a very good ppt

1. INTRODUCTION
The renin angiotensin is a critical
regulator of blood volume,electrolyte
balance,and systemic vascular
resistance. While the baroreceptor reflex
responds short term to decreased arterial
pressure,the RAAS is responsible for
acute and chronic alterations

2. Regulation of
blood volume
and blood
pressure by
RAAS

3. Renin Angiotensin system (RAS)

4. Micturition
 Micturition is the
discharge of urine from
the urinary bladder to
the outside of the body
through urethra
 It results from an
interplay of involuntary
and voluntary actions by
the internal
external
and
urethral
sphincters

5. Regulation of
micturition

7. Role of Kidneys in Acid Base Balance
+
🞑 Excretionof H+ and Formationof NH4
2-
+ HPO3
+ NH3
-
H+
H+
H2PO3
+
NH4
🞑 R
eabsorption of HCO3
-
H+ + HCO3
- H2CO3 CO2 + H2O
- +
H+ excreted as H2PO3 and NH4
-
HCO3 absorption regulates blood CO2 levels

8. Absorption of HCO3
-

9.  Buffer system
 Carbonicacid bicarbonate
NaCl + H2CO3
NaHCO3 + H2O
HCl + NaHCO3
NaOH + H2CO3
Phosphate buffer
NaOH + NaH2PO4
HCl + Na2HPO4
H2O + Na2HPO4
NaCl + NaH2PO4
 Haemoglobin-oxyhaemoglobin
 Respiration
CO2 + H2O H2CO3
 Kidney excretion
H+ +CO3-

10. Feedback mechanismof kidneys to regulate
Acid-Basebalance
3
 Acidosis
🞑 Reabsorption of HCO3
-
🞑 Secretionof H+ from
CD
🞑 Formation of NH+
 Alkalosis
🞑 Excretion of HCO3
-
🞑 R
educing secretion of
H+ from CD
🞑 R
educing glutamate
metabolism and
Formation of NH3
+

11. Renal function tests
 Glomerular function testsor clearance tests
Inulin clearance test
Creatinine clearance test
Urea Clearance test
 T
ubular function tests
Urea Concentration
Urine acidification
 Analysisof blood / serum
Estimation of blood urea, serum creatinine, protein & electrolyte
 Urine examination
Volume,pH,Specific gravity, Osmolality, Presenceof certain abnormal constituents
(Proteins, blood, ketone bodies, glucose)

12. Clearance tests
The volume of plasma that would be completely cleared
of a substance per minute. It is expressed as ml/min
C = (u x v)/p
Where
u= conc of substance in urine
V= volume of urine excreted per min
P= conc of substance in plasma
 Creatinine clearance (145ml/minute)
 Urea clearance (75ml/minute)
75 % less than normal values that indicates the
renalimpairement

13. Creatinine clearance
The volume of plasma that would be completely cleared
of creatinine per minute. It is expressed as ml/min
C = (u x v)/p
Where
u= conc of creatinine in urine
V= volume of urine excreted per min
P= conc of creatinine in plasma
 Creatinine clearance = 145ml/minute

14. Urea clearance
The volume of plasma that would be completely
cleared of urea per minute. It is expressed as
ml/min
C = (u x v)/p
Where
u= conc of urea in urine
V= volume of urine excreted per min
P= conc of urea in plasma
 Urea clearance - 75ml/minute

15. Symptomsof Kidney Failure
 Weakness
 Lethargy
 Shortnessof breath
 Widespread edema
 Anemia
 Metabolic acidosis / Metabolic alkalosis
 Heart arrhythmias
 Uremia (high urea level in the blood)
 Lossof appetite
 Fatigue
 Excessive urination / Oliguria

16. Disorders of kidneys
1. Glomerulonephritis
2. Nephrotic syndrome
3. Acute renal failure
4. Diabetic kidney
5. Acute pyelonephritis
6. Chronic renal failure
7. Urolithiasis
8
. R
enal tumours
9. Urinary T
ract Infections (UTI)

17. Glomerulonephritis
 It is the inflammatory condition of the glomerulus. In
many cases immune complexes lodge in the walls of
the glomeruli they often cause an inflammatory
response that impairsglomerular function
 Effects: Hematuria, asymptomatic proteinuria, acute
nephritis, chronic renal failure, nephrotic syndrome

18. Nephrotic syndrome
 This is not a disease in itself but is an important
feature of several kidney diseases.
 The main characteristicsare:
• Marked proteinuria
• Hypoalbuminaemia
• Generalised oedema
• Hyperlipidaemia.

19. Diabetic kidney
 Renal failure is the cause of death in 10% of all
diabetics and up to 50% of cases of the insulin-
dependent (type I) diabetes mellitus . There is damage
to large and small blood vessels in many parts of the
body. The effects include
🞑 progressive glomerulosclerosis followed by atrophy of the
tubules
🞑 acute pyelonephritis with papillary necrosis
🞑 atheroma of therenal arteries and their branches, leading
to renal ischaemia and hypertension
🞑 nephrotic syndrome

20. Acute renal failure
 It is the condition where there is a sudden and severe
reduction in the glomerular filtration rate and kidney
function that is usually reversible over days or weeks when
treated
 Causes:
🞑 prerenal: theresultof reducedrenal blood flow, especially severe
and prolonged shock
🞑 renal, or parenchymal: damage to the kidney itself due to, e.g.,
acute tubular necrosis, glomerulonephritis
🞑 post-renal: obstruction to the outflow of urine, e.g. tumourof the
bladder, uterus or cervix, large calculus in the renal pelvis.

21. Chronic renal failure
 It is the condition when irreversible damage occurs
to nephrons which is so severe that 75% of renal
function has been lost and the kidneys cannot
function effectively.
 Causes: glomerulonephritis, diabetes mellitus,
chronic pyelonephritis and hypertension.
 Effects: Uraemia, polyuria, acidosis, electrolye
imbalance, anaemia, hypertension

22. Renal calculi or kidney stones
 Calculi (stones) form in the kidneys and bladder
when urinary constituents normally in solution are
precipitated. The solutes involved are oxalates,
phosphates, urates and uric acid. Stones usually
consist of more than one substance, deposited in
layers.
 Causes: Dehydration, pH of urine, Infection,
metabolic conditions such as gout

23. References
 Rossand Wilson – Human Anatomy and Physiology textbook
 Tortora – Anatomy and Physiology textbook
 Medical physiology by Sembulingam
 Mahesh Prasad et al., Human Anatomy and PhysiologyII
(Nirali prakashan)
 S.B.Bhise and Y
adav Human Anatomy and PhysiologyII
(Nirali prakashan)

24. THANK YOU