Kidney Function And Drugs Flashcards
Nephron
1) . Is the
2) It’s job is to…
3) kidney damage is so bad because…
4) consists of
1) basic functional unit of the kidney
2) . Job is to regulate water and soluble matter (especially electrolytes) in the body
3) because it does not generate
4) consists of the renal corpuscle (glomerulus, bowmans capsule) proximal convoluted tubules, loop of Henle, distal convoluted tubules and collecting ducts
Trigone of bladder
2 ureters
I urethra
Glycosaminoglycans (GAGS)
1) found
2) . What do they do
3) defects are factor in…
4) examples
GAGS
1) they are found covering the transitional epithelium of the urinary tract
2) they keep microorganisms and crystals from adhering to the bladder wall
3) the defects in surface GAGs are believed to be a factor in FLUTD
4) ex- cranberry juice, crab abiding makes the bladder wall slippery so bacteria doesn’t stick
AZODYL
Think…
Claims to have the potential to reduce azotemia though enteric (intestine) dialysis
Azotemia= AZODYL
What are used for urolith treatments?
3
Urinary acid fires
urinary alkalizer
xanthine oxidase inhibitors ( with diet think… Thin … Can (b) thin) oko
With urolith treatment we should
1) types of urolith includes
2) each type is….
Put on diet
1) struvite (magnesium ammonium phosphate) calcium orca late, calcium phosphate, irate, cystine, and mixed
2) each type is treated differently and may include :
dietary management as well as
drug treatment
What is a urolith
Abnormal mineral masses in urinary system (ex: kidney/bladder)
Compact sand grid= stone
What's is a urinary acidified used for? Ex: It Produces Prevents Side effects But since introduction of \_\_\_\_\_\_, urinary acidifiers have not been routinely prescribed
Used for urolith treatment
Ex: Methigel
It’s used to produce acid urine <7
It assists in dissolving and preventing formation of struvite urolith
Side effects:gi disturbances
Since introduction of urinary acidifying diets
Urinary alkalizer
Ex:
Used in
Difficult to
The side affects
Ex: potassium citrate, sodium, bicarbonate
Used in the management of ammonium acid urate, calcium oxalate crystals and Cystine urolihiasis
Difficult to dissolve calcium oxalate crystals without altering calcium metabolism in body
Side effects are possible fluid and electrolyte imbalances
Xanthine oxalate inhibitors
Ex:
- decreases….
1) found mostly in
2) side effects
Ex: Allopurinol
- decreases the production of uric acid produced by xanthine oxidase
1) found mostly in dalmatians and patients with gout
2) Side effects: uncommon
What is ACE
Angiotensin Converting enzyme
used in renin-angiotensin-aldosterone system
Ace inhibitors cause….
No water retention!!
Renin-angiotensin-aldosterone system
Regulates
Occurs when
Regulates blood pressure and water (fluid) balance
When blood volume is low, kidneys secrete renin directly into circulation
Steps of the Renin-angiotensin-aldosterone system
Renin converts angiotensin I to angiotensin II by ACE (angiotensin converting enzyme)
angiotensin lI causes blood vessels to constrict which increases blood pressure and also secretes aldosterone (builds up fluid in the body)
The Aldosterone causes kidney tubules to increase reabsorption of sodium (Na) and water into the blood, which increases volume of fluid in the body and increases blood pressure
ACE inhibitors drop blood pressure by
Ace inhibitors block conversion of angiotensin I to angiotensin ll
decrease aldosterone secretion decrease peripheral arterial resistance and alleviate vasoconstriction
which all drop blood pressure
ACE inhibitors treat
Side effects
Examples
ACE inhibitors treat:
severe or non-responding hypertension,
heart failure,
protein losing glomerulonepathies
Side effects: are complications in patients with renal insufficiency
Ex: benazepril, captopril, enalapril
Vasodilators and calcium channel blockers
May be be substituted for or used in combination with other mess when …
Vasodilator a example:
Calcium channel blocker ex:
Side effects
When previous drug therapy to control hypertension fails
Vasodilator example- Dopamine
It May be used to promote diuresis in patience unresponsive to loop or osmotic diuretics
Calcium dilator example: silo tarzen, amlodipine
Side effects: hypotension Edema conduction disturbances Heart faliure Bradycardia
Vasodilator example
Dopamine
Maybe used to promote diuresis in patients unresponsive to loop or osmotic Diuretics
Calcium channel blocker example
Dilitazem and amlodipine
What is GFR?
Glomerular penetration rate
How fast plasma is filtered through glomerulus
What to hormones are responsible for the majority of urine volume regulation
Antidiuretic hormone (ADH)
Aldosterone
What does aldosterone do?
It increases reabsorption of sodium (Na) in DCT and collecting ducks back into the blood
This causes and osmotic imbalance which causes water to go back into the blood along with the sodium
Collecting ducks are the site of …
Anti-diuretic hormones (ADH ) which prevents dehydration
Antidiuretic hormones do what especially
Stop urination
Prevent water loss
Regulate fluid balance
It is a failsafe mechanism so that we don’t dehydrate if we have lack fluid intake
Increase in urine volume
Polyuric
Increase in thirst
Polydipsia
Cholinergic agonist is for
Expulsion
urinary incontinence
Anticholinergic agents are for
Retention
urinary incontinence
Aderenergic agonists are split into
Alpha and beta
With potassium sparing diuretics
Think
Conserve potassium
Enhance excretion of sodium and water
and reduces excretion of potassium
Hyperkalemia if given with potassium (uncommon)
Hypokalemia involves-
Hypo-k loss
Ex- loop diuretic, thiazides diuretic, carbonic anhydrase inhibitors
Hyper- k retention
Uncommon-potassium sparing diuretic
With loop diuretic think…
Lasix ( furosemide)
It inhibit reabsorption of sodium at LOOP of Henle
Promote CL, k and water
Lung fluid
Micturition
Expulsion of urine in the urinary bladder into the urethra (urinating)
Secretion
1) Leaves through…. Which are also…
2) secreted are … Think hon
1) the tubular filtrate in the DCT leaves through the collecting ducks as urine
Collecting ducts are also the site of antidiuretic hormone action which prevents dehydration
2) important substances secreted are hydrogen, potassium, and ammonia
Gloucosuria
Rates?
Renal threshold of glucose: The blood glucose level gets too high, The amounts of glucose filtered through the glomerulus exceeds the amount That
can be reabsorbed and it is lost in the urine
Rates: 180 for a dog
And 240 for a cat
Diuresis
Increasing urine flow
Think diuretic
Diuretic drugs…
Ex:
Used to remove excess extracellular fluid by increasing urine flow (diuresis) and Na excretion and reducing hypertension (sodium +water= lower blood pressure)
Ex: cplot loop diuretic Osmotic diuretic Thiazide diuretic Potassium-sparing diuretics Carbon anhydrase inhibitors
When Na is reabsorbed excessively ( maybe with Cl and water)
____ can be an issue
Hypokalemia
Deficiency of k
Promote k excretion
Whenever there is a Hypokalemia risks or loss of k we have to …
Give water!!!
Hypertension
High blood pressure
What help with lung fluid?
Loop diuretics
What are the functions of the kidney
Think thbpp
Filter toxins in blood, mainly urea Maintain homeostasis Production of hormones Blood volume control Blood pressure regulation
Homeostasis is a function of the kidney
It is maintained by
FFA
Filtration, reabsorption, secretion
Fluid balance regulation
Acid base balance regulation
Filtration of kidneys
Glomerular capillaries have large fenstrations in capillary endothelium (single layer)
But they’re not large enough to allow blood cells or large protein to pass
High bp in glomerular capillaries force some plasma out into the space of Bowmans capsule
Glomerular filtrate rate: GFR is how fast plasma is filtered through glomerulus
Kidneys are located
Retroperitoneal: outside the abdominal cavity
Right more cranial
Urinary system…
2 kidneys, 2 ureters, urinary bladder, and urethra
Hilus
Indented medial side of kidney where the ureters, nerves, blood and lymph vessels enter and leave
Kidney are the most….
It….
Important single route of waste removal
Filters all waste products out of the bloodstream, but allow elements needed by the body to stay in
Reabsorption
When….
______ leaves ______ and enters the
About ___ of reabsorption occurs in ____ (examples)
Then filtrate goes to _____ and then ____
Useful substances go back into bloodstream
Glomerular filtrate leaves Bowman’s capsule and enters that PCT
(Called tubular filtrate)
About 65% of reabsorption occurs in PCT (water, any, CL, K, CA, bicarb, 100% glucose and amino acids)
Filtrate now goes to loop of Henle and then DCT
Secretion
_____ in the ____ leaves through the _____ ______ as _____
Important substances secreted are _____, _____, and ______
The tubular filtrate in the DCT leaves through the collecting ducts as urine
Important substances secreted are hydrogen, ammonia, and potassium
(Think… Hap)
The presence of abnormal amount of protein in the urine is used as an
Indicator of glomerular damage
Kidney hormones are responsible for the
Two hormones are responsible for the majority of urine volume regulation and how the body keeps fluid
Antidiuretic hormone (ADH) and aldosterone
Secretion
Impaired
All these actions may be inhibited in cases of renal failure or dysfunction
Impaired renal excretion of biotransformation cause delayed elimination of many drugs and enhances their toxicity and duration of action
Delayed Excretion will increase the drugs half-life and therefore cause toxicity
The doctor may extend the regiment or drop the dose
Presence of abnormal amounts of protein in the urine is used as
What is gloucosuria?
An indicator of glomerular damage
Renal threshold of glucose: when the blood glucose level gets too high, the amount of glucose filtered through the glomerulus exceeds the amount That can be reabsorbed and it is lost in the urine
Canine: 180 mg/Dl
Feline: 240 mg/dl
Antidiuretic hormone (ADH)
1) Acts on_____
2) Used to ______
3) it prevent ___ and regulates_____
1) Acts on DCT and collecting ducts to promote water reabsorption
2) used to stop urination/ water-sodium stays
3) prevent water loss from the body, regulate fluid balance
Antidiuretic hormone (ADH) When it works properly...
If ______ is not releasing adequate amounts of ADH…
So there is ____, ____
One of these factors when diagnosing _______
Ex: vasopressin
Antidiuretic hormone
When working properly, it’s the body’s failsafe mechanism so that we don’t dehydrate if we have lack of fluid intake
If the posterior pituitary gland is not releasing adequate amounts of ADH, water is not Reabsorbed
So there is an increase in urine volume (polyuric) and therefore an increase in thirst (polydipsia)
One of the factors when diagnosing diabetes insipidus
Ex: vasopressin
Aldosterone
Increases reabsorption of sodium in DCT and collecting ducts back into the blood
This causes an osmotic imbalance which causes water to flow back into the blood along with the sodium
What increases the reabsorption of sodium in DCT and collecting ducts back into the blood
and also causes an osmotic imbalance which causes water to go back into the blood along with the sodium
Aldosterone
Collecting ducts are also the site of
Antidiuretic hormone (ADH) action which prevents dehydration
Define renal dysfunction
What’s happens when waste builds up….
Any pathological condition that results in the inability of the urinary system to adequately remove waste materials from the blood
Waste materials built up in the blood and become toxic to the pet and the resulting condition is called uremia
Define uremia
A resulting condition of…
Uremia increases…
contraindications
Abnormally high concentrations of urea, creatine, and other nitrogenous end products of protein and amino acid metabolism in the blood
Waste materials build up in the blood and become toxic to the pet and the resulting condition is called uremia
Uremia can increase the sensitivity of some tissues to certain drugs
Contraindications- xy alone and ketamine
If it kidney’s functionality is decreased blank may not occur correctly
Erythropoesis
What about erythropoietin?
It’s the formation of erythrocytes
And may not occur correctly with kidneys function impaired
it is a hormone secreted by a healthy kidney That communicates with the bone marrow to make a more RBC
In disease kidneys the hormone is reduced or not at all
Epogen is a last ditch effort to help the non-regenerative anemia
What should a slide look like in diseased kidneys
Non-regenerative anemia, normochromic, normocytic
how does a diseased kidney affect the RBCs?
Bone marrow is unable to respond to the anemia and there are no reticulocytes because it’s non regenerative
What can be done for non-regenerative anemia? And Kidney failure
Sometimes injections of human recombinant erythropoietin (epogen), but this is considered a last ditch effort
PCV should be monitored on a weekly basis until improvement is reached or after the dose has been decreased
PCV you should be in the “teens” before therapies consent
What are the types of kidney failure?
Prerenal uremia
Renal uremia
Post renal uremia
What is pre-Renal uremia and how can we try to fix it
It’s decrease in blood flow to the kidneys
It may be caused by dehydration, CHF, or shock
In this case the kidneys are functioning properly but there isn’t enough blood reaching them, so waste material can’t be adequately removed
And try to fix it with fluids
Yes- kidney function
No- blood flow
What is Renal uremia?
Inability of the kidney to adequately regulate urine production because of that incident nephrons
Examples are toxins inflammation and infection
There is adequate blood flow but not enough functional nephrons, so waste removal can’t take place properly
Yes- blood flow
No-nephrons
What is post renal uremia?
And obstruction that prevents urine from being expelled from the body
Ex: tumor, blood clot or urolith (stones)
What is used to remove access extracellular fluid by increasing urine flow or diuresis and sodium excretion and reducing hypertension?
Diuretic drugs
Cplot
What are the diuretic drugs?
Loop, osmotic, thiazide, potassium sparing, and carbonic anhydrase inhibitors
Think cplot
Remove extracellular fluid by….
Reduce hypertension (sodium/water and low blood pressure)
Increase urine flow (diuresis)
Increase Na excretion
Diuretic Drugs
What are the diuretic drugs?
Loop, osmotic, thiazide, potassium sparing, and carbonic anhydrase inhibitors
Think cplot
Hypertension
High blood pressure
Loop Diuretics… must have
WATER!
Loop Diuretics... ex: \_\_\_\_ \_\_\_\_ inhibits.... actions are .... and given.... Tremendous .... promotes excretion of...
Loop
Ex: Furosemide; Lasix
Inhibits tubular reabsorption of Na at loop of henle
Actions are Quick and given IV
Tremendous diuresis
Promotes excretion of CL, K, and water
Clincal use- pulmonary edema, hypercalcemia nephropathy,
Osmotic Diuretic
Ex:
Administered- IV to promote… by…water is draw into
glamorous filtrate, reducing its reabsorption and increasing the secretion of water
Ex: Glucose and mannitol
Admin. IV to promote DIURESIS by exerting high OSMOTIC PRESSURE in the kidney tubules and limiting tubular reabsorption.
ex: Hydrochlorothiazide
Reduce edema by inhibiting reabsorption of Na, Cl, water at the renal tubules,
Duration of action is longer than looop diuretics
Cross placenta border
Clinical uses: nephrogenic diabetes insipidus and hypertension
Side effects: hypokalemia if therapy is prolonged, cardiac dysfunction
Thiazide DIuretic
Drugs used to treat oliguric acute renal failure (urine production has decreased or almost stopped) and to
Reduce intracranial and intraocular pressure
Side effects are vomiting and electrolyte imbalances
Osmotic Diuretic
Eye and Brain trauma
1) Eye or brain diuretic
2) Pregnant
3) Pulmonary edema
4) conjunction with aldosterone antagonists
5) Reduce intraocular pressure by reducing the production of aqueous humor- used to treat GLAUCOMA
1) Osmotic Diuretic
2) Thiazide DIuretic
3) Loop
4) Potassium-sparing diuretics
5) Carbon Anhydrase inhibitors
Ex:Spironolactone -Weaker diuretic and antihypertensive effects, but they do conserve potassium -usually used in conjunction with other diuretic, mainly loop - -a.k.a. aldosterone antagonists Side effect: HYPERkalememia -ENHANCES SODIUM/WATER EXCRETION -REDUCES POTASSIUM SECRETION
Potassium-sparing diuretics
ex: acetazolamide
- Block action of carbon anhydrase, which is used by the body to maintain acid-base balance
- Reduce intraocular pressure by reducing the production of aqueous humor and may be used to treat GLAUCOMA
- Side effects: Hypokalemia, metabolic acidosis (tachypnea, twitching, mouth ulcers, weight loss, muscle loss)
Carbon Anhydrase inhibitors
Define Urinary Incontinence
Two types
The loss of voluntary control of micturition
1) Neurologic
2) non-neurolgic
Example neurologic…
Urinary Incontinence
Trauma to the spinal cord, tumors of the nervous sytem
Dashond= slip disks/bladder issue
Example of non-neurologic
Urinary Incontinence
neoplasia (cancer), trauma to the bladder itself, stress, hormones
Expulsion to treat urinary incontinence is done with…
CHOLINERGIC AGONISTS
Retention to treat urinary incontinence is done with…
ANTICHOLINERGIC AGENTS
Anticholinergic Agents (retention)
1) their action produces muscle….
2) Used to treat….
3) Side effects…
4) they are….
5) aka…
1) their action produces muscle MUSCLE RELAXATION
2) Used to treat URGE incontinence by promoting the retention of urine in the urinary bladder
3) Side effects… Decreased gastric motility and delayed gastric emptying, which may decrease the absorption of other medications
4) they are…. SLOW!
5) aka… Parasympatholytic because they block Ach at receptor sites in the parasympathetic nervous system.
What treats Urinary Incontinence
Classification based on….
1) Cholingeric Agonists (Expulsion)
2) Anticholinergic Agents (Retention)
3) Adrenergic Antagonists
Beta and Alpha
Reduces internal sphincter tone when the urethral sphincter is in hypertonus (increased tension)
Side effect syncope (pass out)
SYMPATHETIC
Alpha Aderenergic Antagonists
(Ex: prazoin, phenoxybenzamine)
(classified by site of action)
inhibit catecholamines
control mild to moderate hypertension associated with CRF
Decrease Cardiac output and promotion of bronchospasm
Beta Aderenergic Antagonists
(ex: propranolol)
(classified by site of action)
Non-neurologic urinary disorder
1) includes….
2) what can increase urethral tone?
3) how do we treat most urinary incontinence mostly seen in spayed female dogs?
4) DES out so we use
1) includes stress, URGE!!!, Hormone response ectopic ureter formation, over distension
2) Alpha and Beta adrenergic agonists
3) Estrogen treats hormone responsive urinary incontinence in spayed female dogs
4) PPA
When blood volume is low, kidney’s secrete ….
renin directly into blood stream
Kidney’s secrete renin into the bloodstream when…
When blood volume is low
