Jan8 M2-Edema and Diuretics

Question 1

2 components to edema pathophysiology

Answer 1

1. alteration in capillary hemodynamics favoring Na and water mvmt to interstitium
2. renal retention of dietary Na and water with ECF expansion

Question 2

2 components to edema pathophysiology

Answer 2

1. alteration in capillary hemodynamics favoring Na and water mvmt to interstitium
2. renal retention of dietary Na and water with ECF expansion

Question 3

example of cause of edema

Answer 3

low oncotic pressure (ex. loss of albumin in nephrotic syndrome)

Question 4

example of cause of edema related to lymphatics drainage

Answer 4

lymph node infection, blockage, breast cancer surgery

Question 5

example of cause of edema related to high capillary hydrostatic pressure

Answer 5

rise in venous pressure

Question 6

urine protein and urine Na in nephrotic syndrome and why

Answer 6

above 3g protein/day

less than 15 meq/L U Na (holding on to Na)

Question 7

hormones activated in nephrotic syndrome and why

Answer 7

• RAAS because low IV volume so low renal perfusion (renin activated)
• ADH (low IV volume)

Question 8

condition where Na retention, edema and RAAS and ADH always active and why

Answer 8

CHF. low CO = sensed hypovolemia, state of volume contraction

Question 9

what hormones act on the kidney in CHF

Answer 9

• NE and AT2 for proximal Na reabso
• ADH distally
• aldo distally

Question 10

example of cause of edema

Answer 10

low oncotic pressure (ex. loss of albumin in nephrotic syndrome)

Question 11

example of cause of edema related to lymphatics drainage

Answer 11

lymph node infection, blockage, breast cancer surgery

Question 12

example of cause of edema related to high capillary hydrostatic pressure

Answer 12

rise in venous pressure

Question 13

urine protein and urine Na in nephrotic syndrome and why

Answer 13

above 3g protein/day

less than 15 meq/L U Na (holding on to Na)

Question 14

hormones activated in nephrotic syndrome and why

Answer 14

• RAAS because low IV volume so low renal perfusion (renin activated)
• ADH (low IV volume)

Question 15

condition where Na retention, edema and RAAS and ADH always active and why

Answer 15

CHF. low CO = sensed hypovolemia, state of volume contraction

Question 16

what hormones act on the kidney in CHF

Answer 16

• NE and AT2 for proximal Na reabso
• ADH distally
• aldo distally

Question 17

SV as fct ov LVEDP curves: how does it change in heart failure and how kidney can change it

Answer 17

curve drops. lower SV for a same LVEDP. kidney retains water and sodium so increases it and moves the curve up

Question 18

why K sparing diuretics called like that

Answer 18

because don’t cause hypoK

Question 19

ascites in what disease and why

Answer 19

fibrotic liver so blood coming from splanchnic circulation is turned away and liver loses serous fluid in peritoneal cavity

Question 20

where to look for edema

Answer 20

feet, hands, face, around the eyes, pulmonary, abdomen

Question 21

normal urine output (per 8 hour shift)

Answer 21

300-400 cc

Question 22

if notice edema, next step in physical exam

Answer 22

weigh the patient

Question 23

limiting factors in thiazides (2)

Answer 23

• they have unknown mechanisms to lower BP

- low Na reabso there

Question 24

thiazide used for what condition

Answer 24

BP control

Question 25

K sparing diuretics 2 modes of action

Answer 25

block (nuclear) aldoR (a TF) so no enac channels made. (spironolactone)
-block ENac channels (triamterine, amiloride)

Question 26

how diuretics get to the tubular lumen usually

Answer 26

are secreted

Question 27

why must increase diuretic dose if low GFR

Answer 27

to get more blood to peritubular capillaries and the vasa recta

Question 28

why is there an upper limit to the dose of diuretic that should be given

Answer 28

maximum dose where transporter is completely inhibited exists. beyond that, no benefit and only side effects

Question 29

limiting factor in loop diuretics

Answer 29

more Na is delivered (and therefore reabsorbed) distally

Question 30

limiting factors in thiazides (2)

Answer 30

• they have unknown mechanisms to lower BP

- low Na reabso there

Question 31

how to follow GFR in patients on diuretics

Answer 31

urea and Cr concentrations

Question 32

big side effect of diuretics

Answer 32

renal failure

Question 33

consequence of giving too much diuretics too fast

Answer 33

loss of IV volume is too big to be compensated: AKI (rise in urea and Cr), less tissue perfusion, drop in CO, etc.

Question 34

rate of fluid removal in pulm edema, ascites and peripheral edema

Answer 34

all slow except pulm edema if hypoxic

Question 35

why diuretics can cause hypokalemia

Answer 35

more Na flow to the distal nephron (CT and CD) so more entry in ENac channels and consequent secretion of K from K channels

Question 36

why diuretics can cause hyperuricemia

Answer 36

nephron compensates to reabso Na so more Na reabso in PCT and urea reabso linked to Na in PCT