renal physiology review-s
TRANSCRIPT
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-Ex ertise
of the KidneyPT 515
Clarkson University
Physical Therapy Program
on em g o, c
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Learnin Ob ectives1. Overview of renal anatomy and the nephron
2. Explanation of kidney function1. The 3 basic processes of urine formation
2. Control of BP and Water balance
3. secretion into tubules
+ +. , ,amino acids
4. Explanation of the important renal functional
milestones
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How many patients with kidney disease?
23 million adults age 20 and above Whats the incidence?
,
What are the main causes?
Diabetes, hypertension, glomerulonephritis, and polycystic kidney.
ESRD due to diabetes is increasing at an annual rate of more than11% per year.
ow many ave a ney transp ant In 2007 17,000
How many are waiting for a transplant?
>54,000 patients are awaiting for a donnor
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Chan e in fre uenc and uantit of urine assed
especially at night (usually increase at first) Blood in the urine (haematuria)
Foaming urine
Puffiness around the eyes and ankles (oedema) ,
are located)
Pain or burnin when assin urine.
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Generally feeling unwell
oss o appet te
Nausea and vomiting Shortness of breath
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Eat lots of fruit and vegetables including legumes (peas or beans) and
grain-based food like bread, pasta, noodles and rice.
Eat only small amounts of salty or fatty food.
Drink plenty of water instead of other drinks.
Maintain a healthy weight.
Exercise regularly.
Dont smoke.
Alcohol has a profound negative effect in eletrolyte, fluid balance and acid-base balance
Have your blood pressure checked regularly.
o t ngs t at e p you re ax an re uce your stress eve s. A low protein diet can treat & prevent some kidney conditions and postpone
dialysis
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Renal Multitasking
Regulation of Water and Electrolyte Balance of body fluids (extracellular)
Excretion of Metabolic Waste
, ,specifically drugs affecting body function)
Regulation of Red Blood cell production
Regulation of Vitamin D production
Gluconeogenesis
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Filtration (youtube)
Blood pressure Water and solutes across glomerular capillaries
Reabsorption (youcap)
The removal of water and solutes from thefiltrate
Secretion ou2tube
Transport of solutes from the peritubular fluidinto the tubular fluid
Excretion = urine (youout)
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Kidney Topography cont
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The Kidney
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Kidne Perfusion
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Cortical and Juxtamedullary Nephrons
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Filtration (youtube)
Blood pressure
Water and solutes across glomerular capillaries
Reabsorption (youcap)
The removal of water and solutes from the filtrate
Secretion (you2tube)
the tubular fluid
=
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FILTRATION
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water , Na+, Cl- and K+.,
peptides is absorbed.
rox ma u u e ce secre e ac s anbases (HCO3). This secretion is a major
rou e or rugs suc as pen c n.
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.
GFR has to do with how much filtrate is runningdown the tubules er unit of time
Fast filtrate will change reabsorption dymanics of
solutes resent in filtrate GFR is used to find how substances are cleared
from the blood (meds)
Kidney disfunction -Filtration problems go frommild to renal failure (need for dyalisis)
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Renal Blood Glomerular Glomerular Peritubular Peritubular
ow cap arypressure
ra on ra e cap aryPressure
ea sorp on
Afferentconstriction
EfferentConstriction
Afferentdilation
Efferentdilation
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REABSORPTION
Proximal Tubule
Thin loop
Distal tubules
Collecting Duct
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step process 1.
2.
Reabsorption of waterand most particlesdissolved (solutes)
are n e o eabsorption of Na
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Proximal Tubule-ReabsorptionMicroscopic Anatomy
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Basis for Peritubular
Reabsorption Peritubular capillaries provide
nutrients for tubules and retrieve the
fluid the tubules reabsorb.
nco c s grea er an y ros a cP in these capillaries, so thereforeget reabsorption NOT filtration.
Must occur since we filter 180l/day,but only excrete 1-2l/day of urine.
Reabsorb 99% H O 100% lucose
99.5% Na+ and 50% urea. Most ofthis occurs at proximal convolutedtubule.
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amount of water you drink? What creates the transition
between filtration to
Reabsorption ? If a substance is not reabsorbed
what happens to it?
What does secreted mean?
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Countercurrent Multiplier
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Countercurrent Multiplier
e cr ca c arac er s cs w ccreate the countercurrent multiplier:
1. The ascending limb of the loop ofD A
Henle actively transports Na+ and co-
transports Cl- ions out of the lumeninto the interstitium.
2. The ascending limb is impermeableto H2O.
Naa
H2O
H2OX
.permeable to H2O but relativelyimpermeable to NaCl.
. 2 a moves ou o u u e n ointersitium is removed by the bloodvessels called vasa recta thusgra ents are ma nta ne an 2 sreturned to the circulation.
Countercurrent Multiplier
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Countercurrent Multiplier
A: The tubule is initially filled with isotonic fluid
B: Na is pumped out of the ascending loop, raisingthe osmotic pressure outside and lowering itns e. o e a e max mum gra en ns e oout) is 200 mosm/L
C: Water flows out of the descending tubule by,
descending tubule to 400 mosm/L
D: Fresh fluid enters from the glomerulus, pushing
concentrated fluid (400 mosm/L) into theascen ng m
E: In the 2nd round the Na pump produces another200 mosm/L gradient across the membrane, but it
,
the external osmolarity rises to 500 mosm/L.F: The 3rd round of Na pumping raises interstitialconcentration to 700 mosm/L, and so on.
The pumping, osmotic flow and filtration flows areshown as separate activities, but in reality they occur
together as a continuous process.
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formation of
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.
High protein diet = more urea = more.
Kidneys filter, reabsorb and secrete urea.
Urea excretion rises with increasingurinary flow.
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Urea toxic at high
levels, but can be
useful in small
Urea recycling
causes buildup ofg urea ninner medulla.
the osmoticgradient at loop of
en e so 2 canbe reabsorbed.
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Kid F i O i
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Kidne Function Overview
Peritubular capillaries Distaltubule
arteriole
GlomerulusF
R
S
Afferentarteriole
Proximaltubule
Bowmanscapsule
R
R S
R RS
LoopofKEY
Collectingduct
Torenalvein
F
R
SE
en e= Filtration: blood to lumen
= Reabsorption: lumen to blood
= Secretion: blood to lumen
ETo bladder andexternal environment
= Excretion: lumen to externalenvironment
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Clin Nephrol. 1998 Nov;50(5):273-83.
Effect of a ketoacid-aminoacid-su lemented ver low rotein diet on the ro ression of advanced renal disease: areanalysis of the MDRD feasibility study.
Teschan PE, Beck GJ, Dwyer JT, Greene T, Klahr S, Levy AS, Mitch WE, Snetselaar LG, Steinman TI, Walser M.
Vanderbilt University, USA. J Am Soc Nephrol. 1999 Jan;10(1):110-6.
Can renal replacement be deferred by a supplemented very low protein diet?
Walser M, Hill S.
J Nephrol. 2001 Nov-Dec;14(6):433-9.
Low protein diets and outcome of renal patients.
Aparicio M, Chauveau P, Combe C.