HK 3810 Package 2 Kidneys.docx

The distal tubule curls back in this area to be close

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The distal tubule curls back in this area to be close to the arterioles Juxtaglomerular apparatus is where the macula densa cells lining the afferent and efferent arteriole side of the distal tubule (within diffusion/paracrine distance to the afferent and efferent arterioles) which are chemoRc that secrete product on the renin releasing cells Juxtaglomerular cells synthesize, store and release renin If NaCl in the macula densa drops, there will be an increase in renin being released into the bloodstream by the juxtaglomerular cells and vice versa AII can be made here because the substrates and products needed are present NaCl delivery to macula densa is done through changing tubular Q Every time we are in a tubule, we care about flow so it is an equilibration time problem Increase GFR increase tubular Q decrease equilibration time decrease time spent at the thick ascending limb, by Na+ Cl- K+ symporters decrease NaCl reabsorbed increase NaCl in the tubule increase NaCl at MD
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HK 3810 Package 2 Kidneys o Decrease in renin decrease in local AII vasodilate efferent > afferent decrease GFR o Tubuloglomerular feedback – increase afferent resistance (vasoconstrict afferent) decrease PG decrease GFR (vasoconstrictor release by MD cells) o Autoregulation – myogenic response NOTE: it is very important to keep GFR constant because increasing GFR by 5% can greatly increase the amount being filtered per day Increase in MAP due to an increase in blood volume increase volume into glomerulus and PG increase GFR increase tubular Q decrease equilibration time in thick ascending limb decrease NaCl out, more in increase in macula densa osmolarity a. macula densa will release a constrictor increase resistance in afferent decrease PG decrease GFR b. decrease renin decrease local AII decrease resistance in efferent decrease PG decrease GFR Now a whole body problem: Increase in atrial stretch from increase in MAP increase ANP a. ANP can vasodilate afferent, vasoconstrict efferent increase PG increase GFR b. ANP can drop ADH so the kidney is less permeable to water so anything that we filter will be lost vasodilate afferent > efferent increase GFR c. Decrease renin decrease AII even more drop stimulus in ADH-VP d. Decrease in AII centrally vasodilation afferent = efferent minimize effects of local AII increase GFR due to more flow to the kidney decrease in ALDO Increase in blood volume cause increase in MAP a. increase atrial stretch increase ANP decrease ALDO, decrease renin vasodilate afferent, vasoconstrict efferent, decrease ADH ( drop H2O reabsorption) increase GFR b. High pressure baroRc in kidney decrease renin c. High pressure baroRc in carotid arteries decrease SNS vasodilate afferent > efferent decrease renin decrease AII increase GFR Left heart failure
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