Exam 3: Kidneys

Question 1

Name the Parts of the Nephron

Answer 1

Renal Corpuscle, Podocytes, Proximal Tubule, Loop of Henle, Distal Convoluted Tubule

Question 2

Name the 2 Parts of the Renal Corpuscle

Answer 2

Glomerulus and Bowman’s Capsule

Question 3

What are Podocytes used for?
*Where are they located?

Answer 3

Filtration
*On top of the glomerulus

Question 4

Name the 4 Parts of the Loop of Henle

Answer 4

Thick/Thin Ascending/Descending Limb

Question 5

What does the Distal Convoluted Tubule do?

Answer 5

Dumps into collecting ducts/tubule

Question 6

Where does Filtration Primarily Occur in the Kidney?

Answer 6

Glomerulus moves fluid from the blood to Bowman’s Capsule
*Bowman’s Capsule produces 100% of the filtrate

Question 7

Where does Reabsorption happen in the Kidneys?

Answer 7

All through the tubules; Mainly Proximal Tubule

Question 8

Where in the Kidney does secretion happen?

Answer 8

Thru the tubules

Question 9

What does the Proximal Tubule Reabsorb? 6 things

Answer 9

Glucose, Water, Bicarb, K+, AA, Na+

Question 10

Where is the Macula Densa Located?
*Function

Answer 10

Located at the end of the Ascending Loop of Henle, touching the Glomerulus
*Monitors Osmolality and volume of fluid in the distal tubule

Question 11

Where is the JG Apparatus Located?
*Function

Answer 11

At the Vascular Pole of the Renal Corpuscle
*Regulates BP by Synthesizing Renin

Question 12

What controls the GFR in the Kidneys?

Answer 12

JG Apparatus

Question 13

How is GFR controlled in the kidneys?

Answer 13

Increase Na+ = Increase BP
Alter Capillary SA
Control Arteriole Diameter
Autoregulation
Neural Regulation [NE and Epi]
Hormonal Regulation

Question 14

Describe the Function of the Sodium Hydrogen Exchanger (NHE3)
*What does this Exchanger form?

Answer 14

Na+ is pumped into the ISF back to the body and H+ is pumped out into the urine
*H+ binds w HCO3 to form Carbonic Acid H2CO3

Question 15

What is the end result of the NHE3 Exchanger?

Answer 15

Na+, H2O, and HCO3 are put back into circulation

Question 16

What Drug/Drug class blocks the NHE3 Exchanger?

Answer 16

Acetazolamide; Carbonic Anhydrase Inhibitors

Question 17

What are the 5 (6) Major Diuretic Classes?

Answer 17

Carbonic Anhydrase Inhibitors
Loop Diuretics
Thiazides
K+ Sparing
Osmotic
SGLT2 Inhibitors

Question 18

What is the MOA of Acetazolamide?
*What Drug Class
*What pH imbalance can it cause?

Answer 18

Oldest Class of Diuretics; mostly used for altitude sickness
*Blocks the NHE3 Exchanger, which wastes NaHCO3, K, and Na+
*Can lower pH and cause Metabolic Acidosis, as it has more free floating H+
*Carbonic Anhydrase Inhibitors

Question 19

What is the MOA of Furosemide?
*Drug Class?
*pH Imbalance
*Toxicity
*Electrolyte SE

Answer 19

Works in the Thick Ascending Limb of the Loop of Henle
*Loop Diuretics
*Increased pH: More likely to develop Alkalosis
*Targets the NKCC2 Transporter [Sodium Potassium 2 transporter] - more Na+ builds up in the lumen, so more Na+ is sent into the urine followed by water
*Allergy is most toxic effect
*Lose Mg and Ca

Question 20

What is the only Loop Diuretic that is not a sulfa?

Answer 20

Ethacrynic Acid

Question 21

If a Pt has a sulfa allergy, what diuretic can they not take?

Answer 21

Loop Diuretic, Thiazides

Question 22

What is the MOA of Hydrochlorothiazide?
*Drug Class
*Synergistic effect when combined with which diuretic class?
*What electrolytes does it lose (little amount)

Answer 22

Targets the NCC co-Transporter (Sodium and Chloride co-transporter) - Inhibits Na+ Transport in the distal convoluted tubule
*Thiazide Diuretics
*Loop + Thiazide
*Bicarb and K

Question 23

Name 2 K+ Sparing Diuretics?

Answer 23

Spironolactone and Amiloride

Question 24

MOA of Spironolactone/Amiloride
*Drug class

Answer 24

Antagonize the effects of aldosterone and inhibit Na+ influx in luminal membrane by slowing down the ENAC

Question 25

What is ENAC in the kidneys?
*What does it do

Answer 25

Epithelial Sodium Channel
*Increases Na+ reabsorption, H2O = Increased BP

Question 26

Where does Mannitol mainly work?
*Where can it effect in the kidney
*Drug Class

Answer 26

Proximal Convoluted Tubule
*Any water soluble area of the tubule is affected by Mannitol
*Osmotic Diuretics

Question 27

What is a normal body Osmolality?

Answer 27

300 mOsm/Kg

Question 28

What are SGLT2 Inhibitors

Answer 28

Glucose Transporters that assist in removing water in the urine

Question 29

What are indications for K+ Sparing Diuretics?
*Toxicity?

Answer 29

Conn’s Syndrome, CHF, Nephrotic Syndrome, Pit Tumor, Adrenocortical Tumor
*HyperK+

Question 30

Indications for Mannitol

Answer 30

Increased ICP, hemolysis, radiocontrast agents

Question 31

Mannitol Toxicity

Answer 31

Renal Failure - Acute Hyponatremia
Dehydration - HyperK and Na+

Question 32

Diuretics in Pts w DI

Answer 32

Insufficient ADH - excessive urination and thirst
Thiazides - Decrease Plasma Volume = Decrease GFR

Question 33

Where is aldosterone located?
*Where is it secreted
*How does it increase BP

Answer 33

Collecting Tubule
*Adrenal Cortex
*Increase Na+ and H2O uptake via ENaC

Question 34

ADH Agonist vs Antagonist

Answer 34

Agonist - Vasopressin
Antagonist - Conivaptan

Question 35

What is the most common use for a Diuretic

Answer 35

Peripheral or Pulmonary Edema

Question 36

What is DI

Answer 36

Insufficient ADH = Polyuria and Polydipsia

Question 37

Tx for DI

Answer 37

Thiazides
*Decrease Plasma volume, GFR