Kidney Diseases Definitions: 1-Oliguria 2-Anuria 3-Polyuria 4-Dysuria 5-Hematuria 6-Proteinuria 7-Glycosuria 8-Aminoaciduria 9-sosthenuria

KIDNEY DISEASES I-Acute renal failure, ARF: Decr BF to Kid A-Prerenal : Heart failure, Hemorrhage, Burns, Anaphylactic shock, Sepsis, RA stenosis B-Intrarenal : Acute glomerulonephritis, Acute tubular necrosis (Ischemia or Toxins) C-Postrenal : Bilateral obstruction of ureter, Bladder obstruction, Obstruction of urethra.

Physiologic effect of ARF 1-Retension of , Water, waste products, and electrolytes in the blood and ECF 2-Edema and hypertension 3-Hyperkalemia (K) can be fatal. 4-Metabolic acidosis can be fatal. 5-In severe cases anuria Artificial kid could be need it.

II- CHRONIC RENAL FAILURE CRF: Decrease in numbers of functional nephrons 70-75%. 1-DM 2-Hypertension 3-Glomerulonephritis, pyelonephritis, TB 4-Analgesic and heavy metals 5-Urinary tract obstruction : renal calculi, hypertrophy of prostate 6-Congential, Polycystic disease

End stage renal disease Progressive deterioration of kid function where the dialysis must be used. Common causes 1-DM 45% 2-Hypertension 27% 3-Glomerulonephritis 8% 4-Polycystic dis 2% 5-Unlown 18%

Effect of CRF 1-Uremia: Increase urea, creatinine & uric acid 2-Edema 3-Metabolic acidosis 4-Anemia 5-Osteomalacia, by decrease production of active vit D 6-Hypertension, by decrease Na and water excretion

KIDNEY TRANSPLANT DIALYSIS WITH ARTIFICIAL KIDNEY

MICTURITION: Fill the bladder progressively – Micturition reflex to empty the bladder. Anatomy : Bladder body (Detrusor muscle) 40-60 mmHg – Neck (posterior urethra) – Internal sphincter- External sphincter(volunary control)

Innervation of bladder 1-Pelvic nerve A Innervation of bladder 1-Pelvic nerve A.Sensory fibers :Strech of the bladder B.Motor fibers :Parasympathetic to detrusor muscle 2-Pudendal (somatic) fibers to the external sphincter 3-Sympathetic fibers through hypogastric nerve mainly to the BV of the bladder and some sensory fibers with it for sensation of fullness and pain

MICTURATION REFLEX Micturition reflex : Primary stretch receptors-sacral segment by pelvic nerve – back to the bladder through parasympathetic nerve fibers. Powerful micturition reflex- pudendal nerve –external sphincter to inhibit it. Higher center ( Pons & cerebral cortex) exert final control: Inhibit reflex or prevent micturition by tonic contraction of external sphincter until convenient time.

Micturition reflex 1-Filling phase inhibit parasympathetic activity (Pelvic nerve), bladder & internal sphincter 2- Urination stimulate parasympathetic 3-Sympathetic mainly bladder for BV 4-Pudendal nerve (somatic): for external sphincter

Voluntary urination : Contraction of abdominal muscle ^ pressure in the bladder –stimulate stretch receptors-excites micturition reflex-inhibit external urethral sphincter -5to10 ml left.

ABNORMAL MICTURATION 1-Destruction of sensory nerve fibers: (Sacral region & Syphilis) 2-Spinal cord damage above sacral region 3-Lack of inhibitory signals from the brain 4- Incontinence during cough or sneezing in women with many kids or men with prostate surgery (Impaired sphincter)