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Effective Circulating Volume Control

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by dr Mohammed Abdel Gawad (drgawad@gmail.com): Nephrology Specialist at Kidney & Urology Center - Alexandria - Egypt.

by dr Mohammed Abdel Gawad (drgawad@gmail.com): Nephrology Specialist at Kidney & Urology Center - Alexandria - Egypt.

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    Effective Circulating Volume Control Effective Circulating Volume Control Presentation Transcript

    • CNECNE ESNT-CNE 5th Course, Cairo May 14-17, 2014 CNECNE Control of Effective Circulating Volumer g Back to Basics – Physiology Concepts Mohammed Abdel Gawad Nephrology Specialist Kidney & Urology Center (KUC) Alexandria drgawad@gmail.com
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 TBW is affected by:TBW is affected by: Gender and AgeGender and Age Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Total body water CompartmentsTotal body water Compartments Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Total body water CompartmentsTotal body water Compartments Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Total body water CompartmentsTotal body water Compartments Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume An odyssey into the milieu intérieur: pondering the enigmas. Schrier RW. J Am Soc Nephrol. 1992;2(11):1549. Effective Circulating Volume refers to that part of the extracellular fluid (ECF) that is in the arterial system and is effectively perfusing the tissues
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 An odyssey into the milieu intérieur: pondering the enigmas. Schrier RW. J Am Soc Nephrol. 1992;2(11):1549. Effective Circulating VolumeEffective Circulating Volume
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 An odyssey into the milieu intérieur: pondering the enigmas. Schrier RW. J Am Soc Nephrol. 1992;2(11):1549. It’s all about TISSUE PERFUSION Make Organs Happy Effective Circulating VolumeEffective Circulating Volume
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume Control – General ConceptControl – General Concept Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume Control – General ConceptControl – General Concept BaroreceptorsBaroreceptors Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Baroreceptors Monitoring - Site • Kimani JK. Ciba Found Symp. 1995;192:215. • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Not stimulated at all by pressures between 0 and 50 to 60 mm Hg, but above these levels, they respond progressively more rapidly and reach a maximum at about 180 mm Hg Baroreceptors Monitoring - Stimulus Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Baroreceptors Signaling - Reflex • Kimani JK. Ciba Found Symp. 1995;192:215. • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Baroreceptors Signaling - Reflex Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Baroreceptors Action on Targets • Kimani JK. Ciba Found Symp. 1995;192:215. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Baroreceptors Action on Targets • Kimani JK. Ciba Found Symp. 1995;192:215. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume Control – General ConceptControl – General Concept Renin – Angiotensin – Aldosteron SystemRenin – Angiotensin – Aldosteron System (RAAS)(RAAS) Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Renin – Angiotensin –Renin – Angiotensin – Aldosteron System (RAAS)Aldosteron System (RAAS)
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAASRAAS StimulusStimulus • Kimani JK. Ciba Found Symp. 1995;192:215. •Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAASRAAS SignalingSignaling . • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid- Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAAS – Action on TargetsRAAS – Action on Targets Angiotensin IIAngiotensin II •Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAAS – Action on TargetsRAAS – Action on Targets Angiotensin IIAngiotensin II •Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAAS – Action on TargetsRAAS – Action on Targets Angiotensin IIAngiotensin II •Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAAS – Action on TargetsRAAS – Action on Targets AldosteronAldosteron • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume Control – General ConceptControl – General Concept Anti-Diuretic Hormone (ADH)Anti-Diuretic Hormone (ADH)
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Anti-Diuretic Hormone (ADHAnti-Diuretic Hormone (ADH)) • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume Control – General ConceptControl – General Concept Atrial Natriuretic PeptideAtrial Natriuretic Peptide
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Atrial natriuretic peptide is the only volume regulatory hormone that decreases effective volume Atrial Natriuretic PeptideAtrial Natriuretic Peptide Atrial natriuretic factor: its (patho)physiological significance in humans. de Zeeuw D et al. Kidney Int. 1992;41(5):1115.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Pressure Natriuresis • Guyton AC. Science. 1991;252(5014):1813. • Mizelle HL, Montani JP, Hester RL, Didlake RH, Hall JE. Hypertension. 1993;22(1):102. It does not require neurally or humorally mediated sensor mechanisms It does not require neurally or humorally mediated sensor mechanisms
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Pressure Natriuresis The increase in systemic pressure is transmitted, via the vasa recta capillaries, to the medullary interstitium Cowley AW Jr. Am J Physiol. 1997;273(1 Pt 2):R1.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Pressure Natriuresis Guarasci GR, Kline RL. Am J Physiol. 1996;270(2 Pt 2):R469.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Sodium reabsorption in different nephron segments
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Differences between osmoregulation and volume regulation
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014  The amount of water in each body compartment is dependent on:  1- osmotic pressure  2- hydrostatic pressure (filtration)  + 3- Membrane characteristics Movement of water – Starling’s ForcesMovement of water – Starling’s Forces • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014  is the number of particles (mmol) contained in one liter of water, so measured in mmol/L.  i.e. it is the concentration by number OsmolalityOsmolality • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Starling’s ForcesStarling’s Forces Osmotic pressureOsmotic pressure • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Starling’s ForcesStarling’s Forces Hydrostatic pressureHydrostatic pressure • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Volume RegulationVolume Regulation Clinical CorrelationClinical Correlation +lymphatic obstruction • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Volume RegulationVolume Regulation Clinical Correlation – Heart FailureClinical Correlation – Heart Failure • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Volume RegulationVolume Regulation Clinical Correlation – NephroticClinical Correlation – Nephrotic Jürgen Floege, John Feehally. Chapter 15. Comprehensive Clinical Nephrology. 4th Edition. 2010
    • ESNT-CNE 5th Course, Cairo May 14-17, 2014 Mohammed Abdel Gawad