RENAL

SYSTEM/URINARY
SYSTEM

GROUP 6
RENAL/URINARY SYSTEM

• Consist of the kidneys, • Purpose:

ureters, urinary bladder, • eliminate waste from the body
and the urethra. • regulate blood volume and blood
pressure
• Control levels of electrolytes and
metabolites
• Regulate blood pH
 PARTS OF RENAL
SYSTEM
• KIDNEY
- Responsible for filtering blood, regulating fluid,
electrolyte balance.
• URETER
- Transport urine from the renal pelvis into the
bladder.
• URINARY BLADDER
- Storage of urine until it is expelled from the body
• URETHRA
- Allows urine to pass out from the body
DRUGS AFFECTING THE RENAL SYSTEM

DIURETICS
-increase the amount of urine produced by the kidneys which cause the
blood pressure to decrease
- Prevent the cells lining in the renal tubules from reabsorbing an
excessive proportion of the sodium ions in the glomerular filter
FIVE CLASSES OF DIURETICS
• Osmotic – Glomerulus and tubule
• Carbonic anhydrase inhibitors – Proximal convoluted tubule
• Loop – Loop of Henle
• Thiazides, thiazide-like – Distal convoluted tubule
• Potassium-sparing – Collecting duct and distal convoluted tubule
OSMOTIC DIURETICS
- uses hypertonic pull to remove fluid from the intravascular spaces and
to deliver large amount of water into the renal tubule
- Use to prevent kidney failure, decrease intracranial pressure and
decrease intraocular pressure
 Major site of Action
-Glomerulus
-Tubule
MANITOL
-used to prevent and treat the low output
of urine associated with kidney failure
- As it gets excreted, it draws water with it,
increasing the water excretion of the
patient and helping avoid or treat the fluid
overload caused by oliguria in acute renal
failure
ROUTE ONSET PEAK DURATION
IV 30-60 min. 1 hr. 6-8 hrs.

ADVERSE EFFECTS CONTRAINDICATIONS

-nausea -severe dehydration
-hives -progressive heart failure
-chest pain -known mannitol
-renal failure hypersensitivity
-chills -established anuria due to
-dizziness renal disease
-sore throat
THIAZIDE DIURETICS
− belong to a chemical class of drugs called the sulfonamide
− inhibits the sodium-chloride cotransporter or pump in the early part of
distal convoluted tubule (DCT)
− first-line of drugs to manage hypertension
➢ Hydrochlorothiazide (most frequently used) – to treat hypertension and
swelling due to fluid build-up
➢ Chlorothiazide (oldest drug of this class) – to treat fluid retention that
is caused by congestive heart failure, severe liver disease and kidney
disease
THERAPEUTIC ACTIONS AND INDICATIONS
• Thiazide acts to block the chloride pump
• Blocking of the chloride pump keeps the chloride and sodium in the
tubule to be excreted in the urine
• Thus, reabsorption of both chloride and sodium in the vascular system
is prevented
• Tubules are impermeable to water, there is an increase in diuretic
effect or urine produced but sodium rich (a saluretic effect)
ADVERSE EFFECTS CONTRAINDICATIONS
• GI upset • Allergy to thiazides or sulfonamides
• Fluid and electrolyte imbalances • Fluid and Electrolyte imbalances
• Urine is slightly alkalinized • Severe renal disease
• Hypotension • Systemic lupus erythematosus (SLE)
• Hypokalemia (normal level: 3.5-5 • Glucose tolerance abnormalities or
mg/dL) diabetes mellitus
• Hypercalcemia (normal level: 8.5 • Gout
-10.5 mg/dL) • Liver disease
• Hyperglycemia • Hyperparathyroidism
• Hyperuricemia • Bipolar Disorder
ROUTE ONSET PEAK DURATION

Oral 1-3 hrs. 4-6 hrs. 6-12 hrs.

METABOLISM EXCRETION

Liver Kidney/urine
LOOP DIURETICS
− named because they work on the loop of Henle
− are also referred to as high-ceiling diuretics or potassium-wasting
diuretics because they cause a greater degree of diuresis than other
diuretics do
THERAPEUTIC ACTIONS AND • Loop diuretics are commonly
INDICATIONS indicated for the treatment of the
● Loop diuretics block the chloride following:
pump in the ascending loop of 1. Acute Heart Failure (HF)
Henle, where normally 30% of all
2. Acute Pulmonary Edema
filtered sodium is reabsorbed.
3. Edema associated with HF or
● These drugs work even in the
with renal or liver disease
presence of acid–base
disturbances, renal failure, 4. Hypertension
electrolyte imbalances, or nitrogen
retention.
MAJOR ADVERSE CONTRAINDICATIONS
EFFECTS
● hypokalemia
• Allergy to a loop diuretic

● volume depletion • Electrolyte depletion

● hypotension • Anuria
● CNS effects • Hepatic coma
● GI upset
● hyperglycemia
ROUTE ONSET PEAK DURATION

Oral 1 hr. 1-2 hrs. 4-6 hrs.

IV 5 mins. 30 mins. 2 hrs.

CARBONIC ANHYDRASE
INHIBITORS
− are relatively mild diuretics
− available agents include acetazolamide
(Diamox) and methazolamide (generic)
− the carbonic anhydrase inhibitors
acetazolamide, dichlorphenamide,
ethoxzolamide, and methazolamide
block the action of the enzyme carbonic
anhydrase, which is needed to maintain
the body’s acid-base balance (hydrogen
and bicarbonate ion balance).
− used primarily to decrease IOP in
patients with open-angle (chronic)
glaucoma. These drugs are not
used in narrow-angle or acute glaucoma.
− other uses include diuresis,
management of epilepsy, and treatment
of high-altitude or acute mountain
sickness.
− may also be used for a patient in
metabolic alkalosis who needs a diuretic.
Carbonic anhydrase inhibitors may be
alternated with a loop diuretic.
THERAPEUTIC ACTIONS AND INDICATIONS
● The enzyme carbonic anhydrase is a catalyst for the formation of
sodium bicarbonate, which is stored as the alkaline reserve in the renal
tubule, and for the excretion of hydrogen, which results in a slightly
acidic urine.
● block the effects of carbonic anhydrase slow down the movement of
hydrogen ions; as a result, more sodium and bicarbonate are lost in the
urine.
● used as adjuncts to other diuretics when a more intense diuresis is
needed.
 ACETAZOLAMIDE
- Reduces absolute and fractional
tubular reabsorption of sodium
and water, and glomerular
filtration rate
- Increase potassium ion and
sodium ion loss inti tubular fluid,
producing alkaline urine
- Inhibits carbonic anhydrase,
which decreases aqueous
humor formation in the eye,
intra ocular pressure and
hydrogen secretion by the renal
tubules
SIDE EFFECTS AND ADVERSE
REACTIONS
• can cause fluid and electrolyte
imbalance, metabolic acidosis,
nausea, vomiting, anorexia,
confusion, orthostatic
hypotension, and crystalluria.
• Hemolytic anemia and renal
calculi can also occur.
CONTRAINDICATIONS
• These drugs are contraindicated
during the first trimester of
pregnancy
• Patients with allergy to the drug
or to antibacterial sulfonamides
or thiazides or in patients with
chronic no congestive angle-
closure glaucoma
ROUTE ONSET PEAK DURATION

Oral 1 hr. 2-4 hr. 6-12 hr.

IV 1-2 min. 15-18 min. 4-5 hr.

METABOLISM EXCRETION

Liver Kidney/urine
POTASSIUM-SPARING DIURETICS
- Act primarily in the collecting duct renal tubules and late distal tubule
to promote sodium and water excretion and potassium retention
- Primarily used in combinations with other diuretics
E.g.
-spironolactone
-amiloride
-triamterene
SPIRONOLACTONE
- Prevents chronic kidney disease ROUTE ONSET PEAK DURATIO
N
caused by ischemic acute kidney
Oral 24-48 hr. 48-72 hr. 72 hr.
injury
- Acts as an aldosterone
antagonist, blocking the actions
METABOLISM EXCRETION
of aldosterone in the distal
tubule Liver Kidney/urine
ADVERSE EFFECTS
-palpitations
CONTAINDICATIONS
-dehydration
-anuria
-vomiting
-hyperkalemia
-diarrhea
-severe renal impairment
-skin rash
- Allergy to drug components
-dizziness
OTHER DRUGS

ANGIOTENSIN CONVERTING ENZYME (ACE)

INHIBITORS
-effectively reduce systemic vascular resistance
in patients with hypertension, heart failure or
E.g.
chronic renal disease -captopril
- Decrease the amount of albumin in the urine -enalapril
- Reduces potassium excretion that can lead to -fosinopril
hyperkalemia and variable effects on the
-lisinopril
natriuretic response to diuretics
ADVERSE EFFECTS CONTRAINDICATIOS
-first-dose hypotension -pregnant/breastfeeding mother
-hyperkalemia -history of angioedema
-skin rashes -severe kidney disease
-dysgeusia -allergy to ACE inhibitors
-extreme tiredness -very low blood pressure
ROUTE ONSET PEAK DURATION
Oral 1 hr. 6 hr. 24 hr.
IV 1 hr. 4-6 hr. varies

METABOLISM EXCRETION

Liver Kidney/urine
 URINARY ANTISEPTICS
- Drugs used for urinary tract infection (UTI) which kill or inhibit the growth
of different bacteria in the urine
A. Sulphanomide
- Used to treat infections causes by susceptible organism in the urinary
tract
B. Methanamide
- Contains ingredient that helps to make the urine acidic
- Used to prevent or stop the growth of bacteria in the urine
C.
-