renal organ system

Upload: walt65

Post on 24-Feb-2018

227 views

Category:

Documents


0 download

TRANSCRIPT

  • 7/25/2019 Renal Organ System

    1/161

    Renal organ system

  • 7/25/2019 Renal Organ System

    2/161

    Cortical andjuxtamedull

    arynephrons

    2

  • 7/25/2019 Renal Organ System

    3/161

    Renal corpuscle

    3

  • 7/25/2019 Renal Organ System

    4/161

  • 7/25/2019 Renal Organ System

    5/161

    Normal glomeruli

  • 7/25/2019 Renal Organ System

    6/161

    The glomerular fltration barrier

    1. Capillaryendothelium

    2. Basementmembrane

    3. pithelial layer

    !. "iltration slits o#the podocytes

    $

    %

    %

    %

  • 7/25/2019 Renal Organ System

    7/161

    Tubularcell

    &nterstitial'uidTubul

    ar

    lumen

  • 7/25/2019 Renal Organ System

    8/161

    (istribution o# body )2*

    &ntracellular 'uid

    xtracellular 'uid

  • 7/25/2019 Renal Organ System

    9/161

    &ntracellular 'uid +&C",

    &s 2-3 o# TB

    The major cations o# &C" are /0 andg00

    The major anions o# &C" are proteinand organic phosphates

  • 7/25/2019 Renal Organ System

    10/161

    xtracellular 'uid

    &s 1-3 o# TB

    Composed o# interstitial 'uid andplasma

    The major cation o# C" is Na0

    The major anions are Cl and )C*3

  • 7/25/2019 Renal Organ System

    11/161

    lasma

    1-! o# C"

    1-12 o# TB +1-! 4 1-3,

    The major plasma proteins arealbumin and globulins

  • 7/25/2019 Renal Organ System

    12/161

    &nterstitial 'uid

    &s 3-! o# C"

    is 1-! o# TB

    &ts composition 5 plasma exceptthat has a little protein

    &nterstitial 'uid is an ultrafltrate o#plasma

  • 7/25/2019 Renal Organ System

    13/161

    $6!626 rule

    TB is $67 o# body 8eight

    &C" is !67 o# body 8eight

    C" is 267 o# body 8eight

  • 7/25/2019 Renal Organ System

    14/161

    easuring the 9olumes o# the 'uidcompartments

    (ilution method: a /no8n amount o#substance is gi9en 8hose 9olume o#distribution is the body 'uid

    compartment o# interest

    1. Tritiated 8ater: mar/er #or TB

    2. annitol; inulin: mar/ers #or C"

    3. Radiolabeled albumin mar/er #orplasma 9olume

  • 7/25/2019 Renal Organ System

    15/161

    xercise

    < patient is injected 8ith =66 mg o#mannitol. uilibration period;the ?mannitol@ in plasma is 3.2 mg-166 mA.

    (uring the e>uilibration period; 167 o# themannitol is excreted in urine. hat is thepatients C" 9olume

    Dolume 5 amount-concentration 5

  • 7/25/2019 Renal Organ System

    16/161

    Clearance

    Dolume o# plasma cleared o# asubstance per unit time +mA-2! hrs,

    C 5 FD- +mA-min or mA-2! hr,

    here:

    F 5 Frine concentration +mg-mA,

    D 5 Frine 9olume-time +mA-min, 5 lasma concentration+mg-mA,

  • 7/25/2019 Renal Organ System

    17/161

    xercise

    plasma ?Na0@ is 1!6 m>-A; theurine ?Na0@ is G66 m>-A; and theurine 'o8 rate is 1 mA-min; 8hat is

    the clearance o# Na0

    CNa05 ?F@Na0 x D-?@Na0 5

    G66 m>-A x 1 mA-min E 1!6 m>-A

    5

    = mA-min

  • 7/25/2019 Renal Organ System

    18/161

    Clearance; reabsorption;secretion

    Cx H I"R: net tubular reabsorption o#J

    Cx K I"R: net tubular secretion o# J

    C 5 I"R: no net secretion orreabsorption

  • 7/25/2019 Renal Organ System

    19/161

    easurement o# I"R: clearance o# inulin

    &nulin is #reely fltered

    Not reabsorbed or secreted by renaltubules

  • 7/25/2019 Renal Organ System

    20/161

    I"R calculation

    I"R 5 Cinulin5 ?F@inulinx D-?@inulin+mA-min,

    ?F@inulin5 urine concentration o#inulin +mg-mA,

    D 5 urine 'o8 rate +mA-min,

    ?@inulin5 plasma concentration o#inulin +mg-mA,

  • 7/25/2019 Renal Organ System

    21/161

    xercise

    &nulin is in#used in a patient to achie9e asteadystate plasma concentration o# 1 mg-mA.< urine sample collected during 1 hour has a9olume o# $6 mA and a inulin concentration o#126 mg-mA. hat is the patients I"R

    I"R 5 ?F@inulin x D-?@inulin 5

    126 mg-mA x $6 mA-hr E 1 mg-mA 5 126 mg-mA x 1 mA-min E 1 mg-mA 5 126

    mA-min

  • 7/25/2019 Renal Organ System

    22/161

    stimates o# I"R 8ith BFN

    and serum ?creatinine@ Both BFN and serum ?creatinine@

    increase 8hen I"R decreases

    &n prerenal aLotemia BFN increasesK serum creatinine

    &n prerenal aLotemia BFN-creatinine

    ratio increases +K 26:1,

    t # R"

  • 7/25/2019 Renal Organ System

    23/161

    easurement o# R":clearance o# para

    aminohippuric acid +

  • 7/25/2019 Renal Organ System

    24/161

    R" calculation

    R" 5 C

  • 7/25/2019 Renal Organ System

    25/161

    easurement o# Renal blood 'o8+RB",

    RB" 5 R"-1 %hematocrit

  • 7/25/2019 Renal Organ System

    26/161

    "iltration #raction

    &s the #raction o# RB" fltered acrossthe glomerular capillaries

    "iltration #raction 5 I"R-RB"

    Normally about 6.26 +267 o# the R"is fltered,

  • 7/25/2019 Renal Organ System

    27/161

    &ncreases in the fltration#raction &ncrease the ?protein@ in the tubular

    capillary blood

    &ncrease reabsorption in the proximaltubule

  • 7/25/2019 Renal Organ System

    28/161

    (ecreases in the fltration#raction (ecrease the ?protein@ o# peritubular

    capillary blood

    (ecrease reabsorption in theproximal tubule

  • 7/25/2019 Renal Organ System

    29/161

    (etermining I"R: Otarling#orces

    2P

  • 7/25/2019 Renal Organ System

    30/161

    Changes in glomerulardynamics: I"R; RB"; ""

    1. Constriction o#aMerent arteriole

    2. Constriction o#

    eMerent arteriole3. &ncreased plasma

    ?protein@

    !. (ecreased plasma?protein@

    =. Freteral obstruction

  • 7/25/2019 Renal Organ System

    31/161

    Oummary o# changes in glomerulardynamics

    Efect RFP GFR Filtrationraction

    (FF)

  • 7/25/2019 Renal Organ System

    32/161

    Tubuloglomerular #eedbac/

    &ncreased renal arterial pressureleads to increased deli9ery o# 'uid tothe macula densa

    The macula densa senses theincreased load and causesconstriction o# nearby aMerent

    arteriole Resistance increases to maintain

    constant blood 'o8

  • 7/25/2019 Renal Organ System

    33/161

    Renal 9ascular disease

    (ecrease renal blood 'o8

    &ncrease the release o# renin

    Renal artery fbromuscular dysplasia+hyperplasia,

    Renal artery atherosclerosis

  • 7/25/2019 Renal Organ System

    34/161

    "ree8ater clearance

    &s used to estimate the ability toconcentrate or dilute the urine

  • 7/25/2019 Renal Organ System

    35/161

    "ree 8ater

    roduced in the diluting segment+thic/ ascending loop o# )enle, o# the/idney

  • 7/25/2019 Renal Organ System

    36/161

    Calculation C)2*

    C)2*5DC*O

    here:

    C)2* 5 #ree%8ater clearance+mA-min,

    D 5 urine 'o8 rate +mA-min,

    C*O

    5 osmolar clearance+F*OD-*O, ?mA-min@

  • 7/25/2019 Renal Organ System

    37/161

    xample

    the urine 'o8 rate is 16 mA-min; urineosmolarity is 166 m*sm-A and plasmaosmolarity is 366 m*sm-A; 8hat is the #ree

    8ater clearance

    C)2* 5D % C*O

    C)2* 5 16 mA-min % +C*O 5 166 m*sm-A J16 mA-min E 366 m*sm-A,

    C)2* 5 16 mA-min % 3.33 mA-min 5 0$.G

    mA-min

  • 7/25/2019 Renal Organ System

    38/161

    C)2* and

  • 7/25/2019 Renal Organ System

    39/161

    Reabsorption and secretionrates

    "iltered load: I"R x x

    xcretion rate: D x Fx

    Reabsorption: fltered % excreted

    Oecretion: excreted % fltered

  • 7/25/2019 Renal Organ System

    40/161

    Ilucose clearance

    Ilucose at a normal plasma le9el iscompletely reabsorbed in proximaltubule

  • 7/25/2019 Renal Organ System

    41/161

  • 7/25/2019 Renal Organ System

    42/161

    Reninagiotensinaldosteronesystem

  • 7/25/2019 Renal Organ System

    43/161

    Renin

    Otimuli #or release

    1. (ecreased blood pressure in SI cells

    2. (ecreased Na0 deli9ery to maculadensa cells

    3. &ncreased sympathetic tone +1receptors,

    . "unction

    Con9ert angiotensinogen intoangiotensin

  • 7/25/2019 Renal Organ System

    44/161

    1

    1 1

  • 7/25/2019 Renal Organ System

    45/161

  • 7/25/2019 Renal Organ System

    46/161

  • 7/25/2019 Renal Organ System

    47/161

  • 7/25/2019 Renal Organ System

    48/161

    echanism o# aldosterone

  • 7/25/2019 Renal Organ System

    49/161

  • 7/25/2019 Renal Organ System

    50/161

    echanism o# action o#

  • 7/25/2019 Renal Organ System

    51/161

  • 7/25/2019 Renal Organ System

    52/161

    rythropoietin

    Released in response to hypoxia#rom endothelial cells o# peritubularcapillaries

    &ncreases erythropoiesis

  • 7/25/2019 Renal Organ System

    53/161

    rostaglandins

    aracrine secretion 9asodilatesaMerent arterioles to increase I"R

    &n9ol9ed in

  • 7/25/2019 Renal Organ System

    54/161

  • 7/25/2019 Renal Organ System

    55/161

    V0 shi#ts out o# cells: hyper/alemia

    &nsulin defciency: Q Na0-V0

  • 7/25/2019 Renal Organ System

    56/161

    V0 shi#ts into cells:hypo/alemia

    &nsulin: Na0-V0

  • 7/25/2019 Renal Organ System

    57/161

    Renal )0 handling; acid basephysiology

    xcretion o# )0 as titratable

  • 7/25/2019 Renal Organ System

    58/161

    xcretion o# )0 as titratableacid

    (epends on the amount o# urinarybuMer present +)2*!,

    &n urine the )0 combines 8ith

    fltered )*!W to #orm )2*!

    )2*! is excreted as titratable acid

  • 7/25/2019 Renal Organ System

    59/161

    xcretion o# )0 as N)!0

    The amount o# )0 excreted as N)!0depends on:

    1.The amount o# N)3 produced by renal

    cells2. Frine p)

    . )0 excretion as N)!0 increases as the

    p) o# tubular 'uid decreases.

  • 7/25/2019 Renal Organ System

    60/161

    )0 excretion as N)!0

    $6

  • 7/25/2019 Renal Organ System

    61/161

  • 7/25/2019 Renal Organ System

    62/161

  • 7/25/2019 Renal Organ System

    63/161

    Oerum anion gap

    ?Na0@ % +?Cl@ 0 ?)C*3@,

    Normal range is X1$ m>-A

    Represents unmeasured anions inserum

    1. hosphate

    2. Citrate

    3. Oul#ate

    !. rotein

  • 7/25/2019 Renal Organ System

    64/161

    Normal anion gap alteration

    hen the ?Cl@ is increased to replace)C*3

    &ncreased anion gap

  • 7/25/2019 Renal Organ System

    65/161

    &ncreased anion gapalteration

    hen the ?@ o# an unmeasured anionis increased to replace )C*3

  • 7/25/2019 Renal Organ System

    66/161

    etabolic acidosis

    &ncreased ?)0@

    (ue to o9erproduction or ingestion o#a fxed acid or loss o# base

    )C*3 decreases as it is used as abuMer

    "eatures o# metabolic

  • 7/25/2019 Renal Organ System

    67/161

    "eatures o# metabolicacidosis

    )C*3: decreased

    C*2: decreased

    ?)0@: increased

    Causes o# normal anion gap

  • 7/25/2019 Renal Organ System

    68/161

    Causes o# normal anion gapmetabolic acidosis

    (iarrhea ; glue sniYng

    Type & +distal, renal tubular acidosis

    1. (e#ect in collecting tubules ability to excrete )0

    2. )ypo/alemia; ris/ #or Ca00 /idney stones.Type && +proximal, renal tubular acidosis

    1. (e#ect in proximal tubule )C*3 reabsorption

    2. )ypo/alemia; hypophosphatemic ric/ets

    .Type &D +hyper/alemic, renal tubular acidosis

    1. )ypoaldosteronism-lac/ o# response toaldosterone

    2. )yper/alemia;QN)! excretion in proximal tubule

    Causes o# high anion gap metabolic

  • 7/25/2019 Renal Organ System

    69/161

    Causes o# high anion gap metabolicacidosis

    Vetoacidosis

    Aactic acidosis

    Chronic renal #ailure +uremia,

    Oalicylate intoxication

    ethanol-#ormaldehyde intoxication

    thylene glycol intoxication &ron tablets; &N)

    Compensation #or metabolic

  • 7/25/2019 Renal Organ System

    70/161

    Compensation #or metabolicacidosis

    )yper9entilation

  • 7/25/2019 Renal Organ System

    71/161

    etabolic al/alosis

    (ecreased arterial )0

    (ue to loss o# fxed )0 or gain o#base

  • 7/25/2019 Renal Organ System

    72/161

    "eatures o# metabolical/alosis

    )C*3: increased

    C*2: &ncreased

    )0: decreased

    Causes o# metabolic

  • 7/25/2019 Renal Organ System

    73/161

    Causes o# metabolical/alosis

    Domiting

    )yperaldosteronism

    Aoop and thiaLide diuretics

  • 7/25/2019 Renal Organ System

    74/161

    Compensation #or metabolical/alosis

    )ypo9entilation

    Opecial situation: 9olume contraction

  • 7/25/2019 Renal Organ System

    75/161

    Opecial situation: 9olume contractionmetabolic al/alosis

    The reninangiotensin &&aldosteronesystem acti9ates

    The reabsorption o# )C*3 increases

    The metabolic al/alosis 8orsens

  • 7/25/2019 Renal Organ System

    76/161

    Respiratory acidosis

    Caused by a decrease in respiratoryrate and retention o# C*2

    C*2increases

    )0 and )C*3 &ncrease

    Causes o# respiratory

  • 7/25/2019 Renal Organ System

    77/161

    Causes o# respiratoryacidosis

    Oedati9ehypnotics; generalanesthetics

    Neurologic diseases +IBO;

  • 7/25/2019 Renal Organ System

    78/161

    Compensation #or respiratoryacidosis

    &ncreased excretion o# )2*! andN)!0

    &ncreased reabsorption o# ne8 )C*3

    &ncreased C*2supplies more )0 tothe renal cells #or secretion

    &ncreased )C*3 normaliLes p)

    i l/ l i

  • 7/25/2019 Renal Organ System

    79/161

    Respiratory al/alosis

    Caused by an increased respiratory rate

    (ecreased C*2results in a decrease in)0 and )C*3

    "eatures:1. C*2: decreased

    2. )0: decreased

    3. )C*3: decreased!. )ypocalcemia

    Causes o# respiratory

  • 7/25/2019 Renal Organ System

    80/161

    Causes o# respiratoryal/alosis

    neumonia and pulmonary embolus

    )igh altitude

    sychogenic

    Oalicylate intoxication

    Compensation #or respiratory

  • 7/25/2019 Renal Organ System

    81/161

    Compensation #or respiratoryal/alosis

    (ecreased excretion o# )2*! andN)!0

    (ecreased C*2causes a defcit o#

    )0 in the renal cells #or secretion (ecreased reabsorption o# ne8 )C*3

  • 7/25/2019 Renal Organ System

    82/161

    C t i i

  • 7/25/2019 Renal Organ System

    83/161

    Casts in urine

    &ndicate renal disease

    RBC t

  • 7/25/2019 Renal Organ System

    84/161

    RBC casts

    Ilomerulonephritis

    &schemia

    alignant hypertension

    hit bl d ll t

  • 7/25/2019 Renal Organ System

    85/161

    hite blood cell casts

    Tubulointerstitial in'ammation

  • 7/25/2019 Renal Organ System

    86/161

    Iranular casts

  • 7/25/2019 Renal Organ System

    87/161

    axy casts

  • 7/25/2019 Renal Organ System

    88/161

    )yaline casts

    Non specifc

    " tt t

  • 7/25/2019 Renal Organ System

    89/161

    "atty casts

    Nephrotic syndrome

    Ilomerular disorders

  • 7/25/2019 Renal Organ System

    90/161

    Ilomerular disorders

    Nephrotic syndrome

    Nephritic syndrome

    Rapidly progressi9e

    glomerulonephritis

    Normal glomerulus

  • 7/25/2019 Renal Organ System

    91/161

    Normal glomerulus

    Nephritic syndrome

  • 7/25/2019 Renal Organ System

    92/161

    Nephritic syndrome

    &n'ammatory process hen it in9ol9es glomeruli:

    Aeads to hematuria and RBCs casts in

    urine

  • 7/25/2019 Renal Organ System

    93/161

    p pglomerulonephritis

    ost #re>uently seen in children eripheral and periorbital edema

    Resol9es spontaneously

    Aight microscope:1. nlarged; hypercellular glomeruli 8ith

    neutrophils

    2. Zlumpybumpy[ appearance

    . lectron microscope: subepithelial immunecomplexes; humps

    . &mmuno'uorescence: granular pattern

  • 7/25/2019 Renal Organ System

    94/161

    pithelial

  • 7/25/2019 Renal Organ System

    95/161

    pimmunocomplexes

    Iranular appearance on

  • 7/25/2019 Renal Organ System

    96/161

    ppimmuno'uorescence +&",

    Rapidly progressi9e +crescentic,

  • 7/25/2019 Renal Organ System

    97/161

    p y p gglomerulonephritis

    oor prognosis tiology:

    1. Ioodpasture syndrome: linear &"

    2. egener granulomatosis: c

  • 7/25/2019 Renal Organ System

    98/161

    p ypIoodpastures syndrome

    Crescent proli#eration

  • 7/25/2019 Renal Organ System

    99/161

    Crescent proli#eration

    Crescent appearance on &"

  • 7/25/2019 Renal Organ System

    100/161

    Crescent appearance on &"

    (iMuse proli#erati9e

  • 7/25/2019 Renal Organ System

    101/161

    glomerulonephritis

    tiology:1. Aupus +CC o# death,

    2. embranous proli#erati9e glomerulonephritis

    3. Can present as nephrotic syndrome. icroscopy:

    1. Oubendothelial (N

  • 7/25/2019 Renal Organ System

    102/161

    deposits

    Bergers disease +&g

  • 7/25/2019 Renal Organ System

    103/161

    glomerulonephropahty,

    *#ten presents 8ith a FR& or acutegastroenteritis

    &ncreased synthesis o# &gue stones

    Tx: al/aliniLation o# urine

  • 7/25/2019 Renal Organ System

    121/161

    /idney disease

    ultiple; large; bilateral cysts destroyingparenchyma

    nlarged /idneys

    utation in

  • 7/25/2019 Renal Organ System

    122/161

    /idney disease

    &n#antile presentation in parenchyma uence

    )ypertension; portal hypertension;

    progressi9e renal insuYciency

  • 7/25/2019 Renal Organ System

    123/161

    Renal cell carcinoma

  • 7/25/2019 Renal Organ System

    124/161

    Renal cell carcinoma

    C renal malignancy &n9ades &DC and spreads 9ia the blood

    etastasiLes to lung and bone

  • 7/25/2019 Renal Organ System

    125/161

    Clinical #eatures

    )ematuria alpable mass

    Oecondary polycythemia

    "lan/ pain "e9er; 8eight loss

    reneoplastic syndromes:

    1. ctopic erythropoietin

    2. ctopic

  • 7/25/2019 Renal Organ System

    126/161

    a s o a ce ca c o a

    C tumor o# urinary tract system ainless hematuria suggests bladder

    cancer

  • 7/25/2019 Renal Organ System

    127/161

    C renal malignancy o# early childhood )uge palpable 'an/ mass and hematuria

    ay be associated 8ith hemihypertrophy

    syndromes +Bec/8ithiedemannsyndrome,

    mbryonic glomerular structures

  • 7/25/2019 Renal Organ System

    128/161

    py p

  • 7/25/2019 Renal Organ System

    129/161

    py p

    Coarse; asymmetric corticomedullaryscarring

    Blunted calyx

    Tubules can contain eosinophiliccasts +thyroidiLation,

    (ruginduced interstitialnephritis

  • 7/25/2019 Renal Organ System

    130/161

    nephritis

  • 7/25/2019 Renal Organ System

    131/161

    CC o# acute renal #ailure in hospital Oel#re9ersible but #atal i# le#t untreated

    Cause: ischemia; myoglobinuria +crush injury,;toxins

    hases: initiating e9ent; maintenance +lo8 urine,;reco9ery +23 8ee/s,

    (eath C occurs during initial oliguric phase

    athology:

    1. Aoss o# cell polarity

    2. pithelial cell detachment

    3. Necrosis

    ! Iranular casts

    Renal papillary necrosis

  • 7/25/2019 Renal Organ System

    132/161

    p p y

    Oloughing o# renal papillae Iross hematuria; proteinuria

    ay be triggered by recent in#ection or

    immune stimulus tiology:

    1. (

    2.

  • 7/25/2019 Renal Organ System

    133/161

    Nephrosclerosis

  • 7/25/2019 Renal Organ System

    134/161

    p

    C renal disease in essentialhypertension

    )yaline arteriolosclerosis o# cortical

    arterioles Tubular atrophy; interstitial fbrosis;

    glomerular sclerosis

    Omall /idneys 8ith a fnely granularcortical sur#ace

    Aab: proteinuria; hematuria +no

    casts, aLotemia

    Renal in#arction

  • 7/25/2019 Renal Organ System

    135/161

    Causes: emboli #rom le#t heartthrombi; atheroembolic renaldisease; 9asculitis

    &rregular; 8edgeshaped palein#arctions in cortex

    Oudden onset o# 'an/ pain and

    hematuria

    (iMuse cortical necrosis

  • 7/25/2019 Renal Organ System

    136/161

    Complication o# obstetricemergencies and septic shoc/

    (ue to (&C limited to renal cortex 0

    9asospasm "ibrin clots in arterioles and

    glomeruli

    Bilateral; diMuse; pale in#arct o# renalcortex

  • 7/25/2019 Renal Organ System

    137/161

    y

    (ecreased proximal tubule transporto# amino acids; glucose; phosphate;uric acid

    Can be congenital or ac>uired tiology:

    1. ilsons disease

    2. Ilycogen storage diseases3. Cisplatin; expired tetracycline

    "eatures o# "anconissyndrome

  • 7/25/2019 Renal Organ System

    138/161

    syndrome (ecreased phosphate reabsorption:

    ric/ets

    (ecreased bicarbonate reabsorption:

    metabolic acidosis; type && RT< (ecreased early Na0 reabsorption:

    increased distal Na0 reabsorption;

    hypo/alemia

  • 7/25/2019 Renal Organ System

    139/161

  • 7/25/2019 Renal Organ System

    140/161

    (ecreased RB" leads to decreased I"R Na; )2* and urea are retained by /idney

    BFN-creatinine ratio increases to

    conser9e 9olume Frine osmolarity K =66

    Frine Na0 H 16

    "eNa0H 17 Oerum BFN-Cr K 26

    &ntrinsic renal aLotemia

  • 7/25/2019 Renal Organ System

    141/161

    (ue to acute tubular necrosis; ischemia; toxins Aess commonly due to glomerulonephritis

    atchy necrosis leads to debris

    (ebris obstruct tubules and there is 'uid bac/'o8

    across necrotic tubules I"R decreases; BFN reabsorption is impaired

    BFN-creatinine ratio decreases

    Frine has epithelial-granular casts

    Frine osmolarity H 3=6 Frine Na0 K 26

    "eNa0: K 27

    Oerum BFN-Cr H 1=

    ostrenal aLotemia

  • 7/25/2019 Renal Organ System

    142/161

    *ut'o8 obstruction: stones; B);neoplasia; congenital anomalies

    (e9elops only 8ith bilateral

    obstruction Frine osmolarity H 3=6

    Frine Na0 K !6

    "eNa0 K !7 Oerum BFN-Cr K 1=

    Conse>uences o# renal#ailure

  • 7/25/2019 Renal Organ System

    143/161

    #ailure &nability to ma/e urine and excrete

    nitrogenous 8astes

    Na0 and )2* retention: hypertension;pulmonary edema; C)"

    )yper/alemia etabolic acidosis

    Fremia

  • 7/25/2019 Renal Organ System

    144/161

    &ncreased BFN and creatinine Nausea and anorexia

    ericarditis

  • 7/25/2019 Renal Organ System

    145/161

    lectrolyte disturbances

    Na0

  • 7/25/2019 Renal Organ System

    146/161

    Ao8: disorientation; stupor; coma )igh: irritability; delirium; coma

    Cl

  • 7/25/2019 Renal Organ System

    147/161

    Ao8: 2dary to metabolic al/alosis;hypo/alemia; hyperaldosteronism

    )igh: 2dary to nonanion gap

    acidosis

    V0

  • 7/25/2019 Renal Organ System

    148/161

    Ao8: F 8a9es on CI; 'attened T8a9es; arrhythmias; paralysis

    )igh: pea/ed T 8a9es; 8ide ]RO;

    arrhythmias

    Ca00

  • 7/25/2019 Renal Organ System

    149/161

    Ao8: tetany; neuromuscularirritability

    )igh: delirium; renal stones;

    abdominal pain

    g00

  • 7/25/2019 Renal Organ System

    150/161

    Ao8: neuromuscular irritability;arrhythmias

    )igh: delirium; hyporre'exia;

    cardiopulmonary arrest

    hosphate

  • 7/25/2019 Renal Organ System

    151/161

    Ao8: bone loss; osteomalacia )igh: renal stones; metastatic

    calcifcation

  • 7/25/2019 Renal Organ System

    152/161

    (iuretics

    annitol

  • 7/25/2019 Renal Organ System

    153/161

    *smotic diuretic &ncreases tubular 'uid osmolarity; increasing

    urine 'o8

    Fses: drug o9erdose; shoc/;

    intracranial-intraocular hypertension;rhabdomyolysis

    Toxicity:

    1. Aung edema2. (ehydration

    3. C& in anuria and C)"

    Carbonic anhydraseinhibitors

  • 7/25/2019 Renal Organ System

    154/161

    inhibitors

  • 7/25/2019 Renal Organ System

    155/161

    Oite o# action: thic/ ascending limb o#loop o# )enle

    echanism: inhibition o# Na0; V0;

    2Cl symport ajor eMects:

    1. &ncrease Na0; Cl; V0 and Ca00

    excretion2. &mpair ability to concentrate urine

    3. &mpair ability to dilute urine

    "urosemide

  • 7/25/2019 Renal Organ System

    156/161

    Oul#onamide loop diuretic &ncreases Ca00 excretion

    Fses: edematous states; hypertension;hypercalcemia

    Toxicity:1. *totoxicity

    2. )ypo/alemia; hypocalcemia; hypomagnesemia

    3. (ehydration

    !. Oul#a allergy

    =. &nterstitial nephritis

    $. )yperuricemia; gout

    thacrynic acid

  • 7/25/2019 Renal Organ System

    157/161

    ssentially same action as#urosemide

    Not a sul#a drug

    Fse: diuresis in patients allergic tosul#a drugs

    Toxicity:

    1. Oimilar to #urosemide2. (oesnt cause hyperuricemia

    ThiaLide diuretics

  • 7/25/2019 Renal Organ System

    158/161

    Oite o# action: early distal tubule echanism: inhibition o# Na0 % Cl

    symport

    ajor eMects:1. &ncrease Na0; Cl; V0 excretion

    2. (ecrease Ca00 excretion

    3. &mpair ability to dilute urine +not ?@,

    )ydrochlorothiaLide

  • 7/25/2019 Renal Organ System

    159/161

    Fses: hypertension; C)"; idiopathichypercalciuria; nephrogenic diabetesinsipidus

    Toxicity:

    1. )ypo/alemic metabolic al/alosis

    2. )yponatremia

    3. )yperglycemia

    !. )yperlipidemia +gi9e indapamide,=. )yperuricemia

    $. )ypercalcemia

    G Oul#a allergy

    V0 sparing diuretics

  • 7/25/2019 Renal Organ System

    160/161

    Oite o# action: late distal tubule and collectingduct

    echanism:

    1. Triamterene; amiloride; eplerenone: inhibition

    o# Na0 reabsorption and V0 secretion in CCT2. Opironolactone: aldosterone antagonist in CCT

    . ajor eMects:

    1. &ncrease Na0 excretion

    2. (ecrease V0 excretion

    3. (ecrease )0 excretion

    Fses and toxicity o# V0 sparingdiuretics

  • 7/25/2019 Renal Organ System

    161/161

    Fses: hyperaldosteronism; V0depletion; C)"

    Toxicity:

    1. )yper/alemia2.