Step I Acetazolamide effects on urinary NaCl

[syoung]

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FA 2015, page 553 shows Acetazolamide -> NaHCO3 diuresis. And on page 552, it would inhibit NaHCO3 and NaCl reabsorption.

Acetazolamide Wiki says you would lose Na, et al. Our renal lecture on this was brief, but it mentioned that in cases of refractory edema (decreased Loop sodium delivery due to low GFR and/or enhanced proximal reabsorption) you can use acetazolamide to increase delivery of NaCl out of the proximal tubule.

Yet on page 554, it says that urine NaCl would not go up for Acetazolamide. Anyone know why?

 

[animando]

Because loop of Henle and DCT are able to retain the extra NaCl. Therefore Diamox is a bad drug for hypertension.

 

[Slade009]

Ok let me make this as simple as possible. Acetazolamide basically is in the category of diuretics so by definition you should definitely lose urinary NaCl as a result and possibly serum NaCl. AZM also makes you pee BiCarb(HCO3-) and since Bicarb is excreted and lost, to maintain the electrical gradient the kidney pumps in Chloride(Cl-) in its place causing hyperchloremia as well.

Thus AZM= Pee Bicarb (low HCO3-) + high Chloride (hyperchloremia) + Acidosis (due to loss of the base that is Bicarb)

Hopefully this will clear things. Rmbr different authors and books have different ways of explaining the same things sometimes so in my personal experience you should stick to one source per subject that suits you and once you understand it well and want more info about details then you can reference other sources and look up different books. It's just a more efficient way of studying.