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Done by : Ahmed Sultan & Nour Alhouni
Supervised by : Dr. Manal Eljerbi
Kidney's Anatomy
It's a bean shaped organ Located on the posterior abdominal wall behind the peritoneum beside the vertebral Column.
The Right kidney is lower than the left because of its relation to the liver.
Intro
The lateral border of the kidney is convex
While the medial border is concave, containing the hilum where the nerves , blood & lymph vessels enter & exit .
In a Cross Section :
Kidney functions
The functional Unit of the kidney
The nephron
The Nephron
the kidney composed of 1-2 million nephrons
It consists of two main parts:
a renal corpuscle and its associated renal tubular system.
The Renal "Malpighian" Corpuscle
Blood Renal Barrier
Structure:
1- Fenestrated endothelium of blood capillaries; not closed by diaphragms.
2- Basement membrane: thick,
3- Pedicles of Podocytes with filtration slits between them; closed by slit diaphragms.
Function :
It is a selective filter, allowing only molecules below a certain size, and of a certain charge, to pass from the blood and enter the renal tubular system.
The Renal Mesangium & the juxta- glomeular apparatus
There are two groups of mesangial cells:
Intraglomerular mesangial cells
Extraglomerular mesangial cells
1. Intraglomerular mesangial cells
Site: between the glomerular capillaries.
2. Extraglomerular mesangial cells "Lacis cells, polar cushions"
Occupy the space bounded by afferent arteriole, macula densa, efferent arteriole & vascular pole of the renal corpuscle.
*** They’re continuous with the intraglomeular mesangial cells.
3. Mesangial Matrex
The RAAS
The renal Tobular system
The tubules
The Renal Interstitium
The Cortical Interstitium
The Medullary Interstitium
CKD IS :
A lasting damage to the kidney that can get worse over time.
What is CKD ?
GFR < 60 ml/min for 3 months or longer .
Stages Of CKD :
Stages
• Stage 1 with normal or high GFR (GFR > 90 mL/min)
• Stage 2 Mild CKD (GFR = 60-89 mL/min)
• Stage 3 Moderate CKD (GFR = 30-59 mL/min)
• Stage Stage 4 Severe CKD (GFR = 15-29 mL/min)
• Stage 5 End Stage CKD (GFR <15 mL/min)
Causes - Risk Factors
- Sex
- Family History
- Age & Race
- Obesity
Causes
- Diabetes Mellitus
- Hypertension
- Glomerulonephritis
- Autoimmune Disease
- Infections "HepC , HIV"
- Nephrotoxic "NSAID"
CKD Symptoms :
- 15% of US adults —37 million people— are estimated to have CKD.
Symptoms
- Asymptomatic in 90% of the cases
- Back & Flank Pain
- Itchy skin
- Loss Of Appetite
- Peripheral Edema
- Fatigue
- Trouble sleeping
- Most (9 in 10) adults with CKD do not know they have it
- 1 in 2 people with very low kidney function who are not on dialysis do not know they have CKD.
- Initially, there are changes at the afferent & efferent arterioles of the glomerulus and the GFR .
The Diabetes Effect
- Changes within the Renal Curpscle itself :
These include a thickening of the basement membrane, a widening of the slit membranes of the podocytes, an increase in the number of mesangial cells, and an increase in mesangial matrix .
- The matrix invades the glomerular capillaries and produces deposits called Kimmelstiel-Wilson nodules.
Histopathology
- The Blood Vessels
- The RAAS
- The Immune cells Infiltration
- Glomerulosclerosis
The HTN Effect
Histopathology
CKD Complications :
Prevention & Treatment
- Heart Disease and Stroke
- Anemia
- Low calcium levels and high phosphorus
levels in the blood
- High potassium levels in the blood
- Extra fluid in the body
- weakened immune system.
Prevention
Prevention
- Test Regularly For CKD
- Blood test
- Urine Test
- Control The Risk Factor
Treatment
- Management of the underlying cause
- Diet Management
- Diuretics
- Erythropoietin Supplements
- Calcium & Vit D Supplements
- Dialysis
- Kidney Transplant
Bibliography
CKD
The silent killer of the kidney
- Robin's Basic Pathology 10th edition (2018) .
- Wheater's Basic Histopathology 4th edition (2002) .
- Junqueira's Basic Histology text & atlas 13th edition (2009) .
- Gray's Atlas of Anatomy 2nd edition (2015).
- CDC centers for disease control & prevention www.cdc.gov/ckd
- www.webmd.com
- www.ehow.com
-www.worldkidneyday.org
Thanks
Thank you for your attention !
Any Questions ?