Title: Renal Physiology
1Renal Physiology
- Dr. April Strader
- Course PHYS 410-
- MWF 8-9am
- Chapters -3, 32-39
- Office 453-1533
- Email astrader_at_siumed.edu
- Office hours
- Life Science III Room 2066
2Lecture 1Objectives - Body Water Spaces
- 1. Learn the approximate volumes of total body
water, extracellular, intracellular, interstitual
and plasma volumes. - 2. Describe how determining the volume of
distribution of various substances can be used to
measure the volumes of the above body water
spaces. - 3. Given appropriate data, calculate the volume
of distribution of a substance. - 4. Describe the principles which govern the
distribution of fluid between the intracellular
and extracellular compartments. - 5. Describe the effects of drinking water, or
the intravenous infusion of saline solutions of
different osmolalities on the volumes and
osmolalities of various body fluid spaces. - 6. Outline the forces which govern the
distribution of fluid between plasma and
interstitial fluid. - 7. Define edema and explain the mechanism by
which it develops in various pathological
situations.
3Lecture 1Objectives - Body Water Spaces
- 1. Learn the approximate volumes of total body
water, extracellular, intracellular, interstitual
and plasma volumes. - 2. Describe how determining the volume of
distribution of various substances can be used to
measure the volumes of the above body water
spaces. - 3. Given appropriate data, calculate the volume
of distribution of a substance. - 4. Describe the principles which govern the
distribution of fluid between the intracellular
and extracellular compartments. - 5. Describe the effects of drinking water, or
the intravenous infusion of saline solutions of
different osmolalities on the volumes and
osmolalities of various body fluid spaces. - 6. Outline the forces which govern the
distribution of fluid between plasma and
interstitial fluid. - 7. Define edema and explain the mechanism by
which it develops in various pathological
situations.
41. Total Human Body Water Spaces
example for 70kg male with 45 hematocrit
(60 of Body Weight)
Total Body Water (TBW) 42 L
Intracellular Fluid -25 L
Extracellular Fluid 17 L
Fluid within all body cells.
Blood Plasma 3 L
Interstitial Fluid 13 L
Transcellular Fluid -1 L
(does not include the 2.5L of cellular elements
of Blood cells, platelets, etc) Total Blood
Volume 5.5L
Dense connective tissue, cartilage and tendons,
and bone matrix.
Synovial fluid in joints and CSF. Does NOT
include fluids that are considered outisde body
such as urine in bladder.
Table 3-1 p.51
51. Intracellular and Extracellular Fluids
25L
17L
42 LITERS
Fig. 3-1 p.51
6Lecture 1Objectives - Body Water Spaces
- 1. Learn the approximate volumes of total body
water, extracellular, intracellular, interstitual
and plasma volumes. - 2. Describe how determining the volume of
distribution of various substances can be used to
measure the volumes of the above body water
spaces. - 3. Given appropriate data, calculate the volume
of distribution of a substance. - 4. Describe the principles which govern the
distribution of fluid between the intracellular
and extracellular compartments. - 5. Describe the effects of drinking water, or
the intravenous infusion of saline solutions of
different osmolalities on the volumes and
osmolalities of various body fluid spaces. - 6. Outline the forces which govern the
distribution of fluid between plasma and
interstitial fluid. - 7. Define edema and explain the mechanism by
which it develops in various pathological
situations.
7- Determining the Volume of Distribution of
- Substances to Measure Volumes of Body
Water Spaces.
Markers for body water spaces Body water
space Markers Total body water T20,
D20 Extracellular water inulin (NOT
insulin) Plasma 125I albumin, 51Cr
erythrocytes, Evans blue (binds to
albumin)
Some spaces you cannot measure with markers and
need to be calculated by subtraction.
Intracellular water Total Body water
Extracellular water Interstitial water
(extravascular water) Extracellular water -
Plasma
nib
8Lecture 1Objectives - Body Water Spaces
- 1. Learn the approximate volumes of total body
water, extracellular, intracellular, interstitual
and plasma volumes. - 2. Describe how determining the volume of
distribution of various substances can be used to
measure the volumes of the above body water
spaces. - 3. Given appropriate data, calculate the volume
of distribution of a substance. - 4. Describe the principles which govern the
distribution of fluid between the intracellular
and extracellular compartments. - 5. Describe the effects of drinking water, or
the intravenous infusion of saline solutions of
different osmolalities on the volumes and
osmolalities of various body fluid spaces. - 6. Outline the forces which govern the
distribution of fluid between plasma and
interstitial fluid. - 7. Define edema and explain the mechanism by
which it develops in various pathological
situations.
93. Given the appropriate data, calculate the
volume of distribution of a substance.
- V1 volume injected V2 volume of
distribution - C1 concentration injected C2 final
concentration - After injection, allow time for equilibration
- V2(volume of dist.) V1 x C1
- C2
103. Eg. Calculate the Extravascular Extracellular
Volume of a Patient Using an infusion of inulin.
- 1 mM of inulin is intravenously infused into
your patient in 100 ml of physiological saline.
Inulin cannot enter cells, but can diffuse freely
across blood vessel walls and therefore
distributes in the extravascular extracellular
space. The final inulin concentration in blood
plasma after equilibrium (and accounting for
excretion in urine) is 7.7µM. - What is the Extracellular Volume of the Patient
(in liters)? - What is the Extravascular Extracellular Volume
(in liters)? - Using the equation C1xV1 C2xV2
- C1 1mM C2 7.7 µM
- V1 100ml V2 ?
113.
C1
V1
C2
V2
( 1 mM ) x ( 100ml ) ( 0.0077 mM ) x V2
V2
12, 987 ml ( or approx. 13 L)
This is the Extracellular Volume. To find
Extravascular Extracellular Volume, remember,
plasma volume 3L , therefore, this volume is
13 L 3 L 10 L
12 Intracellular and Extracellular Fluids
25L
17L
42 LITERS
Fig. 3-1 p.51
13Lecture 1Objectives - Body Water Spaces
- 1. Learn the approximate volumes of total body
water, extracellular, intracellular, interstitual
and plasma volumes. - 2. Describe how determining the volume of
distribution of various substances can be used to
measure the volumes of the above body water
spaces. - 3. Given appropriate data, calculate the volume
of distribution of a substance. - 4. Describe the principles which govern the
distribution of fluid between the intracellular
and extracellular compartments. - 5. Describe the effects of drinking water, or
the intravenous infusion of saline solutions of
different osmolalities on the volumes and
osmolalities of various body fluid spaces. - 6. Outline the forces which govern the
distribution of fluid between plasma and
interstitial fluid. - 7. Define edema and explain the mechanism by
which it develops in various pathological
situations.
14What factors determine the distribution of fluid
between the intracellular and extracellular
compartments.
- Extracellular Fluid (ECF) vs. Intracellular
Fluid (ICF) - -plasma
- -interstitial fluid (IF)
1. OSMOLALITY
- Solute concentrations vary dramatically between
ECF and ICF. - -The plasma and the interstitial fluid have very
similar composition (solutes). - -The major difference between plasma and
interstitial fluid is plasma proteins. - HOWEVER, the Osmolality of the ECF and the
ICF are the same!!!
Osmolality total concentration of ALL
particles that are in a solution
Table 3-2 and Figure 3-1 (p. 51-52) BB
154.
2. ELECTRONEUTRALITY
All solutions must respect the principle of bulk
electroneutrality the number of positive
charges in the solution must equal the negative
charges (Table 3-2) p.52
Adding up the cytosolic Na and K we see
that the sum GREATLY exceeds the sum of the
Cl- and HCO3- ions. The excess positive
charge is balanced by the negative charge on
intracellular proteins and smaller anions and
inorganic phosphates. (p. 53-54)
164.
In general, particles move according to
concentration (osmolality) and electrochemical (
? ) gradients.
p. 54
Water movement is PASSIVE and moves from low
osmolality to high osmolality.
The actual transport of solutes is very complex
(including transporters and pumps) and will be
covered in more detail later, but for now,
remember that NaCl is largely excluded from the
intracellular compartment.
17Lecture 1Objectives - Body Water Spaces
- 1. Learn the approximate volumes of total body
water, extracellular, intracellular, interstitual
and plasma volumes. - 2. Describe how determining the volume of
distribution of various substances can be used to
measure the volumes of the above body water
spaces. - 3. Given appropriate data, calculate the volume
of distribution of a substance. - 4. Describe the principles which govern the
distribution of fluid between the intracellular
and extracellular compartments. - 5. Describe the effects of drinking water, or
the intravenous infusion of saline solutions of
different osmolalities on the volumes and
osmolalities of various body fluid spaces. - 6. Outline the forces which govern the
distribution of fluid between plasma and
interstitial fluid. - 7. Define edema and explain the mechanism by
which it develops in various pathological
situations.
185. Describe the effects of drinking water, or
the intravenous infusion of saline solutions of
different osmolalities on the volumes and
osmolalities of various body fluid spaces.
- EC vol. IC vol. EC
osm. IC osm. - Isotonic saline
Water
Hypertonic Saline
Hypotonic saline
Think these through, dont memorize it! Page
79. (study figure 3-17)
19Lecture 1Objectives - Body Water Spaces
- 1. Learn the approximate volumes of total body
water, extracellular, intracellular, interstitual
and plasma volumes. - 2. Describe how determining the volume of
distribution of various substances can be used to
measure the volumes of the above body water
spaces. - 3. Given appropriate data, calculate the volume
of distribution of a substance. - 4. Describe the principles which govern the
distribution of fluid between the intracellular
and extracellular compartments. - 5. Describe the effects of drinking water, or
the intravenous infusion of saline solutions of
different osmolalities on the volumes and
osmolalities of various body fluid spaces. - 6. Outline the forces which govern the
distribution of fluid between plasma and
interstitial fluid. - 7. Define edema and explain the mechanism by
which it develops in various pathological
situations.
206. Outline the forces which govern the
distribution of fluid between plasma and
interstitial fluid.
- Starling Forces Starlings law of the Capillary
Pc hydrostatic pressure of capillary ?c
protein (oncotic) pressure of capillary Pi
hydrostatic pressure of interstitual fluid ?i
protein osmotic (oncotic) pressure of the
interstitual fluid Kf hydraulic conductance of
capillary (ml/min) Net movement out of capillary
into interstitium (ml/min) Kf (Pc Pi) (?c
?i) Basically, movement is governed by
(hydrostatic pressure protein (oncotic)
pressure)
215. Filtration when fluid moves OUT of a
capillary Absorption when fluid moves INTO a
capillary
- FIND THE NET PRESSURE FOR EACH SCENARIO
- Net Filtration
B. Net Absorption
capillary
capillary
Pc pc
Pc pc
-1
-1
3
3
26
32
Pi
30
Pi
25
pi
pi
Assume that Kf equals 1.
225. Filtration when fluid moves OUT of a
capillary Absorption when fluid moves INTO a
capillary
- FIND THE NET PRESSURE FOR EACH SCENARIO
- Net Filtration 8mmHg
B. Net Absorption -5mmHg
capillary
capillary
Pc pc
Pc pc
-1
-1
3
3
26
32
Pi
30
Pi
25
pi
pi
Assume that Kf equals 1.
23Lymph
- The lymphatic capillaries are responsible for
- returning interstitial fluid and proteins to
the vascular compartment. - -one-way flap valves permits fluid and protein
to enter, not leave. - -lymph capillaries merge into large thoracic
duct which empties into the large veins. - -lymph vessels have smooth muscle for movement
and - surrounding skeletal muscle contractions.
24Lecture 1Objectives - Body Water Spaces
- 1. Learn the approximate volumes of total body
water, extracellular, intracellular, interstitual
and plasma volumes. - 2. Describe how determining the volume of
distribution of various substances can be used to
measure the volumes of the above body water
spaces. - 3. Given appropriate data, calculate the volume
of distribution of a substance. - 4. Describe the principles which govern the
distribution of fluid between the intracellular
and extracellular compartments. - 5. Describe the effects of drinking water, or
the intravenous infusion of saline solutions of
different osmolalities on the volumes and
osmolalities of various body fluid spaces. - 6. Outline the forces which govern the
distribution of fluid between plasma and
interstitial fluid. - 7. Define edema and explain the mechanism by
which it develops in various pathological
situations.
257. Define edema and explain the mechanism by
which it develops in various pathological
situations.
- EDEMA
- Accumulation of fluid in interstitial space (due
to filtration out of the capillaries), usually
caused by a disruption in Starling forces, that
exceeds the ability of lymphatics to return it to
the circulation (p. 472-473)
26(No Transcript)
277. Various examples of Edema Formation
EXAMPLE
CAUSE
Pc
(Arteriolar dilation, venous constriction,
heart failure)
pc
(decreased plasma protein concentration, severe
liver failure, nephrotic syndrome loss of
protein in urine)
Burns Inflammation (release of histamines or
cytokines)
Kf
Standing, parasitic infection of lymph nodes
(filariasis)
Impaired Lymphatic drainage
28EDEMA FROM THE NEPHROTIC SYNDROME
297.
Kwashiorkor the one who is displaced
- Severe protein deficiency and malnutrition
- Edema results from decreased plasma proteins
- (decreased albumin in blood).
30FILARIASIS