QuestionSBA
QuestionChoice
This patient has presented with the signs and symptoms of heart failure including orthopnoea, reduced exercise tolerance, dyspnoea, raised JVP and ankle oedema. Her doctor would have prescribed her a loop diuretic such as furosemide for symptomatic relief of heart failure. Loop diuretics block the Na+/K+/2Cl- co-transporter in the loop of Henle. This prevents the reabsorption of salt and water and causes a diuresis effect.
10003756
a
Loop of Henle
QuestionChoice
The patient would have been given a loop diuretic such as furosemide for symptomatic relief of her heart failure - furosemide acts on the Loop of Henle, not the proximal convoluted tubule. Carbonic anhydrase inhibitors such as acetazolamide can act on the proximal convoluted tubule and have a weak diuretic action, however, are not routinely used for heart failure management.
10003757
b
Proximal convoluted tubule
QuestionChoice
The patient will have been given a loop diuretic such as furosemide for symptomatic relief of their heart failure, which acts on the Loop of Henle, not the distal convoluted tubule. Potassium-sparing diuretics such as aldosterone antagonists (such as spironolactone) act on the late distal convoluted tubule and early collecting duct. Spironolactone can be used in heart failure but is not given purely for symptomatic relief.
10003759
d
Distal convoluted tubule
QuestionChoice
The efferent arteriole is not part of the nephron and therefore cannot be the correct answer. The efferent arteriole is targeted by ACE inhibitors and ARBs which cause vasodilation. This can be useful to target in proteinuric diseases such as diabetic nephropathy.
10003760
e
Efferent arteriole
QuestionChoice
The patient would have been given a loop diuretic such as furosemide for symptomatic relief of her heart failure - furosemide acts on the Loop of Henle, not the collecting duct. Potassium-sparing diuretics such as aldosterone antagonists (e.g. spironolactone) act on the late distal convoluted tubule and early collecting duct. Spironolactone can be indicated in heart failure but is not given for symptomatic relief.
10003758
c
Collecting duct
Concept
Chapter
2693
4196
Salt transport in loop of Henle
Topic
168
Renal Physiology
13298
A 74-year-old female is referred by her GP to the cardiology clinic. She complains of being no longer able to climb the stairs at home. When questioned, she states she uses 4 pillows in bed at night. On examination, she is dyspnoeic with a raised JVP and ankle oedema. The cardiology registrar starts her on medication for symptomatic relief.

Where on the nephron is this medication most likely to act?
a