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Drugs and the kidney
- 1. Drugs and the Kidney www.freelivedoctor.com
- 6. Serum Creatinine and GFR Serum creatinine Glomerular filtration rate (GFR) www.freelivedoctor.com
- 9. The nephron and electrolyte handling www.freelivedoctor.com
- 21. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) The ALLHAT Collaborative Research Group Sponsored by the National Heart, Lung, and Blood Institute (NHLBI) www.freelivedoctor.com
- 22. Cumulative Event Rates for the Primary Outcome (Fatal CHD or Nonfatal MI) by ALLHAT Treatment Group Chlorthalidone Amlodipine Lisinopril www.freelivedoctor.com Years to CHD Event 0 1 2 3 4 5 6 7 Cumulative CHD Event Rate 0 .04 .08 .12 .16 .2 RR (95% CI) p value A/C 0.98 (0.90-1.07) 0.65 L/C 0.99 (0.91-1.08) 0.81
- 23. Overall Conclusions Because of the superiority of thiazide-type diuretics in preventing one or more major forms of CVD and their lower cost, they should be the drugs of choice for first-step antihypertensive drug therapy. www.freelivedoctor.com
- 42. From Knauf & Mutschler Klin. Wochenschr. 1991 69:239-250 70% 20% 5% 4.5% 0.5% Volume 1.5 L/day Urine Na 100 mEq/L Na Excretion 155 mEq/day 100% GFR 180 L/day Plasma Na 145 mEq/L Filtered Load 26,100 mEq/day CA Inhibitors Proximal tubule Loop Diuretics Loop of Henle Thiazides Distal tubule Antikaliuretics Collecting duct Thick Ascending Limb www.freelivedoctor.com
- 45. N N SO 2 NH 2 SO 2 NH 2 NH 2 NH 2 NH 2 SO 2 NH 2 Cl Cl SO 2 NH 2 SO 2 NH 2 Cl SO 2 NH 2 N C N SO 2 Prontosil Sulfanilamide p-chlorobenzene sulfonamide 1,3 disulfonamide 6 cholrobenzene Cholrothiazide www.freelivedoctor.com
- 47. General Structure of Thiazide Diuretics www.freelivedoctor.com
- 48. Inhibition of high-affinity 3 H-metolazone binding by ions www.freelivedoctor.com Ion % Control NaF 143±9 LiCl 4±1 NaCl 20±0.5 KCl 44±2 Choline chloride 36±7 NaBr 24±2 NaI 25±1 KI 12±2 Na acetate 82±5 K acetate 95±5 Disodium sulfate 152±22 Dipotassium sulfate 118±12 Trisodium citrate 112±5
- 49. Correlation of the daily clinical doses of thiazide diuretics with their affinity for high-affinity 3 H-metolazone binding sites in rat kidney. Correlation coefficient r=0.7513. www.freelivedoctor.com
- 52. Schematic drawing of temporal changes in mean arterial pressure (MAP), total peripheral vascular resistance (TPR), cardiac output (CO) and plasma volume (PV) during thiazide treatment of a hypertensive subject www.freelivedoctor.com
- 71. Maximum Doses of Loop Diuretics www.freelivedoctor.com Clinical Condition Dose of furosemide (mg) intravenous Oral Renal Insufficiency 0 < Cl Cr < 50 80 160 Renal Insufficiency Cl Cr < 20 200 400 Nephrotic Syndrome 120 240 Cirrhosis 40 80 Congestive Heart Failure 40-80 80-160