Exam 4: Intro to Diuretics and Renal Disease Flashcards
What are diuretics used for?
Control ECF volume (hypertension and edema)
Increase urine volume output
Lower ECF volume
What are the different diuretic types?
Osmotic Loop blockers Thiazide diuretics Carbonic anhydrase inhibitors Aldosterone antagonist Na+ channel blocker
What do osmotic diuretics do?
Increase tubular osmolarity
What is an example of osmotic diuretics?
Mannitol
What do loop blockers diuretics do?
Inhibit Na, K, Cl cotransport
What is an example of loop blocker diuretics?
Furosemide
What does furosemide do?
Block concentration and diluting ability
What do thiazide diuretics do?
Inhibit Na and Cl cotransport
What is an example of thiazide diuretics?
Hydrochlorothiazide
What do carbonic anhydrase inhibitors do?
Inhibit H+ secretion and bicarb reabsorption thereby blocking Na reabsorption
What is an example of carbonic anhydrase inhibitors?
Acetazolamide
What do aldosterone antagonist diuretics do?
Block aldosterone receptor
What is an example of aldosterone antagonist diuretics?
Spironolactone
What do Na channel blocker diuretics do?
Block Na entry
What is an example of Na channel blocker diuretics?
Amiloride
What are the 2 reasons that loop diuretics raise urine output out of electrolytes?
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
What happens with uremia?
Accumulation of nitrogenous waster products
What happens with hyperkalemia?
Arrhythmias and other neuromuscular dysfunction
What does acidosis affect?
CNS function and all cell processes
What causes acidosis?
Retention of hydrogen ions and organic acids, loss of bicarb
What happens with hypertension or hypotension?
Failure to excrete or conserve Na and H2O
Failure to produce renin leading to no angiotensin
Edema or dehydration
What hormone does anemia effect?
Renal erythropoietic factor
What does osteomalacia effect?
Vitamin D
What are subclinical renal disease signs?
None
What are clinical renal disease signs?
General malaise Inappetence Polyuria/polydipsia Weight loss Weak and lethargic Hypertension Edema
What things are critical in the improvement of quality of life of chronic renal failure?
Control of hypertension
Anemia
Describe prerenal disease
Diminished renal blood flow
Is hypertension a common problem as a common cause of renal disease?
No, it is more a common result of renal disease
What does uncontrolled hypertension do?
Worsen renal disease
Is primary or secondary hypertension more common?
Secondary
What are examples of postrenal disease?
Nephrolith-diminished filtration affected nephrons
Ureter-diminished filtration effected kidney
Urethra-diminished filtration both kidneys
Vessiculo-uretral reflux can result in pyelonephritis
What is creatinine created by?
Metabolism
What is creatinine filtered by?
Glomerulus
Is creatinine reabsorbed?
No
What happens with nephron loss?
Decreased filtration capacity Decreased overall creatinine clearance Creatinine doubles in concentration New equilibrium at high Cr concentration Greater BP which lads to greater GFR
How do you calculate Urine Prot/Cr ratio?
Ur_prot / Ur_Cr
How do you calculate GGT/Cr ratio or LDH/Cr ratio?
Ur_GGT or LDH / (Ur_Cr x 0.01)
How do you calculate the fraction excretion of electrolytes?
((P_Cr / U_Cr) x (U_x / P_x)) x 100
How do you calculate creatinine clearance?
(U_Cr x V) / P_Cr
What are the normal urine protein/creatinine ratios?
Dog’s is less than 0.5
Cat’s is less than 0.4
Horse’s is around 0.3
What are the normal levels of GGT/Cr ratio?
0-25 IU GGT/g Cr
What are the normal levels of LDH/Cr ratio?
Up to 12 IU LDH/g Cr
What are the normal levels of the sodium fraction excretion?
Less than 0.8 to 1%
