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3 physiologic processes in the kidney
- filtration
- secretion
- reabsorption
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sum of all 3 physiologic processes of the kidney
renal clearance (CLrenal)
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functions of proximal tubule (3)
- 1) reabsorption of water, Na, K, Ca, Cl, HCO3, glucose, AAs phosphate
- 2) formation of vit D
- 3) secretion of drugs & toxins
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what determines the final osmolality of urine?
ADH
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carbonic anhyrdrase inhibitor (acetazolamide) site of action
proximal convoluted tubule
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loop diuretic (bumetanide, furosemide, torsemide, ethacrynic acid) sits of action
ascending loop of Henle
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thiazide site of action
distal convoluted tubule
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spironolactone & potassium sparing diuretics (amiloride, triamterene) site of action
collecting tubule & duct
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inhibit passive reabsorption of water & transport processes in thick ascending limb
osmotic diuretics
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inhibits the formation of carbonic acid from CO2 & water resulting in a reduction of reabsorption of Na+ & HCO3- in the proximal tubule
carbonic anhydrase inhibitors
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functions of Loop of Henle
- generation of hypertonic medulla
- dilution of urine
- impermeabililty to water in thick ascending limb
- transport of NaCl
- Mg reabsorption
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most potent diuretics
loop diuretics
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function of distal tubule
- Na & Cl reabsorption
- regulated Ca absorption
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most commonly used diuretics
thiazides
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thiazide MOA
inhibit Na+/Cl- minus symporter in distal convoluted tubule on luminal membrane
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function of collecting duct
- final adjustment of urinary solute concentrations & osmolarity
- K+ secretion
- HCO3 regulation
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MOA of potassium-sparing diuretics
- exchange Na+ & K+ through blockade of ENaC
- mediate H+ secretion into tubule lumen
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MOA of spironolactone
- mineralocorticoid R antagonist
- inhibits transcription by blocking binding of aldosterone to MR
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clinical use of spironolactone
cirrhosis
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clinical use of thiazides
mild CHF
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