Atlas Of Diseases Of The Kidney by Robert W. Schrier PDF

By Robert W. Schrier

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This effect involves both increases in the number of Na channels at the luminal membrane and increases in the number of Na-K ATPase (Sodium-potassium adenosine triphosphatase) pumps at the basolateral cell membrane. Arginine vasopressin (AVP) stimulates both Na absorption (by interacting with V2 receptors and, perhaps, V1 receptors) and water transport (by interacting with V2 receptors) [44–46]. V2 receptor stimulation leads to insertion of water channels (aquaporin 2) into the luminal membrane [47].

Unlike other states of hypoproteinemia and vasodilation, however, nephrotic syndrome usually is associated with normotension or hypertension. Coupled with the observation made in Figure 2-36 that natriuresis may take place before increases in serum albumin concentration in patients with nephrotic syndrome, these data implicate an important role for primary renal Na retention in this disorder (dark blue arrow). As suggested by Figure 237, the decrease in urinary Na excretion may play a larger role in patients with acute glomerulonephritis than in patients with minimal change nephropathy [71].

CAUSES OF VOLUME DEPLETION Extrarenal losses (urine sodium concentration low) Gastrointestinal salt losses Vomiting Diarrhea Nasogastric or small bowel aspiration Intestinal fistulae or ostomies Gastrointestinal bleeding Skin and respiratory tract losses Burns Heat exposure Adrenal insufficiency Extensive dermatologic lesions Cystic fibrosis Pulmonary bronchorrhea Drainage of large pleural effusion Renal losses (urine sodium concentration normal or elevated) Extrinsic Solute diuresis (glucose, bicarbonate, urea, mannitol, dextran, contrast dye) Diuretic agents Adrenal insufficiency Selective aldosterone deficiency Intrinsic Diuretic phase of oliguric acute renal failure Postobstructive diuresis Nonoliguric acute renal failure Salt-wasting nephropathy Medullary cystic disease Tubulointerstitial disease Nephrocalcinosis FIGURE 2-21 In volume depletion, total body sodium is decreased.

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Atlas Of Diseases Of The Kidney by Robert W. Schrier


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