Note: An increased A-a gradient may occur in hypoxemia due to shunting, ventilation-perfusion

mismatch, or impaired gas diffusion across the alveoli due to fibrosis or edema.
*TA Dr. Mariam:Note:
> Hypoxia is inadequate supply of oxygen to tissue.
> Hypoxemia is decreased oxygen content in arterial blood ( decreased PaO2

*TA Dr. Mariam:* Nephron is the functional unit of the kidney, composed of a renal corpuscle and a
renal tubule.
*TA Dr. Mariam:Note: Two types of nephrons:
> Cortical nephron => located close to the outer part of the renal cortex;
> Juxtamedullary nephrons => near the junction of the renal cortex and medulla
*TA Dr. Mariam:2 mechanisms of kidney autoregulation:
- Myogeninc
- Tubuloglomerular feedback (TGF)

*TA Dr. Taher:ReKap: Glomerular filtration normal values:

PBS = 8mmHg; PGC = 45
π BS= 0mmHg; π GC= 24mmHg
GC = glomerular capillary
BS = Bowman space
P = hydrostatic pressure
π = osmotic pressure
Normal net filtration pressure is : PGC-πGC- PBS = 45-24-8 = 13 mmHg
*TA Dr. Taher:ReKap: Nephrotic syndrome :
- Proteinuria (>3.5g/day)
- hypoalbuminemia
- generalized edema
- hyperlipidemia and fatty casts in urine
- loss of antithrombin III ( risk of thromboembolism)
- loss of immunoglobulins ( risk of infection)
*TA Dr. Taher:ReKap: Nephritic syndrome:
- Proteinnuria (<3.5 g/day)
- Hematuria
- RBC casts
- Mild to moderate edema
- Oliguria
- Hypertension
- Azotemia
*TA Dr. Taher:ReKap: FF = GFR/RPF
*TA Dr. Taher:ReKap: Constriction or dilation of afferent arteriole donot change the filtration
fraction as the fraction or percentage of filtrate will remain almost the same which is in general 20%
*TA Dr. Taher:ReKap: ACE inhibitors are contraindicated in Hyperkalemia / Cough secondary to ACE
# use / Bilateral Renal artery stenosis
Switch to ARB in cough due to ACE# which is interfering with Bradykinin metabolism and increases
Bradykinin, so give ARB
*TA Dr. Abdo:Rate of Transport is dependent upon:
-Solute concentration.
-Number of transporters.
*TA Dr. Abdo:Filtered Load =
=Glomerular Filtration Rate x Plasma Concentration, or · FL = GFR x P
*TA Dr. Abdo:Para-aminohippurate (PAH) is filtered by the glomeruli and is actively secreted by the
proximal tubules
*TA Dr. Abdo:Clearance of Para-aminohippurate (PAH) is a marker of Effective Renal Plasma Flow.
*TA Dr. Abdo:Elevated levels of PAH can compete with Penicillin, Furosemide, Acetazolamide,
Salicylate for secretion as they are transported by the same carriers.
*TA Dr. Abdo:As the GFR decreases, clearance of Creatinine decreases, this results in the increase of
plasma creatinine concentration.
*TA Dr. Abdo:Inulin:
-gets filtered
-does NOT get secreted or reabsorbed.
-Therefore the filtered load of Inulin equals the rate of inulin excretion.
-Inulin serves as a marker for GFR.
*TA Dr. Abdo:•Clearance of Inulin is independent of plasma concentration.
*TA Dr. Abdo:Free water clearance represents the amount of solute-free water excreted.