Renal and CT Flashcards
1
Q
Diuresis
A
increase in urine flow (mL/min) = UV
2
Q
Natriuresis
A
increase in urinary sodium exctretion (UNaV)
3
Q
Kaliuresis
A
increase in urinary potassium excretion (UKV)
4
Q
Chloruresis
A
increase in urinary chloride excretion
5
Q
Bicarbonaturia
A
increase in urinary bicarbonate excretion
6
Q
Renin
A
- from JG cells in afferent arteriole ⇒ angiotensin II
- increased with sympathetic stimulation, renal hypoperfusion, ↑ cAMP, ↓ angII, ↑ intracellular Ca
- renin-angiontensin system activated by diuretics.
7
Q
Aldosterone
A
- released from zona glomerulosa in adrenal gland.
- ⇒ ↑ Na reabsorption via ENaC in distal nephron.
- ↑ aldosterone whenever renin is ↑
8
Q
ADH
A
- released from posterior pituitary gland when have ↑ plasma osmolality, ↓ BP
- influenced more by osmolality than BP
- ⇒ ↑ water reabsorption in collecting duct via V2 receptor stimulation
9
Q
ANF (Atrial Natriuretic Factor)
A
- released from atrium in resopnse to volume expansion.
- can ⇒ ↑ GFR and Na and water excretion
10
Q
Angiontensin
A
- constricts afferent arterioles ⇒ ↓ GFR.
11
Q
Inulin
A
- marker for GFR, not a natural substance.
- presence in urine is an indication of filtration.
12
Q
Sulfonilamide
A
- carbonic anhydrase inhibitor.
- has sulfonamide moiety for activity.
13
Q
Acetazolamide
A
- carbonic anhydrase inhibitor
- rapid onset (30 min)
- excreted by tubular S2 segment but acts on S1 segment.
- inhibits 85% of proximal tubular HCO3- reabsportion
- inhibits 45% whole kidney HCO3- reabsorption
- inhibits NHE3 on lumenal side of proximal convoluted tubule ⇒ ↓ Na inside cell ⇒ nonfunctional Na K ATPase on interstitial side. (prevents production of H+ needed for this antiport)
- also affects Na HCO3- symport on interstitial side from ↓ Na inside cell ⇒ ↓ HCO3- brought to blood.
- ⇒ ↑ HCO3- excretion, ↑ urinary pH, ↑ urine volume, ↑ Na excretion, ↑ urine K+, ↑ luminal negativity (promotes K excretion)
- uses: glaucoma - ↓ ocular pressure
- altitutde sickness prophylaxis - ↓ CSF pH
- short-term diuretic for edema in CHF - potentiates distally-acting agents, corrects metabolic alkalosis
- antiepileptic in catamenial epilepsy
- corrects metabolic alkalosis
- alkalinates urine - ↑ solubility of uric acid and cystein, ↑ aspirin excretion, ↑ urinary phosphate excretion
- side effects: hyperchloremic metabolic acidosis, renal stone formation, hyperkalemia
- contraindications: in K+ depletion, pts with hepatic cirrhosis (may ↑ excretion NH4+ ⇒ hepatic encephalopathy)
14
Q
Dichlorphenamide
A
- carbonic anhydrase inhibitor
- uses: glaucoma
15
Q
Methazolamide
A
- carbonic anhydrase inhibitor.
- uses: glaucoma
16
Q
Dorzolamide
A
- topically active for glaucoma ⇒ ↓ intraocular pressure
17
Q
Brinzolamide
A
- topically active for glaucoma ⇒ ↓ intraocular pressure
18
Q
Mannitol
A
- osmotic diuretic
- does not cross water permeable membranes, ↓ fluid reabsoprtion (proximal tubules, thick ascending limb)
- IV only
- causes water to leave cells, keeps nephrons patent.
- freely filtered, not reabsorbed by kidney.
- uses: ↓ intraocular pressure in glaucoma, ↓ intracerebral pressure, anuria states (rhabdomyolysis)
- side effects: hypovolemia
- contraindications: CHF = ↓ kidney function so not filtered ⇒ hyponatremia, hypervolemia
19
Q
Urea
A
- osmotic diuretic
- not orally active
20
Q
Glycerin
A
- osmotic diuretic
- orally active
21
Q
Isosorbide
A
- osmotic diuretic
- orally active
22
Q
Furosemide
A
- loop diuretic
- aka Lasix
- has sulfonamide group
- bound to plasma proteins, filtration enhanced by proteinuria
- secreted by S2 segment of proximal tubules
- acts from luminal side of TAL
- dosage: 20-40mg
- given orally or IV
- orally: onset of action = 30 min -1hr, duration = 6-8 hr
- IV: onest of action = immediate, duration = 2hr
- inhibits NKCC2 ⇒ ↓ lumen pos. potential ( back-leak of K into lumen) ⇒ ↑ Na, K, Cl in urine, ↓ resoprtion Ca, Mg.
- ⇒ ↓ venous capacitance, ↓ concentrating ability (↓ NaCl reabsorption in medullary TAL), ↓ diluting ability (↓ NaCl resoprtion in cortical TAL), ↑ RBF and GFR
- ⇒ ↑ Na and Cl excretion (Cl>Na), ↑ urine volume, isosthenuria, ↑ Ca and Mg excretion, ↑ PG and renin release, ↑ venous capacitance, block tubuloglomerular feedback, kaliuresis, ↓ osmotic gradient in medulla
-
uses: acute PE - ↓ pulm wedge pressure, ↓ LV filling pressure, in anephric pts, long term benefit, ↑ venous capacitance rapidly
- edematous conditions: CHF, liver cirrhosis, nephritic syndrome, chronic heart failure, acute renal failure
- acute hypercalcemia
- hyperkalemia
- acute renal failure
- anion overdose
- HTN
- side effects: hypokalemic metabolic alkalosis, ototoxicity, hyperuricemia, hypomagnesia, allergic rxn, dehydration, hyperglycemia
23
Q
Ethacrynic Acid
A
- loop diuretic
- aka Edecrin
- prodrug, adducts with cysteine group on methylene group
- no sulfonamide group, has vinyl group
- bound to plasma proteins, filtration enhanced by proteinuria
- secreted by S2 segment of proximal tubules
- acts from luminal side of TAL
- given orally or IV
- orally: onset of action = 30 min -1hr, duration = 6-8 hr
- IV: onest of action = immediate, duration = 2hr
- inhibits NKCC2 ⇒ ↓ lumen pos. potential ( back-leak of K into lumen) ⇒ ↑ Na, K, Cl in urine, ↓ resoprtion Ca, Mg.
- ⇒ ↓ venous capacitance, ↓ concentrating ability (↓ NaCl reabsorption in medullary TAL), ↓ diluting ability (↓ NaCl resoprtion in cortical TAL), ↑ RBF and GFR
- ⇒ ↑ Na and Cl excretion (Cl>Na), ↑ urine volume, isosthenuria, ↑ Ca and Mg excretion, ↑ PG and renin release, ↑ venous capacitance, block tubuloglomerular feedback, kaliuresis, ↓ osmotic gradient in medulla
-
uses: acute PE - ↓ pulm wedge pressure, ↓ LV filling pressure, in anephric pts, long term benefit, ↑ venous capacitance rapidly
- edematous conditions: CHF, liver cirrhosis, nephritic syndrome, chronic heart failure, acute renal failure
- acute hypercalcemia
- hyperkalemia
- acute renal failure
- anion overdose
- HTN
- side effects: hypokalemic metabolic alkalosis, ototoxicity, hyperuricemia, hypomagnesia, allergic rxn, dehydration, hyperglycemia