Distal Convoluted Tubule (DCT): Pathophysiology

by Carlo Raj, MD

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    Continuing our discussion of the nephron where at the level of the loop and the distal convoluted tubule. Put these together and as we go through this, it is important that you pay attention here. Once again the physiology is important so that you can then make sense of the pathology. Otherwise things become really confusing and you start memorizing. There is no end to it. Overview: We are done with the PCT in its entirety. We are moving down through the descending limb, through the loop and as you move through the loop, tell me about the urine tonicity? Increased. Hypertonicity. As we move into the area of C in ascending limb of thick ascending limb and you have a symport there called your sodium- potassium-2 chloride and then, later on, we get into the portion where it says D as in delta. There will be distal tubule and there we shall take a look at our sodium chloride channel. Let us take a look at our loop. Now the loop is well as we moved down the descending limb, it is impermeable to water and thus, you have medullary hypertonicity. What kind of segment would you then call this? The concentrating segment. Good and makes the urine as you can imagine where? In the medullary loop of Henley as being hypertonic. Impermeable to water. What is my next step? You are going to move up the ascending limb and as you move up the ascending limb, what then happens? While you are focused, once again we have organized this cell plenty. Let us do it here once more. We have your urine on your left side, the lumen. Then you have the epithelial cell or the renal epithelial cell and then on the right side, you have interstitium...

    About the Lecture

    The lecture Distal Convoluted Tubule (DCT): Pathophysiology by Carlo Raj, MD is from the course Diseases of the Nephron. It contains the following chapters:

    • Tubular Transport
    • Bartter and Gitelman Syndrome
    • Antenatal Bartter Syndrome
    • Gitelman Syndrome

    Included Quiz Questions

    1. Urine that is hypotonic to plasma.
    2. Urine that is hypertonic to plasma.
    3. Urine with an osmolarity of 600 mOsm/L.
    4. Urine with an osmolarity of 300 mOsm/L.
    5. Urine that is isosmotic to plasma.
    1. Thick Ascending limb of the loop of Henle
    2. Collecting Duct
    3. Thin Ascending limb of the loop of Henle
    4. Distal convoluted tubule
    5. Descending limb of the loop of Henle
    1. Renal outer medullary potassium channel
    2. Epithelial Na channel
    3. Na/H exchanger
    4. Aquaporins
    5. Thiazide sensitive NaCl cotransporter
    1. It is the beginning of the diluting segment.
    2. Fluid in the lumen of this segment is hypertonic
    3. It is not necessary for countercurrent mechanism maintenance.
    4. It contains mostly obligated water.
    5. It is permeable to water.
    1. Na reabsorption in the distal convoluted tubule is inhibited by furosemide.
    2. Na reabsorption is increased by the action of aldosterone.
    3. 5% of Na is reabsorbed in the distal convoluted tubule along with Cl.
    4. 25% of Na is reabsorbed in the thick ascending limb along with K and Cl.
    5. 65% of Na is reabsorbed isotonically in the proximal convoluted tubule.
    1. Metabolic alkalosis
    2. Anion gap metabolic acidosis
    3. Respiratory acidosis
    4. Respiratory alkalosis
    5. Non-anion gap metabolic acidosis
    1. Hypotension
    2. Fatigue
    3. Cardiac arrhythmia
    4. Ileus
    5. Muscle weakness
    1. Inhibition of NaCl symport
    2. Inhibition of NaK2Cl symport
    3. Inhibition of ROMK channel
    4. Inhibition of Na/H+ exchanger
    5. Inhibition of isotonic fluid reabsorption
    1. NaCl symporter
    2. NaK2Cl cotransport
    3. Na-Ca exchanger
    4. Epithelial Na Channel
    5. Outer medullary potassium backleak channel
    1. Potassium
    2. Sodium
    3. Calcium
    4. Magnesium
    5. Chloride
    1. Hypocalciuria
    2. Secondary hyperaldosteronism.
    3. Hypomagnesemia
    4. Metabolic alkalosis
    5. Hypokalemia
    1. Furosemide
    2. Indomethacin
    3. Amiloride
    4. Spironolactone
    5. ACE inhibitors
    1. Inhibit prostaglandin
    2. Reduce inflammation
    3. Decrease filtration fraction
    4. Fever reduction
    5. Analgesia
    1. Thick ascending limb of the loop of Henle
    2. Distal convoluted tubule
    3. Descending limb of the loop of Henle
    4. Proximal convoluted tubule
    5. Collecting duct
    1. Nocturia
    2. Mental retardation
    3. Hyperventilation
    4. Hypertension
    5. Sensorineural deafness
    1. Magnesium
    2. Hydrogen
    3. Potassium
    4. Calcium
    5. Sodium
    1. Hypocalciuria
    2. Hypomagnesemia
    3. Hyperprostaglandinemia
    4. Hypokalemia
    5. Hyponatremia
    1. Suppresion of ADH
    2. Loss of isotonic NA reabsorption
    3. Activation of PTH receptors
    4. Aldosterone activation
    5. Inhibition of NaK2Cl cotransport

    Author of lecture Distal Convoluted Tubule (DCT): Pathophysiology

     Carlo Raj, MD

    Carlo Raj, MD

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