Objectives

Physiology of body fluids
  1. Recognize how the body fluid compartments differ with respect to their volumes and their ionic compositions
  2. Describe both the driving forces responsible for movement of water across cell membranes and the fluids in the capillary wall
  3. Identify the volumes changes of the intracellular and extracellular fluid compartments under various pathophysiological conditions
  4. Evaluate and calculate body compartments volume using the dilution methods
  5. Use the appropriated formula to both estimate and/or to get the precise value of the plasma osmolality
Water movement between body compartments
  1. Calculate shift of water between body compartments
  2. Describe the Darrow-Yannet diagram
  3. Identify the associated changes during homeostasis of volume and osmolality in the Darrow–Yannet (DY) diagram
  4. Use the Darrow –Yannet (DY) diagram to describe unbalance conditions in body water and osmolality
  5. Define the DY diagram given a condition (i.e. dehydration, primary adrenal insufficiency (hypotonic volume contraction), etc.)
  6. Describe how plasma protein concentration [Pr] and hematocrit (Hct) can be used to define status of hydration under physiological or pathological situations
  7. Describe how changes in plasma volume can affect Hct and [Pr] whereas plasma concentration affects only Hct
  8. Describe volume expansion and contraction under isotonic, hyperosmotic and hyposmotic conditions and situations in which the previous conditions occur
Functions of the key components of the kidney
  1. Identify how in the glomerulus the filtration barriers to plasma proteins exert their action
  2. Characterize the range of molecular size and their filtration properties depending of the electrical charge
  3. Describe the physiologic significance of the juxtaglomerular apparatus (JGA)
  4. Identify the functional consequences of the blood vessels supply the kidneys
  5. Recognize the functional units of the kidney: the nephron
  6. Recognize physiological compensations during nephron loss, for example in aging or when having only one functional kidney
The function of the nephron segments
  1. Identify the cellular function of several segments of the nephron
  2. Describe the transport of substances (Na+, K+, Cl, Glucose, etc.) and water in each segment of the nephron: PT, DLH, ALH, DT and DT
  3. Describe the mechanism of transport in each nephron segment
  4. Define the normal range (percentage) of reabsorption or secretion of Na+, K+, water, etc. along the nephron under both normal volume and in volume depletion
  5. Describe the transport of solute and water in absence of hormonal control
  6. Describe the fine-tune of solute and water transport that require hormonal control
  7. Recognize how the anatomical arrangement of the nephron produce highly effective transport of solute and water
  8. Identify the importance of the concentration gradient between cortex and medulla of the nephron
  9. Describe the countercurrent mechanism
  10. Identify the importance of the countercurrent mechanism occurring between ALH and the DLH
Processes performed by the kidney
  1. Recognize global process regulated by the kidney (i.e. osmolality, blood pressure, acid-base balance, etc.)
  2. Describe the basic process in the urine formation: Filtration, Reabsorption and Secretion and Excretion
  3. Define the processes occurring in the nephron segments
  4. Describe the principal processes produced by the nephron: Filtration, Reabsorption, Secretion and Excretion
  5. Apply the equation involving Filtration, Reabsorption and Secretion to evaluate Excretion
  6. Describe the Clearance (C) concept
  7. Describe Glomerular Filtration Rate (GFR)
  8. Define the normal value of GFR
  9. Describe how pressures (hydrostatic and oncotic) affect the GFR
  10. Describe how filtration coefficient (Kf) affect the GFR
  11. Describe why creatinine (Cr) can be used to estimate GFR
  12. Identify the relationship between Cr concentration and GFR
  13. States the GFR differences obtained in population by gender and ethnicity
  14. Recognize why exogenous Inulin can be used to evaluate GFR
  15. Calculate GFR based in the clearance concept
  16. Define normal range of Renal Plasma Flow (RPF)
  17. Describe factor that affect RPF
  18. Describe why PAH can be used to evaluate the effective (eRPF)
  19. Calculates eRPF using the clearance concept
  20. Calculate effective Renal Blood Flow (eRBF) using eRPF and the hematocrit (Hct) values
  21. Identify the normal range of RBF
Control of GFR and RPF by the kidney
  1. Describe the Ultra-filtration Process in the Glomerulus
  2. Recognize the importance of the negative charge of the foot processes
  3. Compare the filterability of molecules in the glomerulus based in its size
  4. Compare the filterability of molecules in the glomerulus based in its electrical charge
  5. Describe the importance of filtration coefficient (Kf)
  6. Describe the Autoregulation of GFR and RPF
  7. Describe the Myogenic mechanism responsible of the Autoregulation
  8. Describe the Tubuloglomerular Feedback mechanism responsible of the Autoregulation
  9. Describe the control of GFR and RPF by changes in the flow resistance of the afferent (AA) and efferent arteriole (EA)
  10. Define Filtration Fraction (FF)
  11. Compare the action of the resistance of the afferent (AA) and efferent arteriole (EA) in the FF
  12. Identify hormones and substances involved in changes in resistance of AA and EA
  13. Identify changes in RBF and GFR during hemorrhage
  14. Describe sequence of mechanism that produce changes in RBF and GFR during hemorrhage
Tubular transport of sodium and water
  1. Describe how filtered load of water and sodium are almost completely reabsorbed in a water balanced subject
  2. Describe the secretion/reabsorption of Urea and Potassium (K+) in a water balanced subject
  3. Describe the transcellular and paracellular transport of substances
  4. Recognize the functional differences among the Apical and Basolateral membranes of the tubular cells
  5. Recognize the importance of the Na+– K+ pump in the basolateral membrane of the tubular cells
  6. Describe the percent of Na+ reabsorption along each segment of the nephron
  7. Describe the mechanisms involving sodium transport along the tubular segments of the nephron
  8. Recognize the hormonal action in the transport of Na+ in the DT and cortical CD
  9. Describe the percent of Water reabsorption along the PT, DLH, CD segments of the nephron
  10. Recognize the hormonal action of the transport of water along the CD
  11. Recognize Na+ reabsorption with Bicarbonate, Glucose, aa, lactate, and Pi transport in the first half of proximal tubule
  12. Recognize Na+ reabsorption with Cl, in the second half of proximal tubule
  13. Compare the solute (Na+, Cl, Pi, HCO3, Glucose, aa, Lactate) concentration along the proximal tubule
  14. Describe the mechanism of Na+ reabsorption in the thick ascending limb of Henle’s loop (TAHL)
  15. Describe the mechanism of water reabsorption in the descending limb of Henle’s loop (DLHL)
  16. Describe the differences among the transcellular (Na+– K+– Cl) transport and paracellular (Na+, K+, Ca++, Mg++) transport
  17. Describe the Na-transport in the early segment of the distal tubule that produce dilution of the “pre-urine”
  18. Describe the Na-transport in the late segment of the distal tubule and cortical collecting duct
  19. Describe the functional difference among Principal and Intercalated Cells
Osmolarity regulation in body fluids
  1. Recognize the relationship between antidiuretic hormone (ADH) level and Urine osmolality (Uosm), Total solute excretion and urine flow rate (V)
  2. Describe how changes in osmolality and vascular pressure activates the ADH secretion
  3. Recognize why the ADH release is more sensitive to the osmotic than the hemodynamic control
  4. Identify how baroreceptors modulates the osmotic control in the ADH release
  5. Describe the renal mechanism for dilution of the urine
  6. Describe the renal mechanism for concentration of the urine
  7. Describe Free Water Clearance (CH2O) concept
  8. Calculate Free Water Clearance (CH2O)
The Effective Circulatory Volume (ECV)
  1. Define the Effective Circulatory Volume (ECV)
  2. Describe the components that monitor ECV
  3. Describe ECV during Edema produced in congestive heart failure
Regulation of potassium by the nephron
  1. Describe the importance of K+ regulation in the Extracellular Fluid (ECF)
  2. Describe the body homeostasis of K+
  3. Identify the factors influence the K+ distribution among the fluid extracellular (ECF) and the intracellular (ICF)
  4. Compare the action of hyperosmotic and hypoosmotic ECF in the K+ distribution
  5. Compare the action of metabolic acidosis and alkalosis in ECF in the K+ distribution
  6. Describe the level in H+ during both [Ca++ ] and [Pr] changes
  7. Describe the transport of K+ along the tubular segments of the nephron during normal or increased [K+] and during [K+] depletion.
  8. Describe the secretion of K+ by the principal cell of the distal tubule and the cortical collecting duct
  9. Describe the mechanism controlling the K+ secretion by aldosterone
  10. Compare the cellular mechanism in the α-intercalated cells and Principal cells in K+ reabsorption and secretion in the late distal tubule (DT) and early collecting duct (CD)
Regulation of calcium and phosphate by the nephron
  1. Describe the maintenance of Ca++ homeostasis
  2. Recognize the action of calcitriol, parathyroid hormone (PTH) and calcitonin in the excretion of Ca++
  3. Recognize the relationship between Ca++ and PTH and calcitonin levels
  4. Describe the cellular mechanism of calcium reabsorption along the nephron
  5. Describe the maintenance of phosphorous homeostasis
  6. Recognize the action of calcitriol, PTH, calcitonin and other factors in the excretion of Pi
  7. Describe the cellular mechanism of phosphorous reabsorption along the nephron
Basic principles of diuretics
  1. Recognize the importance of Na+ in the diuretics action
  2. Describe the action of Carbonic anhydrase inhibitor in the nephron
  3. Describe and name the action of Osmotic diuretics on the nephron
  4. Describe and name the action of Loop diuretics on the nephron
  5. Describe and name the action of thiazide diuretics on the nephron
  6. Describe and name the action of K+-sparing diuretics on the nephron
Basic about Micturition
  1. Describe the micturition process
  2. Describe the cystometrogram