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Renal Pathophysiology III :

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Renal Pathophysiology III : Diseases that affect the kidney and urinary tract Acute and chronic renal failure Plumbing Problems Kidney Stones Calcium Cystine Struvite ... – PowerPoint PPT presentation

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Title: Renal Pathophysiology III :


1
Renal Pathophysiology III
  • Diseases that affect the kidney and urinary tract
  • Acute and chronic renal failure

2
Plumbing Problems
  • Kidney Stones
  • Calcium
  • Cystine
  • Struvite
  • Vesicoureteral Reflux

3
Struvite Bladder Stones from a Dog
4
(No Transcript)
5
Acute Renal Failure
  • Defined by increases in serum creatinine and
    urea, reflecting decreased GFR
  • Creatinine is used as an indicator of GFR
  • Urea is passively reabsorbed in the renal
    tubules. More urea in the blood indicates less
    urea is being filtered.
  • Normal Values
  • plasma creatinine 1 mg/dl
  • plasma urea (BUN) 8-25 mg/dl

6
Causes of Acute Renal Failure
  • Pre-renal kidneys ok, but blood flow/suppy is
    reduced, resulting in decreased GFR.
  • Intrarenal usually result of acute tubular
    necrosis
  • Post-renal results from obstruction of urinary
    tract (eg kidney stone).

7
Risk Factors for CKD
  • Hypertension
  • Diabetes
  • Autoimmune diseases
  • Low birthweight
  • Exposure to certain drugs,
  • Genetic factors eg polycystic kidney disease
  • Socioeconomic risk factors include
  • Older age
  • African American, Native American or Hispanic
    ethnicity,
  • Low income/education.

8
Polycystic Kidney Disease
http//phil.cdc.gov/PHIL_Images/02071999/00002/20G
0027_lores.jpg
9
Autoimmune Disease Example Lupus (SLE)
  • Cause of SLE is unknown, genetic and immune
    factors involved.
  • Autoantibodies against many cellular components,
    including DNA, and other molecules in the nucleus
    and cytoplasm of cells are produced
  • Characterized by flares followed by periods of
    remission.
  • 90 of cases are in women of childbearing age.

10
Renal Damage from Lupus
  • In the renal system, damage results largely from
    deposition of antigen-antibody immune complexes
    in the glomeruli.
  • This leads to the appearance of protein in the
    urine, and can cause acute renal failure.

11
Antigen-Antibody Complex
http//www.cartage.org.lb/en/themes/sciences/lifes
cience/generalbiology/ Physiology/LymphaticSystem/
Antibodymediated/antigenAB.gif
12
Deposition in Tissues Leads to Inflammation
http//www.bact.wisc.edu/Microtextbook/images/book
_4/chapter_15/15-30.gif
13
Diabetic Nephropathy
  • Diabetics have abnormal thickening of the
    mesangial matrix, the material that surrounds and
    supports the glomerular capillaries.
  • Diabetics also tend to have atherosclerosis.
    When it affects the renal artery, it can decrease
    renal blood flow, further lowering the GFR.

14
Normal Protein Handling by Kidney
http//www.unckidneycenter.org/patients/images/pro
tein.jpg
15
Proteinuria
  • Glomerular proteinuria altered size and change
    function of glomerular barrier
  • Tubular proteinuria altered reaborption
  • Overload proteinuria excessive filtered load

16
Nephrotic syndrome
  • protein in urine greater than 3g/day
  • decreased protein concentrations in the plasma
  • edema
  • excess lipids in the plasma
  • Characteristic of SLE and diabetic nephropathy.

17
Edema in Nephrotic Syndrome
18
Chronic Renal Failure
  • Results from irreversible, progressive injury to
    the kidney.
  • Characterized by increased plasma creatinine and
    urea, indicating decreased GFR, as well as loss
    of hormonal functions of the kidney.

19
Consequences of Kidney FailureProblems with Na
and Water Balance
  • Na handling can lead to hypo- or hypernatremia
  • If GFR is low, and salt intake is high, the
    kidneys cannot excrete enough salt and salt is
    retained.
  • But, if the salt intake is very low, the
    diminished capacity of the tubule to reabsorb
    sodium can lead to excessive sodium loss and
    hyponatremia.
  • Water handling
  • The ability of the kidney to generate the osmolar
    gradient that allows for excretion of
    concentrated or dilute urine is compromised.
  • Problems of osmolarity (hypo or hypernatremia)
    occur if the patients drink too much or too
    little water.
  • Consequences
  • Hypertension
  • Edema

20
Other Consequences of Renal Failure
  • Uric Acid retention
  • may result in gout or arthritis, also causes
    itchiness and rash.
  • Potassium Handling
  • Potassium excretion increases with GFR. Big
    reductions in GFR result in inability to excrete
    K, and increased plasma potassium results.
  • This can result in cardiac arrthymias.
  • Acid Base Status
  • Normal metabolism results in the formation of
    acid, which is normally excreted in the urine.
  • When the GFR gets low enough, acids cannot be
    excreted and plasma pH drops (i.e. the
    concentration of H ions increases).
  • Buildup of Drugs and Toxins
  • The kidney is a major site of excretion of many
    drugs.
  • Patients with reduced kidney function have a
    reduced ability to excrete these and they may
    build up in the blood.

21
Still Other Consequences of Renal Failure
  • Calcium metabolism
  • Failure to activate vitamin D decreases calcium
    absorption in the gut
  • Causes breakdown of bone
  • Also, failure to excrete phosphate leads to
    formation of calcium phosphate salts in soft
    tissues, which further lowers plasma calcium
    levels.
  • Hormonal abnormalities
  • The kidneys help clear the body of insulin, so
    patient with renal failure often have
    hyperinsulinemia.
  • Sex steroid levels are low, often causing
    amenorrhea in women and impotence in men.
  • Anemia
  • The kidney is the site of production of
    erythropoetin, a hormone necessary to the
    formation of red blood cells.
  • Neurologic effects
  • Build up of toxins can cause seizures, and other
    neurologic problems
  • Gastrointestinal consequences
  • Nausea and vomiting resulting from electrolyte
    disturbances.

22
Treatment of Chronic Renal Failure Dialysis
  • Hemodialysis must go to a clinic about 3 times
    per week for about 4 hours
  • Peritoneal Dialysis more frequent, but can be
    done at home
  • Also Transplantation

23
http//www.renalpatients.co.uk/images/kidney.jpg
24
Hemodialysis
http//www.ebme.co.uk/arts/neph/image3.gif
25
Peritoneal Dialysis
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