Nephrology and Kidney Function Overview

Study Notes

Glomerulus consists of afferent and efferent arterioles, with blood entering and leaving through these vessels.
Surrounded by Bowman’s capsule, crucial for urine production directed towards the ureter.
Contains glomerular capillaries, where nephropathy is often identified.
Bowman’s space, proximal tubule, distal convoluted tubular, and macula densa are integral components.
Histological features include podocytes located in the visceral layer of the glomerular capsule.

Renal artery is the entry point for blood, waste, and water while the renal vein carries filtered blood away.
Ureters transport excess water and toxic waste as urine.
Importance of hemodynamics and oxygenation for maintaining renal function; disruptions can arise from conditions like hypovolemia and cardiac issues.
Oxygen partial pressure varies, impacting kidney function and potential disease states.

Patient history is essential; include family medical history of nephropathies, diabetes, and hypertension.
Pediatric evaluations focus on ureteral vesical reflux, while adult assessments consider lifestyle factors like drug use and dietary habits.
Diuresis types: polyuria (e.g., diabetes), oliguria (e.g., acute renal failure), anuria, and dysuria, each indicating different underlying conditions.

Urinalysis assesses visual, chemical, and microscopic characteristics of urine, important for diagnosing diseases like kidney disorders and UTIs.
Normal urine color ranges from colorless to deep amber, affected by hydration levels and dietary factors.
Unusual urine color can signal dehydration, kidney stones, STIs, or diabetes.

Protein in urine can indicate heart failure, kidney disease, or dehydration.
Urine pH tests help identify kidney issues or infections based on acidity levels.
Elevated levels of ketones in urine suggest inadequate glucose availability, often seen in diabetes.
Presence of glucose in urine may indicate diabetes or gestational diabetes.
Microscopic examination for RBCs helps detect bleeding in the urinary system but cannot locate the source.

Increased intrarenal vasoconstriction is linked to conditions like hepatorenal syndrome.
Management of hepatorenal syndrome involves considerations for liver transplantation, with vasoconstrictors and albumin used to assess patient response.

Indications for transplantation differ for candidates vs. non-candidates; non-candidates may require renal replacement therapy if unresponsive to pharmacological interventions.
Candidate patients prioritized for transplantation may discontinue treatment based on response to therapy, typically within 14 days.