Diuretics and Kidney Diseases PDF

12/24/24 Diuretics and kidney 1 diseases Derek Owens DrAP, CRNA 1 2 Module 4 ´ Guyton 32 ´ Hammer 16 ´ Learning Objectives...

12/24/24 Diuretics and kidney 1 diseases Derek Owens DrAP, CRNA 1 2 Module 4 ´ Guyton 32 ´ Hammer 16 ´ Learning Objectives 1. Summarize the cause and pathophysiology of kidney disease. 2. Differentiate between acute kidney injury and chronic kidney disease. ´ Guyton chapter 32 2 3 Diuretics mechanism of action Decrease sodium and chloride reabsorption 3 1  12/24/24 4 Osmotic diuretics ´ Increase osmotic pressure in the renal tubules 4 5 Loop diuretics ´ Decrease sodium, chloride, potassium reabsorption ´ Thick ascending loop of Henley 1. Increase tubular solutes 2. Disrupt the countercurrent multiplier system 5 6 Thiazide diuretics ´ Early distal tubules 6 2  12/24/24 7 Carbonic anhydrase inhibitors ´ Proximal tubules 7 8 Mineralocorticoid receptor antagonist ´ Competes with aldosterone 8 9 Sodium channel blockers ´ Block sodium channels in the luminal membrane 9 3  12/24/24 10 Kidney diseases ´ Acute kidney injury (AKI) ´ Chronic kidney disease (CKD) 10 11 Acute kidney injury ´ Prerenal ´ Intrarenal ´ Postrenal 11 12 Pre-renal acute kidney injury ´ Normal renal blood flow ´ 1100ml/min or 20 to 25% of cardiac output 12 4  12/24/24 13 Intrarenal acute kidney injury ´ Glomerular capillary injury ´ Renal tubular epithelium injury ´ Renal interstitium injury 13 14 AKI caused by glomerulonephritis ´ Immune reaction 14 15 Tubular necrosis ´ Severe ischemia ´ Poisons, toxins, or medications 15 5  12/24/24 16 Postrenal acute kidney injury ´ Bilateral obstruction of the ureters ´ Bladder obstruction ´ Obstruction of the Urethra 16 17 Physiological effects of AKI ´ Edema and hypertension ´ Hyperkalemia ´ Metabolic acidosis 17 Chronic kidney disease ´ Irreversible loss of functioning nephrons ´ 70 to 75% 18 18 6  12/24/24 Chronic kidney disease leading to end stage 19 renal disease Adaptive changes 19 20 Injury to renal blood vessels ´ Atherosclerosis ´ Fibromuscular hyperplasia ´ Nephrosclerosis 20 21 Glomerulonephritis ´ Inflammation of glomerular loops ´ Unable to filter plasma 21 7  12/24/24 22 Interstitial nephritis ´ Interstitial nephritis ´ Inability to empty ´ Urine outflow obstruction 22 23 Nephrotic syndrome ´ Proteinuria 23 24 Nephron function in chronic kidney disease ´ Fluid and electrolytes ´ Up to 75 to 80% nephron loss ´ Waste products ´ Accumulation proportional to nephron loss 24 8  12/24/24 25 Isosthenuria ´ Inability to concentrate urine ´ Rapid flow ´ C ollecting d ucts ´ Loop of H enley ´ Diluting mechanism ´ Rapid flow ´ Loop of H enley ´ High solute load 25 9