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Renal basic science, Physiology, Embryology, Anatomy - Coggle Diagram
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Physiology
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nephron physiology
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collecting tubule
aldosterone→on mineralcorticoid receptor→protein synthesis; ↑K conductance, Na/K pump, K secretion, HCO₃⁻/Cl exchanger
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early PCT
generate and secret NH₃, which enables the kidney to secrete more H⁺
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AT Ⅱ→stimulate Na/H exchange→↑Na, H₂O, HCO₃⁻ reabsorption
all glucose and amino acids and most HCO₃⁻,Na⁺, Cl⁻,PO₄³⁻, K⁺, H₂O, and uric acid
renal tubular defect
Gitelman syndrome
metabolic alkalosis, hypomagnesemia, hypokalemia, hypocalciuria
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Liddle syndrome
metabolic alkalosis, hypokalemia, hypertension, ↓aldosterone
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Bartter syndrome
metabolic alkalosis, hypokalemia, hypercalciuria
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Fanconi syndrome
metabolic acidosis, hypophosphatemia, osteopenia
hereditary defect, multiple myeloma, drug
reabsorption defect in PCT→↑excretion of amino acids, glucose, HCO₃⁻, PO₄⁻, etc
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electrolyte disturbance
Mg
-: tetany, TdP, hypokalemia, hypocalcemia
+: ↓DTRs, lethargy, bradycardia, hypotension,
PO₄³⁻
-: bone loss, osteomalacia(骨軟化症), rickets
+: renal stone, metastatic calcification, hypocalcemia
Na
-: nausea, malaise, stupor, coma, seizure
+: irritability, stupor, coma
K
-:U wave and flattened T wave, arrhythmias, muscle cramps, spasm, weakness
+: wide QRS and peaked T wave, arrhythmias, muscle weakness
Ca
-: tetany, seizure, QT prolongation, twitching, spasm
+: stone, bone pain, abdominal pain, urinary frequency, psychiatric overtone
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kidney endocrine
calciferol (vitaminD)
PCT cells convert 25-OH vitamin D₃ to 1,25-(OH)₂ vitamin D₃ (activate)
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dopamine
secreted by PCT cell, promoting natriuresis
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filtration
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Pはこちら側から向こう側への圧力,πはこちら側に引き込む圧力
glucose clearance
at 200mg/dL, glucosuria begin, at 375mg/min (cotransporter), all transporters are fully saturated
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at normal level, glucose is completely reabsorbed in PCT by Na/glucose cotransport
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potassium shift
K into cell
hypoosmolarity, alkalosis, β-adrenergic agonist, insulin
K out of cell
digitalis, hyperosmolarity, lysis of cell, acidosis, β-blocker, high blood sugar
Embryology
metanephros
ureteric bud (尿管芽)
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give rise to ureter, pelvis, calyx, collecting duct
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permanent; first appears in 5th week of gestation; nephrogenesis continues through weeks 32-36 of gestation
aberrant interaction result in congenital malformation of the kidney (eg. renal agenesis, multicystic dysplastic kidney)
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Potter sequence
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renal failure(obstructive uropathy, bilateral renal agenesis, chronic placental insufficiency)
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horseshoe kidney
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hydronephrosis, renal stone, infection, chromosomal aneuploidy syndrome, renal cancer
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duplex collecting system
associated with vesicoureteral reflux and ureteral obstruction, ↑ risk for UTIs
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Anatomy
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course of ureters
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renal pelvis→travel under gonadal artery→ocer common iliac artery→under uterine artery/vas deferens(精管)
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