ilovehjamesp

[ilovehjamesp]

for 2024:

read a lot and read everything

film and art and music are what builds ur soul

be outside

love and romance will not come to you any quicker if you are focused on it constantly

possessions don't improve things

movement does improve things

university is <4 years of the rest of your life - make the most of it

find the pleasure in hard work

lose the pleasure in scrolling

creation is essential

joy, love & intelligence are the tenets of life

stagnation isn't inevitable. no person is in a fixed state. you can always change

[ilovehjamesp]

“Focus on you. People wake up with different feelings everyday.”

— Unknown

[ilovehjamesp]

[ilovehjamesp]

following the oth/leyton parallels, this quote but make it byler:

“It was a comet. The boy saw the comet and he felt as though his life had meaning. And when it went away, he waited his entire life for it to come back to him. It was more than just a comet because of what it brought to his life: direction, beauty, meaning. There are many who couldn’t understand, and sometimes he walked among them. But even in his darkest hours, he knew in his heart that someday it would return to him, and his world would be whole again… And his belief in God and love and art would be re-awakened in his heart. The boy saw the comet and suddenly his life had meaning.” ― Lucas Scott

[ilovehjamesp]

“All we have to decide is what to do with the time that is given us.”

— J.R.R. Tolkien

[ilovehjamesp]

🤣

[ilovehjamesp]

“May you pick up your tea when it’s exactly the right temperature, and may you happen to glance out the window when the light is just how you like it.”

— this is the sweetest thing I’ve ever read (via clinginess)

[ilovehjamesp]

I don't have a dream job. I want to be a fairy and sleep in a tulip

[ilovehjamesp]

someone wrote this inside of the copy of the little prince i got at the thrift store

”Life is always just today and the today you have to try to enjoy, not tomorrow or the day after”

[ilovehjamesp]

what if it all works out. HOW ABOUT THAT HUH

[ilovehjamesp]

an education

[ilovehjamesp]

How do your kidneys work?

[ilovehjamesp]

[ilovehjamesp]

Diuretics Revision

There are five classes of diuretics that have a similar end effect yet multiple modes of action. They are:

Osmotic Diuretics

Carbonic Anhydrase Inhibitors

Loop Diuretics

Thiazides

Potassium Sparing Diuretics

Osmotic Diuretics

Osmotic diuretics are generally inert compounds which are filtered by the glomeruli of the kidney yet aren’t reabsorbed from the tubule of the nephron. They act by increasing the osmolarity of the contents of the tubule. This in turn reduces the amount of water that is reabsorbed where the nephron is permeable to water such as:

Proximal Convoluted Tubule

Descending Loop of Henle

Distal Convoluted Tubule

It also has the effect of raising plasma osmolarity.

Uses include:

Acute renal failure

Decreasing raised intra-cranial pressure (Due to plasma effects)

Unwanted effects include:

Hyponatraemia due to increased extra-cellular fluid volume

Examples of an osmotic diuretic include Mannitol

Carbonic Anhydrase Inhibitors

Carbonic Anhydrase (CA) is an enzyme found within proximal tubule cells which takes part in the reaction where carbon dioxide and water form bicarbonate and hydrogen ions.

Bicarbonate and hydrogen ions in the tubular fluid are combined to form carbon dioxide and water which then diffuse into the cell. Here another CA enzyme combines them again to reverse the reaction and recreate bicarbonate and hydrogen ions. The bicarb is transported through the basal membrane into the interstitium while the hydrogen ion pumped out by a membrane transporter at the apical (tubular) end of the cell in order to bring a sodium ion in. These sodium ions are moved on into the interstitium and help maintain a higher osmolarity outside the tubules than in.

By blocking CA you prevent this downstream reuptake of sodium and as such lower the size of the concentration gradient which in turn reduces the amount of water reabsorbed.

Uses include:

Renal Stones (Uric Acid - Increased bicarb left in tubule to decrease pH)

Metabolic Alkylosis

Side effects include:

Potassium loss

Metabolic Acidosis

Examples of Carbonic Anhydrase Inhibitors include Acetazolamide

Loop Diuretics

The Loop of Henle consists of two sections, the descending limb and the ascending limb.

The descending limb is highly permeable to water while the ascending limb is not.

There is a large membrane transport protein on the tubular surface of the ascending limb cells which moves one sodium, one potassium and two chloride ions from the tubular fluid to the interstitium surrounding it. By doing so it helps to create an area of very high osmolarity surrounding the permeable descending limb which then drags water from the tubular fluid.

Loop diuretics block this large simporter and as such prevent the large concentration gratient being set up. It can reduce function by up to 30%.

Uses include:

Oedema

Moderate Hypertension

Hypercalcaemia

Hyperkalaemia

Side effects include:

Hypovolaemia

Hypotension

Potassium, magnesium and calcium loss

Metabolic Alkylosis

Examples of Loop Diuretics include Frusemide (BNN)/ Furosemide (INN)

Thiazides

Thiazides act by inhibiting sodium and chloride ion reabsorbtion in the early distal convoluted tubule. This naturally increases the osmolarity of the tubular fluid and reduces water reabsorption. Thiazides normally cause a 5 to 10% reduction in function.

Uses include:

Cardiac Failure

Hypertension

Severe Resistant Oedema

Hypercalcuria

Nephrogenic Diabetes Incipidus

Unwanted effects include:

Potassium loss (More sodium is delivered to the distal part of the DCT where it is exchanged for potassium)

Metabolic acidosis

Diabetes (Inhibits insulin secretion)

Examples of Thiazides include Bendroflumethiazide

Potassium Sparing Diuretics

There are two classes of K sparing diuretics

Aldosterone Receptor Antagonists - Spironolactone

Aldosterone Sensitive Sodium Channel Blockers -  Amiloride

Both of these groups reduce sodium reuptake in the distal tubule and also the concomitant loss of potassium by around 5%.

Uses include:

With non-potassium sparing diuretics - Amiloride

Primary/secondary hyperaldosteronism - Spironolactone

[ilovehjamesp]

(via How do our kidneys work? (Renal Anatomy) - YouTube)

[ilovehjamesp]

(via The Kidney and Nephron - YouTube)

[ilovehjamesp]

Kidney Anatomy - overview

 renal system

processes blood plasma

maintains homeostatic balance (pH, electrolytes, blood volume)

removes urea (waste product of protein metabolism)

The kidney is surrounded by perirenal fat and sits in the retroperitoneal space

Blood Supply

Path of drainage 

Collecting duct

minor calyx

major calyx

renal pelvis

ureter

urinary bladder

Nephrons

the nephron is the functional unit of the kidney. There are approx 1m nephrons per kidney