#4 Owen - Diuretics, Kidney Diseases Flashcards
Your doctor has place you on a diuretic. He explains that after a few days output will eventually subside and equal input due to compensatory mechanisms. You ask him what the point is. What will he tell you?
The purpose was to reduce the extracellular fluid volume.
Your friend is trying to remember the name of the diuretic that he is on. All he knows is that it inhibits the Na+, K+, and Cl- co-transport. What do you think it is and where is the mechanism of action?
Furosemide (Loop diuretic)
Thick Ascending Loop of Henle
The LOOP of FURY ascends up Mt. Saint Henle
Your grandmother calls you up because she knows that you have been studying diuretics. She tells you she is on Chlorothiazide and wants you to explain to her how it works and what class of diuretic it is.
[If you don’t want your THIghs to look like DISTAL TUBULES you should not keep Na+ or Chlorine around]
You are on Skype so you draw her a picture of the renal tubule and you point out the EARLY DISTAL TUBULE. You tell her that CHLOROTHIAZIDE which is a THIAZIDE keeps the Na+/Cl- from leaving the tubule. Since water follows Na+, it helps remove water from the body.
Explain the mechanism of carbonic anhydrase inhibitors and give an example.
CAAP (Carbonic Anhydrase Inhibitors like Acetazolamide work in the PROXIMAL tubule)
The drug inhibits H+ secretion so that bicarb is not made in the tubular lumen. HCO3 is then excreted. This is why Carbonic Anhydrase Inhibitors do not cause metabolic alkalosis but can cause metabolic acidosis.
Which diuretics work in the collecting tubules?
[COLLECT POTato SPears (spironolactone)to block ALDO]
K+ sparing diuretics
Spironolactone - aldosterone antagonist
Amiloride/Triamterene - Na+ channel blockers
You are monitoring a patient’s GFR rate. In past labs creatinine and urea were present. You begin to see PO4 and H+ in the urine. Estimate where GFR might be?
PO4 and H+ appear below 30.
Creatinine alone would suggest under 50.
What is isosthenuria? How would you test for it?
Inability of the kidney to concentrate or dilute the urine due to loss of nephrons. Impaired due to rapid flow of tubular fluid preventing water reabsorption and countercurrent mechanism.
Restrict water intake for 12 or more hours.
What metabolites increase during uremia? decrease?
NPN (Nonprotein Nitrogens - Urea, creatinine and uric acid)
K+, Na+, H+, Phenols, Sulfates, Phosphates, Guanidine bases, Water
HCO3
During treatment of kidney failure, dialysis will cause what to be lost?
Erythropoietin is lost.
Difference in concentration gradients causes waste to move out of blood.
