Pharmacology of kidney

 

Kidney is an organ which helps the excretion of drugs and at the same time controls the excretion of solutes and water. Hence it is a very important organ for pharmacology. When it fails, drug administration needs to be revised because the drugs will then not be excreted in time and their blood concentration will rise unnecessarily.

The most important area of drug action in the kidney is diuresis and this acts in four main locations.

Proximal convoluted tubules: The diuretics which act on the proximal tubules assist the loss of water without solute of which sodium ions is the most important. Example is mannitol which is used mainly to reduce intracranial pressure for that singular reason.

Loop of Henle:  Drugs which act in this region prevent Na+ ion reabsorption by inhibition of the Na+ K+ ATpase system that actively transports solute out of the loop into the medullary interstitium, thereby creating a hypertonic environment in the interstitium. They are called the  loop diuretics and they include frusemide, piretanide, torasemide, and ethacrynic acid.

Cortical dilution site: Thiazide acts on this region to prevent sodium reabsorption and inhibit the NaCl co transporter (NCCT).

Distal convoluted tubule: Diuretics acting in this site must be antagonist to aldosterone such as spinorolactone. But amiloride and triamterene act by inhibiting ENaCl. They are all potassium sparing while other diuretics are potassium loosing.m loosing

 

 

 

 

Posterior view Internal view Fresh kidney Nephron blood supply

 

 

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PAS stain in glomerulus

 

 

 

 

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