DRUGS

AFFECTING
THE KIDNEY
2
3
Diuretics • Agents that increase the amount of urine produced
by the kidneys

4
Diuretics • Diuretics (“water pills”) are the drugs which increase
the urine out put (or) urine volume .
• What is natreuretic agent ?
• Any drug when introduce into the body increases the
out put of sodium
• ie., loss of sodium in urine.
Therapeutic • Diuretics are very effective in the treatment of
conditions like:-

approaches – Chronic heart failure

– Nephrotic syndrome
– Chronic hepatic diseases
– Hypertension
– Pregnancy associated edema
– Cirrhosis of the liver.
 Normal • Two important functions of the kidney are:-
• To maintain a homeostatis balance of electrolytes and
Physiology of water.
• To excrete water soluble end products of
Urine metabolites.

formation
– Each kidney contains approximately one million
nephrons and is capable of forming urine
independently.
– The nephrons are composed of glomerulus, proximal
tubule, loop of henle, distal tubule.
• Approximately 1200 ml of blood per minute flows
through both kidneys.
• Ions such as sodium, chloride,calcium are reabsorbed.
• Total amount of glucose, amino acids, vitamins,
proteins are reabsorbed.
• If the urine contains above it represents the
disorders.
• For example proteins such as albumin in higher
amounts causes albuminaria.
 GFR • 1 cardiac output -5 lit/min.
• Out of that 20% goes to kidneys i.e.1 lit/min.
Formation • 1 lit of blood of has 40%of cells and 60%of plasma.
• 600 ml of plasma is not entered into glomerulus only
a part of plasma can enter into it and the rest pass
through the efferent arteriole.
• Only 20% can enter into glomerelus that is 120 ml.
• This 120 ml/min (180L/day) makes glomerular filtrate
(99%reabsorbed).
• Urine output is about 1 – 1.5L/Day
 Oliguria

Types of
urine
frequency

Normal Polyuria
Classes of • Five major classes
1. Thiazides and thiazide-like

Diuretics 2. Loop diuretics

3. Potassium-sparing
4. Carbonic anhydrase inhibitors
5. Osmotic diuretics

11
 General
• Treatment of edema
– Urine output will increase and excess fluid is flushed

indications
out of the body

for the use

of the
diuretics

12
 General • Treatment of CHF
– The sodium loss in the kidney is associated with water

indications loss

for the use

of the
diuretics

13
 General • Treatment of Hypertension
– Diuretics will decrease the blood volume and serum

indications sodium

for the use of

the diuretics

14
 General • Treatment of Glaucoma
– Diuretics will provide osmotic pull to remove some of

indications the fluid from the eye to decrease the IOP

for the use of

the diuretics

15
 Time of Usually in the morning!!
administration of
the diuretics

16
 Diuretics
Comparison

17
 Diuretics
Comparison

18
Thiazides • Prototype: Hydrochloro thiazide
1. Bendroflume thiazide
2. Ben thiazide
3. Chloro thiazide (Diuril)
4. Hydroflume thiazide
5. Methylclo thiazide
6. Trichlorme thiazide

19
Thiazide-like 1. Indapamide
2. Quinethazone
3. Metolazone
4. Chlorthalidone

20
Thiazides • Pharmacodynamics
• These drugs BLOCK the chloride pump
• This will keep the Chloride and Sodium in the distal
tubule to be excreted into the urine
• Potassium is also flushed out!!

21
Thiazide • Special Pharmacodynamics: Side effects
• Hypokalemia
• DECREASED calcium excretion => hypercalcemia
• DECREASED uric acid secretion => hyperuricemia
• Hyperglycemia

22
 Loop • Prototype: Furosemide
1. Bumetanide

Diuretics 2. Ethacrynic acid

3. Torsemide

23
 Loop Pharmacodynamics
• High-ceiling diuretics
Diuretics • BLOCK the chloride pump in the ascending loop of
Henle
• SODIUM and CHLORIDE reabsorption is prevented
• Potassium is also excreted together with Na and Cl

24
 Loop • Special Pharmacodynamics: side-effects
• Hypokalemia
Diuretics • Bicarbonate is lost in the urine
• INCREASED calcium excretion => Hypocalcemia
• Ototoxicity- due to the electrolyte imbalances

25
Potassium Prototype: Spironolactone
1. Amiloride

sparing 2. Triamterene

diuretics

26
Potassium Pharmacodynamics
• Spironolactone is an ALDOSTERONE antagonist
sparing • Triamterene and Amiloride BLOCK the potassium
secretion in the distal tubule
diuretics • Diuretic effect is achieved by the sodium loss to offset
potassium retention

27
Potassium • Pharmacokinetics: Side effects
• HYPERkalemia!
sparing • Avoid high potassium foods:

diuretics
– Bananas
– Potatoes
– Spinach
– Broccoli
– Nuts
– Prunes
– Tomatoes
– Oranges
– Peaches
28
Osmotic Prototype: Mannitol
• 1. Glycerin
Diuretics • 2. Isosorbide
• 3. Urea

29
Osmotic Pharmacodynamics
• Mannitol is a sugar not well absorbed in the nephron
Diuretics => osmotic pull of water => diuresis

30
Osmotic • Pharmacokinetics: side effects
– Sudden hypovolemia

Diuretics • Important for the nurse to warm the solution to allow

the crystals to DISSOLVE in the bottle!

31
 Carbonic • Prototype: Acetazolamide
• 1. Methazolamide
Anhydrase
Inhibitors

32
 Carbonic • Pharmacodynamics
• Carbonic Anhydrase forms sodium bicarbonate
Anhydrase • BLOCK of the enzyme results to slow movement of
hydrogen and bicarbonate into the tubules
Inhibitors • plus sodium is lost in the urine

33
 Carbonic • Pharmacokinetics: side effects
• Metabolic ACIDOSIS happens when bicarbonate is
Anhydrase lost
• Hypokalemia
Inhibitors

34
The Nursing • ASSESSMENT
• Assess the REASON why the drug is given:
Process and
the diuretics

35
The Nursing • ASSESSMENT
• The nurse must elicit history of allergy to the drugs
Process and • Allergy to sulfonamides may contraindicate the use of
thiazides
the diuretics • Assess fluid and electrolyte balance
• Assess other conditions like gout, diabetes,
pregnancy and lactation

36
The Nursing • ASSESSMENT
• Physical assessment
Process and • Vital signs

the diuretics • Special electrolyte and laboratory examination

• Assess symptom of body weakness which may
indicate hypokalemia

37
The Nursing • Nursing Diagnosis
• Fluid volume deficit related to diuretic effect
Process and • Alteration in urinary pattern

the diuretics • Potential for injury (ototoxocity, hypotension)

• Knowledge deficit

38
The Nursing • IMPLEMENTATION
• Administer IV drug slowly
Process and • Safety precaution for dizziness/hypotension

the diuretics • Provide potassium RICH foods for most diuretics,

with the exception of spironolactone
• Provide skin care, oral care and urinary care

39
The Nursing • IMPLEMENTATION
• Monitor DAILY WEIGHT- to evaluate the effectiveness
Process and of the therapy
• Monitor urine output, cardiac rhythm. Serum
the diuretics electrolytes
• ADMINISTER in the MORNING!
• Administer with FOOD!

40
The Nursing • EVALUATION: for effectiveness of therapy
• Weight loss
Process and • Increased urine output

the diuretics • Resolution of edema

• Decreased congestion
• Normal BP

41
 42