Renal Endocrine Function, Diuretics, Micturation

Gluconeogenisis: Production of Glucose from Glutamine and Lactate in proximal tubules during fasting. By product is
NH4 from glutamine important in renal acid excretion.

Substance Production Activity Other

1,25-Dihydroxyvitamin Produced in Proximal tubules- Increased Ca deposition/ Ca
D3 (active form Vitamin activated by PTH (low Ca levels) reabsorption of GI tract
D) Calcitriol
PTH-Increases thick acending loop of
henle and distal tubular Ca
reabsorption
Erythropoietin Produced by Hepatocytes (90% Stimulates RBC production in hypoxia Low EPO
peritubular fibroblast cells in renal (low pO2) causes
cortex) 1. Low blood volume Anemia
2. Anemia associated
3. Low Hb with
4. Poor blood flow chronic
5. Pulmonary disease Renal
failure
Renin Enzyme in Production of Released by:
Angiotensin II 1. Increased sympathetic Activation
1. Antinaturetic 2.Decreased delivery of NaCl to
2. Vasoconstrictor (efferent) macula densa
3. Increase Aldosterone
1. 3. Decreased renal perfusion
pressure

Diuretics: Given to patients with increased Blood pressure to reduce the Extracellular fluid by increasing Na
Excretion and prevent edema.

Drug Other Names Where How Filtered Side Effects

Load
 Effects
Norm 1%
Osmotic Mannitol (freely Proximal tubule / thin Affect H2O transport Increase Increased K
Diuretics filtered, not descending loop of across epithelial cells Na secretion, HCO3,
reabsorbed) henle by altering osmotic excretion Ca
driving forces. Stays in to 10% of
Glucose- tubular fluid and Filtered
diabetic pts. creates osmotic load
pressure to prevent
H2O from being
reabsorbed
Carbonic Acetazolamide Proximal Tubule Alter reabsorption of Increase Increased K
Anhydratase (most) Na by inhibiting CA and Na secretion, HCO3,
Inhibitors limiting activity of Na/H excretion Ca
exchange mechanism. to 5-10%

Less H produced inside

the cell due to
blockage of H2CO3
production from H20
and Co2. Less Na
reabsorbed, more Na
in tubular fluid, H20
follows, more h20 in
tubular fluidNaturesis
+ Diuresis
Loop Diuretics Bumetanide, Loop of Henle (mostly Inhibit Na reabsorption Acutely Increased K
furosemide, thick) block Na/K/2Cl Increase secretion, Ca
ethacrynic transporter. Impair Na
kidney to excretion Impaired
concentrate/dilute up to 20% Concentrating/dil
 urine. of filtered uting
load
Thiazide Clorothiazide, Early distal Inhibit Na Reabsorption Increase Increased K
Diuretics metolazone tubule(diluting by blocking Na-Cl Na to 5- excretion and
segment) symporter in the apical 50% decreased urinary
membrane. Filtered diluting ability
Load
Decreases ability to
dilute tubular fluid.
Potasium A. Principle Cells (late Inhibit Na reabsorption 3-5% of Decreased K
Sparing Aldosterone distal tubule and and K secretion filtered excretion,
Diuretics Antagonist cortical collecting load Increased HCO3
1. duct) excretion
Spironolactone
2.Eplerenone

B. Blocks Na
Channels
1. Amiloride
2.Triamterene
Micturation: Urine expelled from the bladder is unchanged from the fluid which left the collecting ducts.

1) Filling
2) Emptying
a. An autonomic spinal cord reflex that can be inhibited or facilitated in the cerebral cortex or brain
stem.
b. Ureter has smooth muscle that propels urine from renal pelvis to bladder by peristaltic waves.
i. Mechanical stimuli (stretch), chemical stimuli, or depolarization, AP trigger contraction
ii.Occurs w/o neural stimulation, yet regulated by Sympathetic /Parasympathetic / some
Autonomic (pudendal)
c. Bladder - Smooth Detrusor muscle contracts to increase pressure
 i. Neck- internal sphincter prevents emptying until critical threshold of pressure
ii.UG diaphragm- External Sphincter- Skeletal muscle- Voluntary control
iii.Innervated by sympathetic/parasympathetic (motor)/autonomic nerves (pudendal ext.
sphincter)
d. Micturation Reflex: As bladder fills, contractions are more frequent, of greater duration, greater
intensity
i. Micturation 1- waves initiated by sensory stretch receptors, through sacral cord and reflexed
back through parasympathetic fibers of same pelvic nerves
1. Rapid and progressive increase in pressure
2. Period of sustained pressure
3. Return of pressure to basal tone
ii.Unsuccessful reflex is followed by inhibition state for 1 hour or so
iii.Eventually extremely powerful to cause reflex by pudendal nerve
iv.Voluntary urination by voluntary contraction of abdominal muscles to increase bladder
pressure and stimulate micturation reflex, inhibit external urethral sphincter