Renal tutorial 4

Acid-base balance
Renal function tests
Acid base balance
Physiological buffers
Renal mechanisms for the control
of acid-base balance:

1.H+ secretion and excretion.

2.HCO3- reabsorption and
addition of new HCO3-.
3.Ammonia (NH3) secretion.
 Secretion of H+

The epithelial cells of the

proximal tubule, the thick
segment of the ascending
loop of Henle, and the
early distal tubule all
secrete H+ into the tubular
fluid by sodium-hydrogen
counter-transport, (
secondary active secretion
of H+. )
In the late distal tubule
and in the collecting
tubules.

Primary active secretion

of H+ occurs in the
intercalated cells
2. Reabsorption of filtered
Bicarbonate: occurs primarily in
the proximal tubule

CO2, under the influence of the

enzyme carbonic anhydrase,
combines with H2O to form H2CO3,

which dissociates into HCO3- and H+.

The H+ is secreted from the cell into

the tubular lumen by sodium-
hydrogen counter-transport.
HCO3- generated in the cell then
moves to the renal interstitial fluid
and the peritubular capillary blood.

The net result is that for every H+

secreted into the tubular lumen, an
HCO3- enters the blood.
As long as there is excess HCO3-
in the tubular fluid, most of the
secreted H+ combines with
HCO3-.

However, once all the HCO3- has

been reabsorbed and is no
longer available to combine with
H+, excess H+ can combine with
HPO4- and other tubular buffers.

After the H+ combines with

HPO4- to form H2PO4, it can be
excreted as a sodium salt
(NaH2PO4), carrying with it the
excess hydrogen.
 3. Ammonia secretion
Ammonium ion is synthesized
from glutamine, (from the
metabolism of a.a in the liver).

The glutamine is then

delivered to the kidneys

Once inside the cell, each

molecule of glutamine is
metabolized in a series of
reactions
The cells of the proximal
tubule then convert the
glutamine back to
bicarbonate and NH4+.

The NH4+ is secreted by the

Na-H countertransport
into the lumen of the
proximal tubule,
the bicarbonate exits into
the interstitium and then
into the blood. This is new
bicarbonate
6. All are true for renal handling of
acids in metabolic acidosis except
a) Hydrogen ion secretion is increased

b) Bicarbonate reabsorption is decreased

c) Urinary acidity is increased

d) Urinary ammonia is increased.

 It is important for diagnosis , prognosis
and management of renal diseases .
 evaluate how well the kidneys are
functioning.

Types :
1-

2- determine the amount of renal failure

taken place
Discussed before please revise the
previous classed
Creatinine is a chemical waste molecule that is
generated from muscle metabolism

Because the muscle mass in the body is

relatively constant from day to day, the
creatinine level in the blood normally remains
essentially unchanged on a daily basis.
0.8-1.1 ml/min
A phosphate test measures the amount of
phosphate in a blood sample

The kidneys help to control the amount of

phosphate in the blood
The amount of phosphate in blood affects the
amount of calcium in the blood
 adults

(3:4.5)mg/dl
the normal PH of blood through the arteries is
7.4±.02
The PH of blood through the veins is
7.38±0.02
We indicate the PH of blood by the blood gas
test
 Blood gas test are ordered when you have symptoms of an (O2
/CO2 or PH imbalance)
 The blood gas test do not tell the direct cause of the imbalance
 abnormal results mean A PH imbalance
Blood either too acidic (Acidosis) or alkaline (Alkalosis)
This means it’s a condition that affects either respiratiory or
metabolic processes
 :

Abnormal values:
1- moderate renal failure :

2- acute renal failure :

3- chronic renal failure :

Definition :
.
Normal value :

Importance :
The first part of the urine stream is discarded,
then a small sample of urine is collected into
a container. The sample can be measured
immediately or stored for later measurement.
2- diarrhoea.
2- urine is collected from the bladder every
one hour for 5 hours .
Below 1.010

(due to impaired function of distal tubules)

2- at the end of 12 hours a urine sample is
taken and the specific gravity is
measured.
Importance:

Detect a problem.
 locate a suspected obstruction to the flow of
urine.

 gives information about the function of each

kidney separately.
 Image Assessment:

The kidneys are assessed and compared for:

Regular appearance, smooth outlines, size, position, equal
filtration and flow.
The ureters are assessed and compared for:
Size, a smooth regular and symmetrical appearance.
The bladder is assessed for:
Regular smooth appearance and complete voiding.
An injection of x-ray contrast
media

The contrast is removed from the

bloodstream via the kidneys

the contrast media becomes

visible on x-rays just after
injection
Normal Appearance:
 Gradual
appearance
1
2

3
Kidney stones
 Computed
tomography
(CT)