Renal Physiology

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Proximal nephron

Back 1

Activities vitamin D

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Kidney produce erthropoeitin

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Not be able to produce blood cells

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Renin

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Produce by juxtaglomerullary cells and cause increase in BP and perfusion pressure in kidney

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Renal medulla contain

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Only collecting ducts and loop of henle

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Collecting ducts function

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Passively absorb water by ADH due to 1200 osmolarity of solution

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Cortex more metabolically active

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Medulla more susceptible to ischaemia

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Maccula densa more NaCl

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Constriction of Afferent arterioles Dec RBF and GFR

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GFR control by

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Stretching and Tubular glomerular feedback

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Constriction of R2

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Inc GFR results in diuresis

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Increase R1

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Dec GFR, less will be delivered, higher will be recovery percentage

Its done in order to conserve more water and substance

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R1 and R2

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Normal GFR 120 ml /min if we remove 1 kidney

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GFR dec only by 25 percent because other nephrons compensate

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GFR factors

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If inject saline to a patient

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It doesn't contain plasma proteins but dilute plasma proteins and that increases GFR

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In vomiting and diarrhoea

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Loses water and increase plasma proteins that decreases GFR that induce the Diuresis

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GFR at afferent and efferent sites

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If Filteration fraction increase

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The plasma proteins contents increase at efferent site which cause of increase of reabsorption at peritubular capillaries

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Force promoting filtration

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Always takes as positive in addition

And only PGC is positive that is 45 mmHg

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Capillaries have larger pores than proteins but it don't allows proteins to pass

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Because capillaries pores are negatively charged

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If we disrupt the membrane of the nephron

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It will filter the protein that will appear in urine

I.e nephrotic syndrome

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If substance freely filtered by kidney then the ratio of plasma conc. / Filtrate conc.?

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TF/P=1

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If increase the plasma conc. Of glucose or freely filtered substance the more glucose will be filtered

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But the percentage remains 20%

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If flow decrease

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Then the filtration increase and vice versa

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If we give angiotensin 2 blocker

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It mainly affects efferent and dilates thAt dec GFR and dec FF

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Kidney secrets

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Fixed acids and H+

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Filteration load

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GFR*Px

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In pregnancy glucose appears in urine

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Because both GFR and Px increases

Filteration load increases of glucose

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Plasma cretinin

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Is the clinical index of GFR that is index of renal Function

Creatine is estimate of GFR

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GFR depends upon

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Capillaries permeability

Surface area

Both causes nephrotic syndrome in distorted situation

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Transport proteins

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Acquired defects in proteins are cause of kidney diseases and Transport proteins are important drug targets

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Tm

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Front 32

Increase transporters proteins

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Increase TM

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Tm reached when u saturate the carriers

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Not under normal physiological conditions

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Transport medicated proteins

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Transport only natural isomers not others

D glucose is natural but L glucose is not

But this rule don't apply in simple diffusion

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Competition

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Front 36

Secondary active transport

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Will always indirectly depend on Atpase activity

If we decrease Atpase pump in diagram secondary active transport will decrease because cell Na conc will increase

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Secondary active transport example

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Front 38

No reabsorption of glucose after proximal part

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All other is excreted then

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Glucose transport

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Splay is present because you don't saturate carrier at the same time

At start of splay nephrons start to dump the glucose because some nephrons are saturated

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380mg/min is TM transport maximum normally

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And TM is a good and perfect index of functional nephrons..

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If we remove one kidney

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The TM become half completely and it can be compensated...

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Reabsorption of glucose

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Minimum glucose appears in plasma at point C and reabsorption is below TM

Point E???

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If we increase GFR

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Renal threshold decreases

In pregnancy renal threshold decreases

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Reabsorption

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Urea follows water if you excrete more water in diuresis more urea will be excrted

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Proximal reabsorption gradient

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Front 46

More GFR

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More metabolical rate of the kidney

More Filteration is done of Na and more reabsorption is done..

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Tubular secretion

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Freely filtered substance are not reabsorbed and PAH is freely filtered...

Protein carriers pump this PAH from peritubular capillaries to lumen

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PAH

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Front 49

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Asdf

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Imp formulas

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Front 51

Filter load - Excretion rate = reabsorption

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Reabsorption

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Clearance

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Clearance curve

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Front 54

If drug stops the filtration of glucose

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The GFR will be equal to Clearance

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Water clearance

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Front 56

Type 2 renal acidosis

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If Na H pump fail and there will be lose of bicarbonate ion that will cause renal acidosis type 2

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2/3 water is absorbed in proximal tubules

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And all other are maximum absorbed in proximal tubes

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Back 58

D is sodium

F is glucose

B is inulin

A is PAH

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Inulin conc.

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Lowest at start of the bowman capsule

Highest at the end of the system

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At Arrow side if value is 1.0 it means that water is not absorbed so value of inulin is constant

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All the reabsorption in proximal part is due to water absorption and all this is powered by Na K Atpase pump

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All is dependent on Na K pump..

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Back 62

Osmolarity max at tip of loop of henle

Osmolarity decreases in ascending thick limb

Fluid leaving ascending limb is hypotonic

Early part of distal tubule has lowest osmolarity

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Uncontrollable diabetics

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Proximal part don't works

Results in large amount of urines

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Loop

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Bicarbonate absorbed

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In late distal tubules is brand new

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Type 2 renal acidosis

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Due to diminished capacity of reabsorption of bicarbonate ion in proximal tubules

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Fanconi syndrome

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Proximal tubule gets defective and carbonic anhydrase inhibitor.

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Renal acidosis type 1

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Failure of distal tubule to secrete fixed acid...

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Acidosis in cell shrinkage promote hyper kalemia

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Alkalosis in cell swelling promote hyopkalemia