Na⁺

H₂O

Glucose

Amino acids

Cl

HcO³

K⁺

Mg

Ca

urea

H⁺

NH⁴

H₂O

Cl^-

K⁺

Na⁺

Ca⁺⁺

Cl^-

Na⁺

H⁺

K⁺

NH⁴ (moves into PCT)

HCO₃ (moves out of PCT)

filtration pressure in glomerulus

permeability of glomerular membrane

hydrostatic pressure in the glomerular capillaries

also plasma oncotic pressure

1. SNS

2. Autoregulation

afferent arteriole stretch-->tubuloglomerular feedback(?)-->macula dense sense inc. GFR, send signal to glomerulus to dec. GFR

Vasoactive prostaglandins involved

1) secrete rennin-->angiotensin II

2) endothelial cells in glomerular capsule have ACE capabilities-->constrict afferent or efferent arteriole

3) erythropoetin

4) activate vitamin D

E. Coli

proteus

enterobacter

1) F & E balance

2) eliminate water soluble waste

dilution of urine, voiding of urine

urea, low PH (cranberry juice)

premenopausal, prostatic secretions

10% asymptomatic

frequency, dysuria, suprapubic pain, cloudy urine, hematuria

dipstick (nitrates, pos. WBC)

UA: bacteria, RBC's WBC's

culture may not be performed

young fem.: 3 day course of antiBx

young male: 7-10 day course of antiBx

fem. >65: 10 day course of antiBx

male > 65: 14-28 day course of antiBx

avoid caffeine, ETOH, Chocolate, spicy food, tomatoes, some berries

inc. fluid intake/cranberry juice

some fem. are given low dose prophylactic

same as for cystitis.

vesicoureteral relfux

pregnancy

neurogenic bladder

urinary obstructions

sudden onset of fever and chills

costovertebral tenderness or pain

signs of UTI

(infants children, elderly have more generalized symptoms)

UA: WBC's, RBC's WBC casts(?)

urine culture

CBC: inc. WBC, inc. neutrophils

gross hematuria, red cell casts, white cell casts

proteinuria

azotemia and oliguria

edema and fluid volume excess

periorbital edema

inc. BP

Hx of recent disease

UA: hematuria, proteinuria, RBC and WBC casts

inc. BUN, inc. Creatinine

antibodies to strep(?)

renal biopsy

treat causative factor

dialysis

antimicrobials, antihypertensives, steroids, diuretics

restrict Na⁺ intake

edema

hyperlipidemia

hypercoagulability

dec. immunity

vit. D deficiency

hypocalcemia

inc. glomerular perm.-->protienuria-->hypoalbuminemia(see below)-->dec. plasma oncotic pressure-->generalized edema. and dec. blood volume-->RAAS activation (leads to salt and water retention) and ADH secretion (water retention)

Hypoalbuminemia-->stimulation of liver synthesis-->hyperlipidemia(?) and excess clotting factors

Tx underlying disease

steroids

sodium restriction

rest

diuretics

Diet: low NA, low fat, adequate to high protein

Vit D, iron, calcium

Dialysis, transplant

4x more likely in men

50-60% reccurence rate in 10 years

inc. concentration of solute

abnormal urinary pH

low urine volume

lack of stone formation inhibitors (citrates and magnesium)

excess bone reabsorption of calcium

abnormal large intake of Ca or vit. D

impaired renal Fx

hyperabsorption of oxalate (soy prod., IBD)

bowel surgery

overdose of Vit C

genetics

fat malabsorption

from inc. uric acid

urinary pH too low

high purine intake

ureteral colic pain

sudden onset

proceeds quickly to intense, severe, and sharp

starts in flank, migrates to ipsilateral groin

physical findings

UA: hematuria, urine pH, WBC

serum BUN and creatinine to check renal Fx

KUB or CT or IVP to locate stone

lithotripsy

prevention of future stones

calcium: consume adequate Ca and Vit D

Oxalate: peanuts, rhubarb, tea, coffee, spinach, nuts, chocolate

uric acid: limit organ meats, fish, purine rich food

struvite: prevent/treat infection

dilute urine (2L or more a day)

medications

high fluid intake, reduce Na⁺, adequate K⁺, fruits and vegetables

dec. calculus forming material (calcium, oxalate, uric acid, struvite)

sudden severe dec. in renal Fx that is potentially reversible (deadly in the moment but better than chronic)

dec. GFR, oliguria/anuria, azotemia

diminished perfusion to kidneys (dec. MAP):

hypovolemia

volume shifts

dec. CO (HF)

MI

inc. vascular resistance (HTN, atherosclerosis)

vascular obstruction (renal infarction)

septic shock (not enough CO?)

acute tubular necrosis (eventual symptom of all renal failures):

trauma

antiBx

severe muscle exertion (rhabdomyolysis-->urine very dark)

infectious disease

metabolic disorders (diabetes)

glomerulonephritis

vascular lesions

solvents

pesticides

heavy metals

obstruction of urinary flow at renal pelvis or below:

ureteral obstruction (surgeries, hysterectomy)

bladder obstruction

urethral obstruction

stones

cancer

BPH

systolic + diastolic + diastolic

3

(diastolic is added twice because the heart spends twice as much time in systole)

dec. GFR-->dec. filtrate-->RAAS system activated-->Na⁺ and H₂O retention--dec. UO-->azotemia

Dec. GFR-->renal endothelial ischemia-->release of vasoconstrictors and inhibition of vasodilators-->ischemia of nephron-->acute tubular necrosis

sense flow and inc. or dec. GFR

(involves vasoactive prostaglandins, ASA and NSAIDS can cause kidney disease)

obstruction of urine flow distal to kidney--> inc. in retrograde pressure into kidney-->inc. pressure in bowmans capsule(tubule starts degrading, ATN)-->opposition to GFR-->dec. urine formation-->azotemia

Build-up of retrograde urine in nephron-->ischemia of nephron-->ATN(sides of tubules start shedding, blocks tubules)

1. oliguric phase (1-2 wks), collection of debris in tubules, UO<500ml/24hr

2. diuretic phase (2 days-2 wks), very large diuresis, >500ml/24hr (kidneys starting to recover, many people still die becuase urine still cannot be concentrated)

3. convalescent phase (3-12 months) kidneys regain normal Fx

inc. creatinine

inc. BUN (urea)

dec. Na⁺(normal or diluted)

inc. K⁺ (biggest issue)

dec. Ca⁺⁺ (hypocalcemia)

inc. PO4^- (hyperphosphatemia)

inc. Mg⁺⁺ (do not give MOM)

dec. HCO3^-

dec. arterial pH

dec. H/H (erythropoietin)

dec. or fixed specific gravity

inc. glucose

inc. protein (degradation of bowmans)

inc. RBC

inc.WBC

dec. creatinine

(also xray US CT nuc-med to asess renal blood flow and kidney structure)

progressive loss of renal function over months to years

can be slowed but is ultimitely irreversible

ESRD if not treated with dialysis or transplant is fatal

GFR <60 for months

ATN

congenital kidney conditions

polycystic kidney conditions

infections

renal cancer, benign renal tumors

systemic diseases: DM (#1 cause), HTN, lupus, others

1. Dec. renal reserve (dec. GFR): <75% nephron loss, no s/s, BUN/Creatinine normal

2. Renal insufficiency: 75-90% nephron loss, slight elevation in BUN/creatinine, polyuria, nocturia, may be controlled by diet/meds

3. end stage renal disease: >90% loss, azotemia, uremia, F&E abnormalities, renal osteodystrophy (Ca-->bones become malformed), dialysis or transplant

anuria leads to fluid overload: (JVD, rales, bounding pulse, HTN, peripheral edema, "megalies"

renal diabetes (glucagon is metabolized in kidneys, so it stays in system pulling glucose into bloodstream?)

rennin causes RAAS which causes fluid overload

hormone irregularities (infertility, impotence, amenorrhea, dec. libido)

osteodystrophies

same as for acute