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Opt 212 Chap 22
Diuretics Lecture 8
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10/20/2007

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Term
What is tubular reabsorption?
Definition
Going from the tubular lumen to the peritubular capillaries
Term
What is movement from the peritubular plasma to the tubular lumen?
Definition
tubular excretion
Term
Where is the site of the organic acid and base secretory systems?
Definition
proximal tubule

organic acid-middle third

organic base-upper and middle segments of the proximal tubule
Term
Which is more concentrated, the desceding limb of the loop of Henle or the peritubular capillaries?  Why?
Definition
The descending limb of the loop of Henle is three times more concentrated because of the countercurrent mechanism responsible for water reabsorption.
Term
Where do osomotic diuretics act at?
Definition

the descending loop of Henle

Term
Which parts of Henles loop are impermeable to water?
Definition
Ascending loop of Henle and the Distal convoluted tubule
Term
What do the intercalating cells of the collecting tubule and duct effect?
Definition
H+ secretion
Term
What do the principal cells of the collecting duct do?
Definition
Absorb K+ and secrete Na+
Term
What receptors on the principal cells of the collecting duct or tubule influence K+ secretion and Na+ reabsorption?
Definition
Aldosterone receptors
Term
How does sodium enter the principal cell?  How does sodium enter the blood from the channels?
Definition
Sodium enters the principal cells through channels but goes on to enter the blood by Na+/K+ ATPase.
Term

What does vasopresin do to water from the collecting tubules and ducts?

Definition
Vasopresin is an antidiuretic hormone.  It promotes the reabsorption of water from the collecting ducts by cAMP.
Term
What two factors cause fluid to escape from the portal vasular system and colelct in the abdomen forming a hepatic ascite?
Definition
decreased blood osmolarity and increased portal blood pressure due to the portal system being obstructed in cirrhosis.
Term
What condition results from decreased ability of the liver to inactivate the steroid hormone aldosterone resulting in excessive Na+ and water reabsorption?
Definition
Secondary Hyperaldosteronism
Term
What is it called when the kidneys are damaged by disease, the glomerular membranes allow plasm proteins to enter the glomerular ultrfiltrate.  The loos of protein from the plams reduces the colloidal osmotic pressure, resulting in edema.
Definition
Nephrotic syndrome
Term
What does premenstrual edema result from?
Definition
Premenstrual edema is associated with menustration and results from imbalances of hormones such as estrogen excess which facilitates teh loss of fluid into the extracellular space.
Term
Name three non edematous diseases diuretics can treat?
Definition
1.  Hypertension
2.  Hypercalcemia
3.  Diabetes insipidus
Term

What percentage do you need of one kidney for survival?

Definition
10%
Term
What percentage of blood is circulated through the kidneys per minute?
Definition
20%
Term
What percent of fluid in the tubules is reabsorbed back into the blood?
Definition
90%
Term
How do you design a diuretic drug?
Definition

Stop as little as 1% of the reabsorption in the kidneys

Term
What type of heart condition leads to fluid accumulation due to reduced kidney profusion?
Definition
congestive heart failure, The kidney thinks the body is hypovolemic, but the body really has too much fluid
Term
Is a diuretic often a first line drug in glaucoma?
Definition
No, it's rarely a first line drug.  It's a best secondary drug when added to Xalatans and Lumigans.
Term
Why do you call the thiazides cieling diuretics?
Definition
Because increasing the dose above normal does not increase the diuretic response.
Term
Where do thiazides effect the kidney?
Definition
the distal tubule
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