Water Treatment for Dialysis Jeff Kaufhold, MD FACP Nephrology Associates of Dayton Oct 2008.
Renal Physiology Overview Jeff Kaufhold, MD FACP.
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Transcript of Renal Physiology Overview Jeff Kaufhold, MD FACP.
Renal PhysiologyRenal PhysiologyOverviewOverview
Jeff Kaufhold, MD FACPJeff Kaufhold, MD FACP
Renal PhysiologyRenal Physiology
StructureStructureClearanceClearanceWater BalanceWater BalanceElectrolytes Electrolytes Acid-Base BalanceAcid-Base BalanceHormonal FunctionsHormonal Functions
Renal AnatomyRenal Anatomy
• Renal Artery and VeinRenal Artery and Vein• Cortex – filtering GlomeruliCortex – filtering Glomeruli• Medulla – Tubules, regulates water/ lytesMedulla – Tubules, regulates water/ lytes• UretersUreters• BladderBladder• Urethra and Sphincter controlUrethra and Sphincter control
Anatomy of Urinary TractAnatomy of Urinary Tract
Glomerular PhysiologyGlomerular Physiology
FiltrationFiltrationFiltration membraneFiltration membrane
Endothlial cell layerEndothlial cell layerBasement membraneBasement membraneEpithelial cell layerEpithelial cell layerElectrical charge – negativeElectrical charge – negative
Clearance = waste product removalClearance = waste product removalUltrafiltration = water removalUltrafiltration = water removal
Filtration MembraneFiltration Membrane
Glomerular Blood FlowGlomerular Blood Flow
Glomerular PhysiologyGlomerular PhysiologyBlood flow determinantsBlood flow determinants
Filtration
Systemic
EfferentAfferent
Effect of Angiotensin on Effect of Angiotensin on Glomerular Blood FlowGlomerular Blood Flow
Glomerular PhysiologyGlomerular PhysiologyBlood flow determinantsBlood flow determinants
Filtration
PG'sTGF
Local
EfferentAfferent
Glomerular PhysiologyGlomerular PhysiologyBlood flow determinantsBlood flow determinants
Filtration
Systemic
PG'sTGF
Local
EfferentAfferent
Glomerular filtrationGlomerular filtration
Glomerular PhysiologyGlomerular Physiology
Pathologic conditions:Pathologic conditions:Renal Artery StenosisRenal Artery StenosisHypertension / Medication effectsHypertension / Medication effectsMembrane problemsMembrane problems
Lead to blood in urine – hematuriaLead to blood in urine – hematuria -Loss of negative charge leads to protein in -Loss of negative charge leads to protein in
urine – proteinuriaurine – proteinuria -Diabetes, Glomerulonephritis-Diabetes, Glomerulonephritis
Blood Flow to TubulesBlood Flow to Tubules
Renal Tubule PhysiologyRenal Tubule PhysiologyOverviewOverview
Prox. tubule Distal Tubule
Loop of Henle
Collecting ductreabsorption
Proximal TubuleProximal Tubule
Function:Function: ReabsorptionReabsorptionFeatures:Features: Brush border with ciliaBrush border with cilia Carbonic Anhydrase for Carbonic Anhydrase for
reclaiming Bicarbreclaiming Bicarb Filtration FractionFiltration FractionPathology: Renal tubular AcidosisPathology: Renal tubular Acidosis
Renal Tubule PhysiologyRenal Tubule PhysiologyOverviewOverview
Prox. tubule Distal Tubule
Loop of Henle
Collecting ductreabsorption
blood
Tubule membrane
UltrafiltrateTubule lumen
Tubule membrane
Renal Tubule PhysiologyRenal Tubule PhysiologyOverviewOverview
Prox. tubule Distal Tubule
Loop of Henle
Collecting duct
Renal Tubule PhysiologyRenal Tubule PhysiologyOverviewOverview
Prox. tubule Distal Tubule
Loop of Henle
Collecting ductimpermeable to
H2Osolute
imperm. to
Renal Tubule PhysiologyRenal Tubule PhysiologyOverviewOverview
Prox. tubule Distal Tubule
Loop of Henle
Collecting duct
Renal Tubule PhysiologyRenal Tubule PhysiologyOverviewOverview
Prox. tubule Distal Tubule
Loop of Henle
Collecting duct
Ion Exchange Sodium for Potassium/Hydro
Renal Tubule PhysiologyRenal Tubule PhysiologyOverviewOverview
Prox. tubule Distal Tubule
Loop of Henle
Collecting duct
Renal Tubule PhysiologyRenal Tubule PhysiologyOverviewOverview
Prox. tubule Distal Tubule
Loop of Henle
Collecting duct
ADH +
ADH -
permeable to H2O
impermeable
Function of Nephron TubulesFunction of Nephron Tubules
Renal Tubule PhysiologyRenal Tubule PhysiologyOverviewOverview
Prox. tubule Distal Tubule
Loop of Henle
Collecting duct
ADH +
ADH -
permeable to H2O
impermeable
solute exchange
reabsorption
impermeable toH2Osolute
imperm. to
InterstitiumInterstitium
The tissue in between the tubulesThe tissue in between the tubulesFunction:Function: AmmoniagenesisAmmoniagenesis Countercurrent multiplierCountercurrent multiplierPathology:Pathology: RTA, Loss of concentrating ability, RTA, Loss of concentrating ability,
AINAIN
Countercurrent MultiplierCountercurrent Multiplier
Way to keep the concentrating ability of the Way to keep the concentrating ability of the kidney isolated from the rest of the bodykidney isolated from the rest of the body
Components:Components: Urine flow with sodium chloride pumpUrine flow with sodium chloride pump Blood flow from Vasa RectaBlood flow from Vasa RectaPathology:Pathology: Sickle Cell /Trait, bladder obstructionSickle Cell /Trait, bladder obstruction
Countercurrent MultiplierCountercurrent Multiplier
Countercurrent MultiplierCountercurrent Multiplier
Countercurrent MultiplierCountercurrent Multiplier
WARM
COLD
Renal PhysiologyRenal PhysiologyEndocrine FunctionsEndocrine Functions
Renin – control of BPRenin – control of BPErythropoietin – turns on bone marrow to Erythropoietin – turns on bone marrow to
make red blood cellsmake red blood cellsVitamin D activation – regulates bone Vitamin D activation – regulates bone
metabolism, Calcium, Phosphorus and metabolism, Calcium, Phosphorus and Parathyroid Gland.Parathyroid Gland.
Volume regulationVolume regulationActive SensorsActive Sensors
Renal Autonomic nervesRenal Autonomic nervesPassive systemPassive system
Like a system of lakes and spillwaysLike a system of lakes and spillways
Renal StructureRenal Structure
Artery
Vein
Ureter
C
M
P
Renal Structure
U
U 300
1200
Cortex
Medulla
Glomerulus
Vascularbundle
osmoticgradient
collecting tubule
Renal PhysiologyRenal PhysiologySensing of VolumeSensing of Volume
Effective Arterial Blood Volume (EABV)Effective Arterial Blood Volume (EABV) Pathology:Pathology: Congestive Heart FailureCongestive Heart Failure CirrhosisCirrhosis PregnancyPregnancy Nephrotic SyndromeNephrotic Syndrome AldosteronomaAldosteronoma
Pathologic StatesPathologic States CHFCHF Renal Artery StenosisRenal Artery Stenosis Low Blood FlowLow Blood Flow
Pathologic StatesPathologic States CirrhosisCirrhosis PregnancyPregnancy Nephrotic SyndromeNephrotic Syndrome
Leaky capillaries
Pathologic StatesPathologic States AldosteronomaAldosteronoma Tumor which Tumor which Produces too much Produces too much Aldosterone, causingAldosterone, causing Fluid retentionFluid retention
Pathologic StatesPathologic States Aldosteronoma Aldosteronoma
causescauses Fluid retentionFluid retention HypertensionHypertension Perfusion of outer Perfusion of outer
glomeruli sets upper glomeruli sets upper limit on how much limit on how much fluid can be retained.fluid can be retained.
Pathologic StatesPathologic States Removal of Removal of
Aldosteronoma Aldosteronoma causescauses
Diuresis until volume Diuresis until volume is normal again, andis normal again, and
Hypertension Hypertension improvesimproves
Why Kidney Patients willWhy Kidney Patients willCome to Physical TherapistsCome to Physical Therapists
Hip FracturesHip FracturesStrokesStrokesHeart attacks and heart surgeryHeart attacks and heart surgeryDeconditioningDeconditioningNeuropathyNeuropathy
Glomerular PhysiologyGlomerular Physiology
Afferent. ArtAfferent. Art AT II constrictAT II constrict
ACE-i dilateACE-i dilate
PG's NET dilatePG's NET dilate
TGF NET constrictTGF NET constrict
NSAID's constrictNSAID's constrict
Aminophylline dilateAminophylline dilate
Diltiazem dilateDiltiazem dilate
Filt PressFilt Press maintainedmaintained
reducedreduced
increaseincrease
parallelsparallels
reducereduce
increaseincrease
reducedreduced
Efferent Art.constrict
dilate
no effect
no effect
no effect
no effect
dilate