Renal Physiology II
PHYSIOLOGY (3rd Shifting) | Dr. Solidum | 15 January 2019
OUTLINE
B. During Volume Expansion
C. During Volume Contraction
DURING VOLUME EXPANSION
 Volume expansion occurs during overhydration
 During this time, the high and low volume sensors send signals
to the kidneys to increase NaCl and water excretion. These
signals include:
 Decreased renal sympathetic nerve activity
 Release of ANP (atrial natriuretic peptide) and BNP (brain
natriuretic peptide) from the heart and urodilatin in the
kidneys
 (NTK: BNP, although it stands for brain natriuretic
peptide, is a misnomer as it is produced by the
cardiac muscle cells in the ventricles. Its effect is
similar to ANP)
 Urodilantin
- Hormone that is stimulated by blood
pressure rise
- Inhibits NaCl and water reabsorption across
the medullary portion of the collecting duct
- More potent natriuretic and diuretic than
ANP
 Inhibition of ADH secretion from the posterior pituitary
gland and decreased ADH action on the collecting duct
 Decreased renin secretion → decreased production of
angiotensin II
 Decreased aldosterone secretion (because of decreased
angiontensin II) → increased ANP
Figure X. Integrated response to volume expansion
Note: Numbers 1-3 represent the 3 general responses to
volume expansion (explained below).
S 01 // T 04 Echon, Munsayac, Tendido, Reynaldo, Vadillo
↑𝑈𝑁𝑎+𝑉= ↑𝐺𝐹𝑅 𝑥 𝑃𝑁𝑎++ − ↓𝑅
Where:
UNa+V = Na+ excretion rate
PNa+ = Plasma Na+ concentration
R = Tubular reabsorption of Na+
GFR = Glomerular Filtration Rate
 Three general responses to volume expansion:
 (1) Increased GFR
 As a result of the decrease in sympathetic nerve
activity
 Decreased sympathetic nerve activity → vasodilation
of afferent and efferent arterioles and increased RPF
→ increased glomerular capillary hydrostatic pressure
→ increased GFR → increased filtered load of Na
- Due to the vasodilation of the afferent and
efferent arterioles, the RPF also increases
- RPF increases to a greater degree than GFR, so
filtration fraction (GFR/RPF) decreases
 ANP and urodilatin (natriuretic peptides) also increase
GFR by dilating the afferent arteriole and constricting
the efferent arterioles
 (2) Decreased Na reabsorption in the Proximal Tubule
 Volume expansion → decreased sympathetic nerve
activity → decreased Na reabsorption
 Decreased angiotensin II activity → decreased Na
reabsorption by the proximal tubule
 Increased hydrostatic pressure in the glomerular
capillary → increased hydrostatic pressure in
peritubular capillary → decreased water and solute
reabsorption
 (3) Decreased Na reabsorption in the collecting duct
 Increase in the filtered load of Na and decrease in
proximal tubule NaCl reabsorption → large amounts of
NaCl in the loop of Henle and distal tubule
 Decreased sympathetic nerve activity and low
aldosterone levels → decreased NaCl reabsorption
 Amount of Na delivered to the beginning of the
collecting duct is increased
 Final component in the response: increased water excretion
Figure 16. Segmental Na reabsorption during euvolemia (left) and volume expansion
(right). Source: Berne and Levy 5th ed
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Note: Volume expansion: Less reabsorption, more excretion.
DURING VOLUME CONTRACTION
 Volume contraction occurs during dehydration
 During this time, the high and low volume sensors send signals
to the kidneys to decrease Na and water excretion (body
prioritizes conservation of fluid to prevent total dehydration).
These signals include:
 Increased renal sympathetic nerve activity
 Increased secretion of renin → increased production of
angiotensin II → increased secretion of aldosterone from
the adrenal cortex
 Inhibition of ANP secretion (from the atrial myocytes) and
urodilatin (from the kidneys)
 Stimulation of ADH secretion by the posterior pituitary
gland
peritubular capillaries → increase water and solute
reabsorption
 (3) Increased Na reabsorption in the collecting duct
 Reduction in the filtered load and enhanced proximal
tubule NaCl reabsorption → decreased Na in loop of
Henle and distal tubule
 Increased sympathetic nerve activity and high
aldosterone levels → increased NaCl reabsorption
 Fraction of filtered load of Na reabsorbed in these
segments is less than that seen in the euvolemic state
- Net result: less Na delivered to beginning of
collecting duct
 Final component in the response: decreased water
excretion

Figure 18. Segmental Na reabsorption during euvolemia (left) and volume contraction
(right). Source: Berne and Levy 5th ed
Note: Volume contraction: More reabsorption, less excretion.

Figure X. Integrated response to volume contraction. IX. REFERENCES

Note: Numbers 1-3 represent the 3 general responses to volume  2021A Trans
 Berne and Levy
contraction (explained below).
 Dr. Solidum’s discussion
 Transer’s Notes
↓𝑈𝑁𝑎+𝑉= ↓𝐺𝐹𝑅 𝑥 𝑃𝑁𝑎++ −↑𝑅
Where:
UNa+V = Na+ excretion rate
PNa+ = Plasma Na+ concentration
R = Tubular reabsorption of Na+
GFR = Glomerular Filtration Rate

 Three general responses to volume contraction:

 (1) Decreased GFR
 Increased renal sympathetic activity →
vasoconstriction of afferent and efferent arterioles →
decreased glomerular capillary hydrostatic pressure→
decreased GFR → decreased filtered load of Na
 (2) Increased Na reabsorption in the Proximal Tubule
 Increased sympathetic nerve activity and angiotensin
II production → increased proximal tubule Na
reabsorption
 Decreased hydrostatic pressure in glomerular
capillary → decreased hydrostatic pressure in

S 01 // T 04 Echon, Munsayac, Tendido, Reynaldo, Vadillo 2 of 3

S 01 // T 04 Echon, Munsayac, Tendido, Reynaldo, Vadillo 3 of 3