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Renal System (Physiology (Functions of the Kidney (Excretion (Water, Salts…
Renal System
Physiology
Functions of the Kidney
Metabolism
Gluconeogenesis
Excretion
Water
Salts
Metabolites
Foreign Substances
Hormones
Erythropoietin
Calcitriol
Homeostasis
Acid-Base
Electrolyte
Processes of the Nephron
Functions of the Nephron
Filtration
Factors Affecting Glomerular Filtration
Glomerular Hydrostatic Pressure
Glomerular Colloid Osmotic Pressure
Bowman's Capsule Pressure
Glomerular Filtration
GFR = U x V / P
Vascular Control
Increase GFR
Afferent Arteriole Vasodilate
Efferent Arteriole Vasoconstrict
Decrease GFR
Afferent Arteriole Vasoconstrict
Efferent Arteriole Vasodilate
Reabsorption
Pathways of Reabsorption
Transport Systems on Renal Epithelium! :red_flag:
Secretion
Net Excretion
Substances Excreted
Sugar
All Reabsorbed
Some Filtered
None Secreted
Sodium
Some Secreted
Some Reabsorbed
Some Filtered
Creatinine
None Secreted
None Reabsorbed
Almost all Filtered
Factors Affecting Net Excretion
Amount Filtered
Amount Reabsorbed
Amount Secreted
Water Homeostasis
Salt Homeostasis
Acid Base Homeostasis
Acute Kidney Injury
Key Conditions
Glomerulonephritis
Etiology
Host Immune Response to Antigen
Deposition of Immunoglobulins and Lymphocytes in Glomerulus
Mechanisms of Immune Injury to Glomerulus
Direct Antibody Injury
Macrophage Recruitment by Fc Fragments
Lymphokines from Activated T-Cells
Polymorphonuclear Lymphocyte recruitment from Complement Chemotaxis
Complement Membrane Attack Complex
Possible Immunopathogenesis
Circulating Immune Complex Trapping
E.g.
Post-Infectious Membranoproliferative Glomerulonephritis
IgA Nephropathy
In Situ Immune Deposition onto Exogenous Antigens
E.g.
Lupus Nephritis
In Situ Immmine Deposition onto Endogenous Antigens
E.g.
Anti Glomerular Basement Membrane Glomerulonephritis Antigen (Collagen)
Membranous Antigen (PLA2R)
Patterns of Injury
Endothelial Pattern in Contact with Circulation
Presenting Syndromes
Nephritic Glomerulonephritis
Nephritic Symptoms
Haematuria
Oedema
Hypertension
Oliguria
RPGN
APSGN
Nephrotic Glomerulonephritis
Nephrotic Glomerulonephritis
Nephrotic Symptoms
Proteinuria
Hypoalbuminaemia
Oedema
Hyperlipidaemia
Lipiduria
Membranous Nephropathy
Management
Self Resolution
Progression to Crescentic Glomerulonephritis
Self Resolution
Progression to End Stage Kidney Disease
Diagnosis
Renal Biopsy
Immunofluorescence
Granular Appearance
Haphazard Deposition
Circulating or In-Situ Foreign Antigen Complex
Linear Appearance
Anti-GBM Antibodies
Acute Kidney Injury
Definition
An Abrupt Reduction in Kidney Function (within 48hrs)
More than 22.4umol/L increase in Serum Creatinine
50% increase in Serum Creatinine
Oliguria <0.5ml/kg/hr for >6hrs
Etiologies
Pre Renal
Haemodynamic Insult
Renal
Ischaemic
Toxic
Immunologic
Post Renal
Obstruction
Presentation
Case
Pathophysiology
Kidneys highly sensitive to changes in BP
Hypotensive Insult
Reduced Renal Perfusion
Reduced GFR
Medullary Ischaemia
Acute Tubular Necrosis
1 more item...
Arteriolar Vasoconstriction
NSAIDS also
Loss of Role of Vasa Recta
Countercurrent Mechanism
Hypoxic Environment
Management
Hypertension
Etiology
Presentation
Pathophysiology
Management
Diabetic Kidney Disease
Presentation
Etiology
Pathophysiology
Management
Polycystic Kidney Disease
Chronic Kidney Disease
Presentation
Etiology
Management
Pathophysiology
Anatomy
Kidneys
Ureters
Bladder
Urethra
Pharmacology
ACEi
ARB
Diuretics