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  <head>
    <title>017-02 Glomerular haemodynamics, tubular energetics, and renal diagnostic patterns</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Glomerular filtration, tubular transport, concentration, and clearance">
      <outline text="Filtration is pressure constrained">
        <outline text="Needs plasma flow, pressure gradient, intact surface"/>
        <outline text="Afferent tone sets inflow, efferent sets outflow"/>
        <outline text="Moderate efferent constriction preserves glomerular pressure">
          <outline text="Renal blood flow falls, filtration fraction rises"/>
        </outline>
        <outline text="Angiotensin two supports efferent tone in low volume">
          <outline text="Blockade risky with renal-artery disease or depletion"/>
          <outline text="Long term it protects proteinuric kidneys"/>
        </outline>
        <outline text="Prostaglandins maintain afferent dilation under stress">
          <outline text="Afferent loss, efferent loss, diuretics combine"/>
        </outline>
        <outline text="Below the autoregulatory range filtration follows pressure"/>
        <outline text="Above it, transmitted pressure injures capillaries"/>
      </outline>
      <outline text="Barrier selectivity and protein patterns">
        <outline text="Endothelium, basement membrane, podocyte slits differ"/>
        <outline text="The injured layer sets the finding combination"/>
        <outline text="Nephritic: red cells, low filtration, hypertension, oedema"/>
        <outline text="Nephrotic: hypoalbuminaemia, oedema, infection, thrombosis"/>
        <outline text="Syndromes describe physiology, not one histology"/>
        <outline text="Protein may be glomerular, tubular, overflow, post-renal">
          <outline text="Albumin predominance supports glomerular leakage"/>
          <outline text="Light chains exceed reabsorptive capacity"/>
        </outline>
      </outline>
      <outline text="Tubular transport and its oxygen cost">
        <outline text="Filtered sodium load creates most transport work"/>
        <outline text="Demand is highest where reclamation is greatest"/>
        <outline text="The medulla transports much on little oxygen"/>
        <outline text="Proximal failure loses bicarbonate, phosphate, glucose, amino acids">
          <outline text="Generalised dysfunction gives a Fanconi pattern"/>
        </outline>
        <outline text="Thick limb dilutes fluid and builds the gradient"/>
        <outline text="Potassium loss also follows distal delivery and flow"/>
      </outline>
      <outline text="Concentrating and diluting urine">
        <outline text="Gradient, water permeability, and delivery all needed"/>
        <outline text="Antidiuretic hormone supplies aquaporin permeability"/>
        <outline text="Water diuresis gives dilute high-volume urine"/>
        <outline text="Solute diuresis raises excreted osmoles"/>
        <outline text="Volume and osmolality separate the mechanisms"/>
        <outline text="Concentrating fails early in tubulointerstitial disease"/>
      </outline>
      <outline text="Clearance and non-steady states">
        <outline text="Clearance links excretion to plasma concentration"/>
        <outline text="Reabsorption lowers clearance, secretion raises it"/>
        <outline text="Creatinine rises slowly after abrupt filtration loss">
          <outline text="Early values underestimate severity"/>
          <outline text="Dilution and low muscle mass lower it further"/>
        </outline>
        <outline text="Estimating equations are population tools"/>
      </outline>
      <outline text="Urine sediment in miniature">
        <outline text="Red-cell casts support glomerular inflammation"/>
        <outline text="White-cell casts point to interstitial inflammation"/>
        <outline text="Granular casts and tubular cells: acute tubular injury"/>
        <outline text="Crystals may be incidental or reveal supersaturation"/>
        <outline text="Dipstick blood detects haem pigment, not cells"/>
        <outline text="Dipstick protein misses light chains"/>
      </outline>
      <outline text="Integrating the renal diagnosis">
        <outline text="State filtration, output, sediment, protein, obstruction"/>
        <outline text="Ultrasound assesses size, structure, and drainage">
          <outline text="Normal imaging does not exclude disease"/>
        </outline>
        <outline text="Ask which mechanism is actually operating"/>
        <outline text="Review every medicine against current function"/>
        <outline text="Recovery is more than creatinine normalisation"/>
        <outline text="Residual albuminuria and reduced reserve persist"/>
      </outline>
      <outline text="Endocrine failure over time">
        <outline text="Reduced erythropoietin contributes to anaemia">
          <outline text="Assess iron, bleeding, inflammation, haemolysis, vitamins"/>
        </outline>
        <outline text="Phosphate retention and low active vitamin D"/>
        <outline text="Altered calcium and rising parathyroid hormone">
          <outline text="Bone and vessels remodel progressively"/>
        </outline>
        <outline text="Treatment follows stage, diet, symptoms, dialysis"/>
        <outline text="Over-treatment creates vascular harm"/>
      </outline>
      <outline text="Dialysis decisions">
        <outline text="No single creatinine value starts dialysis"/>
        <outline text="Refractory hyperkalaemia and acid-base disturbance"/>
        <outline text="Pulmonary oedema, poisons, uraemic complications"/>
        <outline text="Judged by clinical context and rate of change"/>
        <outline text="Modality matched to haemodynamics and access"/>
        <outline text="Mechanical clearance is not kidney recovery"/>
      </outline>
      <outline text="Acute kidney injury timeline">
        <outline text="Baseline value and last normal value"/>
        <outline text="Urine output, pressure, contrast, surgery, infection"/>
        <outline text="Record when each medicine started"/>
        <outline text="Several causes commonly coincide on one day"/>
        <outline text="Avoid applying a single label prematurely"/>
        <outline text="Oliguria resistant to volume needs reassessment"/>
        <outline text="Drug accumulation feeds a further injury cycle"/>
      </outline>
    </outline>
  </body>
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