1. Pathophysiology
PHCL 415

2. Lecturer: Haya M. Al-Malaq, Msc- course co-ordenator.
Lecturer: Rania Al-Jaizani, Msc

3. Contact info

4. Grade distribution
Mid 1 -25
Mid 2 -25
Assignment 10
Final 40

5. Text book
Price SA, Pathophysiology, clinical concept of disease process, Fifth edition.
Zdanowicz MM, Essentials of pathophysiology for pharmacy.
Handouts for anatomy part.

6. Part 1 Renal System Disorders

7. Lecture 1 Introduction Anatomy & physiology of renal system
Major functions of the kidney
Manifestation of renal disorders
Diagnosis
UTI NB

8. Introduction
The kidneys are vital organs that play a critical role in the maintenance of stable internal environment.
The kidneys regulate fluid and electrolyte and acid base balance of the body and excrete metabolic wast products and foreign chemicals.
When the kidneys fail to perform vital functions a condition known as uremia or ESRD results and this require dialysis or death may occur within 3-4 wks.

9. Introduction
ESRD is a major cause of morbidity and mortality.

11. Medical encyclopedia- Medline plus

12. Anatomy of Urinary tract
The kidneys are bean shaped organs situated on both sides of the vertebral column.
The rt kidney are slightly lower than left b/c it is bushed down by the liver.
The 2 ureters are tubes inc long extending from the kidneys to the bladder, their only function is to convey urine to the bladder.

13. Anatomy of Urinary tract
The bladder is a collapsible muscle bag with 3 openings (2 ureters, 1 urethra).
The bladder has 2 basic functions: 1) reservoir for urine, 2) expels urine from the body.
The kidney is protected from direct trauma by the ribs and intestine.

14. Microscopic structures of the kidney
Nephron: functional unit of the kidney, in each one, we can survive with onley
Renal corpusle: bowmans capsule and the glumarular capillary tuft
Juxtaglomerular apparatus: produce renin

17. Functions of the kidneys

18. Excretory function
Maintain plasma osmolality near 285 mosm by varying the excretion of water.
Maintain ECF volume and BP by varying excretion of Na+
Maintain the plasma conc of each electrolyte within normal range
Maintain plasma PH near 7.4 by eliminating xs H+ and regenerating HCO3-
Excrete the nitrogenous end product of protein metabolism (urea, UA, Cr)
Serves as excretory route for most drugs

19. Non-excretory functions
Synthesis and activate hormones:
Renin: BP
Erythropoietin: RBCs from BM
Vit D: hydroxylation of Vit D to its vital form
PG: vasodilator acts locally and protect from renal ischemia
Degradation of polypeptide hormones (insulin, glucagon, GH, prolactin, ADH, parathormon, GI hormones)

20. Basic renal physiology
Glomerular ultrafiltration
Autoregulation of renal plasma flow and GFR
Tubular reabsorption and secretion
Regulation of water balance
Regulation of body Na

21. Glomerular ultrafiltration
Renal blood flow 25% of cardiac output
GFR: 125ml/min
Passive process
Same as plasma but with no protien
Charge selective, size selective

22. Autoregulation of renal plasma flow and GFR
RPF and GFR kept constant through the day
1) myogenic strech receptor, 2) tubuloglomerular feed back.
Hormones: NE, angio II, PG

23. Tubular reabsorption and secretion
Electrolytes (Na, K, Ca, Mg, Cl, HCO, HPO) & non electrolytes (glucose, Cr, Ua) are filtered.
Most of filtered substance are reabsorbed through minute pores in the tubules and some substance are secreted.
Active passive transport mechanism.

24. Regulation of water balance
High water intake >>>>>>> diluted urine
Low water intake >>>>>>>> conc urine

25. Regulation of body Na
Renin-angiotensin-aldosterone system

27. Diagnostic procedure in renal disease
Diagnosis
method
Biochemical
Chemical examination
GFR
Morphologic method
Microscopic
exam
Bacterialogic exam
Radiologic exam
Renal biopsy

28. Manifestations of renal disease
Characteristic
Abnormality
Appearance
Color
Odor
Sps gr
Protein
Glucose, ketons
RBCs
Epithelial cells
Bacteria
Oval fat bodies
Casts
Crystals
Cloudy (renal disease)
Red or brown (hematourea) renal dis or jandece
Unplesent in UTI
Lo in RF
Most renal disease DM
UTI, nephritis, neoplasm, stone
Renal disease
UTI
Nephrotic syndrum
Abnormal aminoacidurea

29. UTI

30. Introduction
A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract.
Although urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it. 
When bacteria get into the bladder or kidney and multiply in the urine, they cause a UTI.

31. Types
The most common type of UTI is a bladder infection which is also often called cystitis.
Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more serious.
Complicated, uncomplicated, recurrent.

32. Most common
DM, SCA.
Female (short urethra, absence of prostate, near the annus).
Poor toilet habits.
Pregnancy and prostatits.
Allergy
Urinary catheter
Prostatic stent
Sexual intercourse
Elderly.

36. Treatment Appropriate antibiotic
Surgical correction of obstruction or structural abnormality that might be causing urine retention

37. Neurogenic bladder

38. Introduction
Neurogenic bladder refers to dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of micturition.

39. Introduction
The bladder is a distensible reservoir for urine from which the urine is evacuated at suitable intervals. The innervation of the bladder consist of reflex arc at the S1 & S4 level of the spinal cord, whose function is modified by sensory & motor connections to higher centers in the brain.
Interference of efferent or afferent limbs of the reflex arc can disrupt normal micturition; this condition is referred to as neurogenic bladder.

40. Causes
Neurogenic bladder is often associated with spinal cord diseases, injuries, and neural tube defects including spina bifida.
It may also be caused by brain tumours & other diseases of the brain, & by peripheral nerve diseases.
It is a common complication of major surgery in the pelvis, such as for removal of sacrococcygeal teratoma & other tumours.

41. Types Uninhibited NB Reflex NB Autonomus NB Sensory paralytic NB
Motor paralytic NB

42. Uninhibited NB Defect in corticoregulatory tract.
Lesions that involves cerebral cortex.
The patient is aware of sudden desire to urinate as the bladder fills but maybe unable to inhibit the desire to void even though the situation may not be appropriate.

43. Reflex NB Occurs in spinal cord injury above S2 level.
All bladder sensation is lost.
Empting occur reflexly whenever there is pressure.
Emptying is incomplete b/c lack of motor input.

44. Autonomus NB
Destruction of both limps of the bladder arc as in surgery
Patient cannot initiate urination.
Manual pressure.

45. Sensory paralytic NB
Lesions in the sensory limb of the bladder reflex arc (diabetic neuropathy, MS).
Gradual loss of bladder sensation.
Emptying is incomplete.

46. Motor paralytic NB Involve motor nerve as in tumor
The sensation of bladder fullness is intact but the patient cant initiate urination.
Patient may require catheterization.