Week 1

Structure, Elements of Renal Function GFR and ARF

Learning Objectives
A.
1.
2.
3.

Water and Solute Homeostasis and the Kidney: Terms, Concepts, Definitions
Describe the concept of homeostasis
Differentiate exogenous versus endogenous wastes
Describe what is meant by homeostasis, and examine how the kidney participates in
the homeostasis of water and sodium
4. Diagram the basic concept of body fluid compartments
5. Define and compare the following chemical concepts: osmolality, tonicity,
equivalence, and molarity
B. Gross and Micro-anatomy of the kidney
1. Label gross anatomical structures of the kidney, including renal vasculature
2. Assess the major steps in the embryologic development of the kidney and the
collecting system and how these steps may relate to the following pathologies:
- Cystic diseases of the kidney (ADPKD, ARPKD)
- Duplication of the ureter
- Horseshoe kidney
- Renal agenesis
3. Describe the major anatomical divisions of the kidney
- cortex
- medulla
- anatomy of the renal micro-circulation
4. Identify the characteristic histologic features of the following renal structures:
- Glomerulus
- Bowmans space and capsule
- Renal tubules
- Renal calyces
- Juxtaglomerular complex
C. Glomerular Filtration
1. Diagram the ultra-structure of the glomerulus and the glomerular capillary wall
2. Describe ultrafiltrate formation and the composition of glomerular filtrate
3. Analyze the major physical determinants of glomerular filtration:
- Starling forces
- Afferent and efferent arteriolar resistance
- The effect of renal plasma flow on oncotic pressure
4. Describe what is meant by glomerular filtration rate (GFR)
5. Define and be able to calculate filtration fraction (FF) for a given substance
6. Examine the major physiologic and neurohumeral regulators of glomerular filtration
7. Describe the concept of clearance and examine the importance of creatiniine
clearance in assessing renal function
8. Analyze the relationship between GFR and clearance
9. Compare methods of measuring GFR and their limitations

D.
1.
2.
3.

Overview of Tubular Function

Compare 24hr GFR in relation to daily urine output
Examine the mechanisms of modification of glomerular filtrate by the renal tubule
Compare the change in volume and composition of the glomerular filtrate at it enters
and leaves the following segments of the renal tubule
- Proximal tubule
- Thin descending limb of the loop of Henle
- Thick ascending limb of the loop of Henle
- Distal convoluted tubule
- Collecting duct system

E. Acute Renal Failure

1. Diagram the major factors involved in auto-regulation of RBF and GFR
2. Compare oxygen delivery to the renal cortex, outer medulla, and inner medulla, and
assess the significance of differences in oxygen delivery to these regions
3. Compare the metabolic demands of different parts of the renal tubule
4. Analyze the potential consequences of hypotension and ischemia
5. Describe the hemodynamic consequences of the following categories of
pharmacologic agents drugs on RBF and GFR:
- inhibitors of the renin-angiotensin-aldosterone system (ACEIs and ARBs)
- prostaglandin synthetase inhibitors (NSAIDs)
6. Classify acute renal failure: pre-renal, renal, post-renal
7. Compare mechanisms of acute renal failure: pre-renal, renal, post-renal