Kidney urinalysis

Kidney endocrine

Renin

Erythropoietin

Vitamin D = calcium phosphorous utilization

Kidney anatomy

Two kidneys

Two ureters

Bladder

Urethra

Nephron

Found in kidney cortex

Functional unit

Bowman's capsule

ultrafiltration

Proximal tubule

selective reabsorption (in)

Loop of Henle

Osmoregulation, salt gradient

Distal tubule

selective reabsorption (Out)

Collecting tubule

Osmoregulation, water retention

Kidney responsible for

Renal blood flow

Glomerular filtration

Tubular reabsorption

Tubular secretion

Renal blood flow through kidney

Enter afferent arteriole = enter access

Into the glomerulus

Efferent arteriole = exit

Peritubular capillaries

Glomerular filtration

Blood enters the glomerulus via the afferent arteriole

Glomerular filtrate

Plasma and small particles through capsule

• Water salts, HCO3, H+, urea, glucose, amino acids, some drug

Large particles through efferent arteriole

• Proteins and RBCs

Proximal tubules secreted

Ammonia NH3

Hydrogen

Some drugs

Creatinine

Proximal tubules reabsorbed

80% water

Amino acids

Glucose

Electrolytes

Loop of henle

Descending: water is reabsorbed

Ascending: sodium and chloride reabsorbed

Distal convoluted tubule secreted

Hydrogen and Potassium

Distal convoluted tubule reabsorbed

Sodium

Chloride

Water

Bicarb

Collecting duct

Filtrate

Collecting duct

Renal pelvis

Out of kidney --> ureters

Bladder to be released

Renal threshold

Plasma conc. Too high, reabsorption no longer possible

Spilled int urine 

Glucose renal threshold = 160 mg/dL

Clearence

Must be one that is not secreted or reabsorbed by the tubules

Stable substance

Creatinine is most common stable substance

Renal clearance test

Creatinine clearance

C = U x V / P x 1.73/A

Creatinine clearance ref range

Males = 97-137 mL/min

Female = 88-128 mL/min

Renal function test

Osmolarity

Measures renal concentration ability

1.86 x Na + (glucose/18)+(BUN/2.8) + 9

Proteinuria

Normal urine protein <150 mg/24hours

Renal disease associated with glomerulus

Primary protein excreted = albumin

Pre-albumin (transthyretin) = kidney damage

Rise of interstitial fluid and edema

Nephrotic syndrome

Edema

Hypoalbuminemia (excessive proteinuria)

Albuminuria

Increase in lipids with fatty casts, oval fat bodies

Causes of nephrotic syndrome

Circulatory disruptions that result in decrease in blood flow to the kidney

Glomerulonephritis

Diabetes mellitus, amyloidosis, SLE

Acute Glomerulonephritis

Sudden onset, young adults and children

Circulating immune complexes deposit in glomeruli

Hyaline and granular casts

Increased BUN, creatinine

Anemia

Oliguria

Na+ and water retention

Chronic Glomerulonephritis

Continual or permanent damage to glomerulus

Edema, hypertension, anemia, metabolic acidosis, oliguria to anuria

Blood, protein, variety of casts

Specific gravity of 1.010

Other diseases

Renal failure

Hypotension due to trauma or shock 

Intravascular hemolysis

Pyelonephritis

infection in the kidney

Cystitis

 Infection in the bladder

Acute interstitial nephritis

 Allergic reaction without bacteria, eosinophils present