How do Thiazide diuretics work? when use them?
- Will block the Na,Cl transporter in early distal tubule
- Will cause more sodium to be delivered to late tubule and result in an increase na absorption here
- can then cause hypokalemia as more K will be secreted
-used to treat hypertension, cause kidney to excrete more fluid
Plasma Urea
- what is it?
- what can it measure
- factors affecting it?
- Excretory produce for nitrogen
- depends on protein intake, and breakdown (e.g infections)
- excretion rate depends on GFR - if this is low, than increased urea in blood - more absorbed (less in urine)
Creatinine a better measure
Creatinine
- what does it measure?
- things that influence this?
muscle creates this and then get it excreted (like a muscle waste product)
- proportional to muscle mass
- freely filtered and no tubular reabsorption so it is proportional to GFR
- Plasma creatinine increases if GFR decreases.
-increases if have meat or fish that day, age, gender, muscle mass
Normal GFR
100ml/min
Reasons for acute kidney injury
Pre-renal - low BP e.g due to dehydration, septic shock, haemmorage treat- rehydrate, antibiotics
Renal - acute tubular necrosis - persistant oliguria - treat reason (cause - drugs, toxins ect.)
Post renal - kidney stones, tumours, urinary retention ect. - ultrasound
Chronic kidney disease
Gradual decline in renal function, irreversible
-usually normal urine output
Cause - diabetes, glomerulonephritis, hypertension
Chronic kidney disease
- what it is?
- what are signs
- what is main thing to treat/manage?
Gradual decline in renal function, irreversible
-usually normal urine output
Cause - diabetes, glomerulonephritis, hypertension
- sometimes a smaller kidney
- Uraemia
- Low haemoglobin (kidney stimulates erythropoietin to make red blood cells)
- Low vit D (kidney converts this)
- low calcium (need vit D)
- high phosphate - due to decreased renal excretion
- high parathyroid hormone due to hypocalemia and hyperphosphatemia
-fractures - excesive bone respoption of calcium
treatment - prevent it getting any worse, control complications
-decrease high blood pressure!!
Uraemia
Uraemia is a clinical syndrome associated with fluid, electrolyte, and hormone imbalances and metabolic abnormalities, which develop in parallel with deterioration of renal function.
-abnormally high waste products in the blood
can get anorexia, nausea, vomiting, itchiness, seizures, coma ect.
Proteinuria
Leaking of protein through glomerulus
- mainly albumin
- can measure albumin to creatinine rato
- greater than 25 mg/mmol of proteinuria
renal function can be normal or imparied
Nephrotic vs nephritic syndorme
Nephroptic - low serum albumin, oedema(increased albumin excretion, reduction of oncontic pressure so fluid moves into interstitial space) , fofthy urine
-increased infection
Nephretic - acute kidney disease, hypertension, rbc in urine
Hematuria - causes
Blood in urine
-renal cell carcinoma, stones, infection
Process when you are dehydrate (anti-diuretic hormone)
decrease water increase ECF osmolality osmoreceptors sense this ADH secretion increases goes to kidney increase h20 permeability and absorption , decrease excretion
Renin-Angiotensin system , aldosterone
-when does this system increase and decrease?
What does it do (overall - increase sodium absorption, GFR, thirst, water absorption)
- Increases aldosterone production
- Constricts efferent arteriol (increase GFR)
- Reabsorption of sodium
Factors promoting renin secretion - decrease in afferent arteriol pressure, increase sympathetic activity, decrease NaCL delivery
- Renin is secreted by affereent aterol
- conversts angiotensin to 1 and then goes to 2 as well
Aldosterone - increase ENAC receptor - to absorb more sodium (spironolactone) - from adrenal glands
What can block aldosterone?
spironolactone - stops sodium reabsorption (helps with hypertension)
What does amiloride do?
blocks sodium channels so reduce sodium reabsorption (helps with hypertension)
Atrial natriuretic peptide
Atrial stretch receptors sense an increase filling pressure, will release atrial natriueritic peptide
- will result in decreased absorption of sodium by blockign enac or na-k atase
- inhibts release of aldoseteroen or renin
- vasodilates afferent arteriol to increase GFR
Base excess - positive or negative
Anion gap
Acidosis, alkalosis and hyperkalemia
Positive - metabolic alkalosis
Negative - metabolic acidosis
(just think K+)
Anion gap - this can mean there are unmeasured anions - presnese of metabolic acidosis
-need to absorb more CL- when less hco3 to balance the sodium absorpiton
Acidosis - hyperkalemia
Alkalosis - hypokalmeia
-H+ and K+ compete for secretion with each other (excpet for dihorrea)
ACE inhibitors
Angiotensin converting enzyme inhibitors
- will stop angiotensin 2 forming which is involved in vasoconstriction to reduce blood pressure
e. g benazepril, perindopril
Euvolemic hypovolemic Hypotonic fluid Hypertonic fluid Isotonic fluid
-when to give these fluids
Euvolemic - proper amount of blood in the body
hypovolemic - low blood volume
Hypo- makes cells big (is less concentrated) (give when have high serum sodium)
Hyper - shrinks cells (less concentrated)
Isotonic fluid - same as fluid - cells remain same size
Syndromes with water overload
cirrhosis heart failure nephrotic syndrome SIADH Polydipsia
Uterine fibroids
Symptoms
Treatment
Benign leiomyomata arising form the uterine myometrium
Symptoms - abnormal uterine bleeding
-pelvic discomfort
Treatment
Medication -NSAID during menstural period, IUD- inter uterine device that releases hormones (mirena)
Invasive - Myomectomy (surgical removal of fibroids)
-hysterctomy
Heavy menstrual Bleeding
- Many causes
- Can give progestogens - bind to progesterone receptor to make progesterone
- this will stop oestrogen induced growth of endometrium, stabilizes endometrial vasculature and blocks unrestrained vessel growth , inhibits the clotting cascade
Tranexamic acid
-fibrinolytic that prevents plasminogen activation
-Can also do endometrial ablation if this doesn’t work (destroys lining) - minor procedure, short recovery time
or hysteretomy if still has not worked after 3 months
Endometriosis
Very painful condition where tissue that normally lines the uterus grows outside of the uterus.
Symptoms - pain, menstural irregularities, painful sex, dysmenorrhea, dysuria, bloating ect
looks like black spots
Treatment
-pain medicaiton
Also hormonal suppression of endometrial cells
-laparoscopic excision of the endometrial deposits
-hysterectomy
seminoma
teratoma
seminoma - Germ cell tumour of the testicles, malignant
-radiotherapy
teratoma - tumours made up of hair, bones and muscle (can be benign or malignant)
HGC (human chorionic gondotropin) is a marker for both
