Outline Chapter 15 — Clinical Use of Diuretics - Among most commonly used drugs - Block NaCl reabsorption at different sites along the nephron - The ability to induce negative balance has made them useful in multiple diseases - Edematous states - Hypertension - Mechanism of action - Three major classes - Loop - NaK2Cl - Up to 25% of filtered sodium excreted - Thiazide - NCC - Up to 3-5% of filtered sodium excreted - Potassium sparing - ENaC - Up to 1-2% of filtered sodium excreted - Each...

Outline Chapter 14 — Treatment - Treatment - Both oral and IV treatment can be used for volume replacement - The goal of therapy are to restore normovolemia - And to correct associated acid-base and electrolyte disorders - Oral Therapy - Usually can be accomplished with increased water and dietary sodium - May use salt tablets - Glucose often added to resuscitation fluids - Provides calories ...

Outline Chapter 14 - Hypovolemic States - Etiology - True volume depletion occurs when fluid is lost from from the extracellular fluid at a rate exceeding intake - Can come the GI tract - Lungs - Urine - Sequestration in the body in a “third space” that is not in equilibrium with the extracellular fluid. - When losses occur two responses ameliorate them - Our intake of Na and fluid is way above basal needs - This is not the case...

References JC mentioned that the diagnostic accuracy of 24 hour urine collection increases with more collections! Metabolic evaluation of patients with recurrent idiopathic calcium nephrolithiasis We didn't refer to a particular study on sodium intake and the 24 hour urine but this meta-analysis Comparison of 24‐hour urine and 24‐hour diet recall for estimating dietary sodium intake in populations: A systematic review and meta‐analysis - PMC 24‐hour diet recall underestimated population mean...

References We considered the complexity of the machinery to excrete ammonium in the context of research on dietary protein and how high protein intake may increase glomerular pressure and contribute to progressive renal disease (many refer to this as the “Brenner hypothesis”). Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic...

The Channelers went where no nephrology podcasters have gone before, recording in front of a live audience at the National Kidney Foundation Clinical Meeting in Austin. We had all eight Channelers doing a live podcast.We did a Freely Filtered-inspired draft of the best diuretics. The draft order: Leticia Rolon Anna Gaddy Joel Topf Roger Rodby Josh Waitzman Amy Yau JC Velez And Melanie Hoenig References JC Tolvaptan in Later-Stage Autosomal Dominant Polycystic Kidney...

References We considered the effect of a high protein diet and potential metabolic acidosis on kidney function. This review is of interest by Donald Wesson, a champion for addressing this issue and limiting animal protein: Mechanisms of Metabolic Acidosis-Induced Kidney Injury in Chronic Kidney Disease Hostetter explored the effect of a high protein diet in the remnant kidney model with 1 ¾ nephrectomy. Rats with reduced dietary acid load (by bicarbonate supplementation) had less tubular...

References for Chapter 10 We did not mention many references in our discussion today but our listeners may enjoy some of the references below.  Effects of pH on Potassium: New Explanations for Old Observations - PMC although the focus of this article is on potassium, this elegant review by Aronson and Giebisch reviews intracellular shifts as it relates to pH and K+. Josh swooned for Figure 10-1 is this right? Which figure was it? which shows the relationship between [H+] and pH. You can find...

References for Chapter 9 One of the few papers that Rose wrote as a single author explores electrolyte free water clearance. This seminal paper explores the issue in greater detail than the book. A New approach to disturbances in the plasma sodium concentration Wondering about the volume of sweat? Josh taught us that the volume of “transepidermal volume loss” is not affected by humidity https://www.jidonline.org/article/S0022-202X(15)48145-X/pdf but is greatly affected by temperature: Skin...

References for chapter 8 Robert Schrier proposed a unifying hypothesis to explain the sodium retention seen in edematous states like cirrhosis and heart failure, coining the term effective arterial blood volume (EABV). An open access review in JASN 2007 can be found here:  https://jasn.asnjournals.org/content/18/7/2028#ref-3   John P Peters ASN Annual Award: https://www.asn-online.org/about/awards/award.aspx?awh_key=0ea83199-f86d-4506-9507-d7e4ce688cb4 Short article discussing contributions...

Chapter 7 References Sands JM, Blount MA and Klein JD. Regulation of Renal Urea Transport by Vasopressin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116377/ In this invited piece, Sands and colleagues explain that although urea is permeable across membranes, this is slow, thus urea transporters in the kidney, under control of vasopressin, are needed to facilitate transport and create the medullary gradient.  Text book using 20% of extracellular compartment being in the intravascular...

Deep dive into ANP, PTH, vitamin D, prostaglandins, and Epo.

Deep dive in to ADH and Aldo and Stories. Lots and lots f stories.

References for Chapter 5--the Distal Nephron Roger pointed out the fact that the distal nephron can achieve very low urinary sodium as evidenced by observations in people from the Yanomamo tribe Blood pressure and electrolyte excretion in the Yanomamo Indians, an isolated population in this report, 84% of the participants had urinary sodium 1mmol/24 hours.  Information about the Yanomamo Tribe. It looks like they’re starting to make chocolate, now!  Yanomami The Yanomami are great observers...

Show notes with a full set of references are available here: http://www.rosebook.club/episodes/2021/6/22/chapter-four Also, please fill out our listener survey: https://forms.gle/DVdcJikKZkzY56mXA

Chapter Three: How the proximal tubule is like Elizabeth Warren and other truths my friends from Boston taught me ...

The exciting conclusion to Chapter Two: Renal Circulation and Glomerular Filtration Rate - Determinants of GFR     - First step in making urine is separation of an ultrafiltrate     - Governed by starling forces         - Balance of hydraulic and osmotic forces         - GFR = LpS (P gc – P us - Osmotic Pressure Cap p)             - Normal GFR 95 in women, 120 in men             - Cap Hydrolic pressure remains constant              - glom cap Oncotic progressively...

Back by popular demand…all two of you…the second chapter of The Clinical Physiology of Acid Base and Electrolyte Disorders. ...

The Channel Gang discusses the name of their new podcast and then discuss chapter one of The Book.