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All things Renal

All things Renal. Peer Support Zoulikha Zair. RAAS. Components of the RAAS. Renin Synthesised and stored in the JGA Released in response to low BP and low NaCl in filtrate Angiotensin II Vasoconstriction increased PT Na + reabsorption (indirect via Aldo. in DT)

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All things Renal

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  1. All things Renal Peer Support ZoulikhaZair

  2. RAAS

  3. Components of the RAAS • Renin • Synthesised and stored in the JGA • Released in response to low BP and low NaCl in filtrate • Angiotensin II • Vasoconstriction • increased PT Na+ reabsorption (indirect via Aldo. in DT) • induces aldosterone production • Aldosterone and Sodium Reabsorption • Aldosterone induces expression and activity of SGK (serum and glucocorticoid regulated kinase) • which causes translocation of ENaC to membrane and  expression • driving force is Na+/K+ATPase (activity also increased by aldosterone)

  4. How is bp increased?

  5. GFR and eGFR Glomerular filtration rate • Linked to age, sex and body size • young male = 120ml/min/1.73m2 • lower in females and decreases with age • total volume filtered is ~180 l/day • Regulated by constriction/dilatation of the afferent arteriole (AA) • (if AA is dilated the GFR increases and hydrostatic pressure in the glomerulus ) Estimated GFR • the volume of blood plasma that is cleared of creatinine per unit time • Incorporates, age, sex and ethnicity • Utilises MDRD = modification of diet in renal disease (µmol/L)

  6. What is Acute Kidney Failure? • A sudden (hours to weeks) decline in glomerular filtration rate marked by the accumulation of metabolic waste products with life threatening consequences.

  7. Name three classifications of AKI • Pre-renal - kidneys don’t receive adequate blood supply • Renal hypoperfusion • Local e.g. Renal artery stenosis, Drugs- ACE inhibitors, NSAIDs • Intrinsic – Kidney tissue becomes damaged • Acute tubular injury e.g. ischaemia • Acute glomerulonephritis • Post-renal – obstruction to urinary flow

  8. What ic Chronic Kidney Disease? • Progressive and irreversible loss of renal function over a period of years or months, resulting in the loss of both excretory and hormone functions of the kidney.

  9. How is CKD Classified?

  10. Diagnosis/Classification of CKD is based on eGFR plus evidence of other chronic kidney damage; • Persistent microalbuminaemia • Persistent proteinuria • Persistent haematuria after exclusion of other causes • Structural abnormalities of the kidneys shown by radiology • Biopsy proven glomerulonephritis

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