SODIUM BALANCE
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SODIUM BALANCE
Dr.Mohammed Sharique Ahmed QuadriAssistant prof. Physiology
Al Maarefa College
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OBJECTIVES • Describe the overall handling of Na+ by nephron.• Discriminate the mechanism of reabsorption of Na+ in
different parts of nephron • Describe the tubular reabsorption of water• Explain the concept of tubule glomerular feedback
and glomerulo tubular balance • Discuss how various drugs affect the reabsorption of
sodium (Diuretics).• Illustrate the renal mechanism of regulation of Na+
excretion.(effect of sympathetic , ANP, Starlings forces,& renin-angiotensin-aldosterone mechanism )
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Sodium Balance
• Na+ is major cation in ECF
Amount of sodium in ECF
Volume of ECF
Plasma volume
Blood volume
Blood pressure
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Sodium content VS Sodium concentration
• Na+ concentration is determined not only by the amount of Na+ present but also by the volume of water.
• For example, – a person can have an increased Na+ content but a
normal Na+ concentration (if water content is increased proportionately).
– Or, a person can have an increased Na+ concentration with a normal Na+ content (if water content is decreased).
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OVERALL HANDLING OF NA+
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Na+ Reabsorption• An active Na+ - K+ ATPase
pump in basolateral membrane is essential for Na+ reabsorption
• Of total energy spent by kidneys, 80% is used for Na+ transport
• Na+ is not reabsorbed in the descending limb of the loop of Henle
• Water follows reabsorbed sodium by osmosis which has a main effect on blood volume and blood pressure
Tubule area % of Na+
reabsorbed
Role of Na+ reabsorption
Proximal tubule 67% Plays role in reabsorbing glucose, amino acids, H2O, Cl-, and urea
Ascending limb of the loop of Henle
25% Plays critical role in kidneys’ ability to produce urine of varying concentrations
Distal and collecting tubules
8% Variable and subject to hormonal control; plays role in regulating ECF volume
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Diuretics that act here:- a)Osmotic diuretics – Mannitol,Urea etc b)Carbonic Anhydrase Inhibitors - Azetazolamide
Cellular mechanisms of Na+ reabsorption in the early proximal tubule
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Cellular mechanisms of Na+ reabsorption in the late proximal tubule
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Isosmotic Reabsorption• Na+ enters the cell across the luminal membrane
water follows the solute to maintain isosmolarity.
• Na+ is pumped out of the cell by the Na+-K+ ATPase, at basolateral membranes, water again follows passively.
• Isosmotic fluid accumulates in lateral intercellular space between the proximal tubule cells.
• This isosmotic fluid is reabsorbed in peritubular capillary blood due to high oncotic pressure in peritubular capillaries (πc) .
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Mechanism of isosmotic reabsorption in the proximal tubule
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Regulation of Tubular Reabsorption
Glomerulotubular Balance
• Tubular reabsorption increases/decreases automatically as the filtered load increases/ decreases.
• Glomerulotubular balance ensures that a constant fraction of the filtered load is reabsorbed by the proximal tubule, even if the filtered load increases or decreases.
• Glomerulotubular balance ensures that normally 67% of the filtered Na+ and water is reabsorbed in the proximal tubule
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Glomerulotubular Balance
Increase in GFR
Increase in filtration fraction Increase in concentration of protein in
peritubular capillaries
Increase in πc
Increase reabsorption in proximal tubule
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Effects of ECF volume expansion & ECF volume contraction on isosmotic fluid reabsorption in the
proximal tubule
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PROXIMAL TUBULEPoints to ponder
• Reabsorbs 67% of the filtered Na+. • Reabsorbs 67% of the filtered water. • The tight coupling between Na+ and water
reabsorption is called isosmotic reabsorption.• This bulk reabsorption of Na+ and water (the
major constituents of ECF) is critically important for maintaining ECF volume.
• The site of glomerulotubular balance, a mechanism for coupling reabsorption to the GFR.
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Cellular mechanism of Na+ reabsorption in the early distal tubule
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Thick Ascending Limb of Loop of Henle(points to ponder)
• Load dependent reabsorption
• Electrogenic– The role of lumen possitive potential is
driving the reabsorption of Mg & Ca
• Impermeable to water
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Cellular mechanism of Na+ reabsorption in the early distal tubule
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EARLY DISTAL TUBULE
• IMPERMEABLE TO WATER • CORTICAL DILUTING SEGMENT
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Late distal tubule
• Principal cell :Na+ reabsorption & K+ secretion
• α- inetercalted cells K+ reabsorption & H+ secretion
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Late distal tubule(points to ponder)
• Na+ reabsorption in these segments is hormonally regulated. Aldosterone is a steroid hormone that acts directly on the principal cells to increase Na+ reabsorption
• Water permeability of principal cells is controlled by ADH
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Regulation of sodium balance
• EABV: Portion of ECF that is in arteries & is the volume effectively perfusing the tissues
• The renal mechanism to regulate the Na excretion are – Sympathetic nerve activity– Atriopeptin (ANP)– Starling’s forces in peritubular capillaries– Renin-angiotensin aldosterone system
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– Sympathetic nerve activityIn response to dec arterial pressureV.C of aff arteriole & inc Na reabsorption in proximal
tubule
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– Starlinf forcess in peritubular capillaries
– Renin-angiotensin aldosterone system – In respose to decrease in arterial pressure– Angiotensin II inc reabsorption of Na in proximal
tubule – Aldosterne inc reabsorption of Na in distal tubule
& collecting ducts
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RAAS
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– Atriopeptin (ANP)
• In rsponse to increase in ECF volume • V.D of aff & V.C OF eff arteriol• Incease GFR & dec reabsorption of Na
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References
• Human physiology by Lauralee Sherwood, seventh edition
• Text book of physiology by Linda .s contanzo,third edition
• Text book physiology by Guyton &Hall,11th edition