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Kidney & Urinary System
 

Kidney & Urinary System

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    Kidney & Urinary System Kidney & Urinary System Presentation Transcript

    • kidney & urinary system
    • Outlines
      • Structure of kidney & urinary system
      • Functions of kidney
      • Renal function tests
      • Clinical manifestations of renal diseases
        • Acute renal failure
        • Chronic renal failure
        • Glomerular syndrome
      • Diseases of the kidney
        • Glomerulonephritis
    • Structure of kidney & Urinary system
        • Kidney: Cortex, Medulla
        • Nephron
        • 1. Glomerulus : highly permeable H2O, electrolytes
        • filtration size + charge
        • 2. Proximal convoluted tubules (PCT) :
        • reabsorb H2O
        • Na+, K+, H+, Cl
        • 3. Loop of Henle :
        • - function as PCT
        • - descending ( no H2O )
        • - ascending H2O
        • 4. Distal convoluted tubules (DCT) :
        • - Aldosterone dependent
        • - Na+ reabsorption
        • - K+ excretion
        • - Synthesis - carbonic anhydrase H + ~ pH & electrolytes
        • 5. Collecting ducts :
        • - ADH (antidiuretic hormone) H2O reabsorption
    •  
        • 1. Water balance
      Osmoreceptor (hypothalamus) ADH, Vasopressin (Pituitary) Collecting duct Absorption of H 2 O
        • Function of Kidney
        • 2. Acid-base balance
      Carbonic anhydrase (Distal tubules) Carbonic acid-bicarbonate buffer system H+ excretion Na+ reabsorption H 2 O excretion
    • 3. Excretion of waste product - Acid - base - H 2 O - creatinine - Metabolites 4. Others - erythropoeitin
        • Conclusion : renal functions
              • Filtration
              • Reabsorption
              • Secretion
        • Renal function tests
        • 1. Clearance Value : Creatinine, inulin clearance
        • GFR (glumerular filtration rate)
        • = Cr urine x Volume urine / min
        • Cr in plasma
        • = 120 ml / min / body areas
      • 2. Blood urea nitrogen (BUN)
      • - food
      • - massive destruction of kidney
        • Renal function tests & Diagnosis
    • Urinalysis Physical & chemical properties - pH, Specific gravity (1.022), protein, sugar, etc. Urine sediments - Cell-RBC, WBC, Renal cells, etc. - Urine casts - Crystalline structure
    • Urin a lysis profiles Specific gravity 1.001 - 1.035 Osmolarity 500 - 800 mOsm / kg water pH 4.7 - 8.0 Volume 600 - 1500 ml / 24 hr RBC 0- 1,000,000 / hours WBC 0- 1,000,000 / hour Tubular cells 10,000 - 200,000 / hour Casts 0- 5,000 / 24 hours
    • Hyaline cast : clear, tubular protein Granular cast : high protein from plasma Waxy cast : degraded granular cast Red cell cas t : glomerular disease Fatty cast : tubular damage WBC cast : pyelonephritis Bacteriological examination Renal biopsy Radiologic examination Plain KUB Intravenous pyelography ( IVP ) Granular cast Waxy cast Red cell cast
        • Acute renal failure
        • : urine < 400ml / 24 hr (Oliguria) or > 50-100 ml / 24 hr (anuria)
        • Cause :
        • 1. Hemodynamic changes : low blood volume to kidney
        • - hemorrhage, burn
        • - high hemoglobin, myoglobin
        • 2. Nephrotoxic injury
        • - Ischemic - PCT, DCT damage
        • - Poison - CCI4 , Hg
        • - Infection - Leptospirosis , yellow fever
        • Clinical manifestations
        • Effects of acute renal failure
        • Oliguria
        • Anuria
        • Uremia
        • BUN, K+ , PO4
        • Metabolic acidosis
    • Chronic renal failure Causes : glomerulonephritis, chronic pyelonephritis, nephrosclerosis, lupus erythematosus, diabetes, renal tuberculosis decreased renal function Effects : Uremia syndrome 1. General symptom : Lethargy, insomnia, etc. 2. CVS : hypertension, edema, sterile fibrinous pericarditis 3. GI : เบื่ออาหาร , อาเจียน - gastritis, colitis (NH 3 ) 4. CNS : Lethargy ( ซึม ), peripheral neuropathy 5. Anemi a : Specific for uremia 6. Infection : UTI, Sepsis 7. Metabolic acidosis : หายใจหอบ
    • Glomerular syndrome Nephrotic syndrome Nephritic syndrome Chronic renal failure Nephrotic syndrome Severe proteinuria > 0.15 gm / day upto 10 g / d Hypoproteinemia Generalized edema Hyperlipidemia > 250 mg % Nephritic syndrome Hematuria Oliguria Azotemia : high Creatinine + BUN Hypertension : obstruction of capillary
    • Diseases of Kidney
      • Glomerulonephritis
      • 1) Primary glomerular diseases
      • Glomerular diseases causing nephritic
      • syndrome
        • Diffuse acute proliferative glomerulonephritis (APGN)
        • Rapidly progressive (crescentic) glomerulonephritis (RPGN)
        • Focal glomerulonephritis (FGN)
      • Glomerular diseases causing nephrotic syndrome
        • (Diffuse) minimal change diseases
        • Membranous nephropathy (MGN)
        • Membranoproliferative glomerulonephritis (MPGN)
        • Urinary tract stones
        • Glomerular diseases causing chronic
        • renal failure
        • Chronic glomerulonephritis
      • 2) Secondary glomerular diseases
          • Diabetes mellitus, systemic lupus erythematosus
          • a myloidosis, etc.
        • Histologic alterations
        • 1) Hypercellularity
        • Cellular proliferation : mesangium, endothelium,
        • parietal epithelium
        • Leukocytic infiltration : Neutrophils, monocytes
        • Formation of crescent : Parietal epithelium + PMN
        • 2) Basement membrane thickening : L M , EM
        • Immune complex deposition : Subendothelium,
        • intramembranous, subepithelium
        • Fibrin amyloid : GBM
        • 3) Hyalinization and sclerosis
        • Diffuse : involve all glomeruli
        • F o cal : some glomeruli
        • Global : involve the entire glomerulusaffecting a past of glomerulus
        • Glomerular disease with nephrotic syndrome
        • Minimal changes (Lipoid nephrosis)
        • 2 - 6 yrs child with nephrotic syndrome
        • Etiology : unknown - immunologic mechanism affect
        • visceral epithelium
        • Pathology :
          • Normal glomeruli (LM)
          • Foot process loss (EM)
          • No immune complex
          • Renal tubules (proximal) - lipid
          • Clinic al : Proteinuria, edema, no hypertension
          • Most-respond to c o r t icosteroid
        • Minimal changes (Lipoid nephrosis)
        • Membranous nephropathy
        • Common nephrotic syndrome in adult
        • Etiology : unknown - drugs (NSAIDS), infection, SLE
        • Pathology : Diffuse thickening GBM (LM)
        • Subepithelium deposits
        • Ig deposit c complement
          • Clinic : Proteinuria
          • BUN progress
          • ~ 10% chronic renal failure die
    •  
    •  
        • Membranoproliferative Glomerulonephritis (MPGN)
        • - Basement membrane thickening, increased glomerular cells ,
        • Leukocyte infiltration
        • - Children + young adults
        • Pathology :
        • - Hypercellular + large (Mesangium, WBC?)
        • - Lobular glomeruli
        • - thickened GBM double contour (tram- track)
        • - subendothelium deposit
        • - I g G, C3
        • Clinic al : - NS, some with hematuria
        • ~ 50% chr o nic renal failure 10 yrs