of the Kidneys

Summary

Key Words and Concepts

Self-Study Problems

CHAPTER 3

GLOMERULAR FILTRATION AND RENAL BLOOD FLOW

Objectives

Renal Clearance

Glomerular Filtration Rate

Glomerular Filtration

Determinants of Ultrafiltrate Composition

Dynamics of Ultrafiltration

Renal Blood Flow

Regulation of Renal Blood Flow and Glomerular Filtration Rate

Sympathetic Nerves

Angiotensin II

Prostaglandins

Nitric Oxide

Endothelin

Bradykinin

Adenosine

Natriuretic Peptides

Adenosine Triphosphate

Glucocorticoids

Histamine

Dopamine

Summary

Key Words and Concepts

Self-Study Problems

CHAPTER 4

RENAL TRANSPORT MECHANISMS: NaCl AND WATER ABSORPTION ALONG THE NEPHRON

Objectives

General Principles of Membrane Transport

General Principles of Transepithelial Solute and Water Transport

NaCl, Solute, and Water Reabsorption Along the Nephron

Proximal Tubule

Henle's Loop

Distal Tubule and Collecting Duct

Regulation of NaCl and Water Reabsorption

Summary

Key Words and Concepts

Self-Study Problems

CHAPTER 5

REGULATION OF BODY FLUID OSMOLALITY: REGULATION OF WATER BALANCE

Objectives

Arginine Vasopressin

Osmotic Control of Arginine Vasopressin Secretion

Hemodynamic Control of Arginine Vasopressin Secretion

Arginine Vasopressin Actions on the Kidneys

Thirst

Renal Mechanisms for Dilution and Concentration of the Urine

Medullary Interstitium

Vasa Recta Function

Assessment of Renal Diluting and Concentrating Ability

Summary

Key Words and Concepts

Self-Study Problems

CHAPTER 6

REGULATION OF EXTRACELLULAR FLUID VOLUME AND NaCl BALANCE

Objectives

Whole-Body Na+ Balance

Concept of Effective Circulating Volume

Volume-Sensing Systems

Volume Sensors in the Low-Pressure Cardiopulmonary Circuit

Volume Sensors in the High-Pressure Arterial Circuit

Volume Sensor Signals

Renal Sympathetic Nerves

Renin-Angiotensin-Aldosterone System

Natriuretic Peptides

Arginine Vasopressin

Control of Renal NaCl Excretion During Euvolemia

Mechanisms for Maintaining Constant Na+ Delivery to the Distal Tubule in Euvolemia

Regulation of Distal Tubule and Collecting Duct Na+ Reabsorption in Euvolemia

Control of Na+ Excretion with Volume Expansion

Control of Na+ Excretion with Volume Contraction

Edema

Alterations in Starling Forces

Capillary Hydrostatic Pressure (Pc)

Plasma Oncotic Pressure (?c)

Lymphatic Obstruction

Capillary Permeability

Role of the Kidneys

Summary

Key Words and Concepts

Self-Study Problems

CHAPTER 7

REGULATION OF POTASSIUM BALANCE

Objectives

Overview of K+ Homeostasis

Regulation of Plasma [K+]

Epinephrine

Insulin

Aldosterone

Alterations of Plasma [K+]

Acid-Base Balance

Plasma Osmolality

Cell Lysis

Exercise

K+ Excretion by the Kidneys

Cellular Mechanisms of K+ Transport by Principal Cells and Intercalated Cells in the Distal Tubule and Collecting Duct

Regulation of K+ Secretion by the Distal Tubule and Collecting Duct

Plasma [K+]

Aldosterone

Arginine Vasopressin

Factors that Perturb K+ Excretion

Flow of Tubular Fluid

Acid-Base Balance

Glucocorticoids

Summary

Key Words and Concepts

Self-Study Problems

CHAPTER 8

REGULATION OF ACID-BASE BALANCE

Objectives

?Buffer System

Overview of Acid-Base Balance

Renal Net Acid Excretion

?Reabsorption Along the Nephron

Regulation of H+ Secretion

Formation of New

Response to Acid-Base Disorders

Extracellular and Intracellular Buffers

Respiratory Compensation

Renal Compensation

Simple Acid-Base Disorders

Metabolic Acidosis

Metabolic Alkalosis

Respiratory Acidosis

Respiratory Alkalosis

Analysis of Acid-Base Disorders

Summary

Key Words and Concepts

Self-Study Problems

CHAPTER 9

REGULATION OF CALCIUM AND PHOSPHATE HOMEOSTASIS

Objectives

Calcium

Overview of Ca++ Homeostasis

Ca++ Transport Along the Nephron

Regulation of Urinary Ca++ Excretion

Calcium-Sensing Receptor

Phosphate

Overview of Pi Homeostasis

Pi Transport Along the Nephron

Regulation of Urinary Pi Excretion

Integrative Review of Parathyroid Hormone and Calcitriol on Ca++ and Pi Homeostasis

Summary

Key Words and Concepts

Self-Study Problems

CHAPTER 10

PHYSIOLOGY OF DIURETIC ACTION

Objectives

General Principles of Diuretic Action

Sites of Action of Diuretics

Response of Other Nephron Segments

Adequate Delivery of Diuretics to Their Site of Action

Volume of the Extracellular Fluid

Diuretic Braking Phenomenon

Mechanisms of Action of Diuretics

Osmotic Diuretics

Carbonic Anhydrase Inhibitors

Loop Diuretics

Thiazide Diuretics

K+-Sparing Diuretics

Aquaretics

Effect of Diuretics on the Excretion of Water and Other Solutes

Solute-Free Water

K+ Excretion

HCO?Excretion

Ca++ and Pi Excretion

Summary

Key Words and Concepts

Self-Study Problems

ADDITIONAL READING

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

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

A P P E N D I X C NEPHRON FUNCTION

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

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

A P P E N D I X F REVIEW EXAMINATION

APPENDIX G ANSWERS TO REVIEW EXAMINATION

INDEX