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Urinary Flashcards

0
Q

What do diuretics do?

How do they do this?

A

Increase output of urine, by reducing sodium and water retention

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1
Q

LIst the 5 types of diuretics

A 
Osmotic diuretics 
Carbonic anhydrase inhibitors
Loop diuretics 
Thiazides
Potassium-sparing diuretics
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2
Q

Which hormone stimulates the principal cells in the collecting ducts to reabsorb more Na+ and Cl- and secrete more K+?

A

Aldosterone

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3
Q

What stimulates aldosterone secretion?

A

Decreased blood pressure and increased potassium

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4
Q

What is reabsorbed and secreted in the DCT and collecting duct?

A

Reabsorbed: Na+, Cl-
Secreted: K+
(principal cells)

Intercalated cells: H+ secretion

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5
Q

How would you increase the action of the urethral sphincter muscle?

A

Alpha or beta agonists, eg phenylpropanolamine
Increased adrenoreceptor sensitivity.
Increased noradrenaline release and activity

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6
Q

How would you decrease the activity of the detrusor muscle (of bladder wall)?

A

Anticholinergics/muscarinic antagonists eg Propantheline

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7
Q

How would you fix urinary incontinence?

A

Increase action of the urethral sphincter

Decrease activity of the detrusor (bladder wall) muscle

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8
Q

How does hyper phosphataemia lead to increased parathyroid hormone?

A

Phosphate inhibits formation of vitamin D3. As vitamin D3 exerts negative feedback on PTH, hyper phosphataemia leads to increased PTH.

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9
Q

Which part of the nephron do osmotic diuretics act in?

A

Proximal convoluted tubule

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10
Q

Give an example of an osmotic diuretic

A

Mannitol

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11
Q

Give an example of a carbonic anhydrase inhibitor (diuretic)

Where do they act?

A

Acetazolamide
Dichlofenamide
(All are sulphonamides)
Act in PCT

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12
Q

Give an example of a loop diuretic

What do they do?

A

Furosemide

Inhibition of Na+/K+/Cl- co-transporter

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13
Q

Where do thiazides act?

A

DCT

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14
Q

What do thiazides do?

A

Inhibit Na+/Cl- co-transport (before aldosterone-stimulated Na+/K+ exchange)
Increase Na+, Cl-, Mg2+ and K+ excretion
Decrease Ca2+ excretion
Decrease urine output in some nephrogenic diabetes insipidus
Inhibits conversion of pro-insulin to insulin

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15
Q

What do carbonic anhydrase inhibitors do?

A

Reversibly inhibit carbonic anhydrase enzyme, predominantly in PCT.
Causes decreased H+ secretion, and reduced Na+/H+ exchange
Decreased CO2 reabsorption
Increased NaHCO3 excretion
Alkaline urine

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16
Q

What do osmotic diuretics do?

A

Increase kidney medullary blood flow which reduces interstitial osmotic gradient
Filtered but not reabsorbed, so maintain osmotic pressure within filtrate

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17
Q

What are the key features of principle cells (epithelial cells) in the DCT and collecting duct?

A

Na+/K+ pump on basolateral membrane

Na+ and K+ leak channels on apical membrane

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18
Q

How is Na+ reabsorption and K+ secretion increased in the principle cells of the renal collecting duct?

A

Acutely: increased activity of existing channels and pumps

Long-term: synthesis of new channels and pumps

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19
Q

What do potassium-sparing diuretics do?

A

Do not secrete potassium into urine
Triamterine and amiloride are organic bases, and inhibit active Na+ reabsorption, which decreases Na+/K+ ATPase activity
Spironolactone is a steroid and competitive inhibitor of aldosterone (which reabsorbs Na+ and secretes K+)

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20
Q

Carbonic anhydrase inhibitors cause initial diuresis, but what is their primary function?

A

To treat glaucoma

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21
Q

What is the most common side effect of using diuretics (except K+-sparing)?

A

Hypokalaemia (increased K+ loss)

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22
Q

Give an example of a diuretic treatment (i.e. combination of two)

A

Potassium sparing e.g. amiloride with a loop or thiazide diuretic e.g. hydrochlorothiazide

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23
Q

When using α-agonists to treat urinary incontinence, what can we also use to increase α-adreno-receptor sensitivity?
When might this be contraindicated, why?

A

A natural, short-acting oestrogen i.e. Estriol
Contraindicated in entire bitches.
Adverse effects: swollen vulva and mammary glands, attracts males

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24
What are the adverse effects of using anticholinergics or muscarinic antagonists?
Increased heart rate, dilated pupils and photophobia, dry mouth, constipation
25
How do we treat urinary retention?
We want to increase activity of detrusor muscle (muscarinic agonists eg Bethanecol) Want to decrease activity of urethral sphincter (alpha or beta antagonist)
26
Give an example of an a-antagonist drug used to decrease activity of the urinary sphincter (in urinary retention)
Phenoxybenzamine | Prazosin
27
Which 2 drugs can we use to relax the external urinary sphincter?
Central inhibition: Diazepam Peripheral inhibition: Dantrolene Adverse effect of general muscle weakness with overdose of Dantrolene
28
What drug could we give to treat cystine uroliths? How does it work? What form of preparation is it given as?
Penicillamine Binds to cystine to make a complex that is more soluble than cystine Oral preparation
29
What drug could we give to treat urate uroliths? How does it work? What form of preparation is it given as?
Allopurinol Inhibits xanthine oxidase and decreases formation of Uric acid Oral preparation
30
How can you acidify urine pH?
Methionine | Ammonium chloride/sulphate
31
How can you alkalinise urine pH?
NaHCO3 | Sodium/potassium citrate
32
What are the common clinical signs of renal failure?
``` Azotaemia (increased blood urea and creatinine) Polyuria and polydipsia Anorexia Metabolic acidosis High blood pressure Anaemia Hyperphosphataemia Hypokalaemia ```
33
When managing renal failure, diet should contain increased and decreased what?
Increased potassium | Decreased phosphorus
34
Name 3 phosphate binders used to bind phosphate in the GI tract
Calcium acetate Lanthanum carbonate octahydrate Sevelamer
35
What is cystitis?
Inflammation (not necessarily infection) of the bladder
36
If we want to treat a bacterial bladder infection, what sort of drug should we select? What might we need to manipulate?
One that is excreted, unchanged, in the urine E.g. amoxicillin, trimethoprim, fluoroquinalones May need to manipulate urine pH, as different antibiotics work best at different pHs (e.g. penicillins=5.5)
37
Give an example of a urinary antiseptic | What are its adverse effects?
Methanamine (hexamine). Hydrolysed in urine to release formaldehyde Bladder irritation
38
What is a crystalloid?
A water-based solution with small-molecular-weight particles, freely permeable to the capillary 'membranes'
39
What do buffered crystalloids contain?
HCO3- or, more often, contain molecules (e.g. acetate, lactate, gluconate) which are metabolised in the liver to produce HCO3-
40
What do balanced crystalloids contain? | Give an example of one and state its pH
Contain electrolytes in addition to Na+ and Cl- (such as K+ Ca2+ Mg2+ ), making them similar to plasma Lactated Ringer's (pH 6.7)
41
What is the pH of normal saline solution?
5.7
42
What is a colloid?
A water-based solution with a molecular-weight too large to freely pass across capillary 'membranes' Intravascular volume-replacement solution
43
Give some examples of natural and synthetic colloids
Natural: albumen, plasma, whole blood Synthetic: gelatines, starches, dextrans
44
What is the priority when doing fluid therapy?
Restoration of circulating volume
45
For each litre of ECF volume replacer given, how much remains in the intravascular space?
250mls
46
Why is it not always appropriate to give fluid replacers with high Na solutions?
Sodium may accumulate over time
47
How do colloids work
Large molecules thus can't pass through healthy vascular endothelium. They therefore increase osmotic pressure of the plasma and 'pull' water from the interstitial space. Plasma volume expanders.
48
Why should ECF replacers be used concurrently or soon after colloids?
To replace the fluid taken from the interstitial space
49
How does hypertonic saline work?
7.2% NaCl. Increases blood pressure. Draws water in by osmosis from the interstitial space. Plasma expanders. Any effect is transient, so must be followed by administration of isotonic crystalloids
50
What is the optimum Na concentration of an oral fluid required to achieve optimum rehydration?
120-130mmol/L
51
What is urine specific gravity? | What do we use to measure it?
Ratio of density of urine compared with density of a reference (water=1) Refractometer
52
What is the specific gravity of protein-free plasma?
1.008-1.012
53
Which values for specific gravity are classed as an 'inadequate concentration' in cats and dogs?
Cats
54
What does isosthenuria refer to? | What does it suggest?
The excretion of urine whose specific gravity is within the range of protein-free plasma, typically 1.008-1.012. Suggests that the kidneys have not altered the glomerular filtrate. It is likely that the animal has kidney failure
55
How can you distinguish between renal and pre-renal azotaemia?
Renal-unable to concentrate urine
56
When might you see ketones in urine?
``` Not normally Might see them in: -starvation -ketosis in ruminants -poorly controlled diabetes mellitus ```
57
What kind of problem do you have if you have glucosuria, but plasma glucose is normal?
PCT problem
58
How much protein is normally in urine?
None
59
What is the normal pH range for dogs and cats?
5-9
60
What percentage of urea is reabsorbed in the kidneys?
50%
61
What can we measure to estimate GFR?
Creatinine
62
What are the differences between urea and creatinine?
``` Urea= nitrogenous waste product, made in liver from ammonia from catabolised proteins. Filtered by glomerulus. Some reabsorbed in PCT Creatinine= Produced constantly by muscles. Filtered by glomerulus. Not reabsorbed in PCT ```
63
Why might a patient have high urea in their urine? (7)
``` High protein diet Decreased GFR Recent meal Catabolism (fever) Blocked/ruptured lower urinary tract GI haemorrhage Dehydration ```
64
Why might a patient have low urea in their urine? (3)
Low protein diet Severe liver disease Aggressive fluid therapy
65
How do you evaluate kidney function?
``` Urinalysis (analysis of volume, physical, chemical, and microscopic properties of urine) Blood tests (urea & creatinine, serum electrolytes) ```
66
What waste products are found in urine?
Na+, K+, urea, creatinine

Year 2 (10 decks)

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