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PHRM 844 Therapeutics > Renal Patho and Diuretics > Flashcards

Renal Patho and Diuretics Flashcards

1
Q

the average kidney has how many nephrons?

A

1 million

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2
Q

4 measures of kidney function or damage

A

-serum creatinine
-blood urea nitrogen (BUN)
-creatinine clearance
-GFR

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3
Q

true or false: we lose nephrons as we age

A

true

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4
Q

compensatory response to renal injury (9 steps)

A

renal injury -> decrease # of nephrons -> compensatory inc in size and function of remaining nephrons -> glomerular and tubular lesions -> loss of nephrons > compensatory capacity -> progressive dec in GFR -> azotemia -> uremic syndrome

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5
Q

what two disease states account for > 60% of renal failure cases in US?

A

HTN and diabetes

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6
Q

3 primary causes of intrinsic acute kidney injury

A

sepsis
ischemia
nephrotoxins

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7
Q

common key elements of progressive nephropathies (slide 24 of 45; 3 red arrows)

A

-increased glomerular capillary pressure
-proteinuria
-glomerulosclerosis

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8
Q

2 key abnormalities that give rise of CKD-MBD

A

-impaired phosphate excretion
-decreased production of vitamin D3

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9
Q

hematuria is seen in

a. nephritic syndrome
b. nephrotic syndrome

A

a. nephritic syndrome

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10
Q

proteinuria is seen in

a. nephritic syndrome
b. nephrotic syndrome

A

b. nephrotic syndrome

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11
Q

nephrotic syndrome (3 things to know from table; slide 31)

A

-edema
-proteinuria
-low serum albumin

(usually see proteinuria and edema)

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12
Q

nephritic syndrome (2 things to know from table; slide 31)

A

-hematuria
-red blood cell casts are present

(usually see blood, inflammation (blood urea))

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13
Q

what is glomerulonephritis?

A

inflammation of glomeruli

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14
Q

true or false: glomerulonephritis is only acute

A

false (has both acute and chronic forms)

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15
Q

primary cause of glomerulonephritis

A

Alport syndrome

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16
Q

“presents flank pain with painful urination” refers to which condition?

A

pyelonephritis

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16
Q

what is pyelonephritis?

A

inflammation of kidney tissue

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16
Q

secondary causes of glomerulonephritis

A

infections, drugs, autoimmune disorders (vasculitis, Lupus)

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17
Q

pyelonephritis may lead to _____

A

sepsis

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17
Q

cause of pyelonephritis

A

bacteria from blood or urinary tract (i.e. bacterial infection)

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18
Q

70-75% of acute intersistial nephritis is caused by _____, 4-10% is caused by _____

A

drugs; infection

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19
Q

main drug class associated with interstitial nephritis

A

penicillins

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20
Q

autosomal dominant (adult) polycystic kidney disease is caused by inherited mutation of which two genes?

A

PKD1 (polycystic kidney disease 1) or PKD2 gene in renal tubular cells

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21
Q

autosomal recessive (childhood) polycystic kidney disease is caused by a mutation in what gene?

A

PKHD1 - fibrocystin (polyductin)

22
nephrolithiasis is also known as _____ _____
kidney stones (renal calculi)
23
are kidney stones more prevalent in men or women?
men (lifetime prevalence 10% men, 5% women)
24
nephrolithiasis arises from a supersaturation of solutes, mainly which one?
calcium
25
70-80% of nephrolithiasis is what composition?
calcium oxalate or calcium phosphate
26
uric acid is ___-___% of the composition of kidney stones
10-15%
27
primary treatment for kidney stones (4 of them)
-analgesics -hydration -lithotripsy (shock waves) -surgical removal
28
prevention of kidney stones (2 methods)
-diet (hydration; elim Ca supplements) -diuretics
29
carbonic anhydrase inhibitors act on what part of the nephron?
PCT
30
acetazolamide 3 structural things to know
-sulfamoyl group essential for diuresis -sulfamoyl N unsubstituted to retain activity -derivatives with high partition coeff and lowest pKa have > potency
31
true or false: CA inhibitors have high efficacy as diuretics
false (low efficacy)
32
drug that treats acute mountain sickness
acetazolamide
33
how does acetazolamide treat acute mountain sickness?
the metabolic acidosis produced by the drug counteracts the respiratory alkalosis than can result from hyperventilation in this condition. (drug is taken prophylactically for several days before)
34
osmotic diuretics site of action (2 of them)
PCT and descending loop of Henle
35
true or false: mannitol has a risk of hyponatremia
false (hypernatremia)
36
3 orally active osmotic diuretics
-isosorbide -glucose -glycerine
37
loop diuretics main site of action
thick ascending limb of Loop of Henle
38
which transporter do loop diuretics inhibit?
Na+-K+-2Cl- symporter
39
SAR for loop diuretics (inhib NaK2Cl symporter) (3 things to know; slide 25 of 49)
-substituent at 1 position must be acidic -sulfamoyl group in the 5 position is essential for optimal diuretic activity -activating group in the 4 position
40
5 toxicities of loop diuretics
-dehydration -hypokalemic metabolic acidosis -ototoxicity -hyperuricemia -hypomagnesemia (2 and 3 were highlighted on slides)
41
thiazides act primarily on ___, and the ___ secondary
DCT; PCT
42
thiazides inhibit which transporter?
Na+-Cl- symporter
43
thiazides reduce _____ reuptake
potassium
44
Inhibitors of renal epithelial Na+ channels (ENaC inhibitors) act at what location? (2 of them)
-late DCT -collecting duct
45
clinical use of ENaC inhibitors
-adjunct treatment w thiazide or loop diuretic in heart failure or hypertension
46
toxicities of ENaC inhibitors (2 of them)
hyperkalemia (most important bc potassium sparing) hyperchloremic metabolic acidosis
47
loop diuretics have weak _____ _____ activity
CA inhibitory
48
MRA location of action (2 of them)
-late DCT -collecting duct
49
two subclasses of Na+-Cl- symport inhibitors
-thiazides -hydrothiazides
50
what is the difference in structure between thiazides and hydrothiazides?
thiazides have a double bond at C3-C4, hydrothiazides have no double bond
51
renal epithelial Na+ channel inhibitors (2 drugs)
-amiloride -triamterene
52
which drug is available IV? a. conivaptan b. tolvaptan
a. conivaptan (tolvaptan is oral)
53
which is more selective for V2 receptors? a. conivaptan b. tolvaptan
b. tolvaptan
54
only diuretics that do no act within the tubular lumen
mineralocorticoid receptor antagonists (MRA)
55
two main vasopressin antagonists drugs
conivaptan tolvaptan

PHRM 844 Therapeutics (28 decks)

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