Proximal Convoluted Tubule (PCT): Clinical Effects, Syndroms and Diseases

by Carlo Raj, MD

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    Our discussion earlier was dealing with bicarb. Talked about the physio of it all. Let us give it some clinical correlations like you should be doing in every step of the way. Normally, with this, we are talking about lowering the renal threshold for bicarb. What does that even mean? That means that you're actually not reabsorbing bicarb. Listen to what I just said. We are going to lower our standard terminology, the renal threshold for reclaiming bicarb, which means what? That means the more the bicarb remains within the urine and you are going to get rid of it. So, therefore, your normal bicarb level, which is between 22 to 26, and we are using 24 has now dropped down to 15 where, please? In the plasma, right? Now you tell me, acid-base disturbances from physiology. If you were to drop your bicarb down to 15, what does that mean to you? Acidosis because you don't have as much bicarb. You have lost it. What kind of acidosis? Is this respiratory acidosis or would this be metabolic acidosis? Good. Metabolic acidosis. Are we clear? If metabolic acidosis, let me take one step further, just to make sure we are good here. If you have metabolic acidosis and how you are going to compensate? You are going to try to blow off your carbon dioxide very quickly so therefore within minutes, you are going to start hyperventilating, so that you can blow off that carbon dioxide, aren't you? Continue. So now this results with what? Loss of more of your filtered bicarb than the normal renal threshold. Why might you want to do this? As a method of compensation maybe perhaps you are doing this. Remember that high altitude patient that we talked about acutely. In acute high altitude sickness,...

    About the Lecture

    The lecture Proximal Convoluted Tubule (PCT): Clinical Effects, Syndroms and Diseases by Carlo Raj, MD is from the course Diseases of the Nephron. It contains the following chapters:

    • Clinical Effects
    • Proximal Convoluted Tubule
    • Fanconi Syndrome
    • Hartnup Disease
    • Type 2 (Proximal) RTA

    Included Quiz Questions

    1. 22-26 mEq/L
    2. 18-22 mEq/L
    3. 20-30 mEq/L
    4. 15-30 mEq/L
    5. 26-30 mEq/L
    1. Less bicarbonate is being reabsorbed.
    2. More bicarbonate is being reabsorbed.
    3. Carbonic anhydrase enzymes are oversaturated.
    4. Metabolic Acidosis.
    5. The bicarbonate level in the plasma is too low.
    1. NaHCO3
    2. CO2
    3. CO3-
    4. H2CO3
    5. HCO3-
    1. Compensatory metabolic acidosis
    2. Compensatory respiratory alkalosis
    3. Compensatory metabolic alkalosis
    4. Respiratory acidosis
    5. Respiratory alkalosis
    1. Aldosterone
    2. Renin
    3. Angiotensin II
    4. Cortisol
    5. Parathyroid hormone
    1. Muddy brown granular cast
    2. Hyaline casts
    3. RBC casts
    4. Fatty casts
    5. Waxy, broad casts
    1. Sideroblastic anemia
    2. Megaloblastic anemia
    3. Fanconi anemia
    4. Aplastic anemia
    5. Iron-deficiency anemia
    1. Waxy casts
    2. Coagulation necrosis
    3. Loss of tubular epithelial cell nuclei
    4. Ischemia
    5. Heavy metal poisoning
    1. Calcitriol
    2. Parathyroid hormone
    3. Anti-diuretic hormone
    4. Angiotensin II
    5. Aldosterone
    1. Fanconi anemia
    2. Multiple myeloma
    3. Ischemia
    4. Cystinosis
    5. Lead poisoning
    1. Hyperventilation
    2. Dyspnea
    3. Decreased respiratory drive
    4. Congestion
    5. Cough
    1. Plasma osmolality
    2. Plasma phosphate concentration
    3. Effective circulating blood volume
    4. Urine hydrogen concentration
    5. Plasma bicarbonate concentration
    1. Non-anion gap metabolic acidosis
    2. Anion gap metabolic acidosis
    3. Respiratory alkalosis
    4. Respiratory acidosis
    5. Metabolic alkalosis
    1. Tryptophan
    2. Cysteine
    3. Arginine
    4. Lysine
    5. Ornithine
    1. Nephrolithiasis
    2. Cerebella ataxia
    3. Psychiatric symptoms
    4. Skin photosensitivity
    5. Megaloblastic anemia
    1. Urinalysis
    2. Blood pH
    3. Cerebellar testing
    4. Stool pH
    5. Skin biopsy
    1. Niacin
    2. Cobalamin
    3. Pantothenic acid
    4. Biotin
    5. Thiamine
    1. Impaired bicarbonate production
    2. Impaired bicarbonate reabsorption
    3. Impaired hydrogen secretion
    4. Ineffective carbonic anhydrase
    5. Extensive damage to the proximal convoluted tubule
    1. Increased urine pH
    2. Metabolic alkalosis
    3. Increased plasma pH
    4. Anion-gap metabolic acidosis
    5. Aciduria
    1. 10
    2. 4
    3. 6
    4. 13
    5. 11

    Author of lecture Proximal Convoluted Tubule (PCT): Clinical Effects, Syndroms and Diseases

     Carlo Raj, MD

    Carlo Raj, MD

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