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Review the renin-angiotensin-aldosterone mechanism.
- JG apparatus --> [renin] --> [angiotensin I] --> lungs --> [angiotensin II] --> adrenals --> [aldosterone] --> tubules --> increase Na+ --> increase H2O (ADH) --> increase BP
What are systemic and local effects of angiotensin II? (p.20)
- powerful vasoconstrictor
- stimulates adrenals to release aldosterone
- increases Na+ reabsorption
- increases H2O reabsorption
- increases vascular volume
- increases BP
What is effect of ADH in collecting ducts?
Increased H2O reabsorption
Disorder of glomerular and renal function.
- Glomerulonephritis - autoimmune disease
- capillary wall injured = increased membrane permeability
- may result in permanent kidney damage
- inflammatory condition
- classic form develops in child 1-4 weeks after Group A Streptococcus infection
- kidney can be primary or secondary organ
Know significance of blood creatinine level (creatinine clearance) as marker for renal function.
- Average creatinine clearance = 120 mL/min
- Approximates GFR = 90-130 mL/min
- Good marker for evaluating renal function
- If GFR falls, creatinine clearance overestimates
- Gold standard - creatinine clearance = 24-hour urine
Review sequence of events in the inflammatory process that lead to glomerular injury.
- endothelial and epithelial cell damage
- increased glomerular permeability to proteins
- accumulation of proteins in surrounding matrix with fibrin deposit
- proliferation of mesangial cells
- Autoantibodies react with basement membrane of glomerulus and alveoli
- Lesions develop simultaneously in kidney and lung
Nephrotic syndrome - clinical findings
- massive proteinuria
- generalized edema
- hyperlipidemia and lipiduria
Causes of nephrotoxic syndrome
- Age dependent:
- children <15 years - primary lesion in kidney
- adults - secondary to systemic disease -- diabetes, lupus erythmatosus
Nephritic Syndrome - clinical findings
- hematuria - cola-colored urine
- oliguria and azotemia - to some degree
- *less likely to have generalized edema
Causes of nephritic syndrome
- primary lesion of glomerulus
- secondary to systemic disease
- common occurrence from post-Streptococcal glomerulonephritis developing in children after Streptococcal infection