Transcript Pathophysiology of kidney. Kidney insufficiency

Pathophysiology of kidney.
Kidney insufficiency
Violation of the fundamental functions of the kidneys
• Filtering (reduction mechanisms and increase filtration,
azotemia, renal glomerular acidosis, proteinuria,
hematuria);
• Reabsorption (sodium and water, protein, glucose,
amino acids, phosphate and calcium, Fanconi
syndrome);
• Secretion (renal tubular acidosis) - in violation of water
homeostasis (change in volume extrcellular fluid, hyperand hipohidriya; violation of osmotic homeostasis and
hyper hipoosmiya; violation of acid-base status at
nongasacidosis, and changes the chemical composition
of blood in azotemia, hypoproteinemia, hypoglycemia.
Renal insufficiency
Renal insufficiency - a pathological condition in
which disturbed the constancy of internal
environment from the failure of the kidneys to
perform their functions
Classification of renal failure
1. Over the clinical course: acute and chronic;
2. By origin: prerenal, renal, postrenalna, arenal
3. In terms of dysfunction: total and partial
4. With the development of mechanisms:
glomerular and tubular
Acute renal failure
Chronic renal failure
The main syndromes and kidney disease
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Uraemic syndrome
Anemia
Hypertension
Edema
Violation of acid-base balance
Violation blood clotting
Renal osteodystrophy
Acute and chronic glomerulonephritis
Pyelonephritis
Nephrolithiasis
Nephrotic syndrome
Uremia
• As the blood accumulated wastes that would have
normally preasent in the urine (uria, uric acid, creatine,
creatinine, metylhuanidyn, dymetylhuanidyn, phenols,
indoles, amino compounds, low molecular compounds the total of 200 substances).
• Pathological changes in the body due to intoxication in
renal failure is characterized as uremic syndrome.
• Clinical manifestations of uremic syndrome associated
with lesions of all organs and systems in the first place the nervous system (nausea, vomiting, mental disorders,
peripheral nerve lesions, uremic coma), and disruption of
water and electrolyte metabolism.
Anemia in chronic renal failure
• Anemia in chronic renal failure is revealed at glomerular
filtration rate below 40 ml / min.
• Pathogenesis of anemia due to inhibition of
erythropoiesis by reducing the formation of renal
erythropoietin and increased elaboration of inhibitors of
hematopoiesis, injury to hematopoietic cells and mature
erythrocytes of uremic toxins, loss of transferrin by
proteinuria and red blood cells and iron deficiency due to
chronic blood loss.
• Blood loss arising from hematuria, the formation of
ulcers in the stomach and intestines, hemorrhagic
diathesis.
Hypertension
• Hypertension is one of the manifestations of chronic
renal failure.
Hypertension, dependent on the amount resulting from
the reduction of glomerular filtration rate, reduced output
of blood sodium and water and increased blood volume.
• Hypertension with high renin resulting from renal blood
flow and hypoxia yukstaglomerular cells. Activation of the
renin-angiotensin system leads to hypertension.
Hypertension, regardless of volume reduction occurs
through the formation of renal prostaglandins (E), a
neutral peptide, reducing the activity of kallikrein-kinin
system.
Edema
• Reduced glomerular filtration rate leads to
sodium and water retention in the vascular
bed, there is hypervolemia.
• Violation of glomerular filter causes
massive proteinuria, so the reduced
oncotic pressure of blood and fluid from
the vascular tissue becomes, developing
edema.
Acidosis
• Acidosis - a shift to the acid-base balance internal
environment in the acidic side, which leads to
atsydotychnoho damage cells, inhibition of contractile
function of the heart and in extreme cases - coma
acydotyc.
• Kidneys normally compensate for an excess of hydrogen
in the blood, increasing bicarbonate reabsorption in
proximal tubules of the nephron and forming an
additional amount of bicarbonate in the distal tubules.
Renal tubules and absence of compensatory
mechanisms leads to a decrease in blood pH.
In compensated acidosis pH of blood does not go
beyond the norm due to compensatory mechanisms and
of buffer systems.
Alkalosis
• Alkalosis - a shift to the acid-base balance internal
environment in the alkaline side, leading to cellular
alkalosis (dysfunction of enzymes, oxidative
phosphorylation, swelling of the cells) and
hipokaltsiemiyi.
• In normal kidneys compensate for alkalosis by reducing
the reabsorption of bicarbonate in the proximal tubules of
the nephron.
• When compensated alkalosis pH of blood does not go
beyond the norm due to compensatory mechanisms and
of buffer systems.
In renal failure there are
violations of hemostasis
• Hypercoagulation arises because of the shortage
urokinaze, which is a plasminogen activator, the
loss in the urine of antithrombin III and in
violation of synthesis and deposition of heparin in
the kidneys.
• Hipocoagulation (hemorrhagic diathesis) is
associated with thrombocytopenia due to uremic
toxic effects on hematopoietic cells and loss of
urine, blood clotting factors for proteinuria.
Renal osteodystrophy
• Renal osteodystrophy is a set of degenerative disorders
of bone, arising from disorders of calcium and
phosphorus metabolism in kidney damage.
• Degenerative changes in bones can occur due to bone
resorption (with hyperparathyroidism), osteomalacia,
followed by deformation of the bones (if hipocalciemia in
children), osteoporosis (reduced bone density without
deformation of the bones); osteosclerosis (increased
bone density).
Glomerular disease
• Glomerulonephritis - kidney disease is a diffuse allergic
nature.
• Acute glomerulonephritis has a rapid start, during or after
infection, most often due to hemolytic streptococcus group
A. Also found relationship with viral and parasitic factors,
cooling, diffuse lesions of connective tissue (lupus,
rheumatoid arthritis), burn disease, vaccination. As a
result of damage to the glomerular membrane of
developing oliguria, proteinuria, azotemia, hypertension,
edema, hematuria, abnormalities of the central nervous
system.
• Chronic glomerulonephritis - progressive diffuse bilateral
renal inflammatory disease.
Pyelonephritis
• Pyelonephritis - infection-inflammatory
diseases of the mucous membrane of the
urinary tract and renal parenchyma of the
primary lesion of the interstitial tissue.
• The most common cause of disease is
spreading coccal infection Escherichia coli
or by hematogenous or ascending
direction of the urinary tract. Favorable
conditions for disease is a violation of the
outflow of urine, trophic disorders, reduced
reactivity.
Urolithiasis
Nephrotic syndrome
Change of acid-base status in the gas acidosis
Gas acidosis
Compensated
pH
pCO2
SB
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Partially
compensated
Decompensated
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Change of acid-base status in the nongas
acidosis
Nongas acidosis
Compensated
pH
pCO2
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Partially
compensated
Decompensated
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SB
Change of acid-base status in the gas
alcalosis
Gas alcalosis
pH
Compensated
-
pCO2
SB
Partially
compensated
Decompensated
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Change of acid-base status in the nongas
alcalosis
Nongas
alcalosis
Compensated
pH
pCO2
-
Partially
compensated
Decompensat
ed
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SB стандартний
бікарбонат
Dehydration
• Dehydration (ehsiccosis; son.: Dehydration,
eksikoz) - pathological condition caused by a
decrease in water content in the body. The loss
of water corresponding weight loss of 10-20%,
life-threatening, withdrawal of water initially
healthy adult leads to death within 7-10 days,
and in a hot dry atmosphere - 3-5 days.