lecture 14 dr fawzy
DESCRIPTION
Renal lectures 2013 2-2[1]TRANSCRIPT
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Reabsorption of salt and water & Renal plasma clearance
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Reabsorption of salt, water and glucose
The kidneys filter about 180 l per day, but the urine excreted is about 1 – 2 l (1%)Per day.
This means that 99% of the ultrafiltrate is reabsorbed and 1% excreted.
The minimum volume of urine required per day to eliminate the metabolic wastesis 400 ml (obligatory water loss).
Water reabsorption in the proximal tubules is by osmosis.
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Salt and water reabsorption
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Reabsorption of glucose
Glucose is easily filtered by the glumeruli into the renal tubules.
375 mg/min is reabsorbed and the rest is excreted (Glycosuria).
This occur in the proximal tubule by secondary active transport which transport glucose with sodium.
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65% water reabsorbed
20% water reabsorbed
Reabsorption of salt and water• ~ 65 % of salt and water which were
filtered at the glomerulus are reabsorbed back into blood in the proximal tubule.
• Another 20% of water is reabsorbed in the descending loop of the Henle.
• The total 85% salt and water which are reabsorbed occur constantly and are not under any hormonal regulations.
• Still a large volume (~ 180 L x 15% = 27 L) is remained to be reabsorbed in the rest of the nephron tubules (distal convoluted tubules and collecting ducts).
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Counter current multiplier system
Descending limb of loop of Henle
Ascending limb of loop of Henle
NaCl
< 300
Capillary
> 300 mOsm/L> 300> 300
~ 100 mOsmgoes to distalconvoluted tubules and collecting duct.
NaClWater
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Distal CT
Collecting Duct
100 mOsm
ADH
NaCl
300
400
600
800
300
400
600
800
wat
er
Water reabsorption in distal convoluted tubules and collecting duct
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Vasa recta and countercurrent exchange
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The role of urea in the concentration of the urine
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Plasma concentration and antidiuretic hormone ADH
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Solute
Urea
Glucose
Amino acids
Total inorganic ions*
Protein
Organic toxins
Plasma Filtrate Final urine % reclaimed
+
-
+
+
+
+
+
+
+
+
+
+
+
+
+
++
-
-
50%
100%
100%
95.5%
-
0%
The final products of the process
Composition of the plasma, glomerular filtrate, and the urine:
* mainly Na+ and Cl-
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Renal clearance of inulin
Renal plasma clearance
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Renal clearance of Inulin measurement of GFR
• Inulin is not produced by our cells and it is not metabolized. Also it is fully filtered and neither secreted nor reabsorbed.
Rate of urine formation Inulin concentration in urine
Inulin excreted = V (ml/min) x U (mg/ml)
Inulin Filtered = GFR (ml/min) x P (mg/ml)
Glomerular Filteration Rate Plasma concentration of Inulin
GFR x P = V x U
GFR (ml/min) = V (ml/min) x U (mg/ml)
P (mg/ml)
- Inulin clearance depends on GFR.
Inulin filtered = inulin excrected
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Renal Plasma Clearance of Solutes
Clearance of inulin (ml/min) = GFR (ml/min)
- A substance that is filtered and reabsorbed has clearance < GFR or inulin
- A substance that is filtered and secreted has clearance > GFR or inulin
Clearance (ml/min) = V (ml/min) x U (mg/ml)
P (mg/ml)
Clearance of a solute is the volume of plasma that is completely cleared from that solute in one minute.
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-Urea is filtered like inulin but also partiallyreabsorbed.
-So how clearance of urea is compared to GFR?
UREA CLEARNCE (ml/min) GFR (ml/min)< ?
Clearance of Urea
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PAH is used to measure renal plasma flow.
PAH is filtered like inulin but in addition it is alsosecreted.
-So how clearance of PAH is compared to GFR?
PAH (ml/min) GFR (ml/min)> ?
Clearance of Para-aminohippuric Acid (PAH)
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In the region of the late distal tubuleand the cortical collecting duct, reabsorbtion of Na+ results in secretion of K+ and H+.
In case of hyperacidity H+ is secreted at the expense of K+ this is why hyperacidity is associated with increase in blood K+.
On the other hand hyperkalemia results in secretion of K+ at the expense of H+ causing hyperacidity in the blood.
Reabsorption of Na+ and secretion of K+ are regulated by aldosterone.
Renal control of electrolyte and acid-base balance
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Homeostasis of plasma Na+
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Urine formationFiltration is the process of flow of water and dissolved solutes from the blood plasma to the capsule.
Reabsorption is the back uptake of water and NaCl, glucose, and amino acids from the tubular fluid to the blood.
Secretion is the addition of some substances from the blood capillaries directly into the tubules.
Excretion is the elimination of water and some solutes in form of urine.
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Kidney Disease
• Glomerulonephritis• It is the inflammation of the glomeruli, or small blood vessels in the
kidneys. It may present with isolated hematuria and/or proteinuria (blood or protein in the urine).
• Acute Renal Failure• Acute: Sudden onset. Rapid reduction in urine output-usually
reversible.
• This may be due to infection, drugs, traumatic injury, major surgery, nephrotoxic poisons.
• Emergency dialysis may be needed until the situation resolves and the kidneys begin functioning again.
• Chronic Renal Insufficiency (CRI)• Slow distruction of the filtering capacity of the kidney.
• It is irreversible.
• 75% of function can be lost before it is noticeable.