1. What are the functions of the kidney?
    • 1. Waste excretion
    • 2. Electrolyte balance
    • 3. Regulation of extracellular fluid volume
    • 4. Acid base balance
    • 5. Drug and hormone metabolism
    • 6. Blood pressure regulation
    • 7. Calcium/phosphate balance regulation
  2. What is the general action of most diuretics?
    • Increase the excretion of Na+ and water
    • Decrease the reabsorption of Na+ and Cl- from the filtrate
    • Increased water loss is secondary to increased excretion of NaCl
  3. What are diuretics used to treat?
    • Hypertension
    • Glaucoma
    • Salt/water overload associated with:
    • Nephrotic syndrome
    • Heart failure
  4. What is the therapeutic goal of diuretics?
    Increase excretion of salt and water.
  5. What transport mechanisms are used in the nephron?
    • Active transport
    • Diffusion
    • Ion channels
    • Counter transporters (antiport)
    • Cotransporters (symport)
  6. Exchange systems and their place in the nephron
    • Na+/H+ exchanger---------Proximal Tubule
    • Na+/K+ ATPase-----------Whole Nephron
    • Na+/K+/2Cl- cotransporter---Loop of Henle
    • Na+/Cl- cotransporter--------Distal tubule
  7. What are the 4 kinds of diuretics?
    • Loop
    • Thiazide
    • Potassium sparing
    • Carbonic anhydrase
  8. Give an overview of loop diuretics
    • Mechanism: Bind to Cl- part of Na+/K+/Cl- transporter, inhibiting it.
    • Result: increase Na+ excretion
    • increase Mg2+ excretion
    • increase Ca2+ excretion
    • increase K+ excretion
    • decrease uric acid excretion

    • Side effects: Hypokalaemia
    • Metabolic alkalosis
    • Prerenal uremia
    • Tinnitus
    • Uses: Treatment of salt and water overload associated with
    • pulmonary oedema
    • heart failure
    • renal failure
    • nephrotic syndrome
  9. Give an overview of thiazide diuretics
    • Mechanism: bind to the Cl- part of the Na+/Cl- cotransport system in the distal tubule, to inhibit it.
    • Result: increase Na+ excretion
    • increase Mg2+ excretion
    • increase K+ excretion
    • decrease Ca2+ excretion

    • Side effects: Hypokalaemia
    • Hyperglycaemia
    • Metabolic alkalosis
    • Prerenal uremia

    • Uses: Hypertension
    • Mild heart failure
  10. Give an overview of potassium sparing diuretics
    • Not used primarily as diuretics, rather they are used in conjunction with loop or thiazide diuretics to minimise risk of hypokalaemia.
    • Spironolactone is an aldosterone antagonist, inhibits Na+ retention and K+ secretion.
    • Amiloride blocks sodium channels to inhibit Na+ reabsorption.
    • Side effect: Hyperkalaemia
  11. Give a summary of Carbonic anhydrase inhibitors
    • No longer used as diuretics
    • Used in glaucoma to decrease intraocular pressure.
    • Inhibit the carbonic anhydrase to increase excretion of Na+, K+ and bicarbonate.
    • Side effects: Metabolic acidosis and Alkaline urine
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