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Renal Phys 8: Diuretics and kidney disease
Pasley 4/28/11 lecture 1hr
42
Physiology
Undergraduate 4
04/20/2011

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Term
at first there is an increase in sodium excretion and a drop in ECFV, ECFV stays low, but the sodium excretion decreases after a while
Definition
what happens to ECFV and sodium excretion when diuretic therapy is administered?
Term
Proximal tubule
acetaozolamide
reduces the Na/H+ exchange
Definition
where do CAI diuretics act, give an example of one, and describe what cellular mechanism it inhibits
Term
Thick ascending limb
furoseamide
inhibts triple pump
Definition
where do loop diuretics act, give an example of one, and describe what cellular mechanism it inhibits
Term
Distal convoluted tubule
HydroChloroThiaZide
inhibit NaCl cotransporter
Definition
where do thiazide diuretics act, give an example of one, and describe what cellular mechanism it inhibits
Term
CCT
amiloride - inhbits ENAC
sprinolactone - inhibits MR (mineralcorticoid receptors)
Definition
where do K-sparing diuretics act, give an example of one, and describe what cellular mechanism it inhibits
Term
using an H+/Na+ ATP exchanger
Definition
how is H+ secreted in the PCT?
Term
CO2 is diffused in from the lumen and carbonic anhydrase combines it with water to make HCO3- which diffuses out the basal side back to the renal interstitial fluid
Definition
how is HCO3- reabsorbed in the PCT?
Term
Na+/H+ ATP exchange
Definition
how is H+ secreted in the thick ascending limb?
Term
Na/2Cl/K+ ATP triple symport thing, loop diuretics block this (furosimide, ethacrynic acid, bumetamide)
Definition
how are sodium, chloride and potassium reabsorbed in the Thick ascending limb? what diuretic blocks this?
Term
a symport Na, Cl ATP pump

thiazides
Definition
how is sodium reabsorbed in the early distal tubule? what diuretics block this?
Term
Na+ channel blockers like Amiloride and Triamterene

they block ENaC, so decreased Na+ in the cell messes up the Na/K+ exchanger and so K+ is not secreted
Definition
what diuretic causes hyperkalemia?
Term
they maintain Na/H2O balance but eventually they fail and cause uremia -> coma -> death
Definition
what happens with increased age to nephrons?
Term
GFR/nephron increases because they have to compensate for the others, but overall GFR decreases

more urine volume per nephron is produced too, but less concentrated
Definition
when you have renal disease and lose a kidney, what happens to GFR/nephron? total GFR?
Term
it hypertrophys, the surviving nephrons enlarge
Definition
what happens to a kdiney after nephrons are lost?
Term
no
Definition
can nephrons be regenerated?
Term
chronic kidney disease
Definition
what does persistent proteinuria mean?
Term
1) BP
2) urine albumin
3) serum creatinine
Definition
what 3 simple tests detect CKD?
Term
primary kidney disease
1) decreases nephron #
2) which causes hypertrophy and vasodilation of surviving nephrons
3) increase in arterial pressure
4) increased glomerular pressure and/or filtration
5) this results in glomerular sclerosis
6) this decreases nephron number
Definition
describe the vicious cycle
Term
inability to concentrate or dilute urine
Definition
what is isothenuria?
Term
decreases because you can't concentrate it as well
Definition
what happens to specific gravity of urine as you lose nephrons
Term
addison's disease
Definition
What disease causes decreased Na+ resorption, decreased K+ secretion, lack of aldosterone
Term
Bartter's disease
(same as loop diuretics)
this can cause hypokalemia, (increased K+ and H+ secretion) and metabolic akylosis
Definition
what disease is genetic and causes decreased Na+, Ca++, & HCO3-, reabsorption, hypotension, ***decreased activity of Na-K-2Cl transporter***
Term
Gitlemen's syndrome
Definition
what disorder causes the same things as thiazide diuretics (decreased reabsorption in early distal tubule)
Term
spironolactone (K sparing diuretic)
Definition
what do you use to prevent hypokalemia especially in Bartter's syndrome?
Term
Glucocorticoid remediable aldosteronism (GRA)
Definition
what causes excess aldosterone secretion due to abnormal control of aldosterone synthase by ACTH(genetic)
Term
pesudohyperaldosteronism
Definition
what disorder is caused by a 11-HSD deficiency increasing the effect of aldosterone?
Term
Renin secreting tumor
Definition
what disorder causes excess Aniotensin II formation?
Term
inappropriate ADH syndromes
Definition
what disease causes excess ADH or V2R activity (and hypertension)?
Term
Liddle's syndrome

occurs early in life(genetic)

note: this is the opposite effect of K sparing diuretics (specifically the Na+ channel blockers)
Definition
what disorder causes excessivity of amiloride sensitive Na+ channel (genetic) leading to excess sodium reabsorption in the late distal tubule and collecting duct?
Term
aldosterone increases K+ secretion
Definition
why does conn's syndrome cause hypokalemia?
Term
1) aldosterone
2) high extracellular K+
3) sodium (volume) delivery
4) acid base status: alkalosis increases secretion, acidosis decreases K+ secretion
Definition
what 4 things increase K+ secretion?
Term
it increases, just about directly proportional
Definition
what happens to urinary K+ excretion as plasma aldosterone level increases?
Term
converts cortisol to cortisone
Definition
what does 11HSD do?
Term
pseudohyperaldosteronism
Definition
what disease is apparent mineralocorticoid excess, which causes Na+ retention, K+ & H+ excretion, resulting in hypertension, edema, hypokalemia(weakness and muscle spasm), and metabolic alkalosis
Term
pseudohyperaldosteronism
Definition
what disease results from eating too much licorice
Term
idk there is something jacked up with the aldosterone specificity
Definition
what happens to 11-hydroxysteriod dehydrogenase (11-HSD) in pesudohypoaldosteronism?
Term
Na+ reabsorption: increases
Na+ excretion: remains constant
blood pressure: increases
plasma renin: decreases
aldosterone: decreases
Definition
what does liddle's do to Na+ reabsorption? Na+ excretion? blood pressure? plasma renin? aldosterone?
Term
1) Na+ channel blockers (amiloride, triamterene)
2) or a kidney transplant
Definition
what is the treatment of liddle's?
Term
spironolactone (aldosterone antagonist)
Definition
what is the treatment of pseudohypoaldosteronism?
Term
Fanconi syndrome
Definition
what disorder is characterized by a generalized decrease in resorption often in proximal tubules?
Term
genetic, heavy metal damage, drugs(tetracyclins), mutiple myeloma, tubular necrosis(ischemia)
Definition
what are the causes of Fanconi syndrome?
Term
renal tubular acidosis
Definition
what disease causes decreased H+ secretion leading to acidosis, and is caused by either genetic things or renal injury
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