Renal System

Pathology of Common Glomerular Diseases

Some terminology Azotemia Definition: Raised blood urea nitrogen and creatinine in blood. Due to decreased GFR Causing biochemical abnormality Cause may be: Renal Extrarenal Pre-renal: hypoperfusion (low BP) Post-renal: obstruction Uraemia Definition: Azotemia + clinical signs & symptoms Cause may be: Metabolic Endocrine Gastrointestinal: Uraemic gastroenteritis Peripheral nerves: peripheral neuropathy Heart: Uraemic fibrinous pericarditis Proteinuria…

Micturition

Micturition: Process by which urinary bladder empties. It is a complex act involving both autonomic & somatic nerve pathways & several reflexes that can be either inhibited or facilitated by higher centers in the brain. Micturition involves 2 important steps: Bladder fills progressively tension in bladder wall increases Initiates a nervous reflex micturition reflex: empties…

Kidney & Blood Pressure

The arterial system is not very distensible (if distensible, then BP can be easily maintained when there is increase in volume), therefore arterial blood volume ∞ arterial blood pressure. Determinants of arterial BP Cardiac Output (CO) Total Peripheral Resistance (TPR) Therefore, BP = CO x TPR Scenario Effect of increase in blood volume towards blood…

Renal Blood Flow & GFR

-IMCOMPLETE- Update later Renal blood flow: Volume of blood flowing through both kidneys per minute. Renal plasma flow: Volume of plasma flowing through the kidneys per minute. The kidney receives the most amount blood in the body, why? renal artery short & straight Vessels branch off at right angles reduce energy loss renal artery-interlobar artery-arcuate…

PBL: Nephrotic syndrome

Keywords 5 y/o boy progressive swelling of lower limbs & puffy face (2 weeks) swelling of abdomen (1 week) Frothy urine easily tired, breathless on exertion examined by doctor: generalised oedema, hydrothorax, ascites, gross pitting pedal oedema CVS normal Hb low Urea & creatinine normal Serum albumin low Alkaline transaminase & alkaline phosphatase normal Urinalysis:…

Anatomy of the urinary tract – Part 2

Recap of the previous post : Location of the kidney coverings of the kidney muscles that are clinically related (quadratus lumborum etc) transpyloric plane – hilum differentiate kidney/splenic swelling (refer clinical notes) histology PCT, DCT –> difference in microscopic structure Surgical relations Left kidney Behind stomach lesser sac Infront left kidney : pancreas, splenic artery,…

PBL: End Stage Renal Disease

Theme: Love my cheesecake but hate my injections Keywords: 37 y/o woman visited nephrologist history of diabetes (since 15) & started on insulin injections (type 1) history of hypertension(2 years) & under control with Atenolol (B-blocker) Non compliant with her diet, insulin injections & doctor visits worried that might end up like mother with end…

Anatomy & Histology of the Urinary Tract

Important things to cover Gross anatomy of the kidney Surface anatomy Parts Clinically important relations Coverings of kidney Structures at sagittal section of kidney Blood supply of kidney Microscopic structure of the kidney Gross & microscopic structure of the ureter, urinary bladder & urethra Histology is important (look for atlas of histology) _____________________________________________________________________________________________ Basic anatomy…

Development of urinary tract & common abnormalities

Evolution of Kidney Development (3 stages) Note the image: pronephric system are at the superior (cervical region) portion, mesonephric system at the middle portion and the metanephric system at the inferior (sacral region) portion of the embryo) Mesonephric duct opens into the urogenital sinus. Yellow: endodermal (gut) Blue: intermediate mesoderm (kidney & genital) Each vertebrate’s…