Wolff k+/na+ crossword Flashcards
means plasma K+ conc is <3.5(ish), hyperpolarizes most cell membranes; can be caused by K+ losing diuretics
hypokalemia
a large volume of this in plasma can cause pseudohyponatremia
lipid
refers to the fact that RBF and GFR are maintained approximately constant at MAP of ~100 mmHg +/- 40 mmHg because of myogenic mechanism and tubuloglomerular feedback
autoregulation
type of metabolic alkalosis seen with thiazinde and loop diuretics secondary to K+ loss
hypochloremic
hypovolemic form of this is a sign of neglect in nursing homes
hypernatremia
channel responsible for Ca2+ reabsorption in DCT, major site of regulation with calcitriol increasing its synthesis and PTH helping to regulate its conductance
TRPV5
generic term for the portion of the nephron that increases potassium reabsorption when plasma levels are low
Distal
0.45% NaCl solution is an example of this type of solution that causes cells to swell, can be administered to treat hypernatremia
hypotonic
it means plasma Na+ concentration is <135 mEq/L; seen in 15-20% of hospitalized patients, it is the most common electrolyte abnormality seen in clinical practice
hyponatremia
hormone principally responsible for cellular uptake of K+, can cause hypokalemia with normal acid-base balance
insulin
hyperkalemic/most common form of renal tubular acidosis, caused by lack of aldosterone or failure to respond to it
Type 4
caused by lack of ADH secretion or a failure of the kidneys to respond to it; leads to euvolemic hypernatremia
Diabetes Insipidus
refers to factors such as Ang II, ANP and SNS activity that modify the intrinsic renal relationship between arterial pressure and sodium excretion
extrinsic
class of drugs that interferes with renin secretion and the ability of diuretics to cause a diuresis
NSAIDs
adverse effect associated with administration of tolvaptan for >30 days
hepatotoxicity
ionized form of this divalent cation is a crucial cofactor in many biological processes, plasma levels are maintained in normal range by regulation of reabsorption through TRPM6 channels in DCT in a still poorly understood manner; both loop and thiazide diuretics cause it to be lost in urine, especially thiazide
magnesium
identified the forces that determine the net magnitude and direction of fluid movement across capillary barriers
starling
type of acids that have less of an effect on plasma K+ than, for example, hydrochloric or sulfuric acid
organic
when this (abbr.) is less than about 30 ml/min, thiazides no longer work but loop diuretics still do work when treating hypertension; can be a cause of hyperkalemia when
GFR
V2 agonist used to treat central diabetes insipidus
DDAVP
Receptors that sense body sodium content via measurement of effective blood volume
stretch
whether excreting a maximally dilute or maximally concentrated urine, the elimination of this is approximately unchanged
solute
irrespective of whether hyponatremia or hypernatremia, if this word applies the rate of correction must be slow
chronic
cause of euvolemic hyponatremia
SIADH
this of body is monitored by special sensors in the brain, cannot be eye-balled but instead approximated clinically by summing things that are measured (or measured directly via colligative properties of vapor point elevation or freezing point depression)
osmolality
administered to raise the threshold potential when people present with hyperkalemia
calcium
its blockade of carbonic anhydrase causes a sodium bicarb diuresis with hyperchloremic acidosis; principal uses include urinary alkalinization to hasten elimination of weak acid toxins (aspirin), treatment of metabolic alkalosis, acute mountain sickness, and glaucoma
acetazolamide
whether extracellular or intracellular, means that too much sodium is in this compartment (water followed); extracellular location is a common indication for a loop diuretic
edema
interval widened by hyperkalemia
QRS
occurs when K+ (and Cl-) are lost in urine due to, for example, diuretics; cells donate K+ while taking up H+ (and leaving behind HCO3-) in an effort to maintain hypokalemic plasma K+ levels closer to normal
metabolic alkalosis
nephron cells that can change their phenotype and are normally associated with the maintenance of acid-base balance; they are also a target of thiazide diuretics
intercalated
slowing the progression of this is a reason for continued administration of expensive tolvaptan
APKD
becomes prominent in severe hypokalemia
no U wave
volume expanded by infusion of 0.9% NaCl solution
extracellular
administering a 5% solution of this is ultimately equivalent to infusing approximately that volume of distilled water
dextrose
potential adverse effect of spironolactone use by females
hirsutism
syndrome that is a cause of type 2 RTA due to impaired ability to reabsorb filtered bicarb in the proximal tubule
fanconi
cells in the collecting duct that are the primary target of K+ sparing diuretics
principal
caused by cell lysis in a collected blood sample
pseudohyperkalemia
characteristic of urine excreted with maximally effective doses of furosemide, irrespective of plasma ADH levels
isotonic
substance that promotes free water clearance
aquaretic
potassium excretion is increased when this is increased in the distal nephron
tubular fluid flow rate
positive inotrope used in heart failure whose toxicity is increased by loop diuretic-induced K+ loss
digoxin
real European form of this contains sweet glycyrrhizic acid which dose-dependently potentiates aldosterone effects and increases systolic blood pressure
licorice
consequence of treating hyponatremia too rapidly
osmotic demyelination
substance that promotes excretion of urine, potential cause of hypovolemic hyponatremia
diuretic
a potassium salt formed with this bicarb precursor can be administered to a person with hypokalemia and acidosis
acetate
common cause of hypervolemic hyponatremia
heart failure
loop diuretic that can be used by patients with sulfa allergy
ethacrynic acid
contraindication for loop diuretics and not a good time to start thiazide diuretics
pregnancy
glomerulotubular ______ refers to forces acting across proximal tubular epithelium that result in proportional rather than absolute amounts of ~isotonic fluid reabsorption from the proximal tubule
balance
can cause hyperkalemia
tissue necrosis
recent episodes of this can give rise to hyponatremia, hypovolemia, and metabolic alkalosis with renal retention of K+ and Na+ (eg <20 and 30 mEq/L respectively)
vomiting
part of the coma cocktail, it is also often administered along with other agents to patients presenting with hyperkalemia
glucose
means plasma level is <1.7 mg/dL, often coexists with hypokalemia and hypocalcemia; contributes to clinical signs such as muscle weakness, tremors, tetany, seizures, paresthesias, vertical and horizontal nystagmus, torsades de pointes
hypomagnesemia
not a good time to take a loop or thiazide diuretic given their typical duration of action
bedtime
administration of this to treat bipolar disorder is the most common cause of nephrogenic diabetes insipidus, treated with amiloride
lithium
channel responsible for Mg2+ distal convoluted tubule, can compensate somewhat when Mg2+ reabsorption is blocked in TAL by loop diuretics but downregulates in presence of thiazides leading to more profound Mg2+ loss in urine
TRPM6
occurs in liver disease due to impaired synthesis of plasma proteins and increased portal venous pressure, reason to administer loop diuretics
ascites
broad characterization of diuretics that includes thiazides, loop diuretics, carbonic anhydrase inhibitors, and osmotic diuretics
K+ losing
common term for diuretic class with “high ceiling” effects exerted in the TAL
Loop
consuming this decreases ADH secretion
alcohol
3% NaCl is an example of this type of sodium that causes cells to shrink, can be used to treat acute severe hyponatremia
hypertonic
refers to type of diabetes insipidus when kidney fails to respond to ADH
nephrogenic
potential adverse effect of spironolactone use by males
gynecomastia
prototype for the non-peptide V2 receptor antagonists that can be used judiciously to treat euvolemic and hypervolemic hyponatremia if unresponsive to other measures; causes water excretion without solute excretion
conivaptan
blocks EnaC channels in the principal cells of the connecting tubule and collecting duct, similar to amiloride
triamterene
hormone released by posterior pituitary whose receptor-mediated water-retaining effects are blocked by the vaptans
ADH
well known toxicity of loop diuretics
ototoxicity
receptors in collecting duct that mediate the response to ADH (aka arginine vasopressin) leading to insertion of aquaporin 2 water channels in the luminal membrane for water reabsorption
V2
among the neuromuscular manifestations of hypokalemia
constipation
organ that doesn’t have space for its cells to swell due to hyponatremia, lack of space leads to symptoms of encephalopathy and possible uncal herniation +/- death
brain
disease that causes hyperkalemia despite adequate GFR
addison
suggestive clues include hypervolemic hypernatremia, hypokalemia with metabolic alkalosis, significant urinary Cl- loss despite low plasma levels and hypertension
hyperaldosteronis
ion that exchanges with cellular K+ during acid-base maintenance and/or compensation; reason acidosis can cause hyperkalemia
hydrogen
along with massive, this adjective characterizes the fluid removal response to loop diuretics
rapid
classical aldosterone antagonist; its effects in the principal cells of the collecting duct cause it to act as a K+ sparing diuretic
spironolactone
suggested by acidemia in a patient with a normal anion gap and serum creatinine level, and without diarrhea
RTA
increased by a step change in daily sodium intake
body weight
class of diuretics with medium Na+ losing ability due to effects that include blockade of a transporter in distal convoluted tubules; treatment for nephrogenic diabetes insipidus
thiazide
characterizes the on and off-rate for drugs such as spironolactone that decrease protein expression with disappearance of existing proteins each having their own half-life (hours or days) to see side effects
slow
causes include anything that interferes with normal renin secretion or angiotensin II generation or the actions of angiotensin II or aldosterone
hyperkalemia
caused by loop and thiazide diuretics, increases the risk of gout
hyperuricemia
cause of hyperosmolar hyponatremia
hyperglucemia
prototypical loop diuretic
furosemide
common name for transporter in TAL that, in combination with water impermeability and direction of flow outside of TAL, gives rise to dilute tubular fluid and a hypertonic renal medullary interstitium; target of loop diuretics
NaK2Cl
typical route for KCl administration (40-100 mEq in divided doses) to a person with hypokalemia
oral
hormone whose levels decrease in response to a dietary sodium load to help facilitate its renal elminition
aldosterone
surprising consequences of hyperkalemia, occurs because hyperkalemia increases K+ conductance in SA nodal tissue enough to cause membrane hyperpolarization; other regions of heart do become hyperexcitable so arrhythmias likely
bradycardia
predictable consequence of severe hypokalemia, diabetes insipidus and vaptan administration
polyuria
major pathway for Mg2+ reabsorption in TAL, Ca2+ is also reabsorbed here in addition to its major reabsorption via this pathway in proximal tubules
paracellular
abuse of this can cause extra-renal K+ losses leading to hypokalemia that can occur +/- concurrent metabolic acidosis
laxative
you will learn about the gliflozin class of drugs that lowers circulating glucose levels in diabetes by blocking its reabsorption in the proximal tubule… this causes polyuria as does diabetes itself because glucose excreted in the urine functions as this type of diuretic
osmotic
failure of this to treat hyponatremia in symptomatic hospitalized patients is an indication for vaptans
fluid restriction
refers to the channels directly blocked by amiloride and triamterene in collecting duct cells
EnaC
osmotic pressure is the driving force for water movement across this
cellular membrane
problematic with diuretics presumably in part because of the urgent need to urinate
non-adherence
likelihood of formation from calcium in the urinary pelvis is increased by loop diuretics and decreased by thiazide diuretics due to their differing effects on its reabsorption
stones
this clearance is zero when urine is isotonic, positive when urine is dilute, and negative when urine is hypertonic; negative means the water in which urinary solute was diluted has been returned to the body to dilute to lower plasma osmolality
free water
example of an osmotic diuretic administered in gram quantities o help eliminate excess intracellular volume (causing elevated intracranial pressure) now often supplanted by hypertonic saline
mannitol
a diuretic that blocks epithelial sodium channels in the principal cells of the collecting ducts, effects are rapid when compared to spironolactone
amiloride
loss of this in excess of water is why loop and thiazide diuretics can cause hyponatremia
sodium
membrane potential that is determined by extracellular K+ levels
resting
routine dietary intake of this cation would increase its plasma levels to the toxic range if not for a means for rapid redistribution into cells
potassium
can be hidden source of excessive K+ intake
antibiotics
nephron location where osmotic diuretics and carbonic anhydrase inhibitors exert their effects; increasing or decreasing the fraction of the filtered load reabsorbed here is a primary determinant of sodium excretion
proximal tubule
cotransporter in the DCT that acts to further dilute the tubular fluid; target of thiazide diuretics
Na-Cl
ability impaired in the kidney by loop diuretics, Bartter syndrome and hypokalemia (here presumably due to need for K+ by Na+-K+-2Cl- cotransporter) resulting in polyuria and nocturia
concentrating
with worsening hyperkalemia, may have muscle twitching/weakness and numbness/prickling sensation give way to this type of paralysis
flaccid
selective non-peptide V2 receptor antagonist that can be cautiously administered orally to patients with persistent hyponatremia despite use of initial therapies
tolvaptan
RTA with hypokalemia due to, for example, autoimmunity leading to fibrosis with impaired function in the cortical collecting duct
Type 1
aldosterone antagonist with greater selectivity than spironolactone, also much more expensive
eplerenone
invasive means for treating life-threatening hyperkalemia
dialysis
this of sodium increases as blood pressure increases
urinary output
thirst, tenting of skin, sunken eyes and oliguria are among the signs of this, ultimately a more powerful stimulus of ADH release than increases in plasma osmolality
hypovolemia
hypo- or hyper- means there is too little or too much sodium in the body
volemia
chicory, dandelion leaves, fennel, goldenseal, etc are diuretics of this type of alternative medicine with generally uncharacterized mechanisms of action and uncertain efficacy
herbal
hypo- and hyper- mean that there is too much or too little water diluting the body’s sodium content
natremia
class of diuretics acting in the collecting duct to block Na+/K+ exchange, useful to counterbalance an adverse effect of loop and thiazide diuretics
K+ sparing
healthy way to transiently raise extracellular K+ levels
exercise
tablets that are treatment for hypovolemic hyponatremia
salt tablets
