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SILVERTHORN SAMENVATTINGEN/SUMMARY - Kidney Regulation

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In this document, you get the chapter notes from the chapters on Kidneys and Hormone Regulation of Urination from ‘Human Physiology, An Integrated Approach’ (Dee Silverthorn) 7th Edition. I used these notes to prepare for the SUMMA entrance exam. I ultimately got selected for SUMMA in May 2025. This essentially means that my summaries really effectively and thoroughly cover each chapter (namely Chapters 7 through 26). In other words, you won't miss anything! I include digital images directly from the book. Whether you are trying to catch up in a course, or prepare for the SUMMA entrance exam (like I did), these summaries are excellent. These notes are written in English, as Silverthorn is written in English. If you need associated questions, check out the packet: COMPLEET SUMMA SELECTIE PAKKET, by me! This includes these notes AND over 1400 flashcards covering chapters 7 to 26 (NOTE: the questions I wrote are in Dutch).

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Vasopressin (Antidiuretic Hormone)
Origin: Posterior pituitary
Location of Action: Collecting duct, apical cell membrane
Function: Directs the addition of aquaporins (AQP2) in the apical
membrane, leading to the absorption of water.
Mechanism of Action:
1.​ Increases the insertion of aquaporin-2 channels in the collecting
ducts, enhancing water reabsorption into the bloodstream.
2.​ Reduces urine output and concentrates urine.
3.​ Negative feedback: Water reabsorption dilutes plasma,
reducing ADH secretion.

Stimuli:
1.​ HIGH PLASMA OSMOLARITY: detected by
stretch-sensitive hypothalamic osmoreceptors
(DIRECT)
a.​ When osmolarity increases (>280mOsM),
neurons shrink, stop firing, indicating need to
CVCC for absorption (preservation) of water,
release of vasopressin increases.
2.​ LOW BLOOD VOLUME: detected by atrial stretch
receptors
a.​ When blood volume decreases, neurons stop
firing, indicating need to CVCC for absorption of
water, release of vasopressin increases
3.​ LOW BLOOD PRESSURE: detected by aortic and
carotid baroreceptors in the atria
a.​ When blood pressure decreases, neurons stop
firing, indicating need to CVCC for absorption of
water, release of vasopressin increases
4.​ CIRCADIAN RHYTHM: increased vasopressin
released at night. (DIRECT)

, Aldosterone
Origin: Adrenal Cortex (zona glomerulosa)
Location of Action: Distal tubule and collecting duct Principal Cells, apical cell membrane
Function: Directs the addition of ENaC and in the apical membrane and Na+-K+-ATPase in the basolateral
membrane, leading to the absorption of Na+ and excretion of K+.
Mechanism of Action:
1.​ Increases sodium reabsorption and potassium excretion by upregulating sodium-potassium pumps
and epithelial sodium channels (ENaCs).
2.​ Water often follows sodium osmotically (ONLY if ADH is also present), indirectly increasing blood
volume.
3.​ Negative feedback via normalization of blood pressure and potassium levels.
Stimulus for Release:
1.​ LOW BLOOD PRESSURE: Via the
renin-angiotensin-aldosterone system, specifically
angiotensin II.
Macula densa cells sensing less Na+ flow, trigger renin
release by JGA cells → … → ALD
Increased sympathetic input triggered by the CVCC in
response to low BP or low BV (baroreceptors) leads to
increased renin production → .. → ALD
2.​ HIGH [K+]: High serum potassium (direct stimulus).
Serum potassium concentrations are the most potent
stimulator of aldosterone secretion.
3.​ ACTH (minor role)
Stress stimulates the release of ACTH.
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