Genito-Urinary Flashcards
How do Thiazide diuretics work? when use them?
- Will block the Na,Cl transporter in early distal tubule
- Will cause more sodium to be delivered to late tubule and result in an increase na absorption here
- can then cause hypokalemia as more K will be secreted
-used to treat hypertension, cause kidney to excrete more fluid
Plasma Urea
- what is it?
- what can it measure
- factors affecting it?
- Excretory produce for nitrogen
- depends on protein intake, and breakdown (e.g infections)
- excretion rate depends on GFR - if this is low, than increased urea in blood - more absorbed (less in urine)
Creatinine a better measure
Creatinine
- what does it measure?
- things that influence this?
muscle creates this and then get it excreted (like a muscle waste product)
- proportional to muscle mass
- freely filtered and no tubular reabsorption so it is proportional to GFR
- Plasma creatinine increases if GFR decreases.
-increases if have meat or fish that day, age, gender, muscle mass
Normal GFR
100ml/min
Reasons for acute kidney injury
Pre-renal - low BP e.g due to dehydration, septic shock, haemmorage treat- rehydrate, antibiotics
Renal - acute tubular necrosis - persistant oliguria - treat reason (cause - drugs, toxins ect.)
Post renal - kidney stones, tumours, urinary retention ect. - ultrasound
Chronic kidney disease
Gradual decline in renal function, irreversible
-usually normal urine output
Cause - diabetes, glomerulonephritis, hypertension
Chronic kidney disease
- what it is?
- what are signs
- what is main thing to treat/manage?
Gradual decline in renal function, irreversible
-usually normal urine output
Cause - diabetes, glomerulonephritis, hypertension
- sometimes a smaller kidney
- Uraemia
- Low haemoglobin (kidney stimulates erythropoietin to make red blood cells)
- Low vit D (kidney converts this)
- low calcium (need vit D)
- high phosphate - due to decreased renal excretion
- high parathyroid hormone due to hypocalemia and hyperphosphatemia
-fractures - excesive bone respoption of calcium
treatment - prevent it getting any worse, control complications
-decrease high blood pressure!!
Uraemia
Uraemia is a clinical syndrome associated with fluid, electrolyte, and hormone imbalances and metabolic abnormalities, which develop in parallel with deterioration of renal function.
-abnormally high waste products in the blood
can get anorexia, nausea, vomiting, itchiness, seizures, coma ect.
Proteinuria
Leaking of protein through glomerulus
- mainly albumin
- can measure albumin to creatinine rato
- greater than 25 mg/mmol of proteinuria
renal function can be normal or imparied
Nephrotic vs nephritic syndorme
Nephroptic - low serum albumin, oedema(increased albumin excretion, reduction of oncontic pressure so fluid moves into interstitial space) , fofthy urine
-increased infection
Nephretic - acute kidney disease, hypertension, rbc in urine
Hematuria - causes
Blood in urine
-renal cell carcinoma, stones, infection
Process when you are dehydrate (anti-diuretic hormone)
decrease water increase ECF osmolality osmoreceptors sense this ADH secretion increases goes to kidney increase h20 permeability and absorption , decrease excretion
Renin-Angiotensin system , aldosterone
-when does this system increase and decrease?
What does it do (overall - increase sodium absorption, GFR, thirst, water absorption)
- Increases aldosterone production
- Constricts efferent arteriol (increase GFR)
- Reabsorption of sodium
Factors promoting renin secretion - decrease in afferent arteriol pressure, increase sympathetic activity, decrease NaCL delivery
- Renin is secreted by affereent aterol
- conversts angiotensin to 1 and then goes to 2 as well
Aldosterone - increase ENAC receptor - to absorb more sodium (spironolactone) - from adrenal glands
What can block aldosterone?
spironolactone - stops sodium reabsorption (helps with hypertension)
What does amiloride do?
blocks sodium channels so reduce sodium reabsorption (helps with hypertension)
