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PMCOL 343 > Renal 1 > Flashcards

Renal 1 Flashcards

1
Q

What do the kidneys regulate?

A
  • fluid
  • acid-base
  • electrolyte/ion balance
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2
Q

How much of the glomerular filtrate is reabsorbed?

A

> 99%

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3
Q

Describe the structure of a nephron

A

glomerulus –> proximal tubule –> loop of Henle –> distal convoluted tubule –> collecting duct

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4
Q

What are glomerular capillaries permeable to? impermeable to?

A

permeable to water
impermeable to plasma proteins

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5
Q

What is the function of diuretic?

A
  • decrease reabsorption of Na+ (and Cl-) in the kidney
  • increase excretion of urinary NaCl –> secondary water loss
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6
Q

What is the use of a diuretic?

A

alter volume/composition of bodily fluids

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7
Q

Where do diuretics act?

A
  • directly on cells of nephron
  • indirectly by modifying content of the filtrate
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8
Q

What are the classes of diuretics?

A

1) sodium-glucose cotransporter-2 (SGLT2) inhibitors
2) loop diuretics
3) thiazides
4) K+ sparing diuretics
5) antidiuretic hormone antagonists

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9
Q

Where are SGLT2 found?

A

APICAL membrane of cells in PROXIMAL convoluted tubule

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10
Q

What is the function of SGLT2?

A

reabsorption of glucose and Na+

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11
Q

What is the function of SGLT2 inhibitor?

A

reduce reabsorption of glucose and Na

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12
Q

What are SGLT2 inhibitors mainly used to treat?

A

type II diabetes

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13
Q

Why is SGLT2 inhibitor not used in hypertension?

A

reduce reabsorption of glucose

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14
Q

What are SGLT2 inhibitors used to treat (besides diabetes)?

A

heart failure in diabetes patients at risk for CV disease

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15
Q

How do SGLT2 inhibitors treat heart failure?

A

improvement in cardiac energy metabolism (ketone oxidation in heart)

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16
Q

What are the SGLT2 inhibitors have been shown to treat heart failure in diabetes patients?

A
  • empagliflozin
  • canagliflozin
  • dapagliflozin
17
Q

Which SGLT2 inhibitor treats heart failure in diabetes patients with atherosclerotic cardiovascular disease?

A

dapagliflozin

18
Q

Which SGLT2 inhibitor treats heart failure in diabetes patients with cardiovascular disease?

A
  • empagliflozin
  • canagliflozin
19
Q

Which limb of the loop of henle is responsible for water reabsorption?

A

descending limb

20
Q

Which part of the loop of henle is relatively water impermeable?

A

thin ascending limb

21
Q

Which part of the loop of henle reabsorbs ~25% Na+ and is nearly impermeable to water?

A

thick ascending limb

22
Q

Which transporter is found at the apical membrane of the thick ascending limb of the loop of henle? which way do the ions flow?

A

Na/K/2Cl cotransporter (NKCC2); all flow into loop of henle cell

note: excessive K+ accumulation inside cell

23
Q

Which transporter is found at the basolateral membrane of the thick ascending limb of the loop of Henle? Which way do the ions flow?

A

K/Cl cotransporter; ions flow into interstitium/blood

24
Q

What is the net electrical potential of the lumen at the thick ascending limb of the loop of henle? What causes this? What does this electrical potential lead to?

A

net potential: (+)

cause: diffusion of K+ into lumen via apical K+ channels

leads to: driving force for reabsorption of cations

25
Q

Which drug acts as a loop diuretic?

A

furosemide

26
Q

What class of diuretic is the most efficacious?

A

loop diuretics

27
Q

What is the mechanism of loop diuretics?

A

inhibit NKCC

28
Q

What are the effects of using loop diuretics?

A
  • reduced Na and Cl reabsorption
  • diminished luminal (+) potential, reduced Ca and Mg reabsorption
29
Q

What are the therapeutic uses of loop diuretics?

A

acute pulmonary edema, chronic HF, hypertension, acute renal failure, acute hypercalcemia, hyperkalemia

30
Q

What are the adverse effects of loop diuretics?

A
  • hypokalemia, hypomagnesemia
  • metabolic alkalosis
  • ototoxicity (due to changes in electrolyte composition of endolymph in the inner ears, high K+)

PMCOL 343 (27 decks)

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