Kidney and Diuretics

Question 1

3 functions of the kidney

Answer 1

• regulate extracellular body fluid volume
• maintain ion/pH balance in plasma
• excretion of foreign substances
• renin secretion
• activation of RAAS

Question 2

5 groups of diuretics

Answer 2

1. Carbonic Anhydrase Inhibitors
2. Osmotic Diuretics
3. Loop Diuretics
4. Thiazides and Thiazine-Like Diuretics
5. Potassium-sparing Diuretics

Question 3

Name a carbonic anhydrase inhibitor

Answer 3

acetazolamide

Question 4

effects of CAIs

Answer 4

moderate decrease in Na+ absorption
mild plasma acidosis (due to H+ retention)
urine alkalosis (due to bicarbonate secretion)

Question 5

why is urine alkalosis good

Answer 5

increases the excretion of weak acids, so decreases the chance of crystallisation

Question 6

what else can CAIs be used to treat

Answer 6

Glaucoma, as it decreases formation of AH)

Question 7

where do CAIs predominantly work

Answer 7

proximal tubule

Question 8

Example of a osmotic diuretic

Answer 8

mannitol

Question 9

where do osmotic diuretics work

Answer 9

PCT, Descending Loop, Collecting Tubule (parts of the nephron which are freely permeable to water)

Question 10

are these osmotic diuretics used often?

Answer 10

no

Question 11

how do osmotic diuretics work?

Answer 11

increase the osmolarity of the tubular filtrate, so decreases water reabsorption

Question 12

what else can osmotic diuretics be used in

Answer 12

cerebral oedema and glaucoma

Question 13

most powerful group of diuretics

Answer 13

loop diuretics

Question 14

2 examples of Loop Diuretics

Answer 14

furosemide and bumetanide

Question 15

what symporter do loop diuretics work on

Answer 15

Na+/K+/2Cl- on luminal membrane

Question 16

what effect do these have on the Na/K/2Cl symporter

Answer 16

inhibit reabsorption of these ions

Question 17

another effect of loop diuretics

Answer 17

inhibit Mg/Ca reabsorption

Question 18

Renal effects caused by Loop Diuretics

Answer 18

decreased Na reabsorption
decreased Cl reabsorption
increased K excretion
increased Ca and Mg secretion

Question 19

therapeutics of Loop Diuretics

Answer 19

acute pulmonary oedema
chronic heart failure
renal failure
nephrotic syndrome

Question 20

what is a side effect of Loop Diuretics

Answer 20

hypokalaemia (due to increased K excretion)

Question 21

name 2 thiazides

Answer 21

hydrochlorothiazide and Bendroflumethiazide

Question 22

name 3 thiazide-like diuretics

Answer 22

chlortalidone, indapamide, metolazone

Question 23

where do thiazides/thiazide-like diuretics work

Answer 23

inhibit Na/Cl cotransporter

Question 24

side effect of thiazides/thiazide-like diuretics

Answer 24

hypokalaemia

Question 25

renal effects of thiazides/thiazide-like diuretics

Answer 25

decreased Na reabsorption decreased Cl reabsorption increased K excretion increased Ca reabsorption

Question 26

are these thiazides/thiazide-like diuretics strong?

Answer 26

moderate

Question 27

after prolonged use what other effect can thiazides/thiazide-like diuretics have

Answer 27

vasodilating properties

Question 28

how can thiazides/thiazide-like diuretics be used therapeutically

Answer 28

hypertension mild heart failure sever resistant oedema prevention of kidney stone formation

Question 29

adverse effects of thiazides/thiazide-like diuretics

Answer 29

hypotension, reduced plasma volume, hypokalaemia

Question 30

what are 3 effects of hypokalaemia

Answer 30

tachyarrhythmias, hyperglycaemia, increased cardiac toxicity

Question 31

how to potassium-sparing diuretics work

Answer 31

inhibit the effect of aldosterone

Question 32

are potassium-sparing diuretics strong?

Answer 32

nope

Question 33

how does aldosterone work?

Answer 33

increase synthesis of basolateral Na/K ATPase | increases activation and surface expression of luminal renal Na channels

Question 34

what aldosterone would usually help do

Answer 34

Na taken in from lumen, then exported into the blood in exchange for a K, so K taken out of the blood (so normally result in hypokalaemia)

Question 35

what are the 2 groups of potassium-sparing diuretics

Answer 35

1. Mineralocorticoid (aldosterone) Receptor Antagonists (MRAs) 2. Renal Na+ channel blockers

Question 36

2 examples of MRAs

Answer 36

spironolactone and eplerenone

Question 37

2 examples of renal Na+ channel blockers

Answer 37

amiloride and triamterene

Question 38

the whole point of potassium-sparing diuretics

Answer 38

to block the effect of 2 receptors, so K stays in the blood

Question 39

therapeutic uses of potassium-sparing diuretics

Answer 39

hypokalaemia, heart failure, treat aldosteronisms

Question 40

adverse effect of potassium-sparing diuretics

Answer 40

hyperkalaemia

Question 41

where do potassium-sparing diuretics

Answer 41

distal convoluted tubule

Question 42

where does most water reabsorption happen

Answer 42

collecting duct

Question 43

what increases the expression of Aqua-porin 2 on the luminal membrane

Answer 43

ADH

Question 44

expression of Aqua-poring causes

Answer 44

increased water reabsorption less pee/urine decreases diuresis