A 45-year-old patient with chronic liver disease presents with hypoalbuminemia. Laboratory tests rev

A 45-year-old patient with chronic liver disease presents with hypoalbuminemia. Laboratory tests reveal a low total serum calcium level but a normal ionized calcium level. Which of the following best explains the relationship between hypoalbuminemia and serum calcium levels in this patient? Decreased albumin reduces the total serum calcium by decreasing the concentration of ionized calcium. Decreased albumin reduces the total serum calcium by decreasing the amount of protein-bound calcium. Decreased albumin increases renal calcium excretion, leading to hypocalcemia. Decreased albumin decreases the secretion of parathyroid hormone (PTH), reducing calcium reabsorption. Decreased albumin enhances calcium binding to phosphate, lowering total serum calcium. A pharmacologist is studying the effects of thiazide diuretics on renal calcium handling. Which of the following mechanisms best explains the impact of thiazide diuretics on urine calcium excretion? Inhibition of the Na⁺-K⁺-2Cl⁻ co-transporter leads to a more favorable gradient for calcium reabsorption Increased proximal tubule reabsorption of sodium and therefore proximal tubular reabsorption of calcium Decreased activity of the apical calcium channel (TRPV5) due to reduced intracellular sodium concentration Direct activation of calcium-sensing receptors in the DCT Stimulation of parathyroid hormone (PTH) secretion, increasing calcium reabsorption in the DCT Which of the following factors most directly contributes to the paracellular reabsorption of calcium in the thick ascending limb? Activation of calcium-specific ion channels in the apical membrane Creation of a lumen-positive electrical potential by Na⁺-K⁺-2Cl⁻ co-transport Active calcium transport via basolateral calcium ATPases Solvent drag caused by water reabsorption Paracrine signaling by aldosterone to enhance calcium transport A researcher is studying the mechanisms of calcium reabsorption in the proximal tubule of the kidney. She notes that calcium reabsorption in this segment depends on several factors. Which of the following best describes the primary mechanism of calcium reabsorption in the proximal tubule? Active transport mediated by calcium ATPases in the apical membrane Co-transport with sodium ions via a specific calcium-sodium symporter Passive paracellular diffusion driven by the electrochemical gradient and solvent drag Calcium reabsorption through a calcium-specific ion channel in the apical membrane Calcium secretion into the tubule lumen via an apical exchanger What is known about the role of the circadian clock protein PER1 in the regulation of renal sodium handling in the setting of a high salt diet plus the aldosterone analog DOCP? Knockout of PER1 changes the night/day pattern of renal sodium excretion in female mice but not in male mice Knockout of PER1 changes the night/day pattern of renal sodium excretion in male and female mice Knockout of PER1 changes the night/day pattern of sodium excretion in male mice but not female mice Knockout of PER1 changes the night/day pattern of sodium excretion in female mice but not male mice Which of the following aspects of renal function is regulated by the circadian clock? Glomerular filtration rate (GFR) Blood pressure Sodium and potassium excretion All of the above Which one of the following statements is true: Kidney-specific knockout of PER1 increases renal sodium retention in response to increased dietary salt CRY1 and CRY2 activate expression of a key enzyme that functions in aldosterone production Tau/+ mutant hamsters exhibit improved renal function compared to wild type hamsters The time of day at which blood pressure measurements are made in laboratory mice has no effect on experimental outcomes. The molecular circadian clock regulates renal sodium handling through which one of the following mechanisms: The WNK/SPAK/OSR pathway, which causes decreased phosphorylation of key renal sodium transporters. The CLOCK/BMAL1 and PER/CRY proteins via transcriptional regulation of key renal sodium transporters. Ubiquitin ligase proteins such as NEDD4-2 that cause increased levels of key renal sodium transporters on the apical membrane of renal tubule cells. The CLOCK/BMAL1 and PER/CRY proteins via increased ubiquitination of key renal sodium transporters. Which of the following statements is true with regard to how the proximal tubule reabsorbs about 60% of the Na+ from the filtrate? K+ secretion is coupled to Na+ reabsorption on the apical membrane Na+ and glucose reabsorption are coupled on the large surface area of the basolateral membrane Reabsorption of many substances is coupled to Na+ within the large surface area of the basolateral membrane Reabsorption of many substances is coupled to Na+ within the brush border of the apical membrane Amiloride is considered a “K+-sparing” diuretic because it: Inhibits the Na/H exchanger in the proximal tubule Inhibits NKCC2 in the TAL and NCC in the DCT, respectively, leading to increased delivery of Na+ to the CD Decreases ENaC activity in the CD, resulting in decreased K+ secretion from CD principal cells Increases ROMK expression in the TAL Both B and C. Which of the following statements is true with regard to how aldosterone regulates renal Na+ reabsorption? Aldosterone acts to decrease the activity of NKCC2, NCC, and ENaC Aldosterone action leads to increased NKCC2, NCC, and ENaC activity Aldosterone increases renal Na+ reabsorption in response to angiotensin II Aldosterone increases blood volume and blood pressure by inhibiting NKCC2 Both B and C Which of the following experimental approaches would be most appropriate to determine if NCC (Na⁺/Cl⁻ cotransporter) activity is higher in females than in males? Measure urinary sodium and potassium excretion under baseline and thiazide diuretic treatment conditions in male and female subjects. Perform Western blot analysis of NCC protein expression in renal tissue samples from males and females. Use immunohistochemistry to localize NCC expression in kidney sections from male and female animals. Compare plasma aldosterone levels between males and females under normal dietary sodium intake. What is the functional significance of the afferent arteriole receiving greater sympathetic innervation compared to the efferent arteriole? It allows for more precise control of renal blood flow (RBF) during periods of high blood pressure. It allows for the maintenance of GFR even during mild to moderate activation of the sympathetic nervous system (SNS). It ensures that a decrease in GFR always occurs in response to any level of SNS activation. It maximizes the effect of Angiotensin II on the efferent arteriole, leading to greater sodium retention. A patient presents with symptoms of volume overload. Which of the following physiological responses would be expected? Increased renin release and activation of the renin-angiotensin-aldosterone system (RAAS). Increased sympathetic nerve activity (SNA) leading to vasoconstriction of renal arterioles. Release of atrial natriuretic peptide (ANP) causing vasodilation of afferent arterioles and constriction of efferent arterioles. Contraction of mesangial cells leading to a decrease in the glomerular capillary ultrafiltration coefficient (Kf). How does the effect of Angiotensin II (ANGII) on GFR differ between mild volume depletion and severe volume depletion? In mild volume depletion, ANGII increases GFR, while in severe volume depletion, it decreases GFR. In mild volume depletion, ANGII has a minimal effect on GFR, while in severe volume depletion, it significantly decreases GFR. ANGII increases GFR in both mild and severe volume depletion, but the effect is greater in severe volume depletion. ANGII decreases GFR in both mild and severe volume depletion, but the effect is greater in mild volume depletion. Which of the following conditions would be LEAST likely to directly impact the glomerular filtration rate (GFR)? An increase in the concentration of plasma proteins. A decrease in the filtration surface area of the glomerulus. An increase in heart rate due to exercise. An increase in the resistance of the efferent arteriole. Given that the kidneys receive approximately 25% of the cardiac output, what is the most likely physiological consequence of a significant decrease in cardiac output? Increased urine output to compensate for reduced blood volume. A decrease in renal blood flow (RBF), potentially impacting GFR and overall kidney function. Dilation of the efferent arterioles to increase glomerular hydrostatic pressure. Enhanced reabsorption of water and sodium in the renal tubules to conserve fluid.

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