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renal 4 Flashcards

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1
Q

what is diuresis

A

excessive urine output

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2
Q

what is a diuretic

A

a drug that increases urine output due to action in th ekidney (increase water out and excretion of others)

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3
Q

why use diuretics

A

congestive heart failure

hypertension

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4
Q

why use a diuretic for congestive heart failure

A 
heart weakens
decreased Cardiac output
decreased GFR
increase aldosterone
increased Na and H2O reabsorption
increased ECV and edema
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5
Q

why use a diuretic for hypertension

A

increased ECV
increased plasma volume
increased Blood pressure

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6
Q

how to diuretics gain access to tubules

A

Filtration

secretion

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7
Q

where do osmotic diuretics work

A

in water permeable segments of the nephron (PT and descending loop of henle

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8
Q

where do Ca inhibitors act

A

proximal tubule

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9
Q

what are loop diuretics

A

inhibit Na reabsorption via the NaK2Cl symporter

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10
Q

where do loop diuretics work

A

act in the thick ascnending limb

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11
Q

what is the action of Thiazides

A

block NaCl symptoer

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12
Q

where do thiazides work

A

early distal tubule

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13
Q

what are the types of K sparing diuretics

A

Aldosterone Antagonists

ENaC Blockers

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14
Q

where do K Sparing diuretics work

A

late distal tubule

cortical collecting duct

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15
Q

what is the action of K sparing diuretics

A

inhibit sodium reabsortpion and Potassium secretion

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16
Q

what are Aquaretics

A

ADH antagonists

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17
Q

what is the action of Osmotic diuretics

A

increase osmotic pressure in tubular fluid, therefore impairing Na reabsorption

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18
Q

what are examples of osmotic diuretics

A

mannitol

Pathologicallyy elevated glucose

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19
Q

how do osmotic diuretics get into the tubule

A

via glomerular filtration and are poorly reabsorbed

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20
Q

where do osmotic diuretics have an effect

A

in tubule freely permeable to water

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21
Q

where do osmotic diuretics tend to get reabsorbed

A

PT and DL

- rest reabsorbed downstream

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22
Q

what happens when Osmotic diuretics are reabsorbed downstream

A

results in excretion of 10% of filtered Na

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23
Q

what is the effect on Ca due to osmotic diuretics

A

decrease Ca reabsorption from a decreased solvent drag

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24
Q

what is the action of Carbonic Anhydrase inhibitors

A

reduce Na reabsorption by inhibiting Ca

- reduces H available for Na/H antiporter

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25
what is a CA inhibitor
Acetazolamide
26
how do Ca Inhibitors gain access to the proximal tubule
secretion
27
why does CA inhibitors affect mostly the proximal tubule
1/3 of Na reabsortpion relies on the Na/H antiporter there
28
how large of an effect does CA inhibitors have on excreteion
not large | - increase Na excretion to 5-10% filtered load
29
why does CA inhibitors have not a large effect downstream
downstream segments increase Na reabsoprtion when tubular Na increases
30
what is the most powerful diuretic
Loop diuretics
31
what is the action of loop diuretics
inhibit Na reabsoprtion - inhibit NaK2CL symptorer in thick ascending limb creating not dilute urine - no osmotic gradient estabilished in the medulla interstitum so water is not reabsorbed along collecting duct
32
where do loop diuretics work
in the loop of henle
33
how does the urine change in loop diuretics
starts out not dilute, but then very diluted | - increases Na excretion to 25% of filtered load because Na reabsorption capacity is limited downstream
34
can ADH compensate for loop diuretisc
Nope
35
what is a type of Thiazide diuretic
Chlorothiazine
36
where are thiazide diuretics secreted
into the proximal tubules
37
where do thiazide diuretics act
in the early distal tubule
38
what is the action of thiazide diuretics
block the NaCl transporter | - the kidneys ability to dilute urine is dimished
39
net effect of thiazide diuretics
reabsorption of water in collecting duct occures | - 5-20% of filtered Na is excreted
40
where do K sparing diuretics work
act where K is normally secred into tubular fluid by principal cells
41
what is the action of aldosterone antagonists
blok aldosterone's ability to increase Na transporters in principal cells
42
where must aldosterone antagonists go
must get inside tubular cells to block aldosterone receptors
43
what is an examples of an aldosterone antagnoists
spironolactone
44
what do ENaC blockers do
block Na reabsorption across the apical membrane
45
how do ENaC blockers get to their target
act on membrane protein so gain acess by secretion into proximal tubule
46
what happens to the effectiveness of Diuretics over time
become less effective due to volume contraction counteracting the effects of the diuretics
47
how does increased sympathetic activty in response to reduced blood pressure from diurestics manifest
decrease GFR | increase PT reabsorption and increased renin
48
what does secretion of renin from juxtaglomerular apparatus manifest as
increase angiotensin II and aldosterone | - decrease Na excretion
49
what is the diuretic braking phnomenon
the body's response to lots of diuretics that decrease their effectiveness
50
what are the secondary effects of diuretics
``` Diuretic braking phenomenon: - increased sympa in response to reduced BP - decreased natriuretic peptides - secrete renin - stimulate ADH release Increased excreteion of K Disrutpion of acid-base balance disrupt calcium homeostasis ```
51
why does the use of diretics increase Excretion of K
- diuretics increase flow of tubular fluid, stimulating K secretion - Diuretics reduce ECV-> increase aldosterone-> stimulate K secretion
52
what is used to stop the increased excretion of K from prolonged diuretics
K sparing diuretics
53
what does CA inhibitors do to acid base balance
metabolic acidosis
54
what does Loop and Thiazide diuretics do to acid base balance
reduced ECV | metabolic alkalosis
55
what do K sparing diuretics do to acid-base balance
metabolic acidosis due to H secretion in distal tubule and cortical collectin duct is inhibited
56
what diuretic doesn't affect calcium homeostasis
K sparing diuretics
57
what do osmotic and Ca inhibitors do to Ca homeostasis
reduce reabsorption of CA in the proximal tubule
58
what do loop diuretics do to Ca homeostasis
increase CA excretion by affecting transepithelial voltage that normally is the driving force fro transprot of calcium
59
what do Thiazide diuretics do to Ca Homeostatis
stimulate Ca reabsorption in the distal tubule and reduce excretion
60
how Much Ca does the distal tubule usually reabsorb
9% of filtered calcum via active transportretion
61
what is hemodialysis
removal of waste produces from the blood when kidney function has been impaired
62
is the need for hemodialysis/transplant increasing
Yes
63
how is hemodialysis done in a kidney failure patient
blood briefly removed from the body to be circulated through a dialyzer
64
how does a dialysizer work
A cylindrical bundle of fibers that allows small modcules to diffuse into dialysis fluid
65
what direction do the fluid and blood move in a dialyzer
in countercurrent direction to remove nitrogenous and other waste - adjust osmolarity before blood is returned to the body
66
what is the concentration of NaCL in dialysis fluid
Similar to that of plasma
67
what diffuses from the blood into dialysis fluid
urea Potassium Phosphate
68
what flows from dialysis fluid to the blood
Bicarbonate
69
how often is dialysis done
3-4 hours 3 times per week
70
side effects of hemodilaysis
- Vascular access problems - short term: Fatigue, chest pain, cramps, nausea, headaches (dialysis hangover) - long term: sepsis, endocarditis, osteomyelitis (sec infections) - amyloid deposites in joints
71
what causes a dialysis hangover
Acute, dramatic changes in blood chem
72
what causes amyloid depsoites in joints from hemodialsis
build up of trace minerals in dialysis fliud
73
why do patients with chronic renal failure get anemia
Inadequate secretion of EPO and loss of erythrocytes
74
what cells produce EPO
Interstitial fibroblasts in the renal cortex
75
where is EPO production control
Transcriptional level
76
what stimulates EPO production
PO2 is low
77
how do Transcription factors work for EPO
Hypoxia inducible factors are continually produced but are targeted for degradation when O2 is normal

physiology (32 decks)

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