Exam 4 Physio: Renal 6

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EXAM 4 PHYSIO: RENAL 6

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EXAM 4 PHYSIO: RENAL 6

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Carbonic anhydrase

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Weak diuretics

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Adverse effects of CA?

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1. hypokalemia metabolic acidosis
2. inc Na, K, HCO3, H2O in urine

3.

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Loop diuretics examples?

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1. furosemide (lasix)
2. bumentamide

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Actions of loop diuretics

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block NKCC in TAL

NOTE: NKCC mediates Na uptake in TAL

Powerful diuretics

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Mechanism of loop diuretics

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NKCC in long nephron (i.e. juxtamedullar nephron) generates and maintains the osmotic gradient (300-1200).

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Why is the osmotic gradient important?

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Enables kidney to CONSERVE WATER by excreting conc. urine. Otherwise, the osmotic gradient cannot be concentrated above 300 throughout the medulla causing more water in the urine.

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Another action of loop diuretics?

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Cause principal cells in the CCD to conserve Na.

This leads to K secretion.

Therefore, loop diuretics also increase K secretion similar to CA inhibitors. HOWEVER, the secreted K moves back into the tubules via H/K ATPase.

K moves into tubule while H moves into urine.

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Loop diuretics effect on principal cells and type A intercalated cell:

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Prinicpal cells (try to conserve Na)
1. inc Na reab
2. inc K secretion

Type A intercalated cell (try to conserve K)
1. K reab via H/K ATPase
2. Inc H excretion

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Summar of loop diuretics

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1. strong
2. inhibits Na/K/2C cotransporter in TAL-LH
3. disrupts medullary osmotic gradient (the urine cannot conc more than 300 mOsm)
4. urine: increased excretion of Na, K, H2O, and H.

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Adverse effects of Loop diuretics

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1. Hypokalemia (inc K secretion)
2. metab alkalosis (inc H secretion)
3. vol depletion

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Thiazide diuretic

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Blocks Na/Cl cotransporter (NCC) in the DT

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Thiazide diuretic effect on principal cell and type A intercalated cell?

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Principal cells
1. conserve Na and secrete K
2. secreted K then moves into type A cells via apical H/K ATPase.
3. H secretion occurs

Principal cells (try to conserve K)
1. inc K reab via H/K ATPase
2. inc H excretion

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Effect of thiazide on Ca reabsorption?

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Increases Ca reabsorption

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Adverse effects of thiazide diuretics?

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1. hypokalemia
2. metab alkalosis
3. hypercalcemia

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These diuretics all cause:

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Loss of K

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Effects of low K?

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1. affects resting membrane potential
2. resting membrane potential becomes more neg
3. membrane excitability does not occur well.

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What is K sparing diuretics?

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Designed to save plasma K.

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Where do they act?

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In principal cells of CCD.

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What do they inhibit?

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ENac or aldosterone.

Weak diuretics.