Kidney & Urinary System
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  • 1. kidney & urinary system
  • 2. 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
  • 3. Structure of kidney & Urinary system
  • 4.
      • Kidney: Cortex, Medulla
  • 5.
      • 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
  • 6.  
  • 7.
      • 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
  • 8. 3. Excretion of waste product - Acid - base - H 2 O - creatinine - Metabolites 4. Others - erythropoeitin
      • Conclusion : renal functions
            • Filtration
            • Reabsorption
            • Secretion
  • 9.
      • 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
  • 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
  • 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
  • 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
  • 13.
      • 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
  • 14.
      • Effects of acute renal failure
      • Oliguria
      • Anuria
      • Uremia
      • BUN, K+ , PO4
      • Metabolic acidosis
  • 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
  • 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
  • 17. 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)
  • 18.
    • 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.
  • 19.
      • 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
  • 20.
      • Diffuse : involve all glomeruli
      • F o cal : some glomeruli
      • Global : involve the entire glomerulusaffecting a past of glomerulus
  • 21.
      • 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
  • 22.
      • Minimal changes (Lipoid nephrosis)
  • 23.
      • 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
  • 24.  
  • 25.  
  • 26.
      • 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