Patho 3

Review the renin-angiotensin-aldosterone mechanism.(p.4)

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 vasoconstrictorstimulates adrenals to release aldosteroneincreases Na+ reabsorptionincreases H2O reabsorptionincreases vascular volumeincreases BP

What is effect of ADH in collecting ducts?

Increased H2O reabsorption

Disorder of glomerular and renal function.(p.8-10)

Glomerulonephritis - autoimmune diseasecapillary wall injured = increased membrane permeabilitymay result in permanent kidney damageinflammatory conditionclassic form develops in child 1-4 weeks after Group A Streptococcus infectionkidney can be primary or secondary organ

Know significance of blood creatinine level (creatinine clearance) as marker for renal function. (p.2-3)

Average creatinine clearance = 120 mL/minApproximates GFR = 90-130 mL/minGood marker for evaluating renal functionIf GFR falls, creatinine clearance overestimatesGold standard - creatinine clearance = 24-hour urine

Review sequence of events in the inflammatory process that lead to glomerular injury. (p.10)

endothelial and epithelial cell damageincreased glomerular permeability to proteinsaccumulation of proteins in surrounding matrix with fibrin depositproliferation of mesangial cellssclerosis

Goodpasture's Syndrome(p.10)

Autoantibodies react with basement membrane of glomerulus and alveoliLesions develop simultaneously in kidney and lung

Nephrotic syndrome - clinical findings(p.11)

massive proteinuriageneralized edemahypoalbuminemiahyperlipidemia and lipiduria

Causes of nephrotoxic syndrome

Age dependent:children <15 years - primary lesion in kidneyadults - secondary to systemic disease -- diabetes, lupus erythmatosus

Nephritic Syndrome - clinical findings

hematuria - cola-colored urineoliguria and azotemia - to some degreehypertension*less likely to have generalized edema

Causes of nephritic syndrome

primary lesion of glomerulussecondary to systemic diseasecommon occurrence from post-Streptococcal glomerulonephritis developing in children after Streptococcal infection