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Diffusion

Movement of solutes from high concentration to low concentration (passive)

Osmosis

Movement of water across a membrane from lower solute concentration to higher solute concentration

Filtration

Movement of water/solutes across a membrane due to pressure. Passive

Active Transport

Movement of solutes across membranes against concentration gradient using energy

Main renal functions

Remove waste; balance fluids; balance electrolytes; release hormones

Erythropoietin

Stimulates bone marrow to produce red blood cells

Renin

Helps maintain blood pressure for glomerular filtration

Calcitriol

Stimulates intestines to absorb vitamin D precursors

Levels of urinary obstruction

Renal pelvis; ureter; bladder; urethra

Most common cause of urinary obstruction

Renal calculi (kidney stones)

Most common type of kidney stone

Calcium stones

Nephrolithiasis

Formation of kidney stones

Stasis of urine

Pooling of urine leading to infection and stone formation

Back pressure

Interferes with blood flow and damages renal tissue

Hydroureter

Dilation of proximal ureter due to distal obstruction

Hydronephrosis

Dilation of renal pelvis and calyces from prolonged obstruction

Major obstruction

Irreversible kidney damage (necrosis)

Common manifestation obstruction

Pain; UTI symptoms; dysuria; hypertension

Renal colic

Pain caused by kidney stones moving through urinary tract

Acute

Renal colic pain characteristics

Vasovagal symptoms

Nausea; vomiting; cool clammy skin

Most common UTI pathogen

Escherichia coli (E. coli)

Ascending UTI route

Bacteria enter urethra and travel upward to bladder

Descending UTI route

Microorganisms enter urinary tract via bloodstream from kidneys

Acute cystitis

Lower UTI affecting the bladder. Inflammation of the bladder

Symptoms of acute cystitis

Frequency; burning; pain on urination; lower abdominal discomfort

Acute pyelonephritis

Upper UTI affecting kidney tubules and interstitium, kidney inflammation

Causes of pyelonephritis

Catheterization; reflux; pregnancy; neurogenic bladder

Washout phenomenon

Bacteria removed during urination

Protective bladder factor

Mucin layer lining bladder

Immune defense in UTI

IgA and phagocytic blood cells

Short urethra

Why women have more UTIs

UTI risk factors

Pregnancy; elderly; diabetes; immunosuppression; obstruction; catheterization

Urine formation steps

Filtration; reabsorption; secretion; excretion

Renal corpuscle

Bowman’s capsule + glomerulus

Glomerular filtration

Filtration driven by arterial pressure

Glomerular filtration layers

Endothelium; basement membrane; podocytes

Glomerular filtrate contents

Water; ions; glucose; urea; creatinine; wastes

Substances not filtered

Blood cells; large proteins

Normal GFR pressure range

80–180 mmHg

Renin

Fluid retention, Increases BP and vasoconstriction→Reduced blood flow to kidneys

Angiotensin II

Constriction of efferent arterioles to increase filtration pressure. Increase BP, and vasoconstriction

Aldosterone function

Increase Sodium reabsorption → increases blood volume and BP

ADH function

Increases water reabsorption and icreases BP vasoconstriction → decreases urine volume

ACE

Controls glomerular filtration pressure, reduce proteinuria. Converts angiotensin 1 to 2

Effect of RAAS activation

Vasoconstriction; increased BP; increased plasma volume

Filtration and secretion

Process that removes water/electrolytes from blood

Proteins

Glomerulus prevents filtration of

Juxtaglomerular cells

Secrete renin to initiate RAAS

Neither aldosterone nor ADH

Urine excretion enhanced by

Hematuria

Blood in urine

Proteinuria

Protein in urine

Normal protein excretion

30–150 mg/day (average ~80 mg/day)

Azotemia (Uremia)

Nitrogenous waste in the blood

Oliguria

Decreased urine output

Glomerular disease

Injury allows proteins and RBCs to enter tubules with filtrate

Urinalysis

Purpose is to classify glomerular dysfunction clinically

Nephrotic syndrome

Proteinuria >3.5 g/day

Nephritic syndrome

Proteinuria <3.5 g/day with hematuria

Mixed nephrotic/nephritic syndrome

3.5 g/day proteinuria with hematuria

Biopsy

Definitive diagnosis of glomerular disease

Nephritic syndrome patho

Inflammation of glomerulus with hematuria, decreased GFR, azotemia

Nephrotic syndrome patho

Increased permeability of glomerulus to proteins → proteinuria

Edema cause in nephrotic syndrome

Hypoalbuminemia → fluid leaks into tissues

RAAS activation in nephrotic syndrome

Decreased plasma volume → ↑ angiotensin II & aldosterone → Na⁺ and water retention

Hyperlipidemia in nephrotic syndrome

Increased hepatic protein synthesis

Loss of antithrombin III

Thrombosis in nephrotic syndrome

Loss of immunoglobulins

Infection risk in nephrotic syndrome

Nephrotic syndrome sequence

Glomerular damage → proteinuria → hypoproteinemia → ↓ osmotic pressure → edema

Compensatory response in nephrotic syndrome

Increased lipoprotein production → hyperlipidemia

Glomerulopathies

Diseases affecting glomeruli (primary or secondary)

Intrinsic glomerular damage

Autoimmune (T cells + antibodies against glomerulus)

Extrinsic glomerular damage

Antigens deposited in glomerulus → immune attack

Non-immunologic glomerular disease

Diabetic nephropathy, amyloidosis, SLE

Amyloidosis

Protein deposition in organs → multi-organ failure

Diabetic nephropathy

Nephrotic syndrome with progressive renal failure

Cause of diabetic nephropathy

High glucose → glycoprotein buildup in glomeruli

Glomerulosclerosis

Hardening/thickening of glomerular basement membrane

Diabetes mellitus

Leading cause of ESRD

Tubulointerstitial disease

Damage to tubules and surrounding tissue (not glomerulus)

meds (antibiotics, NSAIDs) or ischemia

Causes of tubulointerstitial disease

Not nephrotic or nephritic

Urinalysis in tubulointerstitial disease

Renal failure

Inability to maintain homeostasis and remove nitrogenous waste

Normal GFR

90–120 mL/min

Azotemia (↑ creatinine and urea)

Effect of decreased GFR

Normal urine output

800–2000 mL/day

Oliguria threshold

Anuria threshold

<100 mL/day

Acute renal failure (ARF)

Sudden loss of kidney function, often reversible

ARF characteristics

↓ GFR, ↑ creatinine/BUN, oliguria, azotemia

Prerenal ARF

Caused by decreased blood flow to kidneys

Intrarenal ARF

Damage within nephron (ischemic or toxic)

Postrenal ARF

Obstruction of urine outflow

Prerenal causes

Hypotension, dehydration, heart failure

Intrarenal causes

ATN, interstitial nephritis, glomerulonephritis, drugs

Postrenal causes

Stones, tumors, prostate enlargement

Chronic renal failure

Progressive, irreversible kidney damage

Chronic renal failture progression

Gradual loss of GFR leading to ESRD

ESRD definition

end stage renal disease , GFR <15 mL/min

Hypertension

Second leading cause of ESRD