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Glomerulosclerosis
Published in Charles Theisler, Adjuvant Medical Care, 2023
Glomeruli are the functional units of the kidneys that enable nephrons to filter waste products such as urea out of the blood. Glomerulosclerosis is scarring or hardening of the glomeruli. This damage can result in proteinuria (loss of large amounts of protein [i.e., albumen] from the blood into the urine), microscopic hematuria (blood and casts in the urine), hypertension, and the nephrotic syndrome (proteinuria plus low albumen and high fat in the blood along with edema in the legs feet or ankles). Glomerulosclerosis may develop in children or adults. African Americans are at higher risk.
Advanced Therapeutic Options in Acute Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Tiffany Dong, Aditi Nayak, Alanna Morris
With increasing diuretic use, many patients will develop diuretic resistance, which occurs when congestion persists despite diuretic therapy. The pathophysiology of diuretic resistance includes cell hypertrophy in the connecting tubule and collecting ducts of the kidney that may be driven by the renin-angiotensin and sympathetic systems.4 In these cases, adding a thiazide diuretic, such as chlorothiazide, or a thiazide-like diuretic, like metolazone, may be beneficial. The combination of a loop with a thiazide for diuresis is termed “dual nephron blockade,” as the thiazide blocks the sodium-chloride transporter in the ascending limb and distal tubule while the loop diuretic blocks the sodium, chloride, and potassium cotransporter of the loop of Henle. The combined effect leads to improved natriuresis.5
Kidney Disease
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
The kidneys are small, symmetrical organs, situated bilaterally adjacent to the spine in the retroperitoneum of the lower abdominal cavity (Figure 15.1). Their purpose is to filter the blood, via nephrons, the structural and functional units within the kidney. Reabsorbed fluids are returned to the bloodstream, while waste products are secreted, then excreted from the renal pelvis through the ureter into the bladder to be removed from the body during urination. A process of filtration, reabsorption, secretion, and excretion occurs several times daily in order to remove waste products from the blood and maintain appropriate fluid balance and electrolyte levels within the body.
The anti-hypertensive effects of sodium-glucose cotransporter-2 inhibitors
Published in Expert Review of Cardiovascular Therapy, 2023
Luxcia Kugathasan, Lisa Dubrofsky, Andrew Advani, David Z.I. Cherney
Under normal physiological conditions, blocking sodium transport in the proximal tubule increases distal tubular load and promotes a compensatory enhancement of sodium, chloride, and potassium reabsorption at the loop of Henle primarily by Na-K-2Cl (NKCC2) cotransporters. However, owing to the natriuretic-diuretic coupling effect of SGLT2 inhibition at the proximal tubule, it has been postulated that a diluted load with a low chloride concentration is delivered to the distal nephron and renders tubular reabsorption at the loop of Henle ineffective (Figure 3) [96]. Specifically, since the proximal tubule is highly permeable to water and SGLT2 inhibition renders glucose non-resorbable, isotonicity between the tubular fluid and blood is maintained by osmoregulation. The resulting diuresis is thought to decrease the chloride ion concentration in the proximal tubular filtrate [92]. Therefore, it is speculated that the requirement of two chloride ions for each cotransport at the thick ascending limb subsequently reduces NKCC2 cotransporter activity in a diluted chloride environment [92,96]. The off-target impact of SGLT2 inhibitors at the thick ascending limb may indicate similar activity to that of a loop diuretic to promote plasma volume contraction, although this effect has yet to be proven [96].
Renal and Hepatic Disease: Cnidoscolus aconitifolius as Diet Therapy Proposal for Prevention and Treatment
Published in Journal of the American College of Nutrition, 2021
Maria Lilibeth Manzanilla Valdez, Maira Rubi Segura Campos
In order to eliminate toxins, it is necessary to excrete metabolites, this process is done by nephrons. The kidney has around one million nephrons, inside them there is the glomerulus (a blood vessel and capillaries) that connects with the tubules and then collects the urine and transports it to the bladder (17). It is important to mention that although there are many nephrons, they cannot be regenerate. Therefore, once a nephron suffers a damage (due to progress of some pathology) this nephron will be lost, due to the above it is important to take care of the kidneys, due to the danger of developing chronic diseases. In Figure 1, the structure of the kidney is presented, through the renal vein it reaches the blood with metabolism products such as urea, creatinine, uric acid, products of the metabolism of hemoglobin and the metabolites of various hormones. These products are eliminated in the urine through the ureter, an excess of urea and uric acid has negative consequences in the organism, it can cause systemic toxicity. Once filtered and without toxins, blood returns to the organism through the renal artery (15).
Advances in understanding vertebrate nephrogenesis
Published in Tissue Barriers, 2020
Joseph M. Chambers, Rebecca A. Wingert
By the time the nephron is fully developed, it will contain a number of unique cell-types that each need to have the appropriate gene expression to complete their vital functions (Figure 1). The nephron begins with the blood filter, or renal corpuscle encompassing the glomerulus and Bowman’s capsule. This contains a number of cell types including capillaries, mesangium, podocytes, and parietal cells. Next, the tubule contains the proximal convoluted tubule, proximal straight tubule, the Loop of Henle (including descending limb, thin ascending limb, thick ascending limb), distal convoluted tubule, and connecting tubule. The proximal tubule functions in absorption and secretion in an effort to regulate pH of the filtrate. Largely, the Loop of Henle functions to concentrate the filtrate by reabsorbing water. The distal tubule ensures proper ion transport occurs to fine-tune the filtrate by regulating potassium, sodium, and calcium levels. Each unique segment is needed to maintain blood homeostasis by completing these functions. Nephron cells must acquire a number of features to be generally considered terminally differentiated, including proper epithelization, cilia formation, and expression of functional proteins such as tight junctions and solute transporters.