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Renal Physiology Overview

Renal Physiology Overview. Jeff Kaufhold, MD FACP. Renal Physiology. Structure Clearance Water Balance Electrolytes Acid-Base Balance Hormonal Functions. Renal Anatomy. Renal Artery and Vein Cortex – filtering Glomeruli Medulla – Tubules, regulates water/ lytes Ureters Bladder

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Renal Physiology Overview

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  1. Renal PhysiologyOverview Jeff Kaufhold, MD FACP

  2. Renal Physiology • Structure • Clearance • Water Balance • Electrolytes • Acid-Base Balance • Hormonal Functions

  3. Renal Anatomy • Renal Artery and Vein • Cortex – filtering Glomeruli • Medulla – Tubules, regulates water/ lytes • Ureters • Bladder • Urethra and Sphincter control

  4. Anatomy of Urinary Tract

  5. Glomerular Physiology • Filtration • Filtration membrane • Endothlial cell layer • Basement membrane • Epithelial cell layer • Electrical charge – negative • Clearance = waste product removal • Ultrafiltration = water removal

  6. Filtration Membrane

  7. Glomerular Blood Flow

  8. Glomerular PhysiologyBlood flow determinants Systemic Efferent Afferent Filtration

  9. Effect of Angiotensin on Glomerular Blood Flow

  10. Glomerular PhysiologyBlood flow determinants Efferent Afferent PG's Local TGF Filtration

  11. Glomerular PhysiologyBlood flow determinants Systemic Efferent Afferent PG's Local TGF Filtration

  12. Glomerular filtration

  13. Glomerular Physiology • Pathologic conditions: • Renal Artery Stenosis • Hypertension / Medication effects • Membrane problems • Lead to blood in urine – hematuria • -Loss of negative charge leads to protein in urine – proteinuria • -Diabetes, Glomerulonephritis

  14. Blood Flow to Tubules

  15. Renal Tubule PhysiologyOverview Prox. tubule Distal Tubule reabsorption Collecting duct Loop of Henle

  16. Proximal Tubule • Function: Reabsorption • Features: • Brush border with cilia • Carbonic Anhydrase for reclaiming Bicarb • Filtration Fraction • Pathology: Renal tubular Acidosis

  17. Renal Tubule PhysiologyOverview Prox. tubule Distal Tubule blood Tubule membrane reabsorption Collecting duct Ultrafiltrate Tubule lumen Loop of Henle Tubule membrane

  18. Renal Tubule PhysiologyOverview Prox. tubule Distal Tubule Collecting duct Loop of Henle

  19. Renal Tubule PhysiologyOverview Prox. tubule Distal Tubule Collecting duct impermeable to imperm. to H2O solute Loop of Henle

  20. Renal Tubule PhysiologyOverview Prox. tubule Distal Tubule Collecting duct Loop of Henle

  21. Renal Tubule PhysiologyOverview Ion Exchange Sodium for Potassium/Hydro Prox. tubule Distal Tubule Collecting duct Loop of Henle

  22. Renal Tubule PhysiologyOverview Prox. tubule Distal Tubule Collecting duct Loop of Henle

  23. Renal Tubule PhysiologyOverview Prox. tubule Distal Tubule Collecting duct ADH + permeable to H2O Loop of Henle ADH - impermeable

  24. Function of Nephron Tubules

  25. Renal Tubule PhysiologyOverview Prox. tubule Distal Tubule solute exchange reabsorption Collecting duct impermeable to imperm. to H2O solute ADH + permeable to H2O Loop of Henle ADH - impermeable

  26. Interstitium • The tissue in between the tubules • Function: • Ammoniagenesis • Countercurrent multiplier • Pathology: • RTA, Loss of concentrating ability, AIN

  27. Countercurrent Multiplier • Way to keep the concentrating ability of the kidney isolated from the rest of the body • Components: • Urine flow with sodium chloride pump • Blood flow from Vasa Recta • Pathology: • Sickle Cell /Trait, bladder obstruction

  28. Countercurrent Multiplier

  29. Countercurrent Multiplier

  30. Countercurrent Multiplier WARM COLD

  31. Renal PhysiologyEndocrine Functions • Renin – control of BP • Erythropoietin – turns on bone marrow to make red blood cells • Vitamin D activation – regulates bone metabolism, Calcium, Phosphorus and Parathyroid Gland.

  32. Volume regulation • Active Sensors • Renal Autonomic nerves • Passive system • Like a system of lakes and spillways

  33. Renal Structure C Artery P Vein M Ureter

  34. Renal Structure Cortex U osmotic gradient 300 Vascular bundle Medulla collecting tubule Glomerulus U 1200

  35. Renal PhysiologySensing of Volume • Effective Arterial Blood Volume (EABV) • Pathology: • Congestive Heart Failure • Cirrhosis • Pregnancy • Nephrotic Syndrome • Aldosteronoma

  36. Pathologic States • CHF • Renal Artery Stenosis • Low Blood Flow

  37. Pathologic States • Cirrhosis • Pregnancy • Nephrotic Syndrome Leaky capillaries

  38. Pathologic States • Aldosteronoma • Tumor which • Produces too much • Aldosterone, causing • Fluid retention

  39. Pathologic States • Aldosteronoma causes • Fluid retention • Hypertension • Perfusion of outer glomeruli sets upper limit on how much fluid can be retained.

  40. Pathologic States • Removal of Aldosteronoma causes • Diuresis until volume is normal again, and • Hypertension improves

  41. Why Kidney Patients willCome to Physical Therapists • Hip Fractures • Strokes • Heart attacks and heart surgery • Deconditioning • Neuropathy

  42. Afferent. Art AT II constrict ACE-i dilate PG's NET dilate TGF NET constrict NSAID's constrict Aminophylline dilate Diltiazem dilate Filt Press maintained reduced increase parallels reduce increase reduced Glomerular Physiology Efferent Art. constrict dilate no effect no effect no effect no effect dilate

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