The Nephron Loop of Henle
Endothelium fenestrated filter
Brenner & Rector 9th ed 2012
Epithelial layer (slit membrane)
Brenner & Rector 9th ed 2012
PCT
Brenner & Rector 9th ed 2012
Brenner & Rector 9th ed 2012
Juxtaglomerular apparatus
Munger KA in B&R “The Kidney” - 2012
Symptoms and syndromes
PROTEINURIA
Dependent of
• Intra glomerular pressure
• Glomerular filter selectivity
• Size selectivity
• Charge selectivity – negative charge – GAG
• Tubular reabsorption
Two electron beam microscopy
Dependent of
• Intra glomerular pressure
• Glomerular filter selectivity
• Size selectivity
• Charge selectivity – negative charge – GAG
• Tubular reabsorption
Disease-dependent mechanisms of albuminuria
Endo Size selectivity, with GSCs in the range
MBG of 0.02– 0.1 for a molecule of 36 A°
Epi radius (alb.)
Nephrotic range AU
Albumin Podocytophaties ,, LES, Serum sickness ,
Overload, FSGS
95% Retrieval
pathway
5% Degradation pathway
Megalin/
Cubilin R
Ep
PCT Non nephrotic AU
DM, HT, Anti GBM
Comper WD Am J Physiol Renal Physiol 295: F1589–F1600, 2008.
Proximal Tubules Have the Capacity to Regulate
Uptake of Albumin
TNFα
ϒ IFN
Wagner MC et all J Am Soc Nephrol. 2016 Feb; 27(2): 482–494.
Symptoms and syndromes
PROTEINURIA
• Physiological < 150mg/24h – LMW
• Tubular ( > 150mg/24h) – LMW
• Glomerular ( >150mg/24h) – LMW + HMW
Normal Micro Albuminuria
albuminuria Proteinuria
/ 24h < 300mg/24h - >300mg/24h
Proteins Av 50mg/24h
Dipstick < 30mg/dl - >30mg/dl
First urine <200 mg/g - >200mg/g
P/Cr
/ 24h < 30mg/24h 30 – 300 mg/ >300mg/24h
Av 10mg/24h 24h
Albumine
Dipstick <3 mg/dl >3mg/dl -
albumin
specific
First urine M <17mg/g M 17-250 M > 250mg/g
A/Cr F <25mg/g F 25-355 mg/g F > 355mg/g
<30 30-300 >300
HEMATURIA
• Glomerular - dysmorfic
• Postglomerular - eumorfic
HP
EDEMA L
• Increased HP – cardiac, nephritic, drug
induced, endocrine
• Decreased COP – nephrotic, liver,
malnutrition
• Increased capillary wall permeability –
inflammation
• Lymphatic - obstruction, overload
CV RAA
• Other – cyclic edema
COP
Renal edema
• Glomerular
• Nephritic syndrome
• Nephrotic syndrome
• Overload edema in failing kidney IP
function
HT K
„The kidney is involved in the genesis of
any type of hypertension“
Arthur C. Guyton 1919 - 2003
> 80% of CKD, 13,5% in target
Glomerular syndromes
• Nephrotic – Edema, Proteinuria >3,5g/24h/1,73m2, Hipo:proteinemia /
albuminemia, dyslipidemie
• Nephritic – Proteinurie <3,5g/zi/1,73m2, HTA, Edem, Hematurie +/- Azothemia
• M.U.Ch – Isollated Gl. Hematuria or Proteinuria
TI Syndromes
• PCT: – LMW proteinuria , AAuria, Glicozuria, NaHCO3 uria, Acidosis
• LH – concentration (Ch TIdisease)
• DCT – organic ac , Na uria , RAA , K uria , - hyperchloremic acidosis, and hypo K
emie
• MIXT
Azothemia
• Acute – AKI
• Chronic – CKD - CRF
