H 2 CO 3

2. Early Proximal tubule Lumen Blood vessel Na+ Na+ Na+ ATP Na+ Na+ Na+ Na+ (65 -80) Na+ Na+ Na+ Na+ K+ Glucose Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+ H+ HCO3- H+ + + HCO3- H+ HCO3- H2CO3 Carbonic anhydrase H2CO3 Carbonic anhydrase H2O CO2 CO2 + H2O + Cl- Base- K+ H2O Cl-

3. Early Proximal tubule Lumen Blood vessel Na+ Na+ Na+ ATP Na+ Na+ Na+ Na+ (65 -80) Na+ Na+ Na+ Na+ Na+ K+ Glucose Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+ H+ HCO3- H+ + + HCO3- H+ HCO3- H2CO3 Carbonic anhydrase H2CO3 Carbonic anhydrase H2O CO2 CO2 + H2O + Cl- Base- K+ H2O Cl-

4. Glucose titration curve Glucose 800 Glucose Filtered 600 Glucose Reabsorbed 400 Glucose flux (mg/min) TmG = 375mg/min Splay 200 Glucose Excreted Splay GFR = 125mL/min 0 200 400 600 800 [Glucose] plasma (mg/dL K = RPT

5. 100 Changes in % of renal filtrate 50 B 20 Fraction remaining in tubular fluid 10.0 A 5.0 Urea 2.0 C 1.0 D 0.50 Water 0.20 0.10 Na+ 0.05 0.02 Proximal tubule Loop of Henle Distal tubule Collecting tubule

6. Changes in % of renal filtrate B Creatinine Inulin A Urea Fraction remaining in tubular fluid C D E Water Glucose F Na+ Proximal tubule Loop of Henle Distal tubule Collecting tubule

7. Case 1 A 75-year-old man is brought to the emergency department because of diarrhea and vomiting for the last 24 hours. The patient lives at home with his son, and his son states that his father has been unable to take in much fluid since his symptoms began. On examination, his mucous membranes are dry and his blood pressure is 90/60 mm Hg. What changes do you expect in the renal plasma flow (RPF) of this patient? Would there be any change in his glomerular filtration rate (GFR)? What impact would this patient physiological state have on his filtration fraction?

9. A 27-year-old woman is being monitored in the intensive care unit after she sustained head trauma in a motor vehicle accident 3 days ago. She has undergone computed tomographic imaging of her head, which revealed cerebral swelling but no evidence of hemorrhage or brain herniation. The patient has been in critical but stable condition. The nurse calls the physician because the patient has developed hypernatremia and has had a significant increase in dilute urine output. The findings are confirmed, and it is determined that the patient has central diabetes insipidus as a result of the head trauma. • How are antidiuretic hormone (ADH) levels affected in patients with this condition? • What is the effect of high ADH on the late distal tubule and collecting ducts? • How does free-water clearance change in the presence of ADH?

10. Solute reabsorption at PCT Cl-

11. Early Proximal tubule Lumen Blood vessel Na+ Na+ Na+ ATP Na+ Na+ Na+ Na+ (65 -80) Na+ Na+ Na+ Na+ Na+ K+ Glucose Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+ H+ HCO3- H+ + + HCO3- H+ HCO3- H2CO3 Carbonic anhydrase H2CO3 Carbonic anhydrase H2O CO2 CO2 + H2O + Cl- Base- K+ H2O Cl-

12. Thick ascending loop of Henle Lumen Blood vessel Na+ Na+ Na+ Na+ (15 - 20) Na+ Na+ Na+ Na+ Cl- ATP Na+ K+ K+ 2Cl- CA2+ Ca2+ Na+ Cl-

13. Early distal convoluted tubule Lumen Blood vessel Na+ K+ Loop diuretics 5% Na+ ATP 2Cl- K+ K+ Cl- K+ Diffusion down the electrochemical gradient Mg 2+ , Ca2+ Cl-

14. Collecting Duct K+ sparing diuretics Aldosterone Lumen Blood vessel Principal Cell R H2O H2O H2O H2O H2O H2O H2O H2O 5 - 7% Na+ Na+ H2O H2O H2O ATP Na+ Na+ Na+ Na+ K+ K+ K+ Na+ Na+ K+ K+ V2 ADH H20 Water channel molecules Intercalated cell Cl-

15. Collecting Duct K+ sparing diuretics Aldosterone Lumen Blood vessel Principal Cell R H2O H2O H2O H2O H2O H2O H2O H2O 5 - 7% Na+ Na+ H2O H2O H2O ATP Na+ Na+ Na+ Na+ K+ K+ K+ Na+ Na+ K+ K+ Ca2+ V2 ADH H20 Water channel molecules Intercalated cell Mg 2+ , HCO3- K+ ATP Cl- H+ Cl-

17. Glucose titration curve Glucose 800 H Glucose Filtered 600 Glucose Reabsorbed 400 Glucose flux (mg/min) I TmG = 375 mg/min 200 A Glucose Excreted C K GFR = 125mL/min 0 F 200 400 600 800 [Glucose] plasma (mg/dL K = RPT