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    3 GFR 2020

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    vraj
    1) The glomerular filtration rate (GFR) is a measure of kidney function and is the amount of filtrate formed by the kidneys per minute, normally around 125 mL/min. 2) Glomerular filtration occurs due to hydrostatic pressure in the glomerular capillaries exceeding the opposing forces of oncotic pressure and capsular pressure, allowing plasma to be filtered through the glomerular membrane into Bowman's capsule. 3) GFR is regulated by neural, hormonal, and autoregulatory mechanisms that control factors like renal blood flow and the diameter of the afferent arteriole to maintain filtration at an optimal level.

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    3 GFR 2020

    Uploaded by

    vraj
    34 views32 pages
    1) The glomerular filtration rate (GFR) is a measure of kidney function and is the amount of filtrate formed by the kidneys per minute, normally around 125 mL/min. 2) Glomerular filtration occurs due to hydrostatic pressure in the glomerular capillaries exceeding the opposing forces of oncotic pressure and capsular pressure, allowing plasma to be filtered through the glomerular membrane into Bowman's capsule. 3) GFR is regulated by neural, hormonal, and autoregulatory mechanisms that control factors like renal blood flow and the diameter of the afferent arteriole to maintain filtration at an optimal level.

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    3 GFR 2020

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    1) The glomerular filtration rate (GFR) is a measure of kidney function and is the amount of filtrate formed by the kidneys per minute, normally around 125 mL/min. 2) Glomerular filtration occurs due to hydrostatic pressure in the glomerular capillaries exceeding the opposing forces of oncotic pressure and capsular pressure, allowing plasma to be filtered through the glomerular membrane into Bowman's capsule. 3) GFR is regulated by neural, hormonal, and autoregulatory mechanisms that control factors like renal blood flow and the diameter of the afferent arteriole to maintain filtration at an optimal level.

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    34 views32 pages

    3 GFR 2020

    Uploaded by

    vraj
    1) The glomerular filtration rate (GFR) is a measure of kidney function and is the amount of filtrate formed by the kidneys per minute, normally around 125 mL/min. 2) Glomerular filtration occurs due to hydrostatic pressure in the glomerular capillaries exceeding the opposing forces of oncotic pressure and capsular pressure, allowing plasma to be filtered through the glomerular membrane into Bowman's capsule. 3) GFR is regulated by neural, hormonal, and autoregulatory mechanisms that control factors like renal blood flow and the diameter of the afferent arteriole to maintain filtration at an optimal level.

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    GFR

    Dr D.V.Deshpande
    Prof &Head
    Dept of Physiology
    Zydus Medical College
    Dahod
    Formation of urine
    Glomerular Stage-Filtrate-primitive urine

    Tubular stage→Modification of filtrate


    (Reabsorption,Secretion)
    Glomerular Stage
    Gl filtration occurs across Glomerular
    membrane which is Barrier between
    plasma in glomerular Capillaries & fluid in
    Bowman’s capsule
    1 2
    Filtration

    Reabsorption

    Secretion

    Excretion 2
    3
    1 Filtration
    2Reabsorption
    3 Secretion
    4 Excretion

    3
    4
    Glomerular membrane

    45
    Fenestra 70-90
    nm

    Meshwork –
    proteogylcan-
    pores-10nm
    BM
    Slit pores 25nm

    Glomerular
    membrane
    5
    Glomerular membrane
    1) Endothelium
    2) Basement membrane of capillary
    &Bowman’s capsule fused.
    3) Epithelium of Bowman’s capsule

    Thickness 0.3μ
    SA 0.8 mt2
    Filtration initial step in urine formation6
    7
    Plasma from Glomerular capillaries filtered
    via Highly permeable ( 100 times more
    than capillaries elsewhere) glomerular
    Membrane

    Filtrate ( protein free ,cell free) enters


    Bowman’s capsule
    7
    8
    Filtrate identical with plasma
    1. Osmolality 300 m osmol / kg water
    2. PH 7.4
    3. Electrolyte & non electrolyte
    concentration same → Ultrafiltrate

     Energy for filtration by capillary


    Hydrostatic pressure in glomerular
    capillary = 60 mm Hg
    8
    9
    Glomerular Filtration Rate
    Definition---Quantity of filtrate from all
    nephrons of both kidneys in 1 minute
    125ml / min = 180 L/day
     10% less in females.

     180 L/ day = 4.5times TBW ( 40 L )


    =12times ECF volume (15L)
    =60 times Plasma volume (3L)
    9
    Starlings Forces controlling GFR.
    1) Capillary Hydrostatic Pressu→60mm Hg
    2) Colloid Osmotic Pressure→32 mm Hg
    (plasma filtered↑conc of plasma
    proteins).
    3) Capsular Hydrostatic Pressure
    →18mmHg.
    4) COP (Bowman ’Capsule) =zero (because
    no proteins).
    NFP = 60 – (32+18)=10mmHg 10
    11
    11
    Hydrostatic Pressure > ColloidOsmotic
    Pressure + Capsular Hydrostatic
    Pressure→filtration
     & If equal→Filtration Equilibrium ( no
    filtration)
    Filtration fraction
    Fraction of renal plasma that becomes
    glomerular Filtrate
     125 / 650 x 100
    = 18 to 20%
    12
    13
    Filtartion coefficient Kf = GFR/ NFP
    =125/10=12.5 ml /mm Hg/min
    Kf depends on
    1) Kf=Capillary Permeability x surface area
    2) ↓Functioning capillaries →↓SA
    3) Contraction of Mesangial cells-↓SA.
    4)↑Thickness→↓Kf
    5) ↑permeability( disease).

    13 14
    6) Molecular size--<4nm filtered,
    >8nm not filtered
    7) Electrostatic charge—Glomerular
    capillaries negatively charged due to sialo
    proteins
    Permeability of cations more than
    anions&neutral molecules
    Albumin diameter <8nm but is anion.
    Normally albumin not filtered.
    14
     Normally 100mg albumin lost in urine
    Not due to filtration but shedding of
    tubular epithelial cells.

    Albuminuria seen in glomerulo nephritis


    when a)↑in pore size of glomerular
    membrane b) Disruption of negative charge
    of glomerular membrane.
    15
    Factors affecting GFR
    1.Renal blood flow ↑RBF→↑GFR,
    ↓RBF→↓GFR.
    2)Glomerular cap HP-Afferent arteriolar
    constriction→↑resistance→↓HP→↓NFP→
    ↓GFR &vice versa
    3 Capsular fluid pressure—HP in Bowman’s
    capsule &tubule opposes filtration
     Ureteric obstruction→↑HP
    pressure→↓ NFP →↓GFR
    1617
    4 Colloid osmotic pressure-COP ↓s filtration.:

     Hypo proteinemia→↓COP→ ↑GFR


     Dehydation→↑ COP →↓GFR.
    6.BP: AR 80 to180 mm of Hg
    BP <80 –GFR ↓ & > 180→↑GFR
    7.Glomerular membrane diseases, thickening
    & destruction→↓GFR
     Gl nephritis→↑cap permeability →↑GFR
    1718
    8.Sympathetic stimulation
    Mild & moderate
    Constriction of afferent arterioles
    (↑reistance) =↑BP
     GFR same
     Severe ↓↓ RBF &↓GFR

    9 Contraction of mesangial cells


     Distortion & encroachment of capillary
    lumen→↓area for filtration→↓GFR
    18 19
    Eg—ATII,ADH,NE,Endothelins
    Relaxation of mesangial cells-
    ↑filtration Eg—ANP,NO,bradykinin

    19
    Physiological variations in GFR
    1. Age:↑ ing age, GFR ↓s because,↓RPF &
    ↓renal tissue mass(Loss of nephrons)
    2. Sex: Females<males
    3. Posture
     Upright posture for long duration
    sympathetic stimulation & ↓effective BV
    ( pooling) →↓GFR
    supine position--↑GFR.
    4. Sleep--↓Cardiac output→↓GFR
    20 21
    5.Pregnancy
     ↑BV→ , ↑CO→↑RBF & ↓vascular
    resistance in renal vessels→↑GFR
    Hormonal changes also responsible.
    40 to 50 %↑in GFR in 2nd &3rd trimester.
    6. Exercise Sympathetic Stimulation→
    afferent arteriolar constriction→↓GFR
    7. Weather winter & rainy season↑es
    (Less loss of water) summer ↓es(↑Loss of
    water-Less ECF volume) 21
    Renal clearance
    Volume of plasma cleared off a substance
    in 1’ by excretion in urine .
    Vol of plasma contains same amount of
    substance excreted in urine in 1’.
     Virtual volume
    Ability of kidney to clear blood of a
    particular substance
    Mathematical way of expressing excretory
    power of kidney
    22
    23
    C = UV/ P
    C: Renal clearance ml/minute
    U : Urine conc of substance mg/ml
    V: Rate of flow of urine ml/min
    P: Plasma conc of substance in mg/ml
    Principles governing renal clearance
    A. Substances freely filtered , neither
    reabsorbed nor secreted (inulin – GFR)
    B. Filtered, Secreted & completely excreted-
    RBF
    23
    Measurement of GFR by Clearance
    Exogenous
    Inulin (fructose polymer )
    Endogenous
     Creatinine &urea
    Criteria of Inulin Clearance
    No combination with Pl Proteins-filtered
    No metabolism, not produced , does not
    alter GFR
    2425
     Not toxic
    Easy estimation
    No reabsorption & secretion
     Filtration = excretion
     GFR X Px /ml = U x X V
     GFR= Ux X V
    Px /ml

    25
    26
    Creatinine Clearance
     Endogenous, Estimation simple
     Blood level constant for 24 hrs
     Collect 1 days urine sample.
     Find Urine creatinine→Ucr mg/ml
     Volume in ml /min
     plasma creatinine (Pcr mg/ml)
    Creatinine Clearance
     Ccr= U cr X V/Pcr mg/ml
     P cr Inversly related to GFR 26
    27
    Regulation of GFR
    I)Neural mechanism II)Hormonal mechanism
    III)Autoregulatory mechanism---1) Myogenic
    mechanism 2) Tubulo glomerular feedback
    I)Neural mechanism
    ↓BV→↓BP→↑Symp activity→ ↑E,NE
    →constriction of afferent arteriole→↓BF to
    glomerulus→↓GFR
    ↑Symp activity in fear,anger etc.

    27
    II) Hormonal mechanism
    1) ATII----Aff arteriolar constriction → ↓GFR
    2) Histamine—arterial dilatation→↑RBF,but
    contraction of mesangial cell→↓GFR
    3) Dopamine a) Vasodilatation→↑RBF→
    ↑GFR b)Relaxes mesangial cells→↑GFR
    4) Atrial natriuretic peptide---
    ↑BV→↑ANP→Dilatation of aff
    arteriole→↑GFR→↑Urine→↓BV.

    28
    5)Endothelin---Secreted by endothelial cells
    of renal vessels,mesangial cells,causes
    vasoconstriction of aff &eff arteriole→↓GFR.
    6) Nitric oxide—Vasodilatation of aff&eff
    arterioles→↑GFR.
    7) Adenosine-i)produced by renal tissue
    ii)vasoconstriction of aff arteriole→↓GFR
    iii)Role in TG feedback.
    8) Gluco corticoids--↑RBF&GFR,how not
    known.
    29
    9) Prostaglandins---i) Vasodilatation
    →↑RBF→↑GFR ii) Relaxation of mesangial
    cells→↑GFR.
    III)Autoregulatory mechanism---1) Myogenic
    mechanism 2) Tubulo glomerular feedback

    30
    Thank you

    32

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