[Year]

PART 1 – EXAM STUDY

CICM
Reesha Cornelio
1: Renal Physiology

 Describe the functional anatomy of the kidneys.

 Describe renal blood flow and its regulation.
 Describe glomerular filtration and tubular function.
 Explain the counter-current mechanisms in the kidney.
 Describe the functions of the kidney.
 Describe the physiological effects of renal dysfunction.

H2 Applied Renal Physiology

 Describe the principles of dialysis and filtration.

H3: Renal Pharmacology

 Understand the pharmacology of diuretics.

 Understand the pharmacology of renal replacement fluid.

H4: Renal Measurement

 Describe the principles of measurement of glomerular filtration rate and renal blood flow.
 Describe the utility of biochemical estimates of renal function (including but not limited to the
measurement of serum creatinine, cystatin C and estimates of Creatinine Clearance such as
eGFR).

DESCRIBE THE FUNCTIONAL ANATOMY OF THE KIDNEYS.

Gross anatomy

 Paired abdominal (retroperitoneal) organ

 Right kidney is related to liver, duodenum, ascending colon, small intestine.
 Left kidney is related to spleen, stomach, pancreas, descending colon.
 Both kidneys are superiorly related to an adrenal gland, and posteriorly to rib 12, the diaphragm,
psoas major, quadratus lumborum and transversus abdominis
 Blood supply: single renal artery
 Venous drainage: single renal vein
 Lymphatic drainage: renal hilar nodes and then lumbar nodes.
 Innervation:
  efferent is strictly sympathetic, from T9-T13
 afferent (pain) via the least splanchnic nerve (T12)

DESCRIBE THE RENAL HANDLING OF SODIUM

 Reabsorption or tubular reabsorption is the process by which the nephron removes water and solutes
from the tubular fluid and returns them to the circulating blood.
 secretion is the process of adding substances from the kidbey into the renal tubule

 Sodium is freely filtered in the glomerulus

 65% is then reabsorbed in the PCT
o The reabsorption is driven by a concentration gradient created by the action of the
basolateral Na/K ATPase
o Most of the sodium is
reabsorbed by the NHE3
sodium hydrogen exchanger.
o Other transport proteins
including SLG2, phosphate co-
transporter Np2a and
multiple organic anion co-
transporters.
 None is reabsorbed in the thin
descending limb.
o It is impermeable to sodium
 Some minimal amount is reabsorbed in
the thin ascending limb
o It is permeable to ions, but
not to water
o Some sodium is reabsorbed
but passively here
 25% is reabsorbed in the thick ascending limb
o Most of this is by the frusemide-sensitive NKCC2 co-transporter
 5-10% is reabsorbed in the distal convoluted tubule
o Most of this is by the thiazide sensitive NCC co transporter.
 The sodium-chloride symporter (also known as Na+-Cl− cotransporter, NCC or NCCT,
or as the thiazide-sensitive Na+-Cl− cotransporter or TSC) is a cotransporter in the
 kidney which has the function of reabsorbing sodium and chloride ions from the
tubular fluid into the cells of the distal convoluted tubule of the nephron.
o This step is loaded-sensitive, reabsorption increases if there is increased sodium delivery to
this segment
 2% is reabsorbed in the collecting duct
o Most of this is passive, via the amiloride-sensitive ENaC channel

How is sodium reabsorption regulated?

 Angiotensin II increases reabsorption by (increases reabsorption by increasing Na+/K+ ATPase

activity in the proximal tubule, and increases NHE3 activity)
 Aldosterone increases ENAC activation in the collecting duct and NA/K/Atpase activity in the thick
ascending limb
 Vasopressin increases expression of ENAC in the collecting duct and NKCC2 in the thick ascending
limb
 Catecholamines by increases NKCC2 expression in the thick thick ascending limb

Describe the types of sodium transporters.

 The NHE3 antiporter imports one sodium ion into the cytosol of a tubule cell
as it ejects one hydrogen ion from the cell into the lumen of the proximal
tubule
o Lives in the PCT
 The Na+/K+-ATPase enzyme is active (i.e. it uses energy
from ATP). For every ATP molecule that the pump uses, three
sodium ions are exported and two potassium ions are imported
 ENaC activity is finely controlled through proteolytic activation, a process wherein specific
enzymes, or proteases, cleave ENaC subunits, resulting in channel activation and increased
sodium reabsorption

What is the total sodium load and reabsorption?

Sodium handling in the proximal tubule