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Many substances handled by the kidney are weak acids or bases At a given pH, the total amount of each one is split between a neutral form and an ionized form Many weak acids are neutral at low pH (acid form) and are dissociated into an anion and a proton at higher pH The lower the pH, the more of the total there is in the neutral acid form, whereas the higher the pH, the greater is the fraction in the dissociated anionic form In general, neutral forms of organic acids and bases are more permeable in lipid membranes than ionized forms, and the neutral forms can diffuse either into or out of the tubular lumen down the concentration gradient of the neutral form In contrast, the ionized forms, once in the lumen, cannot diffuse; they are effectively trapped there Imagine the case in which the tubular fluid becomes acidified relative to the plasma, which it does on a normal diet For a weak acid in the tubular fluid, relatively more will be converted to the neutral free acid form and, therefore, become more permeable This favors diffusion out of the lumen (reabsorption) Therefore, a highly acidic urine (low pH) tends to increase passive reabsorption of weak acids (and promote less excretion) For many weak bases, the pH dependence is just the opposite At low pH they are protonated cations (trapped in the lumen), whereas at high pH they are converted to neutral free base As the urine becomes acidified, more is converted to the impermeable charged form and is trapped in the lumen Less is reabsorbed passively, and more is excreted Having said this, what difference does it make Because so many medically useful drugs are weak organic acids and bases, all these factors have important clinical implications For example, if one wishes to enhance the excretion of a drug that is a weak acid, one attempts to alkalinize the urine (because this traps the ionic form in the lumen) In contrast, acidification of the urine is desirable if one wishes to prevent excretion of the drug Of course, exactly the opposite applies to weak organic bases At any pH, increasing the urine flow increases the excretion of both weak acids and bases (Figure 5 2) Finally, excretion can be reduced by administering another drug that interferes with any active proximal secretory pathway for the drug.

74 N 2O4 ( g )

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Urea is a very special substance for the kidney It is an end product of protein metabolism, simply waste to be excreted, and also a useful tool for the regulation of water excretion Proteins, from which urea is derived, are the action molecules in cells (eg, transporters and enzymes) and the structural substance of the connective tissue (eg, collagen) In addition, proteins are the source of metabolic fuel Excess dietary protein not needed for tissue synthesis is either oxidized right away or converted to fat and stored for later oxidation During fasting, the body breaks down its own protein for fuel, in essence consuming itself When oxidized for fuel, protein is first split into its constituent amino acids These are then separated into a nitrogen moiety (ammonium) and a carbohydrate moiety The carbohydrate goes on to further metabolic processing, but the ammonium cannot be further

G7231 Annex A defines a VAD and CNG for use with G7231 It classifies each 30-ms sample as either active voice or background noise Active voice is encoded according to Figures 6-13 and 6-14 Background noise is encoded as a SID according to Figure 6-15 (see Table A1/G7231) SIDs are sent only intermittently, when an appreciable change is detected in the nature of the background noise

An equilibrium mixture of the compounds is placed in a sealed container at 150 C The amount of the product may be increased by which of the following changes I Adding 1 mole of Ar(g) to the container II Increasing the volume of the container III Raising the temperature of the container (A) (B) (C) (D) (E) III only II and III II only II and III I only

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The reaction shown above was used in an electrolytic cell The voltage measured for the cell was not equal to the calculated E for the cell This discrepancy could be caused by which of the following (A) Both of the solutions were at 25 C instead of 0 C (B) The anode and cathode were different sizes (C) The anion in the anode compartment was chloride instead of nitrate, as in the cathode compartment (D) One or more of the ion concentrations was not 1 M (E) The solution in the salt bridge was Na2SO4 instead of KNO3 Questions 79 80 are concerned with the following half-reaction in an electrolytic cell:

Encoding interval of audio frame: Number of audio frames in encoded voice subframe: Packetization time:

(Impermeable)

75 The Ksp for LaF3 is 2 10 What is the molar solubility of this compound in water (A) 2 10 9 /27 (B) (C)

Figure 5 2 Acidification of the luminal fluid creates, by mass action, the gradients that drive net passive reabsorption of weak acids (top dashed line) and net passive secretion of weak bases (bottom dashed line) The source of the secreted hydrogen ions is discussed in 9

Encoding Format Reference Figure 6-13 Figure 6-14 Compression Bit Rate (Kbps) 62 53

79 Choose the correct statement from the following list (A) (B) (C) (D) (E) The sulfur is oxidized This is the cathode reaction The oxidation state of sulfur does not change + The H serves as a catalyst This is the anode reaction

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