Exam 4: Intro to Diuretics and Renal Disease

Question 1

What are diuretics used for?

Answer 1

Control ECF volume (hypertension and edema)
Increase urine volume output
Lower ECF volume

Question 2

What are the different diuretic types?

Answer 2

Osmotic
Loop blockers
Thiazide diuretics
Carbonic anhydrase inhibitors
Aldosterone antagonist
Na+ channel blocker

Question 3

What do osmotic diuretics do?

Answer 3

Increase tubular osmolarity

Question 4

What is an example of osmotic diuretics?

Answer 4

Mannitol

Question 5

What do loop blockers diuretics do?

Answer 5

Inhibit Na, K, Cl cotransport

Question 6

What is an example of loop blocker diuretics?

Answer 6

Furosemide

Question 7

What does furosemide do?

Answer 7

Block concentration and diluting ability

Question 8

What do thiazide diuretics do?

Answer 8

Inhibit Na and Cl cotransport

Question 9

What is an example of thiazide diuretics?

Answer 9

Hydrochlorothiazide

Question 10

What do carbonic anhydrase inhibitors do?

Answer 10

Inhibit H+ secretion and bicarb reabsorption thereby blocking Na reabsorption

Question 11

What is an example of carbonic anhydrase inhibitors?

Answer 11

Acetazolamide

Question 12

What do aldosterone antagonist diuretics do?

Answer 12

Block aldosterone receptor

Question 13

What is an example of aldosterone antagonist diuretics?

Answer 13

Spironolactone

Question 14

What do Na channel blocker diuretics do?

Answer 14

Block Na entry

Question 15

What is an example of Na channel blocker diuretics?

Answer 15

Amiloride

Question 16

What are the 2 reasons that loop diuretics raise urine output out of electrolytes?

Answer 16

They greatly increase the quantities of solutes derived to the distal parts of the nephrons, and these acts as osmotic agents prevent water reabsorption
They disrupt the countercurrent multiplier system by decreasing absorption of ions from the loop into the medullary interstitium, thereby decreasing the osmolarity of the medullary interstitial fluid

Question 17

What happens with uremia?

Answer 17

Accumulation of nitrogenous waster products

Question 18

What happens with hyperkalemia?

Answer 18

Arrhythmias and other neuromuscular dysfunction

Question 19

What does acidosis affect?

Answer 19

CNS function and all cell processes

Question 20

What causes acidosis?

Answer 20

Retention of hydrogen ions and organic acids, loss of bicarb

Question 21

What happens with hypertension or hypotension?

Answer 21

Failure to excrete or conserve Na and H2O
Failure to produce renin leading to no angiotensin
Edema or dehydration

Question 22

What hormone does anemia effect?

Answer 22

Renal erythropoietic factor

Question 23

What does osteomalacia effect?

Answer 23

Vitamin D

Question 24

What are subclinical renal disease signs?

Answer 24

None

Question 25

What are clinical renal disease signs?

Answer 25

``` General malaise Inappetence Polyuria/polydipsia Weight loss Weak and lethargic Hypertension Edema ```

Question 26

What things are critical in the improvement of quality of life of chronic renal failure?

Answer 26

Control of hypertension | Anemia

Question 27

Describe prerenal disease

Answer 27

Diminished renal blood flow

Question 28

Is hypertension a common problem as a common cause of renal disease?

Answer 28

No, it is more a common result of renal disease

Question 29

What does uncontrolled hypertension do?

Answer 29

Worsen renal disease

Question 30

Is primary or secondary hypertension more common?

Answer 30

Secondary

Question 31

What are examples of postrenal disease?

Answer 31

Nephrolith-diminished filtration affected nephrons Ureter-diminished filtration effected kidney Urethra-diminished filtration both kidneys Vessiculo-uretral reflux can result in pyelonephritis

Question 32

What is creatinine created by?

Answer 32

Metabolism

Question 33

What is creatinine filtered by?

Answer 33

Glomerulus

Question 34

Is creatinine reabsorbed?

Answer 34

No

Question 35

What happens with nephron loss?

Answer 35

``` Decreased filtration capacity Decreased overall creatinine clearance Creatinine doubles in concentration New equilibrium at high Cr concentration Greater BP which lads to greater GFR ```

Question 36

How do you calculate Urine Prot/Cr ratio?

Answer 36

Ur_prot / Ur_Cr

Question 37

How do you calculate GGT/Cr ratio or LDH/Cr ratio?

Answer 37

Ur_GGT or LDH / (Ur_Cr x 0.01)

Question 38

How do you calculate the fraction excretion of electrolytes?

Answer 38

((P_Cr / U_Cr) x (U_x / P_x)) x 100

Question 39

How do you calculate creatinine clearance?

Answer 39

(U_Cr x V) / P_Cr

Question 40

What are the normal urine protein/creatinine ratios?

Answer 40

Dog's is less than 0.5 Cat's is less than 0.4 Horse's is around 0.3

Question 41

What are the normal levels of GGT/Cr ratio?

Answer 41

0-25 IU GGT/g Cr

Question 42

What are the normal levels of LDH/Cr ratio?

Answer 42

Up to 12 IU LDH/g Cr

Question 43

What are the normal levels of the sodium fraction excretion?

Answer 43

Less than 0.8 to 1%