ICSObjectivesforRenalandMaleRepro-2009-2010.docVIP

ICS Objectives for Renal and Male Repro-2009-2010 The parts of the syllabus containing the Cases (ICS) we covered in conferences will have the (case # and conference #) in green. Normal Values of Laboratory Tests Renal Physiology (pgs 1-2)-Kasinath Renal Physiology (pgs 3-18)-Kasinath overview of the functions of the kidney 1) Excretion of: waste products, acid, water 2) Reabsorption of: solutes, bicarbonate, water 3) Secretion of substances: Uric acid, Penicillin, Salicylates 4) Endocrine Functions: secretion of EPO and rennin, conversion of 25(OH) vit D3 to 1:25(OH)2 vit D3 Process and regulation of glomerular filtration Ultrafiltration of plasma at the glomerulus-glomerular capillary wall has size-selective and charge selective barrier preventing loss of plasma proteins. (nl protein excretion~150mg/24hrs) Clearance: UV/P (U=[urinary] V=volume of urine P=[plasma])= volume of plasma from which the substance is totally removed by glomerular filtration. According to the definition then, the amount excreted (UxV)= amount filtered (PxC) Transcapillary hydrostatic pressure difference: ?P=Pgc-Pt (gc=glomerular capillary t=tubule) Transcapillary oncotic Pressure difference: ?∏=∏gc-∏t SNGFR= ?P-?∏ GFR decreased by: ↓ capillary wall area or permeability (glomerulonephritis), Hypotension (↓Pgc(↓ sngfr), Obstructive uropathy (↑Pt(↓sngfr), ?vascular resistance or RPF (?Pgc(?SNGFR RPF: 25% of CO per minute. Kept stable by autoregulation, FF: proportion of RPF that forms the glomerular filtration rate=GFR/RPF x 100 (nl 20-25%) Endocrine functions of the kidney including the renin-angiotensin system EPO: secreted by tubulointerstitial cells ( ↑ RBCs 25(OH) vit D3 converted to 1:25 (OH)2 vit D3 by proximal tubules( ↑ absorption of Ca and Phosphorous in the gut RAAS system: juxtaglomerular apparatus includes renin secreting juxtaglomerular cells in the afferent arterioles, extraglomerular mesangial cells, and columnar epithelial cells of distal tubule. Renin (RAAS): conver