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Renal Disease; Fluid and Electrolyte Disorders
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
There are two kidneys behind the peritoneum at the back of the upper abdomen. The right kidney lies below the liver and so is lower than the left kidney. The outer layer of the kidney is the renal cortex and the inner layer is the renal medulla (Figure 8.1). During development, kidneys form in the pelvis and move upwards. Sometimes one or both kidneys can remain in the pelvis. If both remain in the pelvis, they may fuse together to form a horseshoe kidney.
A pensioner with ‘waterworks’ problems
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
In practice, the first two complications can be taken together. Damage to the renal medulla means that the kidneys’ ability to concentrate urine is temporarily impaired. This leads to diuresis, of which there are several components (urea-, water-, and saltlosing diureses). The important point to make about treating this diuresis is that saline and not 5% dextrose must be used to avoid severe hyponatraemia.
Urinary tract infections in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Affecting 1% to 2% of all pregnancies, pyelonephritis is one of the most common serious medical problems encountered during pregnancy. It will develop in 36% to 42% of untreated women with ASB; this risk falls to £3% with the treatment for bacteriuria (39,49). Only approximately 1.4% of women without bacteriuria early in a pregnancy will subsequently develop pyelonephritis before delivery (40). Pyelonephritis occurs most commonly during the second or third trimester, although up to one-quarter of infections are diagnosed intrapartum or postpartum (1,50,51). In addition to other risk factors for UTIs in general, younger age, nulliparity (51), and sickle cell trait (52) or disease (OR 1.3, 95% CI 1.0–1.8) (53) make pyelonephritis more likely. It is usually an ascending infection, more likely to occur during pregnancy because of the physiologic changes predisposing to urinary stasis. Conditions unique to the renal medulla make the kidney particularly vulnerable to infection in the presence of stasis: high urine osmolarity, high urea and sodium concentrations, and low pH impair chemotaxis and inhibit polymorphonuclear leukocyte phagocytosis.
The intellectual base and global trends in contrast-induced acute kidney injury: a bibliometric analysis
Published in Renal Failure, 2023
Heng Wang, Tingting Gao, Ruijing Zhang, Jie Hu, Yuwen Wang, Jianing Wei, Yun Zhou, Honglin Dong
The pathophysiological mechanisms of CI-AKI are not fully understood, but direct and indirect cytotoxic effects and hemodynamic alterations remain the main mechanisms of injury [44]. In keyword clusters #0 and #4, the keywords ‘oxidative stress’ and ‘nitric oxide’ were associated with pathophysiological mechanisms, while ‘cystatin c’ and ‘gelatinase-associated lipocalin’ were relevant markers of injury. Direct toxic effects of CM on renal tubular epithelial cells lead to cell death and dysfunction [22,79]. Indirect effects are mainly related to ischemic-hypoxic injury due to vasodilatory changes mediated by vasoactive substances, such as endothelin, reactive oxygen species, nitric oxide, and prostaglandins [80–83]. The outer renal medulla has a relatively low partial pressure of oxygen, which when combined with enhanced metabolic demands makes the medulla particularly susceptible to the hemodynamic effects of CM [83–85]. In addition, we found that the pathological changes in the peritubular capillaries precede those in the renal tubules in the early stage of CI-AKI, and the related molecular mechanisms are being investigated.
L-Carnitine alleviates hepatic and renal mitochondrial-dependent apoptotic progression induced by letrozole in female rats through modulation of Nrf-2, Cyt c and CASP-3 signaling
Published in Drug and Chemical Toxicology, 2023
Neven Hassan, Maha Rashad, Ebtihal Elleithy, Zainab Sabry, Ghada Ali, Sherif Elmosalamy
On the other hand, examination of the control group showed normal renal tissue. LTZ exposed group showed distorted renal glomeruli with narrowing and closure of the glomerular space. In addition, the renal medulla exhibited protein casts in the renal tubules which showed necrosis of their epithelial lining, and some of them appeared desquamated. Severe congestion and edema were also noticed in the renal blood vessels. Meanwhile, LC exposed group revealed normal renal corpuscles and renal tubules with intact epithelial lining. However, few corpuscles showed narrowing of the glomerular space and few renal tubules exhibited cytoplasmic vacuolation. The kidneys of rats in LTZ group treated with LC revealed fewer alterations in the renal parenchyma when compared with the group treated with LTZ alone. Also, LTZ group treated with LC exhibited less distorted renal glomeruli; most of them appeared normally, while few of them showed narrowed glomerular space. The renal tubules in LTZ group treated with LC appeared with intact lining epithelium, but some of them showed cytoplasmic vacuolation which was less than what was appeared in LTZ exposed group (Figure 4 and Table 4).
Therapeutic role of Azadirachta indica leaves ethanolic extract against diabetic nephropathy in rats neonatally induced by streptozotocin
Published in Ultrastructural Pathology, 2021
Abd El-Fattah B. M. El-Beltagy, Amira M.B. Saleh, Amany Attaallah , Reham A. Gahnem
The renal sections from control (Figure 2A&A1) and neem supplemented (Figure 2B&B1) rats appeared with normal histological architecture whereas it is differentiated into outer cortex and inner medulla. The renal cortex displayed well-organized renal corpuscles and tubules. The renal corpuscle consists of glomerulus that is surrounded by Bowman’s space and intact Bowman’s capsule that lined with simple squamous epithelium. The renal tubules represented by proximal tubules (PT), distal tubules (DT) and collecting ducts (CD). The PT is characterized by its star-shaped lumen that is lined with brush bordered cubical epithelium. Moreover, the DT has relatively rounded lumen that lined by cubical epithelium with little microvilli. The CD lined with short cubical epithelium and has a relatively wider lumen than the PT and DT. The renal medulla displayed well-organized collecting ducts and Henel,s loops.