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Glomerular Filtration
Process of filtration occurs across a complex
barrier consisting of
Thin fenestrated endothelial lining of the glomerular
capillary
The glomerular basement membrane
The foot processes of the epithelial cells
Afferent art.
Efferent art
Pgc = 45 mmHg
Pt = 10 mmHg
gc = 25 mmHg
Puf = 10 mmHg
When NaCl concentration and fluid delivery are high at the macula
densa,
afferent arteriole tone is increased and single nephron GFR falls
Estimation of GFR with Modified Abbreviated MDRD Equation for Chinese, and a Composite Equation
Constituted From Modified MDRD Equation and the Solely cysC-based Equation. Hitachi Pcr was put into
modified abbreviated MDRD equation to estimate GFR (eGFR 3) (R2=0.86, standard deviation of residual=0.136,
P<0.001 for model fitting):[9]
Urea
Synthesized in the liver from amino acid metabolism
Freely filtered at the glomerulus, but
Undergoes approximately 50% reabsorption during
passage through the nephron.
The clearance of urea is approximately half the GFR,
and plasma urea varies inversely with GFR
The fraction of filtered urea that is reabsorbed is not
constant, being greater during conditions of dehydration
and low urine flow rate
It is also related to the amount of protein absorbed from
the gut, and to the protein catabolic rate
In volume depletion,
depletion there is a decrease in renal plasma
flow, decrease in the intraglomerular capillary pressure.
Filtration fraction will remain the same under these
circumstances and GFR will fall. This is before the
neurohumoral responses kick in.
In response to this change in renal plasma flow, renal blood
flow, we have activation of the renin angiotensin system,
angiotensin II causing vasoconstriction and then a response
as well of vasodilatory prostaglandins causing a reduction in
the vasoconstriction in the afferent arteriole.
This results in actually a further decline in the glomerular
plasma flow but because of the vasoconstriction in the
efferent arteriole, intraglomerular pressure is restored to
normal, filtration fraction actually rises, and GFR is
maintained at a normal level; at the expense though of an
increase in sodium reabsorption and urea reabsorption
triggered both by the increase in angiotensin levels and the
increase in filtration fraction.
FE (urea)
<35%
>35%
Radiocontrast nephropathy.
Is an increase of serum creatinine of 25% at 48 hours or
72 hours; or 50% increase or 100% increase, or is it an
increase of 0.5 or increase of 1 mg/dL?
Increases in serum creatinine are associated with an
increase in mortality, but a decrease in the number of
patients.
Even an increase in serum creatinine of less than 50%,
namely, a 25% to 50% increase in creatinine, is
associated with a doubling in mortality. There is about a
five-fold increase in mortality in patients who have a 50%
to 100% increase in serum creatinine. So small changes
may be important.
The first group received normal saline at 1 mL/kg per hour for 12 hours, pre and post
procedure, a second group that received saline plus mannitol, and a third group that
received the same volume load plus furosemide.
Diuretic Therapy in
ATN
Acute interstitial nephritis. A biopsy from a patient with acute interstitial nephritis
showing the lymphocytic infiltration with many eosinophils in the interstitial.
Acute glomerulonephritis. The characteristic finding that should tip you off to this is the
presence of dysmorphic red cells and red blood cell casts in the urine.