A client has severe protein malnutrition and is taking a drug that is 99% bound to albumin. Which alteration of drug concentration in the urinary filtrate will occur?
1. An increase in the amount of drug actively secreted across the walls of the renal tubule
2. A decrease in the amount of drug reabsorbed across the walls of the renal tubule
3. An increase in the amount of drug filtered into Bowman's capsule
4. An increase in the amount of drug passively secreted across the walls of the renal tubule
Correct Answer: 3
Rationale 1: Plasma protein concentration does not alter the process of active secretion of drug molecules into the filtrate.
Rationale 2: Plasma protein concentration does not inhibit the process of tubular reabsorption.
Rationale 3: A decrease in albumin concentration increases the proportion of free drug in the plasma available to be filtered into Bowman's capsule.
Rationale 4: Secretion is an active process.
Global Rationale: A decrease in albumin concentration increases the proportion of free drug in the plasma available to be filtered into Bowman's capsule. Plasma protein concentration does not alter the process of active secretion of drug molecules into the filtrate. Plasma protein concentration does not inhibit the process of tubular reabsorption. Secretion is an active process.
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