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27 Cards in this Set

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Reabsorption takes place in :
loop of henle, convoluted tubules, collecting ducts.
Active Secretion:
acid and base pumps in the proximal tubules and P-glycoprotein
Excretion
Urine flows from the kidneys to the ureters, bladder, out the urethra.
quantitive measures
GFR and crcl
glomerular filtration depends on the SNGFR (single nephron glomerular filtration rate)
Renal Flow (20% of blood flow)
Hydrostatic pressure (pushs out of the capillaries into the glomerulus, facilitating filtration)
Tubular function:
Proximal tubules
Loop of Henle
Distal Convoluted Tubule
Collecting tubules
Proximal Tubule:
ADH causes water reabsorption
Loop of Henle (LOH)
responsible for concentrating urine
Water, Na, Cl reabsorption in thin ascending limb.
EXTENSIVE Na, Cl, Ca (PTH) reabsorption in thick ascending limb.
Distal Convoluted Tubule (DCT): responsible for diluting urine.
Na, Cl, Ca are reabsorbed here.
H+ ion and K are secreted in DCT.
Collecting tubule:
fine tune the composition of urine
ADH: causes water reabsorption.
ANP and aldosterone: Na reabsorption
Aldosterone: K and H+ ion secretion; some HCO3 reabsorption
Kidney functions:
1. Excretory
2. Regulatory
3. Metabolic
4. Hormonal
5. Endocrine function
Endocrine Function:
Erythopoietin (EPO)
PGs and Kinins
Erythropoetin (EPO):
Uses:
produced when:
ESRD, CANCER, AIDs
Produced in: anemia, ischemia, decrease atmosphere levels of Oxygen
Must be adequate iron, B12, folate.
aldosterone:
Collecting duct:
Increase reabsorption of Na and water.
Secreation of K and H+
Decrease in renal blood flow
- AT II
- Catecholamin
PTH
STIMULATES VITAMIN D.
NEED VITAMIN D3 IN RENAL DZ.
Where does carbonic anhydrase inhibitor work?
- proximal convoluted tubule
- (Diamox - Acetazolamide)
- MOA: prevent conversion of CO2 and water into carbonic acid in the tubular lumen.
Most commonly used for Carbonic Anhydrase inhibitor:
- glaucoma
- metabolic alkalosis.
Loop diuretics used:
- hyponatremia
- renal failure
- hypercalcemia
- HTN
- Peripheal and pulmonary edema.
Loope of Henle MOA:
BLOCK sodium - potassium - 2 chloride symport
Loop diuretics:
Lasix: absorption decreased with gut edema. )50% oral
Bumex: 100% oral
Demadex
Edecrine (ethacrynic acid): more ototoxicity.
Thiazide diuretics:
distal convuled tubules
Na-Cl symport
Hypo natremia : block the diluting portion of the nephron.
Thiazide diuretics used in:
generally ineffective in pt CrCL < 30-50 mL/min
HTN, CHF, ascites.
Increase risk of torsades due to K.
Potassium-Sparing Diuretics:
contraindicated K > 5.5 or Cr > 2.
Collecting Duct
- Dyrenium & Midamor: not effective diuretics.
- Inspra and Aldactone: aldosterone antagonists: causes Na loss and K retention.
Causes of diuretic resistance:
1. excessive Na
2. reduced renal blood flow.
3. inadequate doses or absorption.
Diuretic Resistance:
Acute: due to diuretic induced volume loss; replete excess volume loss to overcome
Chronic diuretic resistance:
- hypertrophy of the distal nephron allows more than quantities of Na to be reabsorbed in the distale tubule. (tx: metolazone)