2/13/2013 7:54:00 AM Class 1: kidney Dr.

Pai Glomerular filtration membrane: Endothelial cells, BM, Podocytes (Visceral Epithelial cells) Features of glomerular filtration SIZE : Highly permeable to water and small solutes Impermeability to larger proteins CHARGE DEPENDENT Proteoglycans ( heparin sulphate ) produces negative charge Albumin is negatively charged- impermeable Nephrin: transmembrane protein, Podocin and Actin Functions Regulation: Blood volume and composition Electrolyte balance Acid base balance Blood pressure Erythropoetin production Calcium hemostasis Filteration: Removal of metabolic waste The nephron: Tubular reabsorption: Glucose, amino acids, sodium Tubular secretion: H+, K+, Drugs, hormones etc. It filter plasma, reabsorb good stuff, Adjust Na,K,H and eliminate waste, Acid base electrolytes, blood volume and calcium balance. JGA Renin Angiotensin Aldosterone secretion Investigation in renal disease: Blood test: o Serum creatinine 0.6-1.2mg/dl

o Serum BUN, 7-21mg/dl o Serum uric acid 2.0-3.0 mg/dl Chemical analysis Microscopic examination: A variety of normal and abnormal cellular elements may be seen in urine sediment such as: Red blood cells White blood cells Casts Crystals . presence of a few is normal higher numbers as a result of bleeding at any point in urinary system White blood cells a few are normal high numbers indicate inflammation or infection somewhere along the urinary or genital tract Hematuria: rbc in urine Dysmorphic rbcs: suggest hematuria of renal origin RBCs cast: indicates hematuria of renal origin

Proteinuria: >300 Normal <150 Nephrotic: >3500 Clinical Symptoms to suspect renal disease Edema Hematuria Oliguria - <400 ml/day , Anuria <100 ml/day Polyuria > 3000 ml/day Hypertension Metabolic acidosis Bone disease Anemia Azotemia: Increase in serum BUN and creatinine BUN: cr ratio Pre-renal: decreased CO

Renal: Renal disease Post-Renal: Urinary tract obstruction Class 2: Nephritic and Nephrotic Syndrome: NEPHRITIC Hematuria Proteinuria mild to moderate Oliguria Mild edema (salt and water retention) Hypertension NEPHROTIC Proteinuria (nephrotic range >3.5g/24h) Hypoalbumimenia Edema ACUTE RENAL FAILURE - rapid decline in kidney function with oliguria, hypertension & azotemia CHRONIC RENAL FAILURE - slow decline in renal function Diagnosis of glomerular disease Kidney biopsy Light microscopy : H&E Special stains: PAS, Silver stain Immunoflorescence Studies Electron microscopy

2/13/2013 7:54:00 AM CONGENITAL HORSESHOE KIDNEY A. Conjoined kidneys usually connected at the lower pole (Fig. 12.1); most common congenital renal anomaly B. Kidney is abnormally located in the lower abdomen; horseshoe kidney gets caught on the inferior mesenteric artery root during its ascent from the pelvis to the abdomen . II. RENAL AGENESIS A. Absent kidney formation; may be unilateral or bilateral B. Unilateral agenesis leads to hypertrophy of the existing kidney; hyperfiltration increases risk of renal failure later in life. C. Bilateral agenesis leads to oligohydramnios with lung hypoplasia, flat face with low set ears, and developmental defects of the extremities (Potter sequence, Fig. 12.2); incompatible with life III. DYSPLASTIC KIDNEY A. Noninherited, congenital malformation of the renal parenchyma characterized by cysts and abnormal tissue (e.g., cartilage, Fig. 12.3) B.Usually unilateral; when bilateral, must be distinguished from inherited polycystic kidney disease IV. POLYCYSTIC KIDNEY DISEASE (PKD) A.Inherited defect leading to bilateral enlarged kidneys with cysts in the renal cortex V. Medullary cystic kidney disease I. and medulla (Fig. 12.4) B. Autosomal recessive form presents in infants as worsening renal failure and hypertension; newborns may present with Potter sequence. 1. Associated with congenital hepatic fibrosis (leads to portal hypertension) and hepatic cysts C. Autosomal dominant form presents in young adults as hypertension (due to increased renin), hematuria, and worsening renal failure. 1. Due to mutation in the APKDl or APKD2 gene; cysts develop over time. 2. Associated with berry aneurysm, hepatic cysts, and mitral valve prolapse MEDULLARY CYSTIC KIDNEY DISEASE A. Inherited (autosomal dominant) defect leading to cysts in the medullary collecting

ducts B. Parenchymal fibrosis results in shrunken kidneys and worsening renal failure. ACUTE RENAL FAILURE (ARF) BASIC PRINCIPLES A. Acute, severe decrease in renal function (develops within days) B. Hallmark is azotemia (increased BUN and creatinine [Cr]), often with oliguria.

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