Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the...
-
Upload
noah-conrad-patterson -
Category
Documents
-
view
222 -
download
4
Transcript of Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the...
![Page 1: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/1.jpg)
Copyright © 2006 by Elsevier, Inc.
Figure 26-3;Guyton and Hall
Nephron:functional unit of
the kidney
Nephron:functional unit of
the kidney
![Page 2: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/2.jpg)
Copyright © 2006 by Elsevier, Inc.
Figure 26-4;Guyton and Hall
Nephron Tubular Segments
![Page 3: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/3.jpg)
Copyright © 2006 by Elsevier, Inc.
Structure ofthe juxtaglomerular apparatus: macula
densa
Structure ofthe juxtaglomerular apparatus: macula
densa
Figure 26-17;Guyton and Hall
![Page 4: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/4.jpg)
Copyright © 2006 by Elsevier, Inc.
Cortical and JuxtamedullaryNephron Segments
Figure 26-5;Guyton and Hall
![Page 5: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/5.jpg)
Copyright © 2006 by Elsevier, Inc.
• http://www.youtube.com/watch?v=glu0dzK4dbU
![Page 6: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/6.jpg)
Copyright © 2006 by Elsevier, Inc.
Summary of Kidney Functions
• Excretion of metabolic waste products: urea, creatinine, bilirubin, hydrogen
• Excretion of foreign chemicals: drugs, toxins, pesticides, food additives
• Secretion, metabolism, and excretion of hormones- renal erythropoetic factor- 1,25 dihydroxycholecalciferol (Vitamin D)- Renin
• Regulation of acid-base balance• Gluconeogenesis: glucose synthesis from amino acids• Control of arterial pressure• Regulation of water & electrolyte excretion
![Page 7: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/7.jpg)
Copyright © 2006 by Elsevier, Inc.
Basic Mechanisms of Urine Formation
Figure 26-8;Guyton and Hall
![Page 8: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/8.jpg)
Copyright © 2006 by Elsevier, Inc.
Renal Handling ofDifferent Substances
Figure 26-9;Guyton and Hall
![Page 9: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/9.jpg)
Copyright © 2006 by Elsevier, Inc.
Renal Handling of Water and Solutes
Filtration Reabsorption Excretion
Water (liters/day) 180 179
Sodium (mmol/day) 25,560 25,410 Glucose (gm/day) 180 0Creatinine (gm/day) 1.8 1.8
1
1800
150
![Page 10: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/10.jpg)
Copyright © 2006 by Elsevier, Inc.
Glomerular Capillary Filtration
Barrier
Glomerular Capillary Filtration
Barrier
Figure 26-10;Guyton and Hall
![Page 11: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/11.jpg)
Copyright © 2006 by Elsevier, Inc.
The Ability of a Solute to Penetrate the Glomerular Membrane Depends on:
• Molecular size ( small molecules > filterability)• Ionic charge (cations > filterability)
![Page 12: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/12.jpg)
Copyright © 2006 by Elsevier, Inc.
Effects of Size and Electrical Charge of Effects of Size and Electrical Charge of Dextran on Filterability by Glomerular Dextran on Filterability by Glomerular CapillariesCapillaries
Effects of Size and Electrical Charge of Effects of Size and Electrical Charge of Dextran on Filterability by Glomerular Dextran on Filterability by Glomerular CapillariesCapillaries
Figure 26-11;Guyton and Hall
![Page 13: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/13.jpg)
Copyright © 2006 by Elsevier, Inc.
Clinical Significance of Proteinuria
• Early detection of renal disease in at-risk patients- hypertension: hypertensive renal disease- diabetes: diabetic nephropathy- pregnancy: gestational proteinuric hypertension (pre-eclampsia)- annual “check-up”: renal disease can be silent
• Assessment and monitoring of known renal disease
• “Is the dipstick OK?”: dipstick protein tests are not very sensitive and not accurate: “trace” results can be normal & positives must be confirmed by quantitative laboratory test.
![Page 14: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/14.jpg)
Copyright © 2006 by Elsevier, Inc.
Figure 26-12;Guyton and Hall
![Page 15: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/15.jpg)
Copyright © 2006 by Elsevier, Inc.
Glomerular Hydrostatic Pressure (PG)
• Is the determinant of GFR most subjectto physiological control
• Factors that influence PG- arterial pressure (effect is buffered by autoregulation)- afferent arteriolar resistance- efferent arteriolar resistance
![Page 16: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/16.jpg)
Copyright © 2006 by Elsevier, Inc.
Re
Effect of Afferent and Efferent Arteriolar Constriction on Glomerular Pressure
PG
GFR
Ra
Ra GFR + Renal Blood Flow
Blood Flow
GFR
PG
Re GFR + Renal Blood Flow
Blood Flow
![Page 17: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/17.jpg)
Copyright © 2006 by Elsevier, Inc.
Figure 26-14;Guyton and Hall
Effect of changes in afferent
arteriolar or efferent arteriolar
resistance
Effect of changes in afferent
arteriolar or efferent arteriolar
resistance
![Page 18: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/18.jpg)
Copyright © 2006 by Elsevier, Inc.
RE
RBF G
GFR
PG
+
_
determined by : FF = GFR / RPF
![Page 19: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/19.jpg)
Copyright © 2006 by Elsevier, Inc.
Kf GFR
PB GFR
G GFR
A G
FF G
PG GFR
RA PG
RE PG
Summary of Determinants of GFR
GFR
GFR
GFR(as long as RE < 3-4 x normal)
![Page 20: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/20.jpg)
Copyright © 2006 by Elsevier, Inc.
Assessing Kidney Function
• Albumin excretion (microalbuminuria)• Plasma concentration of waste products
(e.g. BUN, creatinine)• Urine specific gravity, urine concentrating ability• Imaging methods (e.g. MRI, PET, arteriograms,
iv pyelography, ultrasound etc)• Isotope renal scans• Biopsy• Clearance methods (e.g. 24-hr creatinine clearance)• etc
![Page 21: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/21.jpg)
Copyright © 2006 by Elsevier, Inc.
Clearance
• Clearance is a general concept that describes the rate at which substances are removed (cleared) from the plasma.
![Page 22: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/22.jpg)
Copyright © 2006 by Elsevier, Inc.
Clearance Technique
Renal clearance of a substance is the volume of plasma completely cleared of a substance per min.
Cs = Us x V Ps
Cs x Ps = Us x V
Where: Cs = clearance of substance SPs = plasma conc. of substance SUs = urine conc. of substance SV = urine flow rate
![Page 23: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/23.jpg)
Copyright © 2006 by Elsevier, Inc.
For a substance that is freely filtered, but not reabsorbed or secreted (inulin, 125 I-iothalamate, ~creatinine), renal clearanceis equal to GFR
Use of Clearance to Measure GFR
amount filtered = amount excreted
GFR x Pin = Uin x V
GFR = Pin
Uin x V
Copyright © 2006 by Elsevier, Inc.
![Page 24: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/24.jpg)
Copyright © 2006 by Elsevier, Inc.
Calculate the GFR from the following data:
Pinulin = 1.0 mg / 100mlUinulin = 125 mg/100 mlUrine flow rate = 1.0 ml/min
GFR =125 x 1.0
1.0= 125 ml/min
GFR = Cinulin =Pin
Uin x V
![Page 25: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/25.jpg)
Copyright © 2006 by Elsevier, Inc.
Steady-state relationship
betweenGFR and serum
creatinine concentration
Figure 27-19;Guyton and Hall
![Page 26: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/26.jpg)
Copyright © 2006 by Elsevier, Inc.
Clearances of Different Substances
Clearance of inulin (Cin) = GFRif Cx < Cin: indicates reabsorption of x
Substance Clearance (ml/min) inulin 125 glucose 0 sodium 0.9 urea 70
Clearance creatinine (Ccreat) ~ 140 (used to estimate GFR)if Cx > Cin: indicates secretion of x
![Page 27: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/27.jpg)
Copyright © 2006 by Elsevier, Inc.
1. Sympathetic Nervous System RA + RE GFR + RBF
Control of Glomerular Filtration
3. Angiotensin II RE GFR + RBF
(prevents a decrease in GFR)
2. Catecholamines ( norepinephrine) RA + RE GFR + RBF
![Page 28: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/28.jpg)
Copyright © 2006 by Elsevier, Inc.
Control of Glomerular Filtration
5. Endothelial-Derived Nitric Oxide (EDRF)RA + RE GFR + RBF
4. ProstaglandinsRA + RE GFR + RBF
6. EndothelinRA + RE GFR + RBF
![Page 29: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/29.jpg)
Copyright © 2006 by Elsevier, Inc.
Control of Glomerular Filtration
7. Autoregulation of GFR and Renal Blood Flow• Myogenic Mechanism• Macula Densa Feedback
(tubuloglomerular feedback) • Angiotensin II ( contributes to GFR but
not RBF autoregulation)
![Page 30: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/30.jpg)
Copyright © 2006 by Elsevier, Inc.
Renal ArteryPressure (mmHg)
100
80
Renal Blood Flow
Glomerular Filtration Rate
Renal Autoregulation
Time (min)0 1 2 3 4 5
120
Copyright © 2006 by Elsevier, Inc.
![Page 31: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/31.jpg)
Copyright © 2006 by Elsevier, Inc.
Renal Blood Flow and GFRAutoregulation
Figure 26-16;Guyton and Hall
![Page 32: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/32.jpg)
Copyright © 2006 by Elsevier, Inc.
Macula Densa Feedback
GFR
Distal NaCl Delivery
Macula Densa NaCl Reabsorption
Afferent Arteriolar Resistance
GFR (return toward normal)
(macula densa feedback)
![Page 33: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/33.jpg)
Copyright © 2006 by Elsevier, Inc.
Myogenic Mechanism
Stretch ofBlood Vessel
Cell Ca++
PermeabilityArterial Pressure
Intracell. Ca++Blood Flow VascularResistance
![Page 34: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/34.jpg)
Copyright © 2006 by Elsevier, Inc.
Regulation of GFR by Ang II
GFR Renin
AngII
Efferent ArteriolarResistance
Macula Densa NaCl
BloodPressure
![Page 35: Copyright © 2006 by Elsevier, Inc. Figure 26-3; Guyton and Hall Nephron: functional unit of the kidney.](https://reader035.fdocuments.in/reader035/viewer/2022062407/56649db55503460f94aa73d6/html5/thumbnails/35.jpg)
Copyright © 2006 by Elsevier, Inc.
Macula densa feedback
mechanismfor GFR
autoregulation
Figure 26-18;Guyton and Hall