Renal Disease Affects 20 million Americans yearly 2003 cost of medical care for kidney disease in patients was more than 20 billion dollars Has increased over the past several years Rise in diabetes and controlled diabetes People end up with renal problems as a result of diabetes Medical care cost has gone up due to this Anatomy Kidneys 2 retroperitoneal organs the size of a fist We have 2 kidneys but can survive with one Retroperitoneal lines behind the peritoneum lining of the abdominal cavity Right kidney usually slightly lower than the left kidney We have twice the needed capacity for a kidney Donate a kidney and still function and urinate fine Little to no difficulty filtering the substrates in the body because only need one kidney for entire body Made up of a complex capillary network and array of tubules Tubules components of the nephrons responsible for reabsorption and secretion o Help perform regulatory and metabolic functions that are vital for life o Valuable pieces of kidneys itself Nephrons are the functioning unit on the kidneys Each kidney has approximately 1 2 million nephrons Complex network of veins and capillaries working together to filter Each nephron is made up of glomerulus Glomerulus capillary tufts located between 2 arterioles o Afferent arteriole carry blood to the designated site Afferent carries blood to glomerulus o Efferent arteriole carry blood away from designated site Efferent carries blood away from the glomerulus Ultrafiltrate formed by the glomerulus as blood passes through o Ultrafiltrate similar to blood Filters large proteins and blood cells Initial filtration of metabolic byproducts from the filtered blood with the tubule will be filtered again and again Filtrate then modified as it passes through tubules by either reabsorption of amino acids glucose selective minerals water or by secretion or solutes through urine Can be reabsorbed by the kidney into the circulatory system or secreted through urine Physiology Kidney has 3 functions Excretory o aids in excretion and regulation of body water minerals and organic function of the kidneys without it wouldn t be able to o most important compounds survive 4 5 weeks o especially if patients become hyper catabolic constantly breaking things down because all the waste will build up and won t be excreted reason kidney dialysis is important because won t be able to survive if cant excrete compounds and water regularly body will build up these things o Excretion of regulation of body water minerals and organic compounds are the most important functions of the kidneys o Without the excretory function patient won t be able to survive Metabolic body o Removal of nonessential solutes from the blood o With the conservation of those essential solutes that are necessary for the o Solutes are reabsorbed by the tubules or excreted from the urine to maintain fluid and electrolyte balance o Regulation of the acid base balance through the removal of hydrogen ions from the extracellular fluid in the tubules is also an important metabolic process o Helps keep acid base balance Endocrine o Kidney produces important hormones Active form of vitamin D synthesized in the kidney Synthesizes Erythropoietin EPO Glycoprotein which is synthesized in the kidneys which stimulates erythropoiesis production of RBC in the bone Without the EPO erythropoiesis won t happen the way it should Why when people have kidney disease they have low hematocrit and hemoglobin level because they can t make RBC the way it should Decreases the percent Example o man that is 70 kilograms 1200 milliliters of blood flow through the both kidneys each minutes o 1600 liters per day are going to be filtered through the kidneys resulting in 180 liters of filtrate of which 1 5 liters will be excreted through urine o If not taking care for kidneys will make it difficult o If extra things floating around like not controlling blood glucose levels and high blood sugars all the time then body has to filter more kidneys get wasted if not taken care of it someone has diabetes high blood sugar levels o Kidneys are affected by it o Hypertension not good control of high blood pressure levels kidneys get wasted and tired and result with kidneys disease NEPHROTIC SYNDROME NS Renal Disease Characterized by loss of protein in the urine proteinuria too much protein in the urine o Urine Protein levels is greater than 3 5 grams per 1 73 meter squared of body surface area per day proteinuria Marked deficiency of albumin in the blood hypoalbuminemia due to altered permeability of glomerular basement membrane o Characterized by hyperlipidemia and Hypoalbuminemia albumin levels are 3 5 grams per deciliter with edema present Epidemiology Diabetes mellitus or diabetic nephropathy Lupus Focal Segmental Glomerulosclerosis FSGS scarring of scattered regions of the kidneys Amyloidosis formation and deposit of amyloid complex material that resembles starch within the kidneys Etiology Occurs in 2 in every 10 000 people Results from an underlying disease Most prevalent in children than adults but can occur at any age Other diseases can cause you swelling and scarring of the kidneys Symptoms Anorexia Malaise Puffy eyelids Abdominal pain Muscle Wasting Ascites large belly with buildup fluid of the abdomen Anasarca Pathogenesis Oliguria generalized edema with accumulation of serum and connective tissue o Due to hypervolemia decrease of volume of circulation of blood this disease will occur o Urine output of 400 millimeters o minimum amount of normal urine that can carry away the daily load of metabolic waste products o If someone is not urinating at least 400 millimeters a day oliguria not urinating adequately Acute renal failure ARF o Kidney dysfunction for short duration o Sudden or severe impairment of the kidneys o Occur if there is an hypervolemia Hypoalbuminemia synthesis o Common in low albumin levels due to inadequate rate of hepatic albumin o Synthesis cant compensate for excessive urinary protein losses occurring low albumin levels Edema o Decrease in plasma albumin leading to a decrease in difference between interstitial plasma oncotic pressure plasma volume concentration will shift Interstitial pressure pressure occurring between tissue and plasma oncotic pressure swelling edema o Occur the amount of fluid flowing into the interstitium exceeds the maximum lymph flow End up with swelling that occurs if that fluid flowing into the interstium exceeds the maximum lymph flow back