Professional Documents
Culture Documents
Kidney Anatomy
& Physiology
Morphology of Kidney
Kidneys are a pair of
organs
located behind the
abdomen
About 300 g
4or 5 inches long
Size of a fist
Fibrous capsule
Renal cortex
Renal Medulla
Renal Pelvis
Renal Sinus
Renal papilla
Types of Nephrons:
- Cortical nephrons
- Juxtamedullary nephrons
Parts of a Nephron
Glomerular
apparatus
Proximal tubule
Loop of Henle
Distal tubule
Collecting ducts
Physiology of the
Kidney
Urine formation
Glomerular Filtration
Tubular Reabsorption
Tubular Secretion
Glomerulus
Filters fluid and solutes from blood
Loop of Henle
Reabsorbs Na, K & Cl
Blocks reabsorption of H2O
Dilutes/ Concentrates Urine
Distal Tubule
Na, K, Ca, PO4 selectively reabsorbed
H2O reabsorbed in presence of Antidiuretic Hormone (ADH)
Filtrate continues
Collecting Duct
Rebasorption similar to distal tubule
HCO3 & H reabsorbed/secreted to acidify urine
Filtrate leaves hyperosmotic / hypoosmotic depending on the body
requirements
DIALYSIS
Indications of dialysis
Pericarditis or pleuritis
Progressive uremic encephalopathy or
neuropathy (AMS, asterixis, myoclonus,
seizures)
Bleeding diathesis
Fluid overload unresponsive to diuretics
Metabolic disturbances refractory to medical
therapy (hyperkalemia, metabolic acidosis,
hyper- or hypocalcemia, hyperphosphatemia)
Persistent nausea/vomiting, weight loss, or
malnutrition
Toxic overdose of a dialyzable drug
Goals of Dialysis
Solute clearance
Diffusive transport (based on countercurrent
flow of blood and dialysate)
Convective transport (solvent drag with
ultrafiltration)
Fluid removal
Haemodialysis (HD)
Peritoneal Dialysis
- Both works on similar principles:
Movement of solute or water across
a semi-permeable membrane
(dialysis membrane)
condition
Lifestyle
Patient
Affordability
/ Availability
Haemodialysis
Dialysis
Requirements for
Haemodialysis
Good
Haemodialysis access
2
Aterio-venous fistula
Preferred form of dialysis
access
Typically end-to-side vein-toartery anastamosis
Types
Radiocephalic (first choice)
Brachiocephalic (second
choice)
Brachiobasilic (third
choice, requires
superficialization of basilic
vein, i.e. transposition)
Suitability
Excludes patients with prior peritoneal scarring
e.g. peritonitis, laparotomy
Excludes patients unable to care for self
Continuous
Ambulatory Peritoneal
Dialysis (CAPD)
Automated
CAPD Exchange
Acute Complications of
Dialysis
Hypotension
Cramps
Nausea
and vomiting
Headache
Chest pain
Back pain
Itching
Fever and chills
Acute complications of
Dialysis
Hemolysis
Port wine appearance of the blood in the venous line, a
Acute complications of
Dialysis
Arrhythmias
Usually seen during and between
dialysis treatments
Controversial whether due to
disturbances in plasma potassium
Treatment approach is similar to the
non-dialysis population, except for
medication dosing adjustments
Understanding of Anemia
Definition of Anemia
Anemia - laboratory
diagnosis
Hemoglobin (g/dL)
Hematocrit (%)
RBC Count (106/mm3)
Reticulocytes
WBC (cells/mm3)
MCV (fL)
MCH (pg/RBC)
MCHC (g/dL of RBC)
RDW
(%)
Men
Women
14-17.4
42-50%
4.5-5.9
12.3-15.3
36-44%
4.1-5.1
1.6 0.5%
1.4 0.5%
~4,000-11,000
80-96
30.4 2.8
34.4 1.1
11.7-14.5%
Symptoms of Anemia
Decreased oxygenation
Exertional dyspnea
Dyspnea at rest
Fatigue
Lethargy, confusion
Bounding pulses
Decreased volume
Muscle cramps
Fatigue
Postural dizziness
syncope
Physical examination
Pallor (may be jaundiced think hemolytic)
Tachycardia, bounding pulses
Systolic flow murmur
Glossitis
Angular cheilosis
Decreased vibratory sense/ joint position
sense (B12 deficiency, w/ or w/o
hematologic changes)
Ataxia, positive Romberg sign (severe
B12/folate deficiency)
Differential diagnosis
Anemia
Hypothyroidism
Depression
Cardiac (congestive heart failure, aortic
stenosis)
Pulmonary causes of SOB/DOE
Chronic fatigue syndrome, others
Special considerationsAnemia
In cases of Pregnancy
Causes of Anemia
Anemia due to Bleeding
1.
2.
Causes of Anemia
Anemia due to Low Erythropoietin
Kidney Disease
Normochromic, normocytic
Low reticulocyte count
Frequently, peripheral smear in uremic patients
Causes of Anemia
Anemia due to Decreased response to
Erythropoeitin
Iron-Deficiency
Folate Deficiency
Vitamin B12 Deficiency
Anemia of Chronic Disease
Causes of Anemia
Anemia due to Destruction of Red Blood Cells
1. Hemoglobinopathies
-Sickle Cell Anemia
2. Aplastic Anemia
-Decrease in all lines of cells hemoglobin,
hematocrit, WBC, platelets
-Parvovirus B19, EBV, CMV
-Acquired aplastic anemia
3.Hemolytic Anemia
Treatment options
In
Patient
- Erythropoietic stimulating proteins
-Iron supplementation (nutritional)
- Increase threshold for transfusion
- Blood transfusion
- Blood substitutes
Transition to outpatient
- Dietary changes
- Iron supplementation
- Erythropoeitic stimulating proteins