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Objectives:

Objectives:. 1. Describe how osmolality is regulated by adjustments in water excretion regulated by ADH or adjustments in the intake of water. 2. Define diuresis and antidiuresis and describe how clearance can be used to quantitate the rate of water excretion or retention by the kidney.

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Objectives:

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  1. Objectives: 1. Describe how osmolality is regulated by adjustments in water excretion regulated by ADH or adjustments in the intake of water. 2. Define diuresis and antidiuresis and describe how clearance can be used to quantitate the rate of water excretion or retention by the kidney. 3. Provide an overview of how the kidney produces either a dilute or a concentrated urine. 4. Describe the family of water channels present in the kidney and how one of them is regulated by ADH.

  2. Case Report: • The patient, a caucasian male infant, was born after a full term pregnancy but readmitted to the hospital at the age of 2 months because of failure to gain weight normally, constipation and dehydration. • Lab Data: • PNa= 170 mEq/l; • V = 1000 to 1400 ml/day ; • Uosm < 70 mosmol/kg • Proteinuria, glycosuria and hyperaminoaciduria were absent

  3. Using Clearance to measure water excretion: • V = Cosm + CH2O (in units of ml/min) CH2O= V - Cosm

  4. Using Clearance to measure water excretion: • V = Cosm + CH2O (in units of ml/min) CH2O= V – Cosm (2) Cosm = Uosm . V _____ Posm

  5. Posm Uosm V Cosm CH2O 286 286 2 2 0 Cosm = Uosm . V _____ Posm CH2O= V - Cosm For typical values:

  6. Posm Uosm V Cosm CH2O 286 286 2 2 0 284 100 6 ~2 4 Cosm = Uosm . V _____ Posm CH2O= V - Cosm For typical values:

  7. Posm Uosm V Cosm CH2O 286 286 2 2 0 284 100 6 ~2 4 290 580 1 2 -1 Cosm = Uosm . V _____ Posm CH2O= V - Cosm For typical values:

  8. Using Clearance to measure water excretion: TCH2O= Cosm – V i.e. TCH2O= -CH2O

  9. Renal Aquaporins Location AQP1 Proximal Tubule and Thin Descending loop of Henle AQP2 Apical membrane of collecting duct AQP3 Basolateral membrane of collecting duct AQP4 Basolateral membrane of collecting duct Renal Aquaporins

  10. From Boron and Boulpaep, 2003

  11. Case Report: • The patient, a caucasian male infant, was born after a full term pregnancy but readmitted to the hospital at the age of 2 months because of failure to gain weight normally, constipation and dehydration. • Lab Data: • PNa= 170 mEq/l; • V = 1000 to 1400 ml/day ; • Uosm < 70 mosmol/kg • Proteinuria, glycosuria and hyperaminoaciduria were absent

  12. Objectives: 1) What force drives the movement of water out of the tubular lumen? 2) How is this force generated? 3) How is this force maintained in the interstitium of the kidney medulla while blood flow passes through the region to provide nutrients and carry away the reabsorbed water? 4) How do passive mechanisms and the reabsorption of urea contribute to concentrating the urine?

  13. Countercurrent Exchange From Boron and Boulpaep, 2003

  14. (Urea=600 Na=600)

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