ACE Inhibitors

[ctizzle13498]

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Why do you get hyperkalemia with Ace Inhibitors?

Also, am I right on this: so Ace Inhibitors are contra indicative in pts with bilateral renal artery stenosis bc they decrease the GFR levels by vasodilating the efferent arterioles. Since you have bilateral renal artery stenosis, you are already decreasing the GFR levels, so this just adds to that effect????

 

[jfgavina]

Why do you get hyperkalemia with Ace Inhibitors?

Also, am I right on this: so Ace Inhibitors are contra indicative in pts with bilateral renal artery stenosis bc they decrease the GFR levels by vasodilating the efferent arterioles. Since you have bilateral renal artery stenosis, you are already decreasing the GFR levels, so this just adds to that effect????

1. In bilateral renal artery stenosis (or unilateral if you want, but this works only for one kidney obviously) decreased renal plasma flow makes your JuxtaGA cells secrete renin-->AT-->ACE converts to AT II.

AT-II is going to constrict your efferent arteriole increasing glomerular hydrostatic pressure facilitating GFR. If you inhibit production of AT-II you're taking one of the most basic mechanisms by which kidneys work so you decrease your GFR, therefore you see increases in creatinine.

2. AT II--->in glomerulosa--->Aldosterone. Aldosterone causes reabsorption of Na and excretion of K in collecting tubule if you stop making aldosterone using ACE inhibitor you stop excreting K and get hyperkalemia!

 

[ctizzle13498]

Got it! Thanks that makes sense!

Also 1 more thing:

In the ascending thick limb, normally Na, K, and Cl is reabsorbed, which causes Mg and Ca to also get reabsorbed. This would cause diluted urine because all the solutes are absorbed and you only have water. However, why does it say that with loop diuretics, which inhibit Na, K, Cl reabsorption, thereby inhibiting Mg and Ca reabsorption, that you "prevent concentration of urine."

Shouldn't Loop Diuretics prevent DILUTION of urine, since you now have all these solutes in the urine?

Am I missing something? Please help, thanks in advance!

 

[jfgavina]

Got it! Thanks that makes sense!

Also 1 more thing:

In the ascending thick limb, normally Na, K, and Cl is , which causes Mg and Ca to also get reabsorbed. This would cause diluted urine because all the solutes are absorbed and you only have water. However, why does it say that with loop diuretics, which inhibit Na, K, Cl reabsorption, thereby inhibiting Mg and Ca reabsorption, that you "prevent concentration of urine."

Shouldn't Loop Diuretics prevent DILUTION of urine, since you now have all these solutes in the urine?

Am I missing something? Please help, thanks in advance!

that's gonna mess up with what happens in the medulla, you have less electrolytes inside because they all were prevented from being reabsorbed in ascending loop so you can't pull more water in that segment to equilibrate things inside the cell. basically less osmolarity inside the medullary segment will prevent water from being absorbed so you can't concentrate the urine. kinda difficult to understand I guess we should both to well in the examination w/o understanding it to such deep levels... LOL I bet others did that before. how are your nbmes going, ctizzle? have you been doing some?

 

[ctizzle13498]

Ohhhhh i competelely forgot about that osmolarity junk! That makes sense!

Ok, well test is dec 1: i took took NBME 11 about 2 wks ago got 182, but since then I've hit it hard, so taking another one next sunday: nbme 12. (hopefully be in the 200-210 range)

Then was going to take NBME 6 and 5, and then like 5 days before the test do NBME 7.

Should I take NBME 5? I dunno if its too old or not. When is ur test again? Good Luck, i think you said it's in early November if I'm not mistaken

 

[jfgavina]

Ohhhhh i competelely forgot about that osmolarity junk! That makes sense!

Ok, well test is dec 1: i took took NBME 11 about 2 wks ago got 182, but since then I've hit it hard, so taking another one next sunday: nbme 12. (hopefully be in the 200-210 range)

Then was going to take NBME 6 and 5, and then like 5 days before the test do NBME 7.

Should I take NBME 5? I dunno if its too old or not. When is ur test again? Good Luck, i think you said it's in early November if I'm not mistaken

Don't know anything about 5 but the next one I'm gonna take is 7 maybe tuesday after reading FA for like 999^999 times. as we say here in my country "soft water on hard rock hits so much that it will crash it eventually", this a free translation, but I think you got it eheh

after that that will take maybe 5 one week before and I'm done, will take it just not to lose the rhythm and because I like to donate to NBME 😎

I took 12 3 days ago and got 231 again, didn't improve from my last one 10 days ago!

continue to hit that with strength you will definitely see some improvement I can assure you! doing mine in 7th november, GL to you and me

 

[ctizzle13498]

Will keep you posted next week. Hopefully I see a big jump from 182. I def know A LOT more than I did back then.

 

[pbnj003]

that's gonna mess up with what happens in the medulla, you have less electrolytes inside because they all were prevented from being reabsorbed in ascending loop so you can't pull more water in that segment to equilibrate things inside the cell. basically less osmolarity inside the medullary segment will prevent water from being absorbed so you can't concentrate the urine. kinda difficult to understand I guess we should both to well in the examination w/o understanding it to such deep levels... LOL I bet others did that before. how are your nbmes going, ctizzle? have you been doing some?

isnt is just that the ascending loop is impermeable to water?

 

[jfgavina]

I was talking about the collecting duct..

 

[pbnj003]

ah ok i read ascending thats why!

hope your studying is going well! you are almost done! gluck!

 

[jfgavina]

thanks pbnj003, when do you have yours? GL to you as well

 

[pbnj003]

mine is first week of December! Dont feel like I have much time but trying to hammer away what I can! Your NBME scores look good so far. I hope we both can reach up to the 240 mark 🙂

GLuck!

 

[notarealname]

Don't know anything about 5 but the next one I'm gonna take is 7 maybe tuesday after reading FA for like 999^999 times. as we say here in my country "soft water on hard rock hits so much that it will crash it eventually", this a free translation, but I think you got it eheh

after that that will take maybe 5 one week before and I'm done, will take it just not to lose the rhythm and because I like to donate to NBME 😎

I took 12 3 days ago and got 231 again, didn't improve from my last one 10 days ago!

continue to hit that with strength you will definitely see some improvement I can assure you! doing mine in 7th november, GL to you and me

The Chinese culture says the same thing about the water and rock ^^

Depends on how much time you have left, you can try to read text book in the area that you are weak in. Text books in my opinion gives you the best results.

Have fun studying!