Pearls of Renal System

*Pearls of Renal System*

*Important Points😊*

Increased osmolarity .... Tip of loop of henle
Decreased osmolarity ....... Early DCT & macula

Diluting segment .....Thick ascending limb
Concentrating segment...... CCD ( vasa recta)

Concentrating urine ..... function of.... *Vasa Recta*
Concentrating urine in summer or during fasting... *ADH*

DCT....Impermeable to water

Loop diuretics act on *Thick ascending limb*
Thiazide diuretics act on *Early DCT*
Both together act on... *DCT & CT*
Osmotic diuretics act on.... *PCT*

Renal columns contain... *Medullary rays / collecting ducts*

prone to ischemia....PCT
Maximum water & sodium absorption ....PCT
Maximum water & sodium absorption with any hormone ....PCT
Maximum potassium absorption....PCT
potassium loss due to dietry irregularities .... Distal tubules

H secretion in PCT is related to HCO³— reabsorption

After blood loss GFR & urine out put is increased by.... *Thick Ascending limb*

*Asthenuria* ... Decrease tubulointerstitial feedback
( increase plasma osmolarity / increased fixed sp. gravity )

Juxtamedullary nephrons....Vasa recta

Juxtamedullary nephrons... not supplied by peritubular capillaries

ADH...Acts on osmoreceptors / DCT
ADH....Increase Urea transport to DCT
ADH.... inhibited by alcohol
ADH... regulates plasma volume / urine osmolarity
ADH...V1 receptors cause vasoconstrictio
ADH...V2 receptors act on kidney

Highest tubular transport maximum....Lactate
Least Clearance...
Glucos
Threshold for Glucose....180
Glucose appears in urine.....250

Erythropoeitin secreted by peritubular capillaries
( mesengeal cells )

Amino Acid deficiency causes cell injury...Glycine
Amino acid cause injury to cell....choline
Amino Acid causing renal stones....Lysine
Amino acid in abnormal metabolism....Tryptophan

Isotonic loss...sodium remains same
Hypotonic loss.... Hyponatremia & ICF volume increases
Hypertonic loss.... hypernatremia , ICF volume contracts

Na/K/cl at basolateral membrane
ACE at luminal surface of endothelial cells

Kidney podocytes...at visceral layer of bowman capsule
Cresents formed by parietal cells linning bowman capsule

Paracetamol & sickle cell anemia... cause renal papillary necrosis

Renal calyses in normal VP.... 7
Renal segments....5
Capacity of renal pelvis... less than 5ml

Fanconi Anemia... BRCA 2 mutation

Na/H & Cl/HCO3.... Hypertonic cell volume regulation
K efflux from cell.... Hypotonic cell volume regulation

Smller system in B.P contro.... tubuloglomerular feed back
Long term B.p regulation.... Kidney

Normal Values for Acid base...
PCO2 : 5.3 KPa / 40mmHg
PO2 : 11 to 13 KPa / 75 to 100 mmHg
PH : 7.40
HCO3 : 22 to 26 meq

Maximum flow per gram.... Kidney
Maximum consumption of O2 ...Liver

Countercurrent multiplier require .... hypertonic medullary interstitium

Countercurrent multiplier require...maintaned by vasa recta

After 2 liter fluid loss , person drinks plain water ... increase ICF
1 liter blood loss in 5 min.... Increased venous tone
Lost 8 percent blood in 30 min, Volume significantly reduced...Capillary blood

PKD .. most common death id due to RENAL FAILURE
PKD... associated with Berry Aneurysm & Renal failre

Secreted from kidney... 1,25 dihydrocholecalciferol , Renin, Erythropoeitin
NOT secreted from kidney... Angiotensin 1

Angiotensin ... Increases extracellular K ( moving K out of cell)
Maintainance of ECF k... Na/ K pump
Most COMMON shift of K to ECF....Strenous Exercise

main action of Angiotensin 2... Vasoconstriction
Decrease Angiotensin.... Increases ECF volume

Dialysis pt are Prone to develop... Hepatitis B

GFR measure clinically / best estimated ... Creatinine clearance
GFR best Way to measure.... Inuline
Best way to measure RPF... PAH
Best test for renal failure... Creatinine clearance

Pyuria Culture negative... Poststreptococcal glomerulonephritis.

Persistent pyuria.... PKD & Urine at room temp. i. e. alkaline PH ( not cause by Poststreptococcal glomerulonephritis)

Renin... produced by JG cells
Renin...Long term B.P regulation
Renin...secretion may be stimulated by vasopressor secretion

Renin.. most potent stimulus for release is sympathetic outflow

Renin.. increased by ACE inhibitors, increase K, B1 receptors.
Renin...secretion INVERSLY related to Na & Cl in DCT

Immunoflorescence Granular... PSGN , SLE, Diffuse prolf. GN ,Membrane prolfi. GN

SubENDOthelial deposits...
SLE,
Diffuse prolf. GN,
Membrane prolfi. GN

Sub EPIthelial deposits...PSGN

Intramembranous Deposits...
Diffuse prolf. GN , Membrane prolfi. GN type 2

GB Thickening.... Membranous GN ( IC deposit ) ,
D.M ( type 4 Collagen)

Rapidly progressive GN associated with ...Good pasture, Micrscopic polyangitis (p ANCA)

Focal segmental Glomerulonephritis ... M.C.C of nephritis in Adults , associated with HCV > IV drug abusers , Bad prognosis , Leads to CRF

First sign of DM Nephropathy... Microalbuminuria

Medullary sponge kidney... swiss cheese appearance

Streptococcal infection ... Blood culture
Streptococcal infection COMPLICATIONS....ASO titer

Renal lesions in Wegner's Granulomatosis

Most common ...IgA nephropathy

Hyperaldosteronism.... INCREASED Na, DECREASED K & Renin , Muscle weakness, MET. Alkalosis, HTN.

Most potent stimulus Hypovolemia... Renin Angiotensin

Most potent stimulus Osmolarity....ADH

Most potent stimulus for Aldosteron... K >>> Renin

Mecula Densa sensitive to Na & osmolar load delivered to DCT

CNS manifestations in CRF DUE TO...
HYPOcalcemia,
HYPOnatremia
ACIDOSIS
( not due to hyperosmolarity)

Tetny occurs in REspiratory Alkalosis / HYpercapnia

BORN with PKD ... Autosomal Recessive

When ureteric bud doesn't grow towards metanephric cap.... *Absent ureter*

Sodium Absorption.... Aldosteron
Sodium excretion...ANP

Net SODIUM Absorption... Aldosteron & ANP
MOLE for MOLE Sodium Absorption... Aldosteron

SERUM osmolarity ....
300 m osm

GLOMERULAR capillary pressure increases due to ....... *short afferents*

MAJOR Buffers
Body / ECF.....HCO3
Renal Tubules....Phosphate
ICF...proteins
RBC....Hb

Acute Hemorrhage , sequence of replacement.... Plasma volue > Electrolytes > R.B.C

Plasma Osmolarity INCREASE in...Water deprivation
Plasma Osmolarity DECREASE in...SIDH
Plasma Osmolarity DECREASE by ...INjection of ADH

1 liter blood loss....Negative feedback
2 Liter blood loss ( stage 3 to 4) ....Decrease Stroke Volume

Renal excretion of drug... Affected by glomerular filteration