Water Balance and diabetes Flashcards

1
Q

When is present if you see concentrated urine?

A

ADH

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2
Q

What if you see dilute urine?

A

ADH is absent

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3
Q

What is the diluting portion of the nephron

A

thick ascending limb

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4
Q

What is the concentrating potion of the nephron

A

thick ascending limb

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5
Q

Where can you make the choice to get rid of water

A

End of Distal convoluted tubule

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6
Q

What allows for water to be drawn out other than ADH?

A

medullary interstitum hypertonicity

AND ADH required

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7
Q

What sets up hypertonicity

A

passive thin ascending loop NaCl movement

active NKCC2 in thick ascending loop

Urea transport UTA1 in collecting duct

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8
Q

How is the thin ascending loop able to still move sodium out

A

Presence of urea helps you have a larger gradient difference

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9
Q

What does ADH increase

A

Water AND Urea permiability

ADH-UT-A1
(ADH-AQP2)

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10
Q

What does someone on loop diuretics need to do?

A

measure sodium and water intake because they cannot concentrate/dilute urine

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11
Q

If urine osmolarity is greater than plasma, what would you expect?

A

Free water clearance is negative

retention

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12
Q

If urine osmolarity is less than plasma, what would you expect?

A

Free water clearance is positive

excretion

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13
Q

What is someones Free water clearance on loop diuretics

A

0

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14
Q

Where is AVP made

A

hypothalamus in supraoptic nuclei

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15
Q

Where is AVP secreted

A

posterior pituitary

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16
Q

What does AVP activate

A

V2 which activates cAMP and in turn AQP2 and UTA1

V1 which causes platelet aggregation (vasoconstictor)

17
Q

Where does AVP work

A

Only from Collecting duct on

18
Q

What controls urine water excretion

A

osmoreceptors in the 3rd ventricle

19
Q

What states cause nonosmotic release of AVP

A

hypotension
hypovolemia

(caused by ATII)

20
Q

What disease has too little ADH activity

A

diabetes insipidus

21
Q

What is seen in too much ADH

A

too much water causing hypernatremia

SIADH

22
Q

What causes central Diabetes insipidus

A

deficient ADH secretion

23
Q

What causes nephrogenic diabetes insipidus

A

decreased sensitivity of kidney to ADH

24
Q

What do you use for central diabetes insipidus

A

Desmopressin (V2 selective)

intranasally

25
Q

What is desmopressin used in

A

central diabetes insipidus

nocturnal enuresis
von Williebrand disease

26
Q

What do you have to watch when taking desmopressin

A

water intake

27
Q

What would you see in nephrogenic diabetes insipidus

A

elevated AVP levels

28
Q

What is gestational diabetes insipidus

A

placental vasopressinase causes low serum AVP

29
Q

What is primary polydipsia

A

disorder of excess fluid ingestion

30
Q

How do you treat nephrogenic diabetes

A

Thiazide diuretics

31
Q

How do thiazides help nephrogenic diabetes

A

They prevent the thirst by getting rid of excess sodium

32
Q

What antagonizes V2

A

Tolvaptan

33
Q

What antagonizes V1 and V2

A

Conivaptan

34
Q

What can be used in SIADH and CHF to protect against electrolyte imbalance

A

Tolvaptan

35
Q

What can lithium carbonate cause

A

nephrogenic diabetes insipidus

36
Q

What can demeclocycline cause

A

nephrogenic diabetes insipidus (same as lithium but less toxic)