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For each aspect of renal function outlined A–E, select the most appropriate option from the following list of renal cellular contents or activities. 

1. Carbonic anhydrase. 

2. Renin. 

3. Erythropoietin. 

4. Active exchange of sodium for hydrogen 

5. Passive Na+/H+ exchange. ions. 

6. Active sodium reabsorption. 

7. Active chloride reabsorption. 

8. Water channels. 

A. When a patient is deficient in both hydrogen and sodium ions due to vomiting gastric contents, renal function tends to make the alkalosis worse. 

B. When a patient is deficient in extracellular fluid, adrenal cortical hormones help to restore its volume. 

C. The loop of Henle contains cells which lead to a remarkably high osmolality in parts of the renal medulla. 

D. Certain renal cells can sense the oxygen content of arterial blood and control the blood hemoglobin level. 

E. A high level of antidiuretic hormone leads to a low urinary volume.

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A. Option 4 Active exchange of sodium for hydrogen ions. Stimulation of this pump to retain sodium also favours secretion of hydrogen ions, making the alkalosis worse. In addition, such patients are usually also short of potassium (lost with the vomited fluid) and this is made worse since potassium and hydrogen ions compete for the exchange. This condition is hypokalaemic alkalosis and the cure is to give intravenous sodium plus a safe supplement of potassium. 

B. Option 6 Active sodium reabsorption. As well as the above exchange, sodium absorption can be balanced electrically by chloride absorption; water follows by osmosis to restore the extracellular fluid volume. 

C. Option 7 Active chloride reabsorption. It has been shown that the loop of Henle actively reabsorbs chloride, which is balanced electrically by sodium (reverse of above); in this case water cannot follow, so the lumen becomes hypotonic and the interstitium hypertonic. 

D. Option 3 Erythropoietin. Active tubular cells become hypoxic when perfused with anaemic blood; this leads to synthesis of erythropoietin which stimulates the red bone marrow. 

E. Option 8 Water channels. Antidiuretic hormone induces these, so that the hypertonic renal medullary interstitium can osmotically draw water out of the collecting ducts, leaving a small volume of concentrated fluid to pass to the bladder.

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