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What space are the kidney's located in?
retroperitoneal space
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Which kidney is slightly lower?
right kidney
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Two basic functions of the kidneys
- remove nitrogenous wastes
- maintaint e-, acid/base and fluid balances in blood
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4 primary components of the kidney
- renal capsule (membrane)
- renal cortex (below capsule)
- Medullary Region (renal medulla)
- Renal pelvis (connects to ureter)
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glomerular filitration
passive diffusion of water and small mw ions into bowmans capsule
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Reabsorption of drugs occurs along the
distal tuble and collection tubules
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Secretion
- blood to urine
- carrier mediated
- active transport process
- for bulky compounds
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The primary underlying factor to decreased renal blood flow with age is
the decreased renovascular bed
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3 important hormones keneys release
- erythropoietin
- renin
- calcitriol (calcium maintenance)
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2 primary functions of renal system
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Functions of the nephron
- filtration of water soluble substances
- reabsorption of nutrients, wastes and e-
- secretion of wastes
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site of fluid filtration from blood to nephron tubule
Glomerulus
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Proximal convoluted tubule
Reabsorbs water, electrolytes, bicarb, glucose amino acids and vitamins
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Descending loop of henle
reabsorbs water
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ascending loop of henle
reabsorbs Na, K, CL
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Distal convoluted tubule
- reabsorbs Na, CL, water, urea
- secretes H and K
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Collecting tubule
- reabsorbs water under influence of ADH
- secretes H and K
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Reabsorbs 2/3 of water
proximal convoluted tubule
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Fine tunes sodium and water changes
DCT
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utilizes transporters in the apical and basolateral membranes of tubular cells
transcellular route
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allows passive transpot of substances between tubular cells
paracellular route
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Reabsorption of glucose is accomplished by
proximal tubule cell sodium dependent transporters
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reabsorption mechanism for HCO3-
- conver to CO2 by carbonic anhydrase
- H+ provided by NaH pumps on apical cell membrane
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Secretion of potassium ions
- Na/K pump
- basolateral membrane in distal tubule
- pumps regulated by aldosterone
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increase potassium excretion
Aldosterone
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increases permeability of collecting tuble to water, resulting in increased reabsorption and reduced blood osmolality
ADH
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alter blood volume without affecting blood osmolality
- aldosterone
- angiotensin II
- atrial natriuretic peptide
- urodilatin
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Increase sodium and water reabsorption
- aldosterone
- angiotensin II
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inhibit sodium and water reabsorption
- atrial natriuretic peptide
- urodilatin
-
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fewer sodium ions delivered to the macula densa results in GFR ____
increase
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mesangial cells respond to
- glomerular capillary stretch
- contract to reduce surface area
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Afferent constriction with efferent dilation results in
decreased GFR
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Afferent dilation and efferent constriction results in
increased GFR
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Important chemical mediators of arteriolar resistance
- Angiotensin II
- prostaglandins
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Infants have reduced ability to make concentrated urine due to
kidney immaturity
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Aged individuals have
- reduced numbers of functioning nephrons
- reduces renal blood flow & GFR
- decreased ability to conserve salt and water
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Renal blood flow decreased from 1200 ml/minat age 30 to _____ at age 80
600 ml/min
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Manifestations of Vitamin D deficiency
- soft tissue calcification
- secondary hyperparathyroidism
- renal osteodystrophy
- hypocalcemia
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Tests of renal structure and function
- urinalysis
- blood tests
- ultrasound/CT/MRI
- Renal scans
- Renal biopsy
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Blood tests for kidney function
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Ultrasounds/CT/MRI of kidneys
- size of kidneys
- renal cysts
- hydronephrosis
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Renal scans
- renal blood flow
- urine leaks
- voiding disorder
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detection of protein in the urine?
not normally
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glucose present in urine?
- diabetes
- kidney damage or disease
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Leukocyte esterase (WBC esterase) in urine?
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Ketones in urine?
- diabetic ketoacidosis
- when fat is broken down for energy
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red blood cells in urine?
- inflammation
- disease
- injury to UT
- strenuous exercise
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wbc in urine?
- infection
- cancer
- kidney disease
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sulfur urine smell
asparagus
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sweet urine smell
diabetes
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foul urine smell
infection
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normal urine smell
urea and ammonia
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dark yellow urine
dehydration
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green urine
- asparagus
- food dye
- infection
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orange urine
- blackberries
- beets
- rhubarb
- jaundice
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-
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brown urine
nitrofurantoin
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serum creatinine
more reliable than BUN
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Serum creatinine and BUN levels increase in conditions of
reduced GFR
-
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increases serum creatinine
- meat
- exercise
- muscle mass
- cimetidine
- trimethoprim
- age
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decreases serum creatinine
- muscle wasting
- female gender
- amputation
- vegetarian diet
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Increases BUN
- GI hemorrhage
- corticosteroids
- TCN
- catabolic state
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decreases BUN
- malnutrition
- liver disease
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GFR can be estimated by measuring
the clearance of a filterable substance from the urine
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provides more accurate measurement of GFR
inulin clearance
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simple calculated method of estimating GFR using serum creatinine values
MDRD
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tests in order of clinical utility from most to least
- serum creatinine
- creatinine clearance
- nonisotopic contrast
- radiolabeled inulin
- inulin
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tests of renal function in order of accuracy from least to most
- serum creatinine
- creatinine clearance
- nonisotopic contrast
- radiolabeled inulin
- inulin
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what is the difference between CrCL and GFR?
CrCl approximates GFR
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CrCl may overestimate GFR due to the fact that
creatinine is secreted in the proximal tubule
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When should a 24 hour urine collection be performed?
- extremes of age and body size
- malnutrition/obesity
- skeletal muscle disease
- para/quadriplegia
- vegetarian diet
- pregnancy
- prior to kidney toxic drugs
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cockcroft gault equation for crcl
- [(140-age)x wt in kg]
- 72 x serum cr (mg/dL)
x 0.85 for women
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congenital and inherited disorders of renal function
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Renal unilateral agenesis
- failure of an organ to develope
- 1/1000
- boys > girls
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renal hypoplasia
kidney doesn't develope to normal size
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dysplasia
- abnormality in structure
- aplastic or cystic kidneys
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most common type of dysplasia
multicystic renal dysplasia
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Autosomal dominant polycystic kidney disease
- cysts
- slow progression
- may have hepatic cysts
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autosomal recessive PCKD
- infants with renal, liver, lung impairment
- portal hypertension
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neprhonopthisis
- medulary cystic disease complex
- onset in childhood
- cysts and shrunken kidneys
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Presentation of nephronophtisis
- polyuria
- polydipsia
- bed wetting
- progressive renal failure in 5-10 years
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typical renal cysts
- 1 cm in diameter
- asymptomatic
- usually >50 y/o
- surgical removal
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Partial obsruction
frequent urination
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complete obstruction
no urnination
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antegrade nephrostomy
obstruction to the ureters
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Hydroephrosis
- dilation of renal pelvis and ureters
- obstruction of urine flow
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causes of hydroephrosis
- stone
- stricture
- blood clot
- tumor
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symptoms of hydroephrosis
- pain
- elevated scr
- urinary retention
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diagnosis of hydronephrosis
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Treatment of hydronephrosis
- remove obstruction
- nephrostomy
- stent
- catheter
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Renal calculi
- most common obstruction
- can form anywhere in the urinary tract
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four types of stones
- calcium (most common)
- magnesium ammonium phosphate (uti)
- uric acid
- cystine (cystinuria)
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Drugs that cause kidney stones
- diuretics
- calcium based antacid
- calcium based phosphorus binders
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foods that may cause kidney stones
high oxalate foods
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pyelonephritis
kidney infection
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urethritis
uretheral infection
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cystitis
bladder infection
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inflammatory process that involves flomerular strucures
glomerulonephritis
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Proliferative cellular changes
increase in glomerular or inflammatory cell number
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symptoms of cellular changes
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treatment of cellular changes
immunosuppressive agent
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acute tubulointerstial disorders
- interstitial edema
- pylonephritis
- hypersensitivity to drugs
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chronic tubulointerstitial disorders
interstitial fibrosis, atrophy and monnuclear infiltrates
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polyuria tubulointerstitial disorders
- change in pH
- metabolic acidosis
- deminished reabsorption of sodium and other
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proximal renal tubular acidosis
impared HCO3 reabsorption
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distal renal tubular acidosis
impared secretion of fixed metabolic acid
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aldosterone deficiency
- imparied reabsorption of sodium
- decreased elimination of hydrogen and potassium
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Wilms tumor
- nephroblastoma
- 3-5 y/o with HTN
- gene WT1 on chromosome 11
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Renal cell carcinoma
- 90-95% of all kidney tumors
- ages 55-84
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