Renal Pathology, Diuretics and Anesthesia PP#5

Question 1

ANP is produced by what?

Answer 1

Atrial Myocytes (heart muscle)

Question 2

What are 2 functions of ANP?

Answer 2

• Relax smooth muscles

- Promote NaCl (salt) Water excretion

Question 3

What stimulus causes release of ANP?

Answer 3

Atrial stretch

Question 4

What is the overall function of ANP?

Answer 4

Reduce volume

Question 5

What are the 5 ways ANP decreases fluid volume?

Answer 5

• Inhibit Renin
• Inhibit Aldosterone
• Inhibit ADH
• ↓ Salt reabsorption
• ↑ GFR

Question 6

How does ANP increase GFR?

Answer 6

• Dilation of afferent

- Constriction of efferent

Question 7

Where does ANP decrease salt reabsorption?

Answer 7

Directly on the Collecting ducts

Question 8

What is Natrecor?

Answer 8

Recombinant form of B-type naturetic peptide

Question 9

What other name is Natrecor known by?

Answer 9

Brain natriuretic peptide (BNP)

Question 10

Where is Natrecor (BNP) made?

Answer 10

Ventricular myocardium

Question 11

What 3 things does Natrecor (BNP) do to treat CHF?

Answer 11

• Vasodilate
• Diuresis
• Natriuresis

Question 12

Natrecor (BNP) is also used as a lab marker for heart failure, what is a positive finding?

Answer 12

> 500

Question 13

How do most diuretics work?

Answer 13

• Decrease Na reabsorption from the tubules
• Increased natriuresis
• H20 follows Na (diuresis)

Question 14

4 Common uses of diuretics.

Answer 14

• ↓ ECF
• Edema
• CHF
• HTN

Question 15

What happens to diuretics w/ chronic use?

Answer 15

Potency decreases

Question 16

How do diuretics lose potency after chronic use?

Answer 16

-↓ in ECF will lead to decreases in MAP and GFR and will eventually start the renin - angiotensin system.

Question 17

Name the 6 types of diuretics.

Answer 17

• Osmotic
• Loop
• Thiazide
• Carbonic anhydraze inhibitors
• Aldosterone inhibitors
• Sodium channel blockers

Question 18

Name 2 examples of osmotic diuretics

Answer 18

• Urea

- Mannitol

Question 19

How do osmotics work?

Answer 19

-Draw fluid into tubules

Question 20

In diabetics glucose can mimic what kind of diuretic?

Answer 20

Osmotic

Question 21

Give 3 examples of loop diuretics.

Answer 21

• Lasix
• Bumex
• Ethacrynic acid

Question 22

What do loop diuretics inhibit?

Answer 22

Na-Cl-K co-transporter in the TAL of the loop of Henle

Question 23

How does na/cl/k pump inhibition cause diuresis?

Answer 23

-Increasing solutes in which draws fluid into tubule.

Question 24

What causes the counter current multiplier to be disrupted with loop diuretics?

Answer 24

-interstitium can’t become hyperosmolar

Question 25

What is an example of a thiazide diuretic?

Answer 25

HCTZ

Question 26

How do thiazide diuretics work?

Answer 26

Inhibit NaCl (salt) reabsorption in the early distal tubule

Question 27

What is an example of a Carbonic anhydrase inhibitor diuretic?

Answer 27

-Acetazolamide (Diamox)

Question 28

How does carbonic anhydrase work?

Answer 28

-Reduce Na+ by decreasing bicarb

Question 29

What is the disadvantage of carbonic anhydrase inhibitors?

Answer 29

Acidosis through bicarb loss

Question 30

What is an example of an aldosterone antagonist?

Answer 30

Spironolactone (aldactone)

Question 31

How does aldosterone antagonists work?

Answer 31

Decrease Na reabsorption by competing with aldosterone binding sites.

Question 32

What two diuretics spare K?

Answer 32

- Aldosterone antagonists | - Na channel blockers

Question 33

What is an example of Na channel blocker?

Answer 33

- Amiloride | - Triamterene

Question 34

How does Na channel blocker work?

Answer 34

Decrease activity of Na/K pump in the collecting duct and decreases Na reabsorption

Question 35

Acute renal failure is ________ reversible

Answer 35

potentially

Question 36

Chronic renal failure is an irreversible decrease in what?

Answer 36

Functional nephrons

Question 37

What do end stage renal patients need to live?

Answer 37

Dialysis

Question 38

What are the 3 types of acute renal failure?

Answer 38

Pre-renal Intra-renal Post-renal

Question 39

What are 2 examples of acute pre-renal failure?

Answer 39

- Heart failure | - Hypovolemia

Question 40

In acute pre-renal kidney failure, the kidney does not get enough ________, and becomes _________.

Answer 40

- Blood | - Ischemic

Question 41

What is acute intra-renal kidney failure?

Answer 41

Damage to the kidney

Question 42

What can cause Acute intra-renal kidney failure?

Answer 42

- Toxins - Infection - Autoimmune - Direct injury

Question 43

What is an acute post-renal kidney failure?

Answer 43

Obstruction of collecting system

Question 44

What 4 examples of acute post-renal kidney failure?

Answer 44

- Stones - Urethral valves - Tied off ureter - Kinked foley

Question 45

When do chronic renal symptoms appear?

Answer 45

w/ at least 70% of nephrons not working

Question 46

4 things that cause chronic renal injury.

Answer 46

- Renal vascular injury - Glomerulonephritis - Infection - Nephrotic syndrome

Question 47

What 3 things cause injury to renal vasculature?

Answer 47

- Atherosclerosis - Fibromuscular dysplasia - Nephrosclerosis

Question 48

What is nephrosclerosis?

Answer 48

sclerotic lesion to small arteries

Question 49

3 causes of glomerulonephritis

Answer 49

- deposition antigen-antibody complexes (most commmon) - Sterptococcal infection - Lupus

Question 50

What is vesicoureteral reflux?

Answer 50

- Bladder fails to occlude ureter | - Urine moves up into kidney

Question 51

Describe nephrotic syndrome.

Answer 51

- Loss of negative charge in basement membrane of glomerulus | - Leads to protein in urine

Question 52

What are the effects renal failure on the body?

Answer 52

- Edema (generalized & Pulm) - Acidosis - Nitorgeneous waste build-up - Anemia - Increase in K - Glucose intolerance - Platelet/WBC dydfunction - Gastric ulcers - Perpherial neuropathy

Question 53

What are the effects renal failure on the Heart?

Answer 53

Increase in CO to compensate for decreased O2 capacity

Question 54

What are the effects renal failure on the respiratory system?

Answer 54

- Decreased minute ventilation to compensate for acidosis | - Autonomic neuropathy decreases gastric emptying = increased risk of aspiration.

Question 55

How does renal failure cause Osteomalacia?

Answer 55

- Decrease in Vitamin D = no calcium absorption | - Elevated phosphate stimulates parathyroid which causes skeletal demineralization

Question 56

How does renal failure cause HTN?

Answer 56

- Kidney lesion ↓ H2O and Na excretion. | - The body compensates w/ HTN to force out the H2O and Na

Question 57

How does one damaged kidney effect the good kidney?

Answer 57

Renin and Angiotensin 2, needed for the bad kidney, also affects good kidney and drive up BP