PT and Henle

20 important questions on PT and Henle

What is the sodium balance?

Input and output of sodium. A part is excreted via the feces, a part via sweating and filtration

Where is the largest amount of sodium and water reabsorbed?

In the proximal tubule

--> also other substances: chloride, phosphate, glucose, amino acids, uric acid etc. But sodium and water the largest amount

Where is the descending limb of the Loop of Henle permeable to?

H20 (passive process)
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Where is the thin segment of the ascending limb of the loop of Henle permeable to?

NaCl, passivetransport

Where is the thick segment of the ascending limb of the loop of Henle permeable to?

NaCl, active transport

What is secreted in the proximal tubule?

Creatine, H+ and NH4+ and drugs

How is sodium reabsorbed?

The Na/K pump is very active and this creates a lower sodium concentration in the cells. This results in reabsorption of Na+ from the lumen.

Which two transporters are important for pumping Na+ into the cells of the tubule?

NHE4 = antitransporter Na+/H+
SGLT2 = cotransporter glucose and Na+

Which pump is present in the thick ascending limb?

NKCC2 (Na-K-Cl cotransporter)

Which pump is present in the distal tubules?

Na-Cl cotransporter

What are the pumps for sodium transport in the collecting duct?

ENaC = Na+ and K+ pump (2 seperate pumps) and Na/K pump is the driving force

How many systems are involved in regulation of the sodium balance?

  1. RAAS system
  2. Activation of the autonomic nervous system (pressure sensors)
  3. ANP production by the heart (counteractive)

What is the function of diuretics?

Inhibition of sodium reabsorption
- loop diuretics
- thiazides

What is the role of K+ on sodium reabsorption?

A low [K+] concentration extracellular stimulates the uptake of Na+ and Cl- via the cotransporter NCC --> phosphorylation of the transporter.
A high [K+] concentration extracellular inhibits the NCC cotransporter (dephosphorylation)
--> this transporter is found in the distal convoluted tubule

in the case of a high [K+], Na+ is reabsorbed in the collecting duct, where the ENaC transporter is located. Here, the sodium uptake (less than in the DT) is coupled to K+ excretion (ROMK and BK).  --> eventually more Na+ and K+ excretion

What is the use of SGLT2 inhibitors?

Reduce glomerular hyperfiltration

How do SGLT2 inhibitors work?

The SGLT-2 inhibitors work on the SGLT-2 channels. This inhibits Na+/glucose reabsorption --> more glucose and Na+ in tubules. This leads to an increased Na+ delivery to the macula densa. The macula densa therefore reduces the blood flow to the kidneys via arteriole constriction. This results in normalization of the GFR. --> tubuloglomerular feedback mechanism.

For which disease are SGLT2 inhibitors useful?

Diabetic nephropathy => in the early stages there is hyperfiltration --> damages the kidney (loss of nephrons)

What is the difference in diet between past and now?

More sodium and less potassium
--> normally the kidneys want to retain the sodium and excrete the potassium -> leads to hypertension as concentration of sodium is already high due to diet

What is the function of the proxiumal tubuli?

- reabsorption (Cl, sodium, water, glucose, aa, uric acid etc)
- secretion (creatinine, drugs, H+, NH4+)

Which substance is not reabsorbed in the proximal tubule?

Inulin, so the concentration increases as other substances are reabsorbed

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