Kidney Physiopathology Flashcards
medulla of the kidney
inner part of the kidney, consists of the medullary collecting ducts, loops of Henle, vasa recta and the interstitium.
cortex of the kidney
The renal cortex is the outer part of the kidney. It contains the glomerulus and convoluted tubules
renal pelvis
The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder.
nephron
The functional unit of the kidney is the nephron. Each kidney consists of millions of nephron which plays a significant role in the filtration and purification of blood.
1.5 million
how much sodium is filtered, excreted and reabsorbed per day
filtered = 25000 mEq
excreted = 150 mEq
reabsorbed = 99%
how much water is filtered, excreted and reabsorbed per day
filtered = 180 lt
excreted = 1.5 lts
reabsorbed = 99%
podocytes
cells in Bowman’s capsule in the kidneys that wrap around capillaries of the glomerulus.
adapted to kidney function
what is in the glomerular filtrate
water
glucose
amino acids
urea
components of the filtration membrane
- capillary endothelial fenestrations
- gel like basement membrane
- slit diaphragms within filtration slits between the pedicels of podocytes
Why is ultrafiltration important
Maintaining homeostasis
where does ultrafiltration of blood occur
Across the glomerulus filtration barrier
what are 2 types of glomerulopathies
nephrotic syndrome
nephritic syndrome
Nephrotic syndrome symptoms
- high levels of protein in urine
- low albumin in blood.
-edema
-hyperlipidemia (increase triglycerides and cholesterol) - lipiduria
Nephritic syndrome symptoms
- mild levels of protein in urine
- hematuria - brown urine
- hypertension
- blurred vision
- azotemia
- oliguric
what is post streptococcal glomerulonephritis
- 10-14 days after skin or throat infection
- not caused by bacteria
- autoimmune reaction
- immune complexes deposit at the glomerular membrane
- damage filtration barrier = loss of protein/ albumin in urine
post streptococcal glomerulonephritis symptoms
- hematuria
- loss of protein = proteinuria
- decrease of albumin in blood
- edema (puffy face, pitting edema)
- oliguria
- hypertension
post streptococcal glomerulonephritis diagnosis
- kidney biopsy
- stain glomerulus
- immuno deposits
- flourescence
post streptococcal glomerulonephritis treatment
- no specific treatment
- relive symptoms
- antibiotics = destroy streptococcal bacteria
- blood pressure medicine and diuretic drugs = control swelling and high blood pressure
- corticosteroids
- anti inflammatory medicine - not effective
- limit salt in the diet = control swelling and high blood pressure
role of diuretics
drugs that increase urine output
Glomerular capillaries
have high permeability to water and electrolytes
20% of plasma = filtered into Bowmans space and PCT
exampled of diuretics
Mannitol, Acetazolamide, Furosemide, spironolactone, triamterene, amiloride
function of mannitol
*inert
*increases plasma osmolarity
*filtered at glomerulus and poorly reabsorbed
*increases osmotic pressure in glomerular filtrate
*decreases H2O reabsorption
*doesnt enter brain or eye - draws fluid from tissues
uses of mannitol
- forced diuresis (poisonings)
- actor glaucoma
- cerebral oedema
- slow IV infusion
what happens to mannitol when it gets to the tubule
eliminates and drugs all the water with it
glucose and sodium will be reabsorbed whereas mannitol is not - so drags out all the water
what happens in the proximal convoluted tubule
reabsorption of sodium water and bicarbonate
655 of sodium is reabsorbed in PCT
tubular transport of glucose
glucose nephron tubular lumen -> Proximal tubules epithelial cell -> blood capillary
via facilitated diffusion
SGLT2
- Na+/K+ ATPase on the basal membrane creates a gradient for Na+
- Na+/glucose symporter (SGLT-2) on the luminal membrane->GLUT2 transporter on the basal membrane.
how much glucose is reabsorbed normally in PCT
100% reabsorption
SGLUT2 transporter
glucose reabsorption in diabetes
hyperglycemias
high filtered load of glucose
filtered loas exceeds reabsorption capacity
glucose in urine