Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ RENAL ANATOMY ++ FIGURE 6.1 Anatomy of the urinary tract and kidney. A) The organs of the urinary system include the kidneys, ureters, bladder, and urethra. The function of the urinary system is to filter the blood and create urine as a waste by-product. B) The kidney has an outer region called the renal cortex and an inner region called the medulla. The renal columns are connective tissue extensions that radiate from the cortex to the medulla and separate the renal pyramids and papillae. The papillae are bundles of collecting ducts that carry urine made by the nephron to the calyces for excretion. The renal hilum is the entry and exit site for the blood vessels, nerves, lymphatics, and ureters. Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ RENAL PHYSIOLOGY ++ FIGURE 6.2 Diagram of the nephron. The nephron is the functional unit of the kidney that uses four mechanisms to process the filtrate: filtration, reabsorption, secretion, and excretion. First, blood flows through Bowman’s capsule, and fluid and solutes are filtered out to form a glomerular filtrate. The proximal convoluted tubule, the loop of Henle, the distal convoluted tubule, and the collecting ducts are sites for the reabsorption of water and ions. Shown are the sites at which ions are moved in each segment. The site where each diuretic functions along the nephron is also indicated. Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ RENAL FORMULAS ++ Important renal concepts and formulas: See Table 6.1 Pearls about glomerular filtration rate (GFR): - GFR is measured with exogenous substances (inulin or radioisotopes) or estimated with endogenous substances (creatinine or cystatin C) - In clinical practice, estimated GFR (eGFR) is calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, which has the best accuracy in persons with normal eGFR, or using the Modification of Diet in Renal Disease (MDRD) equation. These equations have largely replaced the Cockcroft-Gault equation. - eGFR is most accurate when a patient is in a steady state (i.e., has a stable sCr). When interpreting eGFR, consider common scenarios that affect the result, such as muscle mass, medication effect (e.g., TMP/SMX), or dynamic states (e.g., early AKI). - If eGFR accuracy is critical, consider calculating eGFR with cystatin C, a freely filtered molecule that is not affected by muscle mass. ++Table Graphic Jump LocationTABLE 6.1Important Renal Concepts and FormulasView Table||Download (.pdf) TABLE 6.1 Important Renal Concepts and Formulas Concept Formula Description Clearance Cplasmaofx = Ux * V/Px mL of plasma cleared of substance X over a specific amount of time Renal blood flow (RBF) (1) RPF = CPAH = [U]PAH * V/[P]PAH(2) RBF = RPF / 1 – Hct The clearance of PAH is used to estimate RPF, then RPF is used to estimate RBF Glomerular ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.