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Kidney PowerPoint (2)

Renal Physiology

Structure

  • Components:

    • Proximal Convoluted Tubule (PCT)

    • Distal Convoluted Tubule (DCT)

    • Collecting Duct

    • Nephron Loop

    • Vasa Recta

3. Urine Formation Steps

A. Blood Flow and Filtration
  • Glomerular Filtration:

    • Renal corpuscle creates a plasma-like filtrate from blood.

    • Movement and filtration steps involved include:

      1. Flow through the renal corpuscle.

      2. Removal of blood cells and plasma proteins while allowing water and small solutes.

B. Tubular Reabsorption
  • Process:

    • Ions and nutrients filtered at the glomerulus are reabsorbed by renal tubules.

  • Mechanisms:

    • Cation exchange and chloride ion transport for sodium ions.

    • Establishment of an osmotic gradient along the nephron.

C. Water Reabsorption
  • Proximal Convoluted Tubules and Collecting Ducts:

    • Water reabsorption occurs via aquaporins, moving toward sodium concentration in blood.

    • Key for maintaining plasma volume and water balance.

4. Tubular Secretion

  • Function:

    • Maintains acid-base balance through urine acidification.

  • Mechanism:

    • Specialized transport systems eliminate weak acids/bases from blood, adding them to filtrate.

5. Renal Dysfunction Effects

  • Consequences of Reduced Function:

    • Decreased urine flow (oliguria or anuria).

    • Accumulation of toxic products and ions.

    • Possible outcomes: uremia, edema, hypertension.

6. Clinical Indications for Diuretic Use

A. Types of Diuretics
  • Classes:

    • Osmotic agents

    • Carbonic anhydrase inhibitors

    • Thiazide and thiazide-like compounds

    • Organic acids

    • Potassium-sparing diuretics

    • ADH antagonists

B. Mechanism of Action
  • Diuretics function by inhibiting water and sodium reabsorption in the kidneys, producing diuresis.

7. Specific Diuretic Classes

A. Osmotic Diuretics
  • Indications:

    • Anuria, oliguria, acute renal failure, drug toxicity, cerebral edema, glaucoma.

  • Mechanism:

    • Administered IV, attract fluid from tissues, and prevent water reabsorption.

  • Adverse effects: Nausea, dizziness, headache, strain on cardiac function.

B. Carbonic Anhydrase Inhibitors
  • Indications:

    • CHF, glaucoma, epilepsy, acute mountain sickness.

  • Mechanism:

    • Inhibits carbonic anhydrase, affecting sodium and potassium secretion.

  • Adverse effects: Drowsiness, gastrointestinal distress, hyperuricemia, and metabolic acidosis.

C. Thiazide and Thiazide-like Diuretics
  • Indications:

    • Edema, hypertension, heart failure.

  • Mechanism:

    • Inhibit sodium transport, increase chloride and potassium excretion.

    • Can cause hypochloremic alkalosis and hypokalemia.

  • Adverse effects: Orthostatic hypotension, hypokalemia, hyperuricemia.

D. Organic Acid (Loop) Diuretics
  • Indications:

    • Edema, thiazide-resistance, CHF, liver cirrhosis.

  • Mechanism:

    • Inhibit sodium/chloride transport, resulting in significant losses.

  • Adverse effects: Nausea, hypotension, hypokalemia, ototoxicity.

E. Potassium-Sparing Diuretics
  • Indications:

    • Treats edema, hypertension, prevents hypokalemia.

  • Mechanism:

    • Inhibit potassium secretion, resulting in mild diuresis.

  • Adverse effects: Nausea, hyperkalemia, gynecomastia.

8. Antidiuretic Hormone (ADH)

  • Function:

    • Regulates water balance by controlling urine water loss.

  • Antagonists:

    • The vaptans interfere with ADH receptors to enhance water elimination.

9. Preferred Treatment Approaches

  • Conditions and Treatments:

    • ADH Antagonists: Hyponatremia.

    • Carbonic Anhydrase Inhibitors: Glaucoma, alkalosis, altitude sickness.

    • Loop Diuretics: CHF, hypertension, acute renal failure.

    • Thiazides: Hypertension, mild heart failure.

    • Potassium-Sparing Diuretics: Post-myocardial infarction.

10. Adverse Effects

  • Common Effects:

    • Electrolyte imbalances, orthostatic hypotension, dehydration, overdose concerns.

11. Drug Interactions and Incompatibilities

  • Concerns with Diuretics:

    • Can potentiate digoxin toxicity.

    • Should not be combined with lithium.

    • Some diuretics are incompatible with specific infusions.

CT

Kidney PowerPoint (2)

Renal Physiology

Structure

  • Components:

    • Proximal Convoluted Tubule (PCT)

    • Distal Convoluted Tubule (DCT)

    • Collecting Duct

    • Nephron Loop

    • Vasa Recta

3. Urine Formation Steps

A. Blood Flow and Filtration
  • Glomerular Filtration:

    • Renal corpuscle creates a plasma-like filtrate from blood.

    • Movement and filtration steps involved include:

      1. Flow through the renal corpuscle.

      2. Removal of blood cells and plasma proteins while allowing water and small solutes.

B. Tubular Reabsorption
  • Process:

    • Ions and nutrients filtered at the glomerulus are reabsorbed by renal tubules.

  • Mechanisms:

    • Cation exchange and chloride ion transport for sodium ions.

    • Establishment of an osmotic gradient along the nephron.

C. Water Reabsorption
  • Proximal Convoluted Tubules and Collecting Ducts:

    • Water reabsorption occurs via aquaporins, moving toward sodium concentration in blood.

    • Key for maintaining plasma volume and water balance.

4. Tubular Secretion

  • Function:

    • Maintains acid-base balance through urine acidification.

  • Mechanism:

    • Specialized transport systems eliminate weak acids/bases from blood, adding them to filtrate.

5. Renal Dysfunction Effects

  • Consequences of Reduced Function:

    • Decreased urine flow (oliguria or anuria).

    • Accumulation of toxic products and ions.

    • Possible outcomes: uremia, edema, hypertension.

6. Clinical Indications for Diuretic Use

A. Types of Diuretics
  • Classes:

    • Osmotic agents

    • Carbonic anhydrase inhibitors

    • Thiazide and thiazide-like compounds

    • Organic acids

    • Potassium-sparing diuretics

    • ADH antagonists

B. Mechanism of Action
  • Diuretics function by inhibiting water and sodium reabsorption in the kidneys, producing diuresis.

7. Specific Diuretic Classes

A. Osmotic Diuretics
  • Indications:

    • Anuria, oliguria, acute renal failure, drug toxicity, cerebral edema, glaucoma.

  • Mechanism:

    • Administered IV, attract fluid from tissues, and prevent water reabsorption.

  • Adverse effects: Nausea, dizziness, headache, strain on cardiac function.

B. Carbonic Anhydrase Inhibitors
  • Indications:

    • CHF, glaucoma, epilepsy, acute mountain sickness.

  • Mechanism:

    • Inhibits carbonic anhydrase, affecting sodium and potassium secretion.

  • Adverse effects: Drowsiness, gastrointestinal distress, hyperuricemia, and metabolic acidosis.

C. Thiazide and Thiazide-like Diuretics
  • Indications:

    • Edema, hypertension, heart failure.

  • Mechanism:

    • Inhibit sodium transport, increase chloride and potassium excretion.

    • Can cause hypochloremic alkalosis and hypokalemia.

  • Adverse effects: Orthostatic hypotension, hypokalemia, hyperuricemia.

D. Organic Acid (Loop) Diuretics
  • Indications:

    • Edema, thiazide-resistance, CHF, liver cirrhosis.

  • Mechanism:

    • Inhibit sodium/chloride transport, resulting in significant losses.

  • Adverse effects: Nausea, hypotension, hypokalemia, ototoxicity.

E. Potassium-Sparing Diuretics
  • Indications:

    • Treats edema, hypertension, prevents hypokalemia.

  • Mechanism:

    • Inhibit potassium secretion, resulting in mild diuresis.

  • Adverse effects: Nausea, hyperkalemia, gynecomastia.

8. Antidiuretic Hormone (ADH)

  • Function:

    • Regulates water balance by controlling urine water loss.

  • Antagonists:

    • The vaptans interfere with ADH receptors to enhance water elimination.

9. Preferred Treatment Approaches

  • Conditions and Treatments:

    • ADH Antagonists: Hyponatremia.

    • Carbonic Anhydrase Inhibitors: Glaucoma, alkalosis, altitude sickness.

    • Loop Diuretics: CHF, hypertension, acute renal failure.

    • Thiazides: Hypertension, mild heart failure.

    • Potassium-Sparing Diuretics: Post-myocardial infarction.

10. Adverse Effects

  • Common Effects:

    • Electrolyte imbalances, orthostatic hypotension, dehydration, overdose concerns.

11. Drug Interactions and Incompatibilities

  • Concerns with Diuretics:

    • Can potentiate digoxin toxicity.

    • Should not be combined with lithium.

    • Some diuretics are incompatible with specific infusions.

robot