NUR 207 Exam #4 With Complete Solution
Latest Update
Anuria
absence of urine formation
Bacteriuria
bacteria in the urine
Enuresis
involuntary discharge of urine (bedwetting)
Glycosuria
•glucose is the urine
Hematuria
•blood in the urine
Ketonuria
acetone bodies (ketones) in the urine
Micturition
the physical action involved in active urination
Proteinuria
protein, usually albumin, in the urine
Pyuria
pus in the urine
Kidney Function
•Fluid & electrolyte balance
•Acid base balance
•HPO4 buffer system
,•NH3 buffer system
•Regulate arterial blood pressure (RAAS)
•Renin
•Angiotensin II
•Aldosterone
•Excrete waste products
•Urea
•Creatinine
kidney stucture
•Cortex (outer layer): glomeruli & tubules
•Medulla (middle layer): renal pyramids
•Renal pelvis (inner layer): calyces
•Nephron - functional unit
•Filters - glomerulus
•Reabsorbs - tubule
Secretes - tubule
General Effect of Diuretic Therapy
•Decreases intravascular volume
•May be useful in extravascular fluid accumulation (ascites, effusions, etc.)
•Decreases mechanical workload on heart
•May be useful in decreasing cardiac workload in heart failure
•May be useful in preventing complications of heart failure
•Decreases serum potassium levels (thiazides & loop diuretics only)
•May be useful therapeutically in hyperkalemia
•Enhances renal function
•Cannot correct true renal failure
Effects of Potassium Sparing Diuretics on Urine Formation
, •Potassium sparing diuretics act on the terminal end of the distal convoluted tubule
(DCT) •Generally, the weakest class of diuretics •Inhibit sodiumpotassium pump
•Sodium stays in the tubule à flushed out •Potassium is resorbed from tubule à
reclaimed •Spironolactone inhibits aldosterone to achieve this effect •Sodium gets
flushed out, water follows •More urine volume is secreted/cleared Urine Formation
Impact of Thiazide Diuretics Thiazide diuretics act on the proximal end of the distal
convoluted tubule (DCT) Moderately aggressive diuretic class
Blocks sodium channels in DCT
Sodium stays in the tubule à flushed out
Sodium gets flushed out, water follows
More urine volume is secreted/ cleared
Urine Formation Effect of Loop Diuretics
Loop diuretics work in the loop of Henle
Potent, quick action à dramatic rise in urinary output
Inhibits the activity of the sodium-potassium-chloride transporter in the thick limb of the
loop of Henle
Tubule clearance of sodium, potassium and chloride dramatically increased
Also increases excretion of trace calcium & magnesium
A lot of sodium is flushed, a lot of water follows
Much greater urine volume is excreted/cleared
Urine Formation Effect of Carbonic Anhydrase Inhibitors (CAI)
•CAIs work in the proximal convoluted tubule (PCT)
•A mild effect as a diuretic is associated with CAIs
•Works by inhibiting carbonic anhydrase; normally allows for bicarbonate to be
reabsorbed
•Bicarbonate remains in tubule à sodium, bicarbonate and chloride is flushed out
•Sodium & bicarbonate gets flushed out, water follows
•More urine volume is secreted/cleared
•Watch for acidosis - less bicarbonate to act as buffer
Urine Formation - Effect of Osmotic Diuretics
Latest Update
Anuria
absence of urine formation
Bacteriuria
bacteria in the urine
Enuresis
involuntary discharge of urine (bedwetting)
Glycosuria
•glucose is the urine
Hematuria
•blood in the urine
Ketonuria
acetone bodies (ketones) in the urine
Micturition
the physical action involved in active urination
Proteinuria
protein, usually albumin, in the urine
Pyuria
pus in the urine
Kidney Function
•Fluid & electrolyte balance
•Acid base balance
•HPO4 buffer system
,•NH3 buffer system
•Regulate arterial blood pressure (RAAS)
•Renin
•Angiotensin II
•Aldosterone
•Excrete waste products
•Urea
•Creatinine
kidney stucture
•Cortex (outer layer): glomeruli & tubules
•Medulla (middle layer): renal pyramids
•Renal pelvis (inner layer): calyces
•Nephron - functional unit
•Filters - glomerulus
•Reabsorbs - tubule
Secretes - tubule
General Effect of Diuretic Therapy
•Decreases intravascular volume
•May be useful in extravascular fluid accumulation (ascites, effusions, etc.)
•Decreases mechanical workload on heart
•May be useful in decreasing cardiac workload in heart failure
•May be useful in preventing complications of heart failure
•Decreases serum potassium levels (thiazides & loop diuretics only)
•May be useful therapeutically in hyperkalemia
•Enhances renal function
•Cannot correct true renal failure
Effects of Potassium Sparing Diuretics on Urine Formation
, •Potassium sparing diuretics act on the terminal end of the distal convoluted tubule
(DCT) •Generally, the weakest class of diuretics •Inhibit sodiumpotassium pump
•Sodium stays in the tubule à flushed out •Potassium is resorbed from tubule à
reclaimed •Spironolactone inhibits aldosterone to achieve this effect •Sodium gets
flushed out, water follows •More urine volume is secreted/cleared Urine Formation
Impact of Thiazide Diuretics Thiazide diuretics act on the proximal end of the distal
convoluted tubule (DCT) Moderately aggressive diuretic class
Blocks sodium channels in DCT
Sodium stays in the tubule à flushed out
Sodium gets flushed out, water follows
More urine volume is secreted/ cleared
Urine Formation Effect of Loop Diuretics
Loop diuretics work in the loop of Henle
Potent, quick action à dramatic rise in urinary output
Inhibits the activity of the sodium-potassium-chloride transporter in the thick limb of the
loop of Henle
Tubule clearance of sodium, potassium and chloride dramatically increased
Also increases excretion of trace calcium & magnesium
A lot of sodium is flushed, a lot of water follows
Much greater urine volume is excreted/cleared
Urine Formation Effect of Carbonic Anhydrase Inhibitors (CAI)
•CAIs work in the proximal convoluted tubule (PCT)
•A mild effect as a diuretic is associated with CAIs
•Works by inhibiting carbonic anhydrase; normally allows for bicarbonate to be
reabsorbed
•Bicarbonate remains in tubule à sodium, bicarbonate and chloride is flushed out
•Sodium & bicarbonate gets flushed out, water follows
•More urine volume is secreted/cleared
•Watch for acidosis - less bicarbonate to act as buffer
Urine Formation - Effect of Osmotic Diuretics
