# Renal Function
## Formation of Urine
- Involves ultrafiltration at glomerulus, tubular reabsorption, and tubular secretion
- Key components conversion from GF to urine:
- Water: 180,000 ml → 1500 ml
- Sodium: 20,000 mmol/l → 150
- Albumin: 4 gm → 0.04-0.1
- Urea: 54 gm → 24

## Glomerular Filtration Rate (GFR)
### Measurement Methods
- Inulin clearance
- Creatinine clearance
- Urea clearance
- 51Cr-EDTA

### Ideal GFR Measurement Substance Characteristics
- Readily filtered at glomerulus
- Neither reabsorbed nor secreted by tubules
- Maintains constant plasma concentration
- Accurately measurable in plasma and urine
- Non-toxic and biologically inert if exogenous

## Plasma Measurements
### Plasma Urea
#### Decreased Levels Causes
- Low protein diet
- Decreased protein catabolism from anabolic steroids
- Chronic liver diseases

#### Increased Levels Causes
- Physiological: High protein diet
- Pre-renal: Decreased perfusion (hypovolemia, low BP, dehydration)
- Renal: Acute & chronic renal failure
- Post-renal: Outflow obstruction

### Plasma Creatinine
- Reliable indicator of uremia
- Derived from muscle protein catabolism
- Not influenced by diet
- Analyzed using alkaline picrate (Jaffi method)

## Tubular Functions
- Urine concentration ability (tested by water deprivation test)
- Normal urine osmolality: >800 mosmol/kg
- Normal plasma osmolality: 285-295 mosmol/kg
- Salt load excretion
- Acid load excretion (normal urinary pH <5.3)

## Renal Failure
### Acute Renal Failure
- Phases: Oliguric → Diuretic → Recovery
- Urinary volume changes
- Affects K+, Na+, urea, and creatinine levels

### Chronic Renal Failure
- Increased urea and creatinine
- Variable Na+ and K+ levels
- Metabolic acidosis
- Elevated phosphate
- Variable calcium levels

## Clearance and Threshold
- Creatinine clearance:
- Adults: 125 ml/min
- Age 70: 90 ml/min
- Age 90: 70 ml/min
- Glucose threshold: 180 mg/dl
- Urea threshold: zero

## Proteinuria Types
- Orthostatic: Present only when standing
- Overflow
- Glomerular: Selective vs non-selective based on protein clearance ratios
- Tubular: Associated with various conditions including Fanconi syndrome and heavy metal poisoning

## Renal Stones
- More common in hot climates
- Types and Frequency:
- Calcium oxalate & mixed: 80-85%
- Magnesium ammonium phosphate: 5-10%
- Uric acid: 5-10%
- Cystine: 1%
- Xanthine: rare

## Genetic Disorders
### Fanconi's Syndrome
- Multiple proximal tubule defects
- Affects amino acids, phosphate, glucose, and bicarbonate handling

### Other Disorders
- Cystinosis: Affects lymphoreticular system and renal tubules
- Cystinuria: Excessive cystine excretion
- Hartnup disease: Affects monoamino monocarboxylic amino acids

الملزمة الاولى

Renal failure

اسئلة البايو النظري م4 بعد التصحيح

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