Uremic Syndrome Acute Kidney Injury Chronic Kidney Disease Lecture 3: Genito-urinary system. 10 – 08 – 2009. Uremic Syndrome Acute Kidney Injury Chronic Kidney Disease nephron the functional unit of the kidney •capable of forming urine •has two major components: gglloommeerruulluuss tubule: proximal Interstitium loop of Henle distal collecting structural organization renal parenchyma cortex medulla nephrons cortical juxtamedullary Renal Function: Excretory Regulatory Endocrine EExxccrreettoorryy FFuunnccttiioonn:: Glomerular Glomerular Filtration Rate (GFR) Creatinin Clearance. UxV/P ml/min GFR: inulin clearance EDTA isotop Tc 99 isotop IIoohheexxaall High Performance liquid chromatography Clinical setting: eGFR: Cockroft-Gault Formula MDRD Formula Cockroft-Gault Formula Male: 1,23 x (140 – age ) x BW (kg) Ccr = ----------------------------------------- ml/min Scr (µ mol/min) Or 140 – age (yrs) x BW (kg) CCccrr == ---------------------------------------------------------------------------------- mmll//mmiinn 72 x Scr (mg/dl) Female: 140 – age (yrs) x BW (kg) Ccr = ----------------------------------------- ml/min 72 x Scr (mg/dl) Or Ccr( male) x o.85. NNKKFF--KKDDOOQQII rreeccoommmmeennddaattiioonn Adults Cockcroft-Gault equation: GFR (ml/min) = (140-age) X Weight /72 x Scr X(0.85 if female) MMDDRRDD ((mmooddiiffiiccaattiioonn ooff ddiieett iinn rreennaall ddiisseeaassee)) eeqquuaattiioonn:: GFR (ml/min/1.73 m2) = 186 X (SCr) -1.154 X (Age) -0.203 X (0.742 if female) X (1.210 if black) Children Schwartz equation: GFR (ml/min) = 0.55 x length/Scr Counahan-Barratt equation: GFR (ml/min/1.73m2)= 0.43 X Length/Scr Renal Function: Excretory Regulatory Endocrine RReegguullaattoorryy FFuunnccttiioonn:: Tubulo-interstitial * water and electrolyte balance * acid-base balance Renal Function: Excretory Regulatory Endocrine EEnnddooccrriinnee FFuunnccttiioonn:: renal parenchymal renin, prostaglandin, erythropoietin, calcitriol