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Clinical Microscopy
Renal Function
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Ange T
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Cards (32)
Nephron
- basic structural & functional unit of the kidney
1
to
1.5
million nephrons PER kidney
consists of
glomerulus
and
renal tubules
Total Renal Blood Flow:
1200
mL/min
Total Renal Plasma Flow:
600-700
mL/min
Glomerulus
- "
working portion
" of the kidney
Glomerulus
- resembles a "
SIEVE
"
Glomerulus
-
non-selective
filter of
plasma substances with MW
of <
70k Da
MW =
<70k Da
Renal Threshold for
Glucose
=
160-180mg/dL
Glomerular Filtrate:
Specific Gravity
-
1.010
PCT
is the major site (
65
%) of reabsorption
DAM
- collects
water
, so does the
Descending
Loop of
Henle
ASIN-ding loop
=
REABSORBS
ASIN (salt), but NOT
water
ACTIVE transport
- the movement of a substance across the cell membranes into the
bloodstream
by
electrochemical
energy
PASSIVE transport
- the movement of molecules across a membrane by
diffusion
because of a
physical
gradient
Glucose, Amino Acids, Salts -
PCT
ADH
(Anti-Diuretic Hormone) or
Vasopressin
- regulates
WATER
REABSORPTION in the
DCT
and
CD
ADH Deficiency
= Diabetes insipidus (DI)
ADH Excess =
SIADH
(Syndrome of
Inappropriate
ADH
Secretion
)
Aldosterone
- regulates
SODIUM
REABSORPTION in the
DCT
RAAS (Renin-Angiotensin-Aldosterone System)
1 -
Angiotensinogen
2 -
Angiotensin I
3 -
Angiotensin II
PCT
(
Proximal Convoluted Tubule
) - major site for removal of unfiltered substances
CLEARANCE
Tests - used to evaluate
Glomerular
Filtration
Creatinine
=
MOST
COMMON
Inulin
-
GOLD STANDARD
(Reference Method)
Inulin = MW:
5200
Da
COCKGROFT and GAULT Variables
Age
Sex
Body
weight
in kg
Cockcroft-Gault Formula:
Clearance
(mL/min) = [(
140
–
Age
)(
Weight
in
Kg
)/
72
] x
Creatinine clearance
(mg/dL)
MDRD (Modification of Diet in Renal Disease) Variables
Ethnicity
BUN
Serum Albumin
Concentration Tests
- used to evaluate tubular
reabsorption
FISHBERG Test
- used for the
OBSOLETE
test
patient is deprived of fluid for up to
24
hours
p-amino hippuric acid
(
PAH
) test - most commonly used; reference method for
Tubular Secretion
and
Renal Blood Flow
phenolsulfonphthalein
(PSP) test -
obsolete
, results are hard to
interpret