CSB520 Lecture Notes - Lecture 6: Polycythemia, Malignancy, Cervical Canal
Week 8 Lecture - Urinary and Renal Diseases
Sunday, 5 June 2016 10:46 PM
AnatomyAnatomy
•Between vertebrae T12 and L3
•Retroperitoneal between dorsal wall muscles & peritoneum
•Left kidney is higher than right kidney
•Renal capsule
•Adipose
•Renal fascia
•Floating - important
•Normal endocrine system - excretes hormones & cytokines
○If there's a lot of visceral fat, there's a higher chance of
atherosclerosis
•Blood is pushed out into tubule, filtrate travels through PCT,
Loop of Henle, DCT - various changes can happen here, ending
up as urine
○PCT cells do the most work - there's microvilli on the
epithelial cells lining it
•Most likely to turn into cancers - increased levels of
oxidated stress
Renal CirculationRenal Circulation
•Much more than they need to survive - because they need to
screenscreen the blood
•~ 20-25% cardiac output
○Depending on exercise
•>90% to cortex
○Where the glomeruli are
•Kidney filters ~1200mL/min
•Susceptible to:
○Cardiovascular disease
•Can be injured by hypertension
•And when injure = renin activation
○Infective endocarditis
•Inflammation of the endocardium, bacteria breaks
off and travels in the blood - often ending up in the
kidneys
○Drug toxicity
•Lipophilic drugs often end up in faeces, but water
soluble ones will end up in the kidney & urine
•Drugs will be at highest toxicity at the kidneys
○Secondary cancers
•Most common place: lungs
•2nd most common place: liver
•But in the arterial circulation?
•Brain
•Bone
•Kidney (last because of the harsh
environments but huge arterial supply)
Renal PhysiologyRenal Physiology
•Formation of urine - removal of wastes
•Regulations plasma ions (Na+, Cl-, PO43-, K+, Ca2+)
•Regulates pH (H+, HCO3-)
•Endocrine function (vitamin D, RAS, aldosterone, EPO)
○Activation of Vitamin D - essential for healthy bones
•Regulation of blood volume and regulation of blood pressure
○RAAS
•Metabolism - deamination of
aa
, detoxification of drugs/toxins
○Removal of waste
Renal FailureRenal Failure
•Renal disease - very common
•Whenever you get heart disease, you often get kidney disease
○Also associated with diabetes
•Renal failure
○Acute vs Chronic
•Acute:
○Hours/days
○Pre-renal
○Renal
○Post-renal
○E.g. damage to muscles e.g. after an earthquake
•Crush injury
○Whether toxic or ischaemic injury - RAAS
•Chronic:
○Weeks/months/years
○Estimated glomerular filtration rate (eGFR)
mL/min/1.73m2
○CKD stages 1-5
•Stage 5 established or end-stage renal failure
•Dependent on dialysis, waiting for transplant
Common SymptomsCommon Symptoms
•Azotaemia/Uraemia
•Hypertension
•Oedema
•Acidosis
•Potassium
○Muscle, heart arrhythmias
•Hyperphosphatemia
○Muscle, nerves, bone
•Anaemia
HypertensionHypertension
•Renal functions include:
○Regulation of blood volume
○Regulation of blood pressure
•RAAS a survival system for times of blood loss (hypotension)
•Inappropriate/excessive activation --> hypertension (increased
blood pressure in the systemic circulation in this case)
•RAAS
○Renin activates aldosterone and angiotensin
○Aldosterone
•Acts back on kidney
•Increases Na+ uptake in DCT
•Water will passively follow Na+
•Increases Blood Volume
○Angiotensin
•Increases sympathetic tone
•Vasoconstriction
•Increases Vascular Resistance
○Together it increases blood pressure
○Anti-diuretic HormoneAnti-diuretic Hormone
•Increases thirst
•Increases H2O uptake in DCt
•Increasing Blood Volume
OedemaOedema
•Regulates plasma ions (Na+, Cl-, PO43-, K+, Ca2+)
•Increased Na+ --> increased H2O
•= Increased hydrostatic pressure
•Proteinuria (allowing proteins to escape in urine) --> Reduced
colloidal pressure
Formation of Transudates & ExudatesFormation of Transudates & Exudates
•Transudate
○Passive build up on blood in vessels
○Increases hydrostatic pressure, fluid is being forced into
tissue (leaks out)
Document Summary
Week 8 lecture - urinary and renal diseases. Anatomy: between vertebrae t12 and l3, retroperitoneal between dorsal wall muscles & peritoneum. Left kidney is higher than right kidney: renal capsule, adipose, renal fascia, floating - important, normal endocrine system - excretes hormones & cytokines. If there"s a lot of visceral fat, there"s a higher chance of atherosclerosis: blood is pushed out into tubule, filtrate travels through pct, Loop of henle, dct - various changes can happen here, ending up as urine. Pct cells do the most work - there"s microvilli on the epithelial cells lining it: most likely to turn into cancers - increased levels of oxidated stress. Renal circulation: much more than they need to survive - because they need to screen screen the blood, ~ 20-25% cardiac output. Depending on exercise: >90% to cortex. Where the glomeruli are: kidney filters ~1200ml/min, susceptible to: Cardiovascular disease: can be injured by hypertension, and when injure = renin activation.
