Physio Renal 6.
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Medical college lectures: Ranal physiology 2nd year.
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Physio Renal 6.
- 1. Acid – Base Balance. Dr.Mohamad Shaikhani.
- 11. Renal tubular secretion of H+ ion: Proximal tubules. Distal tubule. 1.Occure in proximal tubule segments. 2.Contributes to 95% of H+ secreted by kidneys. 3.Concentrates H+ *4. 4.It is secondary active secretion. 5.It occurs in all proximal tubular cells. 1.Occure in distal tubule segments & pelvis. 2.Contributes to 5% of H+ secreted by kidneys. 3.Concentrates H+ *900. 4.It is primary active secretion. 5.It occurs in only intercalated or dark cells.
- 12. Renal tubTransport of Excess H+ ion in the urine with urinary buffers: .Urinary PH is 6(4.8 – 8),only 1% of H ion secreted in urine is free while 99% is secreted with the urinary buffering systems which include: 1.Amonia BS. 2.Phosphate BS.
- 13. 1.Amonia BS in the renal tubules: Amonia is formed from Gultamin by the enzyme glutaminase in the tubular cells ,the formed ammonia diffuses into the lumen to bind the excess H+ secreted into the tubular lumen to form NH4 which binds with CL coming from NaCL to form NH4CL.
- 14. 2.Phosphate BS in the renal tubules: It is an effective buffer system in the renal tubules as its concentration there is high &its PK 6.8 near to the normal blood PH of 7.4.
- 15. Causes of Acid – Base abnormalities: Acidosis. Alkalosis. Respiratory Metabolic Respiratory Metabolic 1.Hypoventilation causing CO2 accumulation. 2.Respiratory center damage. 3.Respiratory obstruction. 4.Pneumonia. 1.Diabetes Mellitus. 2.Renal failure. 3.Acid ingestion. 4.Alcoholic ketoacidosis. 5.Lactic acidosis. 1.Hyperventilation causing CO2 wash as in hysteria or high altitude. 1.Diuretics. 2.Alkali ingestion. 3.Pyeloric obstruction. 4.Hyperaldosteronism.
- 16. Clinical features: Acidosis: CNS depression leading to drowsiness ,confusion & coma with deep sighing respiration called kausmal’s breath. Alkalosis: On the other hand causes hyper excitability of the CNS causing tetany ,carpopedal spasm ,numbness & convulsions. Treatment: Acidosis: Sodium Bicarbonate or lactate or gluconate IV slowly. Alkalosis: Oral NH4CL or lysine monoHCL. PH measurements; By Glass electrode PH meter of plasma with special care during pl