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Pulmonary Hypertension Medication: Outline of Pharmacological Therapy

In this article, we will be reviewing mainly about the advanced therapies which are available for pulmonary hypertension with the brief coverage of primary therapy. The advanced therapies are especially studied for IPAH.

Renal Glucose Reabsorption: Glucose in the Urine & Disease Correlation

The kidney is a key player in glucose hemostasis by two mechanisms. It filters and reabsorbs glucose from the urine and it releases the sugar during times of fasting through gluconeogenesis. Here you will read everything about it.

Vasodilators: Calcium Channel Blockers, Nitrodilators & More

Hypertension has consistently made its way to the leading causes of morbidity and mortality in recent years. Millions of deaths and disabilities are being documented worldwide because of its complications, such as cerebrovascular accidents and ischemia in various locations in the body. Despite its notorious nature, hypertension is preventable and controllable. This is made possible by making use of various pharmacologic managements that are available today. One of the most common medications used to control blood pressure is a direct vasodilator.

Postganglionic Sympathetic Nerve Terminal Blockers and Monoamine Oxidase Inhibitors

Every day, more and more people are being diagnosed with hypertension. This increase in prevalence worldwide can be attributed to non-modifiable factors other than heredity, age and sex. Without the incorporation of a healthy lifestyle and the promotion of wellness, it would not be shocking for someone to be put at a higher risk for developing complications brought about by the ‘silent killer’.

Alpha Blockers: Mechanism of Action and Uses for Hypertension

Along with the automation of daily activities and improvement in the availability of food in our society, comes the increasing incidence of persons having chronic lifestyle diseases. One of the most prevalent of these is hypertension. It is also important to emphasize that this ‘silent killer’ is becoming more popular among younger populations nowadays. Fortunately, organizations have come up with ways to tackle this problem, including a wide variety of pharmacologic managements that would help lower and maintain blood pressure. One of which is the use of α-adrenergic blockers.

Calcium Channel Blockers: Antagonists at the L-type Calcium Channels in Heart and Vessels

Calcium channel blockers have different scopes of application: they are used for the treatment of arterial hypertension or cardiac arrhythmia. Calcium channel blockers are also applied for the treatment of the coronary heart disease. They are often used if beta blockers cannot be applied due to intolerances or adverse effects.

Antihypertensives: ACE-Inhibitors and Sartans

The arterial hypertonia can be reduced with general measures often. However, medicinal approaches are also advisable in order to reach target blood pressures, which are in an area, as normal as possible. The most commonly prescribed drug are ACE-inhibitors, as they are cheap in price, followed by sartans. Both substances affect the renin-angiotensine-aldosterone system (RAAS) and reduce the blood pressure by the thereby conveyed effects.

Diuretics

Diuretics promote the generation of a negative fluid balance in the body. Additionally, nearly all diuretics increase the excretion of sodium in the kidneys, so that water is linked osmotically and also excreted. The different diuretics affect different parts of the tubule system.

Regulation of ADH & Syndrome of Inappropriate ADH Secretion

Antidiuretic hormone or arginine vasopressin, is a peptide hormone released by the posterior pituitary in response to low plasma volume or increased plasma osmotic pressure. The hormone increases reabsorption of water at the kidney and increases systemic vascular resistance. When ADH is released in an unregulated fashion the circulating plasma becomes diluted, resulting in hyponatremia. This is called syndrome of inappropriate antidiuretic hormone secretion.

Water Balance: Regulation of Fluid Balance

Fluid balance is a carefully regulated system with many mechanisms to monitor and modify the absorption and secretion of water. Water is in constant motion between compartments that make up the body. When the body senses a drop in the effective circulating volume it stimulates a response to restore blood pressure and retain fluids. When there is too much fluid the body increases secretion and excretion of the excess.

Thiazide Diuretics

Thiazide diuretics are some of the most common diuretics currently in use. Their mechanism of action involves inhibition of the Na/Cl co-transporter channel in the proximal part of the distal convoluted tubule, leading to increased sodium and chloride secretion. Their effects on reducing peripheral vascular resistance further contribute to their antihypertensive properties, in addition to their ability in decreasing effective blood volume. Besides hypertension, they are indicated for the treatment of heart failure exacerbation, hypercalciuria and diabetes insipidus. Important side effects include hypokalemia, hypercalcemia, hyponatremia, hyperglycemia, hyperuricemia and hypomagnesemia.

Loop Diuretics

Loop diuretics are one of the important classes of diuretics. Furosemide is the most commonly used loop diuretics. Other loop diuretics used are bumetanide, torasemide and ethacrynic acid. Loop diuretics are the most efficacious in causing diuresis in all the classes of diuretics. All the loop diuretics have the same mechanism of action, but different pharmacokinetic properties. They are used to treat/manage numerous diseases such as edema associated with CHF and liver cirrhosis. Diuretics most commonly cause electrolyte imbalance in the body on prolonged use.

Aldosterone Antagonist

Aldosterone antagonists are the class of drugs used to treat several conditions such as edema, hypertension or congestive cardiac failure (CCF). Aldosterone antagonists act by competitive antagonism of aldosterone binding receptors on the distal convoluting tube and the upper collecting duct. Spironolactone is an important and widely used aldosterone antagonist. Other drugs in this category are eplerenone and finerenone.

Types of Intravenous Fluids

Intravenous fluids are most commonly administered in acute and severe hypovolemic conditions. In the therapeutics, two classes of i.v. fluids are most commonly utilized: crystalloids and colloids; both have their own advantages and disadvantages. The effect of various clinical conditions on the volume of ICF and ECG can be best studied by Darrow-Yannet diagrams.

Renal Cysts

A kidney cyst can arise in any part of the nephron and collecting ducts, and can be found incidentally on imaging tests, or can be part of a renal or systemic disease. Renal cystic diseases consist of a large spectrum of diseases that differ in regards to pathophysiology, prognosis and treatment and that can be usefully divided into hereditary, acquired and developmental conditions. Hereditary renal cystic diseases often lead to kidney failure and are commonly associated with extrarenal manifestations, whereas non-genetic cystic disorders are usually limited to the kidney and rarely result in kidney functional deterioration.

Glomerulonephritis: An Overview

The kidney is the central filter organ of our body. More specifically, it is the small glomeruli that filter those substances from the blood that have to be excreted and thus produce the primary urine. Various factors may cause damages to the glomeruli, resulting in a malfunctioning filtration process. The type of malfunction can vary, and accordingly, so do its clinical manifestations. Differentiating these variable clinical presentations of glomerulonephritis is for many medical students a rather challenging task. The following article will help you to understand the difficult topic of glomerulonephritides

Urinalysis

Urinalysis is the test performed to analyze the physical, chemical and microscopic characteristics of urine. The information from this test might be used to diagnose or rule out diseases based on the findings. Urinalysis is most commonly used in identifying diseases of the urinary tract and diabetes. It includes macroscopic, microscopic/cytological and chemical analysis of the individual elements in urine.

Kidney Stone (Nephrolithiasis) — Classification, Symptoms and Treatment

Nephrolithiasis is a clinical condition characterized by the presence of calculus in the urogenital tract. Calcium oxalate stones are the most common stones. Clinical presentation involves acute presentation with flank pain, which occasionally radiates to the groin. Non-contrast CT is the investigation of choice in nephrolithiasis and can diagnose all types of stones. Management depends on the location and size of the stone. Smaller stones have a greater chance to pass spontaneously, while stones larger than 5 mm need surgical management with percutaneous nephrolithotomy, ureteroscopy and extracorporeal lithotripsy.

Water and Sodium Balance and Their Associated Disorders

Sodium is one of the most important active osmotic solutes in the human body, which is maintained in constant amounts in extracellular and intracellular fluid compartments. Understanding the normal physiological basis of water and sodium balance, and the associated clinical implications of any change in this balance, are of clinical significance, as even small changes can result in emergency conditions. This will be discussed in detail in this article.

Hypertension (High Blood Pressure, HBP) — Classification and Clinical Signs

With a prevalence of approximately 50 %, arterial hypertension is a very common disease. Blood pressure is a risk factor of secondary diseases such as stroke, CHD and cardiac insufficiency. Social connections as well as a relationship between hypertension, body weight and age are apparent. Many individuals with hypertension are not treated at all or receive insufficient therapy and, in many cases, are not aware they have the disease.

Renal Physiology — Renal Clearance, Tubular Transport and the RAAS

The kidney’s physiology is an extremely complex issue in medicine, which is therefore a popular topic in exams. Since the kidney fulfills many important functions in the body in addition to its function as an excretory organ, it can be referred to as a multifunctional organ. The physiology of the kidney derives from the circumstances of its anatomical structures, especially those of the nephrons.

Adrenal Gland Disorders – Aetiology, Symptoms, Diagnostics and Treatment

The adrenal glands are involved in the production and secretion of hormones and control different metabolic pathways. Impairments in the adrenal glands (above the kidneys) thus have a significant impact on bodily functions. Hypercortisolism, hyperaldosteronism, adrenocortical deficiency and phaeochromocytoma are typical for this type of disease. Medical students should be familiar especially with the pathophysiology of the regulatory circuits of these diseases. Not only because this will make their daily clinical understanding of these diseasesmuch easier, but also because these circuits are well-suited for exams.

Embryology: The Development of the Kidneys and the Efferent Urinary Tract (Weeks 3-6)

The development of the kidneys and the efferent urinary tract is complex and unalterably interconnected. It is an essential part of embryonic development and closely connected to sexual development. Malformations lead to severe consequences and are often not compatible with postnatal life. In medical studies this is one of the most important themes in embryology.

The Kidney – The Urinary System’s Main Organ

The kidney (Latin: Ren, Greek: Nephrós) is the urinary system’s main organ. In order to understand the microscopic structure of this organ, it is useful to comprehend well its function. And for this, one has to learn about the different cell types and their structure. The nephron is the kidney’s functional unit and shall be particularly discussed here. After studying this article, you will be able to explain its components. These are the renal corpuscles, renal tubules and the collecting duct system. You will now read a short overview of the functions of the human kidney.

Lupus (Systemic Lupus Erythematosus; SLE) — Diagnosis and Treatment

The autoimmune disease lupus erythematosus belongs to the collagenoses and can show very different clinical symptoms: The symptoms range from mild conditions to severe organ manifestations which makes the diagnosis not easy sometimes. Read all the important facts about lupus erythematosus here to be prepared for the exam and the subsequent medical daily routine.

Diabetes Insipidus (DI) — Causes and Symptoms

Patients with diabetes insipidus present with polyuria, urinary output > 3 L per day and can be central or nephrogenic in origin. In central diabetes insipidus, there is a decrease in the secretion of antidiuretic hormone (ADH), while in nephrogenic diabetes insipidus, the kidneys are unable to concentrate the urine due to ADH resistance.

Dehydration — Isotonic, Hypotonic and Hypertonic Fluid Disorders

Dehydration is an imbalance in the body fluid environment. The imbalance is due to less water intake while there is more water loss. The body can lose water through normal physiologic processes in respiration, urination and sweating, or some pathologic diseases through vomiting, diarrhea and fever.

Alpha and Beta Blockers

In this article, we will study the important pharmacological aspects of alpha and beta blockers such as classification, pharmacokinetics, mechanism of action, important actions on various organ systems, clinical uses and toxicity.

Anti-hypertensive Medications

Hypertension is the rise in blood pressure beyond the defined set point (conventionally ≥ 140/90 mmHg). Hypertension is the known risk factor for a number of cardiovascular events like myocardial infarction, angina and heart failure, sudden cardiac death. The pharmacological therapy for hypertension is discussed in this section. The therapies have evolved over time and the current line of therapy offers tremendous response and decreases the morbidity and mortality associated with this condition. It should be noted that non-pharmacological therapy like exercise and healthy food habits also play an important part in controlling hypertension.

Interstitial Nephritis (Tubolainterstitial Nephritis) — Pathophysiology and Laboratory Investigations

Tubulointerstitial nephritis is an inflammatory condition affecting the tubules and interstitium, while sparing the glomerulus. Acute and chronic pyelonephritis, along with drug induced interstitial nephritis, is the predominant cause of tubulointerstitial nephritis. Urine examination shows characteristic eosinophiluria and WBC casts. The treatment involves the discontinuation of the offending drug, along with steroids, while treatment is mainly supportive in the chronic type. Progression to end-stage renal disease is seen in the majority of tubulointerstitial disorders.

Chronic Kidney Disease (CKD) — Pathophysiology and Diagnosis

Kidneys are central metabolic organs in our body. They regulate our water and electrolyte balance amongst other things, and are responsible for the removal of potentially toxic substances and medications. Shockingly, many of today’s widespread diseases can lead to damaged kidneys and an impairment of their function. Chronic renal failure is a systemic disease with massive effects on the whole organism. It is not always easy to understand all of the various facets of the disease. This article should make the mechanisms and processes easier to understand, and will explain them in more detail.

Acute Renal Failure (ARF, Acute Kidney Failure) — Symptoms and Treatment

No matter in which clinical field you will be working in the future, you will be confronted with cases of acute renal failure. In this acute emergency illness, various pathomechanisms come together and lead to a principally reversible decrease in renal function, often involving disbalances of water and electrolytes. The different types of acute renal failure have to be understood well in order to develop an adequate treatment strategy. This article presents the main aspects of acute renal failure clearly and comprehensively.

Membranoproliferative Glomerulonephritis (MPGN)

Membranoproliferative glomerulonephritis (MPGN) is a type of immune mediated glomerular disease. The name is an indication of its pathology, with thickening of the basement membrane and proliferative changes. MPGN is categorized into three types: type I, type II (also called dense deposit disease) and type III. Students should be familiar with an overview of this condition, including its pathological features that set it apart from other glomerular disorders, as well as the diagnostic approach and management of MPGN.

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Nephrology

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Your Educators of course Nephrology

Carlo Raj, MD

Pravin Shukle, MD

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