Function reabsorption

Hydroxy vitamin D pools ia the blood and is transported on DBF to the kidney, where further hydroxylation takes place at C-1 or C-24 ia response to calcium levels. l-Hydroxylation occurs primarily ia the kidney mitochondria and is cataly2ed by a mixed-function monooxygenase with a specific cytochrome P-450 (52,179,180). 1 a- and 24-Hydroxylation of 25-hydroxycholecalciferol has also been shown to take place ia the placenta of pregnant mammals and ia bone cells, as well as ia the epidermis. Low phosphate levels also stimulate 1,25-dihydtoxycholecalciferol production, which ia turn stimulates intestinal calcium as well as phosphoms absorption. It also mobilizes these minerals from bone and decreases their kidney excretion. Together with PTH, calcitriol also stimulates renal reabsorption of the calcium and phosphoms by the proximal tubules (51,141,181—183). 

In the kidney, ANG II reduces renal blood flow and constricts preferentially the efferent arteriole of the glomerulus with the result of increased glomerular filtration pressure. ANG II further enhances renal sodium and water reabsorption at the proximal tubulus. ACE inhibitors thus increase renal blood flow and decrease sodium and water retention. Furthermore, ACE inhibitors are nephroprotective, delaying the progression of glomerulosclerosis. This also appears to be a result of reduced ANG II levels and is at least partially independent from pressure reduction. On the other hand, ACE inhibitors decrease glomerular filtration pressure due to the lack of ANG II-mediated constriction of the efferent arterioles. Thus, one important undesired effect of ACE inhibitors is impaired glomerular filtration rate and impaired kidney function. 

The parathyroid glands in FHH are reset to maintain a higher than normal serum calcium concentration owing to impaired suppression of PTH release in the face of hypercalcemia (e.g., resistance to CaQ+) (Fig. 2). Similarly the kidneys show a reduced calciuric response to hypercalcemia, which contributes to the hypercalcemia by promoting inappropriately reabsorption of calcium. Mouse models of FHH and NSHPT result from targeted inactivation of one or both CaR alleles, respectively [1,3]. These animals have provided valuable insights into the alterations in tissue function resulting from loss of the receptor. 

Kir 1.1. Bartter Syndrome. Several mutations in the core region as well as in the N and C terminus of Kir 1.1 are found in patients with hyperprostaglandin E syndrome (HPS renal disorder resulting from impairment of tubular reabsorption), an antenatal form of Bartter syndrome. Some of these mutations result in the loss of function of Kiri. 1 channels causing impaired renal K+ secretion and NaCl reabsorption. 

Abnormally high concentrations of sodium and chloride are found in sweat due to impaired reabsorption within the sweat duct from loss of CFTR channels. Patients are usually asymptomatic (other than a characteristic salty taste to the skin).2 In rare instances such as hot weather or excessive sweating during physical activity, patients may become dehydrated and experience symptoms of hyponatremia (nausea, headache, lethargy, and confusion). Similar CFTR defects are also seen in the salivary glands, manifested by increased saliva viscosity and impaired salivary function. 

As kidney function declines, bicarbonate reabsorption is maintained, but hydrogen excretion is decreased because the ability of the kidney to generate ammonia is impaired. The positive hydrogen balance leads to metabolic acidosis, which is characterized by a serum bicarbonate level of 15 to 20 mEq/L (15 to 20 mmol/L). This picture is generally seen when the GFR declines below 20 to 30 mL/minute.38... 

The kidneys are located on the posterior part of the abdomen on either side of the spine, below the diaphragm, and behind the liver and stomach. They are bean-shaped and weigh approximately 150 grams (0.33 lb) each. The primary function of the kidneys is excretion. They work to excrete waste products through a series of steps involving glomerular filtration, secretion, and reabsorption. The kidneys also have several endocrine (e.g., production of erythropoietin and renin) and metabolic (e.g., vitamin D activation and drug metabolism) functions. 

Probenecid is a uricosuric agent that blocks the tubular reabsorption of uric acid, increasing its excretion. Because of its mechanism of action, probenecid is contraindicated in patients with a history of uric acid stones or nephropathy. Probenecid loses its effectiveness as renal function declines and should be avoided when the creatinine clearance is 50 mL/minute or less. Its uricosuric effect is counteracted by low aspirin doses, which many patients receive for prophylaxis of coronary heart disease. 

Bulk flow plays only a minor role in the exchange of specific solutes between blood and tissue cells. A far more important function of bulk flow is to regulate distribution of extracellular fluid between the vascular compartment (plasma) and the interstitial space. Maintenance of an appropriate circulating volume of blood is an important factor in the maintenance of blood pressure. For example, dehydration and hemorrhage will cause a decrease in blood pressure leading to a decrease in capillary hydrostatic pressure. As a result, net filtration decreases and net reabsorption increases, causing movement, or bulk flow, of extracellular fluid from interstitial space into the vascular compartment. This fluid shift expands the plasma volume and compensates for the fall in blood pressure. 

Another important linear parameter is the excitation anisotropy function, which is used to determine the spectral positions of the optical transitions and the relative orientation of the transition dipole moments. These measurements can be provided in most commercially available spectrofluorometers and require the use of viscous solvents and low concentrations (cM 1 pM) to avoid depolarization of the fluorescence due to molecular reorientations and reabsorption. The anisotropy value for a given excitation wavelength 1 can be calculated as... 

The answer is a. (Katzung, p 590.) Bile acids are absorbed primarily in the ileum of the small intestine. Cholestyramine binds bile acids, preventing their reabsorption in the jejunum and ileum. Up to 10-fold greater excretion of bile acids occurs with the use of resins. The increased clearance leads to increased cholesterol turnover of bile acids. Low-density lipoprotein receptor upregulation results in increased uptake of LDL. This does not occur in homozygous familial hypercholesterolemia because of lack of functioning receptors. 

The proteinuria and aminoaciduria, and acidosis and glucosuria where they occur, are probably caused by reversible inhibition of some functions of the renal tubule. There would appear to be no structural damage to the kidney. However, 2 children developed nephrolithiasis while being treated with a low-lactose diet (B7, C5), The time course of events, when galactose is withdrawn from and returned to the diet, suggests that some metabolite of galactose accumulates in the cells of the renal tubules and has an inhibitory effect on the reabsorption of a number of substances. 

The urinary amino acids reflect both their high concentration in the blood, due to poor functioning of the liver, and failure of renal tubular reabsorption. The phenolic acids and tyrosine in the urine are evidence... 

It is contended that the renal slice technique measures primarily basolateral uptake of substrates or nephrotoxins, based on histological evidence of collapsed tubular lumens. This results in the inaccessibility of brush-border surfaces for reabsorptive transport (Burg and Orloff, 1969 Cohen and Kamm, 1976). This observation limits the ability of this model to accurately reflect reactions to nephrotoxins that occur as the result of brush-border accumulation of an injurious agent. Ultrastructurally, a number of alterations, particularly in the plasma membrane and mitochondrial compartments, have been shown to occur over a 2-h incubation period (Martel-Pelletier et al., 1977). This deterioration in morphology is very likely a consequence of the insufficient diffusion of oxygen, metabolic substrates, and waste products in the innermost regions of the kidney slice (Cohen and Kamm, 1976). Such factors also limit the use of slices in studying renal metabolism and transport functions. 

Anti-diuretic hormone is a small peptide shown as Figure 8.9, which is secreted by the pituitary gland located at the base of the brain. The cellular actions of ADH are mediated by activation of a G-protein linked receptor generating cAMP as second messenger. Absence of ADH or a functional defect in the action of ADH-stimulated water reabsorption in the collecting duct results in the condition diabetes insipidus, characterized by the passing of large volumes (= diabetes) of dilute (= insipidus) urine. 

Reabsorption of water is a fundamental function of the kidney because loss of fluid volume and reduction in blood pressure (hypotension) would have devastating consequences on all other tissues, possibly leading to severe metabolic disruption or even death. Blood pressure is monitored by the kidney and regulated by secretion of a proteolytic enzyme called renin, which initiates a cascade involving angiotensin and aldosterone to restore blood volume. 

Figure 8.22. Fluorescence reabsorption in a finite scattering layer with K°/S = 0.1 as a function of the scattering thickness Sd. Ordinate fraction of emitted to true fluorescence intensity in backward (upper) and forward direction (lower). Parameter reduced absorption coefficient at the fluorescence wavelength.

The function of the loop of Henle is to enable production of a concentrated urine. It does this by generating a hypertonic interstitium, which provides a gradient for water reabsorption from the collecting duct. This, in turn, occurs under the control of antidiuretic hormone (ADH). There are several important requirements without which this mechanism would not work. These include the differential permeabilities of the two limbs to water and solutes and the presence of a blood supply that does not dissipate the concentration gradients produced. This is a simplified description to convey the principles. 

The filtered marker undergoes tubular reabsorption and secretion. The clearance of such markers depends on the relative rates of filtration, reabsorption, and secretion. Determination of renal function by these markers, typified by uric acid, is cumbersome. 

Stability The marker for GFR measurement should be biologically inert, which implies the absence of binding to plasma proteins, reabsorption in the renal tubule, deleterious effect on renal function, and intact excretion of the filtrate in the urine without degradation. This biological inert criterion, albeit difficult to achieve synthetically, confers an enormous advantage for speedy regulatory approval, especially if small doses are used. 

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