kidney & urinary system
Outlines <ul><li>Structure of kidney & urinary system  </li></ul><ul><li>Functions of kidney </li></ul><ul><li>Renal funct...
Structure of kidney & Urinary system
<ul><ul><li>Kidney: Cortex, Medulla </li></ul></ul>
<ul><ul><li>Nephron </li></ul></ul><ul><ul><li>1.  Glomerulus :  highly permeable    H2O,  electrolytes </li></ul></ul><ul...
 
<ul><ul><li>1.  Water balance </li></ul></ul>Osmoreceptor (hypothalamus) ADH, Vasopressin (Pituitary) Collecting duct Abso...
3. Excretion of waste product - Acid - base - H 2 O - creatinine - Metabolites 4. Others   - erythropoeitin <ul><ul><li>Co...
<ul><ul><li>Renal function tests </li></ul></ul><ul><ul><li>1. Clearance Value : Creatinine, inulin clearance </li></ul></...
Urinalysis Physical & chemical properties   - pH, Specific gravity (1.022), protein, sugar, etc. Urine sediments     - Cel...
Urin a lysis profiles Specific gravity 1.001 - 1.035 Osmolarity 500 -  800 mOsm / kg water pH 4.7 - 8.0 Volume 600 - 1500 ...
Hyaline cast   : clear, tubular protein Granular cast   :  high  protein from plasma Waxy cast     : degraded granular cas...
<ul><ul><li>Acute renal failure </li></ul></ul><ul><ul><li>:  urine  < 400ml / 24 hr (Oliguria) or   > 50-100 ml / 24 hr (...
<ul><ul><li>Effects of acute renal failure </li></ul></ul><ul><ul><li>Oliguria </li></ul></ul><ul><ul><li>Anuria </li></ul...
Chronic renal failure Causes :  glomerulonephritis, chronic pyelonephritis, nephrosclerosis, lupus erythematosus,  diabete...
Glomerular syndrome Nephrotic syndrome Nephritic syndrome Chronic renal failure Nephrotic syndrome Severe proteinuria   > ...
Diseases of Kidney <ul><li>Glomerulonephritis   </li></ul><ul><li>1) Primary glomerular diseases </li></ul><ul><li>  Glome...
<ul><li>Glomerular diseases causing nephrotic syndrome  </li></ul><ul><ul><li>(Diffuse) minimal change diseases </li></ul>...
<ul><ul><li>Histologic alterations </li></ul></ul><ul><ul><li>1) Hypercellularity </li></ul></ul><ul><ul><li>Cellular prol...
<ul><ul><li>Diffuse :   involve all glomeruli   </li></ul></ul><ul><ul><li>F o cal :   some glomeruli  </li></ul></ul><ul>...
<ul><ul><li>Glomerular disease with nephrotic syndrome </li></ul></ul><ul><ul><li>Minimal changes (Lipoid nephrosis) </li>...
<ul><ul><li>Minimal changes (Lipoid nephrosis) </li></ul></ul>
<ul><ul><li>Membranous nephropathy </li></ul></ul><ul><ul><li>Common nephrotic syndrome in adult </li></ul></ul><ul><ul><l...
 
 
<ul><ul><li>Membranoproliferative Glomerulonephritis (MPGN) </li></ul></ul><ul><ul><li>- Basement membrane thickening, inc...
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Kidney & Urinary System

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Kidney & Urinary System

  1. 1. kidney & urinary system
  2. 2. Outlines <ul><li>Structure of kidney & urinary system </li></ul><ul><li>Functions of kidney </li></ul><ul><li>Renal function tests </li></ul><ul><li>Clinical manifestations of renal diseases </li></ul><ul><ul><li>Acute renal failure </li></ul></ul><ul><ul><li>Chronic renal failure </li></ul></ul><ul><ul><li>Glomerular syndrome </li></ul></ul><ul><li>Diseases of the kidney </li></ul><ul><ul><li>Glomerulonephritis </li></ul></ul>
  3. 3. Structure of kidney & Urinary system
  4. 4. <ul><ul><li>Kidney: Cortex, Medulla </li></ul></ul>
  5. 5. <ul><ul><li>Nephron </li></ul></ul><ul><ul><li>1. Glomerulus : highly permeable H2O, electrolytes </li></ul></ul><ul><ul><li>filtration size + charge </li></ul></ul><ul><ul><li>2. Proximal convoluted tubules (PCT) : </li></ul></ul><ul><ul><li>reabsorb H2O </li></ul></ul><ul><ul><li>Na+, K+, H+, Cl </li></ul></ul><ul><ul><li>3. Loop of Henle : </li></ul></ul><ul><ul><li>- function as PCT </li></ul></ul><ul><ul><li>- descending ( no H2O ) </li></ul></ul><ul><ul><li>- ascending H2O </li></ul></ul><ul><ul><li>4. Distal convoluted tubules (DCT) : </li></ul></ul><ul><ul><li>- Aldosterone dependent </li></ul></ul><ul><ul><li>- Na+ reabsorption </li></ul></ul><ul><ul><li>- K+ excretion </li></ul></ul><ul><ul><li>- Synthesis - carbonic anhydrase H + ~ pH & electrolytes </li></ul></ul><ul><ul><li>5. Collecting ducts : </li></ul></ul><ul><ul><li>- ADH (antidiuretic hormone) H2O reabsorption </li></ul></ul>
  6. 7. <ul><ul><li>1. Water balance </li></ul></ul>Osmoreceptor (hypothalamus) ADH, Vasopressin (Pituitary) Collecting duct Absorption of H 2 O <ul><ul><li>Function of Kidney </li></ul></ul><ul><ul><li>2. Acid-base balance </li></ul></ul>Carbonic anhydrase (Distal tubules) Carbonic acid-bicarbonate buffer system H+ excretion Na+ reabsorption H 2 O excretion
  7. 8. 3. Excretion of waste product - Acid - base - H 2 O - creatinine - Metabolites 4. Others - erythropoeitin <ul><ul><li>Conclusion : renal functions </li></ul></ul><ul><ul><ul><ul><ul><li>Filtration </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Reabsorption </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Secretion </li></ul></ul></ul></ul></ul>
  8. 9. <ul><ul><li>Renal function tests </li></ul></ul><ul><ul><li>1. Clearance Value : Creatinine, inulin clearance </li></ul></ul><ul><ul><li>GFR (glumerular filtration rate) </li></ul></ul><ul><ul><li>= Cr urine x Volume urine / min </li></ul></ul><ul><ul><li>Cr in plasma </li></ul></ul><ul><ul><li>= 120 ml / min / body areas </li></ul></ul><ul><li>2. Blood urea nitrogen (BUN) </li></ul><ul><li> - food </li></ul><ul><li> - massive destruction of kidney </li></ul><ul><ul><li>Renal function tests & Diagnosis </li></ul></ul>
  9. 10. Urinalysis Physical & chemical properties - pH, Specific gravity (1.022), protein, sugar, etc. Urine sediments - Cell-RBC, WBC, Renal cells, etc. - Urine casts - Crystalline structure
  10. 11. 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
  11. 12. 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
  12. 13. <ul><ul><li>Acute renal failure </li></ul></ul><ul><ul><li>: urine < 400ml / 24 hr (Oliguria) or > 50-100 ml / 24 hr (anuria) </li></ul></ul><ul><ul><li>Cause : </li></ul></ul><ul><ul><li>1. Hemodynamic changes : low blood volume to kidney </li></ul></ul><ul><ul><li> - hemorrhage, burn </li></ul></ul><ul><ul><li>- high hemoglobin, myoglobin </li></ul></ul><ul><ul><li>2. Nephrotoxic injury </li></ul></ul><ul><ul><li> - Ischemic - PCT, DCT damage </li></ul></ul><ul><ul><li>- Poison - CCI4 , Hg </li></ul></ul><ul><ul><li>- Infection - Leptospirosis , yellow fever </li></ul></ul><ul><ul><li>Clinical manifestations </li></ul></ul>
  13. 14. <ul><ul><li>Effects of acute renal failure </li></ul></ul><ul><ul><li>Oliguria </li></ul></ul><ul><ul><li>Anuria </li></ul></ul><ul><ul><li>Uremia </li></ul></ul><ul><ul><li>BUN, K+ , PO4 </li></ul></ul><ul><ul><li>Metabolic acidosis </li></ul></ul>
  14. 15. 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
  15. 16. 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
  16. 17. Diseases of Kidney <ul><li>Glomerulonephritis </li></ul><ul><li>1) Primary glomerular diseases </li></ul><ul><li> Glomerular diseases causing nephritic </li></ul><ul><li> syndrome </li></ul><ul><ul><li>Diffuse acute proliferative glomerulonephritis (APGN) </li></ul></ul><ul><ul><li>Rapidly progressive (crescentic) glomerulonephritis (RPGN) </li></ul></ul><ul><ul><li>Focal glomerulonephritis (FGN) </li></ul></ul>
  17. 18. <ul><li>Glomerular diseases causing nephrotic syndrome </li></ul><ul><ul><li>(Diffuse) minimal change diseases </li></ul></ul><ul><ul><li>Membranous nephropathy (MGN) </li></ul></ul><ul><ul><li>Membranoproliferative glomerulonephritis (MPGN) </li></ul></ul><ul><ul><li>Urinary tract stones </li></ul></ul><ul><ul><li>Glomerular diseases causing chronic </li></ul></ul><ul><ul><li>renal failure </li></ul></ul><ul><ul><li>Chronic glomerulonephritis </li></ul></ul><ul><li>2) Secondary glomerular diseases </li></ul><ul><ul><ul><li>Diabetes mellitus, systemic lupus erythematosus </li></ul></ul></ul><ul><ul><ul><li>a myloidosis, etc. </li></ul></ul></ul>
  18. 19. <ul><ul><li>Histologic alterations </li></ul></ul><ul><ul><li>1) Hypercellularity </li></ul></ul><ul><ul><li>Cellular proliferation : mesangium, endothelium, </li></ul></ul><ul><ul><li>parietal epithelium </li></ul></ul><ul><ul><li>Leukocytic infiltration : Neutrophils, monocytes </li></ul></ul><ul><ul><li>Formation of crescent : Parietal epithelium + PMN </li></ul></ul><ul><ul><li>2) Basement membrane thickening : L M , EM </li></ul></ul><ul><ul><li>Immune complex deposition : Subendothelium, </li></ul></ul><ul><ul><li>intramembranous, subepithelium </li></ul></ul><ul><ul><li>Fibrin amyloid : GBM </li></ul></ul><ul><ul><li>3) Hyalinization and sclerosis </li></ul></ul>
  19. 20. <ul><ul><li>Diffuse : involve all glomeruli </li></ul></ul><ul><ul><li>F o cal : some glomeruli </li></ul></ul><ul><ul><li>Global : involve the entire glomerulusaffecting a past of glomerulus </li></ul></ul>
  20. 21. <ul><ul><li>Glomerular disease with nephrotic syndrome </li></ul></ul><ul><ul><li>Minimal changes (Lipoid nephrosis) </li></ul></ul><ul><ul><li>2 - 6 yrs child with nephrotic syndrome </li></ul></ul><ul><ul><li>Etiology : unknown - immunologic mechanism affect </li></ul></ul><ul><ul><li>visceral epithelium </li></ul></ul><ul><ul><li>Pathology : </li></ul></ul><ul><ul><ul><li>Normal glomeruli (LM) </li></ul></ul></ul><ul><ul><ul><li>Foot process loss (EM) </li></ul></ul></ul><ul><ul><ul><li>No immune complex </li></ul></ul></ul><ul><ul><ul><li>Renal tubules (proximal) - lipid </li></ul></ul></ul><ul><ul><ul><li>Clinic al : Proteinuria, edema, no hypertension </li></ul></ul></ul><ul><ul><ul><li>Most-respond to c o r t icosteroid </li></ul></ul></ul>
  21. 22. <ul><ul><li>Minimal changes (Lipoid nephrosis) </li></ul></ul>
  22. 23. <ul><ul><li>Membranous nephropathy </li></ul></ul><ul><ul><li>Common nephrotic syndrome in adult </li></ul></ul><ul><ul><li>Etiology : unknown - drugs (NSAIDS), infection, SLE </li></ul></ul><ul><ul><li>Pathology : Diffuse thickening GBM (LM) </li></ul></ul><ul><ul><li>Subepithelium deposits </li></ul></ul><ul><ul><li>Ig deposit c complement </li></ul></ul><ul><ul><ul><li>Clinic : Proteinuria </li></ul></ul></ul><ul><ul><ul><li>BUN progress </li></ul></ul></ul><ul><ul><ul><li>~ 10% chronic renal failure die </li></ul></ul></ul>
  23. 26. <ul><ul><li>Membranoproliferative Glomerulonephritis (MPGN) </li></ul></ul><ul><ul><li>- Basement membrane thickening, increased glomerular cells , </li></ul></ul><ul><ul><li>Leukocyte infiltration </li></ul></ul><ul><ul><li>- Children + young adults </li></ul></ul><ul><ul><li>Pathology : </li></ul></ul><ul><ul><li>- Hypercellular + large (Mesangium, WBC?) </li></ul></ul><ul><ul><li>- Lobular glomeruli </li></ul></ul><ul><ul><li>- thickened GBM double contour (tram- track) </li></ul></ul><ul><ul><li>- subendothelium deposit </li></ul></ul><ul><ul><li>- I g G, C3 </li></ul></ul><ul><ul><li>Clinic al : - NS, some with hematuria </li></ul></ul><ul><ul><li>~ 50% chr o nic renal failure 10 yrs </li></ul></ul>
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