Diuretics and Osmotic Mechanisms GA 32

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Questions and Answers

Which of the following conditions is MOST LIKELY to be the initiating cause of ESRD, based on the passage?

Hypertension
Polycystic kidney disease
Diabetes mellitus (correct)
Glomerulonephritis

According to the passage, what is the primary reason why hypertension and diabetes mellitus have become the leading causes of ESRD?

Improved understanding of the link between obesity and these conditions. (correct)
Changes in the genetic predisposition for these conditions.
Increased prevalence of these conditions due to aging.
Increased awareness and diagnosis of these conditions.

Which of the following processes is MOST DIRECTLY implicated in the development of ESRD due to hypertension, as described in the passage?

Inflammation and thickening of the walls of small renal arteries. (correct)
Formation of cysts in the kidney parenchyma.
Accumulation of fibrinoid deposits in the renal tubules.
Excessive filtration of blood by the glomeruli.

Based on the information provided, what is the MOST LIKELY impact of occlusion of small renal arteries on kidney function?

Reduced blood flow to the kidneys, leading to decreased filtration. (C) Signup and view all the answers

Which of the following statements BEST describes the relationship between obesity and ESRD as discussed in the passage?

Obesity is a major risk factor for developing diabetes mellitus and hypertension, which are leading causes of ESRD. (A) Signup and view all the answers

What is the MOST LIKELY reason why the number of functional glomeruli decreases with age, as shown in Figure 32-3?

Natural attrition and loss of function of some glomeruli over time. (B) Signup and view all the answers

Based on the information provided, what specific treatment approach might be effective in slowing down the progression of ESRD caused by hypertension, and why?

Drugs that lower blood pressure, to reduce pressure on the small renal arteries. (D) Signup and view all the answers

What is the MAIN implication of the passage regarding the future of ESRD treatment?

Understanding and addressing obesity will be crucial in preventing ESRD. (C) Signup and view all the answers

Which of the following is NOT a consequence of severe renal ischemia that can lead to acute kidney injury (AKI)?

Increased production of erythropoietin, leading to anemia (B) Signup and view all the answers

If not treated, what is the most likely outcome for patients with AKI experiencing complete anuria?

Death within 8 to 14 days due to fluid and waste buildup (A) Signup and view all the answers

What is a plausible reason why renal ischemia can result in hyperkalemia?

Reduced potassium excretion by the kidneys due to nephron blockage (D) Signup and view all the answers

What is the primary mechanism by which severe ischemia leads to acute kidney injury (AKI)?

Damage to the tubular epithelial cells, compromising reabsorption and secretion (C) Signup and view all the answers

What is a potential consequence of fluid and electrolyte overload resulting from severe renal ischemia?

Hypertension due to increased vascular volume and resistance (D) Signup and view all the answers

How does the retention of hydrogen ions contribute to metabolic acidosis in AKI?

All of the above contribute to metabolic acidosis in AKI (D) Signup and view all the answers

Which of the following is a potential consequence of metabolic acidosis in patients with AKI?

All of the above are potential consequences of metabolic acidosis (D) Signup and view all the answers

What is the primary role of an artificial kidney (dialysis) in managing severe AKI?

To replace lost kidney function and remove excess fluids and electrolytes (B) Signup and view all the answers

Which of the following statements accurately describes the primary mechanism of action for most clinically used diuretics?

They decrease sodium reabsorption in the renal tubules, indirectly causing water to be retained in the urine. (D) Signup and view all the answers

How do osmotic diuretics, like mannitol, primarily achieve diuresis?

By increasing the osmotic pressure of the tubular fluid, reducing water reabsorption. (C) Signup and view all the answers

Which of the following factors is NOT directly influenced by the secondary effects of sodium reabsorption inhibition by diuretics?

Glomerular filtration rate (A) Signup and view all the answers

What is the primary clinical application of diuretics?

Reducing extracellular fluid volume, particularly in conditions with edema and hypertension. (E) Signup and view all the answers

How does the presence of excess solutes in the tubular fluid contribute to diuresis in certain diseases?

Excess solutes increase the osmotic pressure of the tubular fluid, preventing water reabsorption. (E) Signup and view all the answers

Which of the following scenarios would NOT likely result in increased urine volume output?

Activation of the renin-angiotensin-aldosterone system (RAAS), leading to increased sodium retention. (E) Signup and view all the answers

What is the primary mechanism by which diuretics increase the excretion of solutes like potassium, chloride, magnesium, and calcium?

Indirect effects due to the inhibition of sodium reabsorption in the renal tubules. (C) Signup and view all the answers

Which of the following statements best summarizes the relationship between natriuresis (increased sodium excretion) and diuresis (increased water excretion) in the context of diuretics?

Natriuresis is the primary cause of diuresis, as increased sodium excretion directly leads to increased water excretion. (B) Signup and view all the answers

What is the primary physiological mechanism underlying the effectiveness of diuretics in reducing hypertension or edema?

Diuretics promote sodium and water excretion, decreasing extracellular fluid volume, which subsequently lowers blood pressure. (A) Signup and view all the answers

Why does the effectiveness of most diuretics diminish over time?

Compensatory mechanisms activated by decreased extracellular fluid volume eventually counteract the diuretic's effects. (D) Signup and view all the answers

What is the primary effect of loop diuretics, such as furosemide and bumetanide, on the nephron?

They prevent sodium and water reabsorption in the thick ascending limb of the loop of Henle. (C) Signup and view all the answers

What is the primary consequence of the kidneys' inability to produce sufficient erythropoietin in chronic kidney disease?

Reduced red blood cell production (D) Signup and view all the answers

How does aldosterone contribute to hypertension in chronic kidney disease?

By increasing sodium reabsorption in the collecting tubules, leading to increased blood volume and pressure (C) Signup and view all the answers

Uncontrolled diabetes mellitus can lead to polyuria. What is the primary reason for this?

Excessive glucose in the tubules acting as an osmotic diuretic, causing increased urination. (B) Signup and view all the answers

What is the relationship between polyuria and polydipsia in uncontrolled diabetes mellitus?

Polyuria causes dehydration, which triggers polydipsia (increased thirst) as a compensatory mechanism. (C) Signup and view all the answers

What is the mechanism by which the kidneys compensate for hypertension in chronic kidney disease?

Increased excretion of sodium and water by the kidneys, returning blood pressure to normal levels (D) Signup and view all the answers

Which of the following contributes to osteomalacia in chronic kidney disease?

Decreased production of active vitamin D, leading to reduced calcium absorption (A) Signup and view all the answers

What is the transport maximum for glucose, and how does it relate to the development of polyuria in diabetes?

The transport maximum for glucose is the maximum amount of glucose that can be reabsorbed by the renal tubules in a given time. When blood glucose levels exceed the transport maximum, excess glucose is excreted in the urine. (B) Signup and view all the answers

What is the significance of the 1-sodium, 2-chloride, 1-potassium co-transporter in the thick ascending limb of the loop of Henle?

Loop diuretics target this co-transporter, blocking its function and leading to increased sodium, chloride, and potassium excretion. (B) Signup and view all the answers

How does the increased serum phosphate concentration contribute to osteomalacia in CKD?

By increasing the release of parathyroid hormone, which can lead to bone resorption (C) Signup and view all the answers

Which of the following is the most likely consequence of a decreased glomerular filtration rate (GFR) in chronic kidney disease?

Increased blood pressure due to fluid retention (D) Signup and view all the answers

How does the decrease in extracellular fluid volume caused by diuretics ultimately impact the effects of the diuretic on urine output?

The decrease in extracellular fluid volume activates compensatory mechanisms, such as increased renin secretion and Ang II formation, which ultimately limit the diuretic's effect on urine output. (A) Signup and view all the answers

What is the primary mechanism of action of recombinant erythropoietin in treating anemia in CKD?

Stimulating the production of red blood cells in the bone marrow (C) Signup and view all the answers

How does pressure natriuresis and pressure diuresis contribute to the regulation of blood pressure in CKD?

By increasing sodium and water excretion, reducing blood volume and pressure (A) Signup and view all the answers

Which of the following is NOT a characteristic shared by both Gitelman syndrome and Bartter syndrome?

Decreased sodium chloride reabsorption in the proximal tubules. (A) Signup and view all the answers

The activation of the RAAS in both Gitelman and Bartter syndromes is primarily a consequence of:

Decreased sodium chloride reabsorption leading to volume depletion. (B) Signup and view all the answers

What is the primary treatment strategy for Gitelman syndrome?

Replacement of lost electrolytes like sodium chloride and potassium. (A) Signup and view all the answers

Which of the following statements about the mechanism of dialysis is CORRECT?

Dialysis utilizes a semi-permeable membrane to facilitate diffusion of unwanted substances from blood to the dialyzing fluid. (C) Signup and view all the answers

What is the primary reason for the development of metabolic alkalosis in patients with Gitelman syndrome?

Increased potassium secretion in the collecting tubules. (A) Signup and view all the answers

Individuals with Gitelman syndrome exhibit mild volume depletion. Which of the following is NOT a likely consequence of this volume depletion?

Increased blood pressure. (B) Signup and view all the answers

Why is the amount of immunosuppressive therapy required for kidney transplant recipients often reduced over time?

The body's natural immune response to the transplanted kidney diminishes. (C) Signup and view all the answers

Flashcards

Diuretics

Medications that increase urine volume and solute excretion.

Mechanism of action of diuretics

Diuretics primarily decrease sodium reabsorption in renal tubules, leading to increased water output.

Natriuresis

Increased sodium output in the urine, often caused by diuretics.

Osmotic diuretics

Diuretics that increase urine output by raising osmotic pressure in tubules, preventing water reabsorption.