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Renal Physiology Overview Jeff Kaufhold, MD FACP.

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Presentation on theme: "Renal Physiology Overview Jeff Kaufhold, MD FACP."— Presentation transcript:

1 Renal Physiology Overview Jeff Kaufhold, MD FACP

2 Renal Physiology Structure Structure Clearance Clearance Water Balance Water Balance Electrolytes Electrolytes Acid-Base Balance Acid-Base Balance Hormonal Functions Hormonal Functions

3 Renal Anatomy Renal Artery and Vein Renal Artery and Vein Cortex – filtering Glomeruli Cortex – filtering Glomeruli Medulla – Tubules, regulates water/ lytes Medulla – Tubules, regulates water/ lytes Ureters Ureters Bladder Bladder Urethra and Sphincter control Urethra and Sphincter control

4 Anatomy of Urinary Tract

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6 Glomerular Physiology Filtration Filtration Filtration membrane Filtration membrane Endothlial cell layer Endothlial cell layer Basement membrane Basement membrane Epithelial cell layer Epithelial cell layer Electrical charge – negative Electrical charge – negative Clearance = waste product removal Clearance = waste product removal Ultrafiltration = water removal Ultrafiltration = water removal

7 Filtration Membrane

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10 Glomerular Blood Flow

11 Glomerular Physiology Blood flow determinants Filtration Systemic Efferent Afferent

12 Effect of Angiotensin on Glomerular Blood Flow

13 Glomerular Physiology Blood flow determinants Filtration PG's TGF Local Efferent Afferent

14 Glomerular Physiology Blood flow determinants Filtration Systemic PG's TGF Local Efferent Afferent

15 Glomerular filtration

16 Glomerular Physiology Pathologic conditions: Pathologic conditions: Renal Artery Stenosis Renal Artery Stenosis Hypertension / Medication effects Hypertension / Medication effects Membrane problems Membrane problems Lead to blood in urine – hematuria Lead to blood in urine – hematuria -Loss of negative charge leads to protein in urine – proteinuria -Loss of negative charge leads to protein in urine – proteinuria -Diabetes, Glomerulonephritis -Diabetes, Glomerulonephritis

17 Blood Flow to Tubules

18 Renal Tubule Physiology Overview Prox. tubuleDistal Tubule Loop of Henle Collecting duct reabsorption

19 Proximal Tubule Function:Reabsorption Function:Reabsorption Features: Features: Brush border with cilia Brush border with cilia Carbonic Anhydrase for reclaiming Bicarb Carbonic Anhydrase for reclaiming Bicarb Filtration Fraction Filtration Fraction Pathology: Renal tubular Acidosis Pathology: Renal tubular Acidosis

20 Renal Tubule Physiology Overview Prox. tubuleDistal Tubule Loop of Henle Collecting duct reabsorption blood Tubule membrane Ultrafiltrate Tubule lumen Tubule membrane

21 Renal Tubule Physiology Overview Prox. tubuleDistal Tubule Loop of Henle Collecting duct

22 Renal Tubule Physiology Overview Prox. tubuleDistal Tubule Loop of Henle Collecting duct impermeable to H2O solute imperm. to

23 Renal Tubule Physiology Overview Prox. tubuleDistal Tubule Loop of Henle Collecting duct

24 Renal Tubule Physiology Overview Prox. tubuleDistal Tubule Loop of Henle Collecting duct Ion Exchange Sodium for Potassium/Hydro

25 Renal Tubule Physiology Overview Prox. tubuleDistal Tubule Loop of Henle Collecting duct

26 Renal Tubule Physiology Overview Prox. tubuleDistal Tubule Loop of Henle Collecting duct ADH + ADH - permeable to H2O impermeable

27 Function of Nephron Tubules

28 Renal Tubule Physiology Overview Prox. tubuleDistal Tubule Loop of Henle Collecting duct ADH + ADH - permeable to H2O impermeable solute exchange reabsorption impermeable to H2O solute imperm. to

29 Interstitium The tissue in between the tubules The tissue in between the tubules Function: Function: Ammoniagenesis Ammoniagenesis Countercurrent multiplier Countercurrent multiplier Pathology: Pathology: RTA, Loss of concentrating ability, AIN RTA, Loss of concentrating ability, AIN

30 Countercurrent Multiplier Way to keep the concentrating ability of the kidney isolated from the rest of the body Way to keep the concentrating ability of the kidney isolated from the rest of the body Components: Components: Urine flow with sodium chloride pump Urine flow with sodium chloride pump Blood flow from Vasa Recta Blood flow from Vasa Recta Pathology: Pathology: Sickle Cell /Trait, bladder obstruction Sickle Cell /Trait, bladder obstruction

31 Countercurrent Multiplier

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33 WARM COLD

34 Renal Physiology Endocrine Functions Renin – control of BP Renin – control of BP Erythropoietin – turns on bone marrow to make red blood cells Erythropoietin – turns on bone marrow to make red blood cells Vitamin D activation – regulates bone metabolism, Calcium, Phosphorus and Parathyroid Gland. Vitamin D activation – regulates bone metabolism, Calcium, Phosphorus and Parathyroid Gland.

35 Volume regulation Active Sensors Active Sensors Renal Autonomic nerves Renal Autonomic nerves Passive system Passive system Like a system of lakes and spillways Like a system of lakes and spillways

36 Renal Structure Artery Vein Ureter C M P

37 Renal Structure U U Cortex Medulla Glomerulus Vascular bundle osmotic gradient collecting tubule

38 Renal Physiology Sensing of Volume Effective Arterial Blood Volume (EABV) Effective Arterial Blood Volume (EABV) Pathology: Pathology: Congestive Heart Failure Congestive Heart Failure Cirrhosis Cirrhosis Pregnancy Pregnancy Nephrotic Syndrome Nephrotic Syndrome Aldosteronoma Aldosteronoma

39 Pathologic States CHF CHF Renal Artery Stenosis Renal Artery Stenosis Low Blood Flow Low Blood Flow

40 Pathologic States Cirrhosis Cirrhosis Pregnancy Pregnancy Nephrotic Syndrome Nephrotic Syndrome Leaky capillaries

41 Pathologic States Aldosteronoma Aldosteronoma Tumor which Tumor which Produces too much Produces too much Aldosterone, causing Aldosterone, causing Fluid retention Fluid retention

42 Pathologic States Aldosteronoma causes Aldosteronoma causes Fluid retention Fluid retention Hypertension Hypertension Perfusion of outer glomeruli sets upper limit on how much fluid can be retained. Perfusion of outer glomeruli sets upper limit on how much fluid can be retained.

43 Pathologic States Removal of Aldosteronoma causes Removal of Aldosteronoma causes Diuresis until volume is normal again, and Diuresis until volume is normal again, and Hypertension improves Hypertension improves

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45 Why Kidney Patients will Come to Physical Therapists Hip Fractures Hip Fractures Strokes Strokes Heart attacks and heart surgery Heart attacks and heart surgery Deconditioning Deconditioning Neuropathy Neuropathy

46 Glomerular Physiology Afferent. Art Afferent. Art AT II constrict AT II constrict ACE-i dilate ACE-i dilate PG's NET dilate PG's NET dilate TGF NET constrict TGF NET constrict NSAID's constrict NSAID's constrict Aminophylline dilate Aminophylline dilate Diltiazem dilate Diltiazem dilate Filt Press Filt Press maintained maintained reduced reduced increase increase parallels parallels reduce reduce increase increase reduced reduced Efferent Art. constrict dilate no effect dilate


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