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Applied Renal Physiology in the PICU

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Pediatric Critical Care Medicine

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Abstract

The kidneys are central to numerous homeostatic mechanisms in the body. Responsible for solute and fluid handling, removal of waste products of nutrients, metabolism, detoxification, and excretion of drugs and metabolites, and regulation of vascular tone, the kidneys also elaborate many metabolites that act in local and distant fashion. The kidneys receive a high proportion of cardiac output per minute and have a high rate of oxygen consumption, evidence of the intensity of regulation that occurs in perpetuity. In this chapter, we will discuss renal physiology using the structure as background, function, and response to illness. Both hemodynamics and filtration will be described in detail. Relevant examples of how commonly encountered disease states affect kidney function will be discussed. Finally, the emerging paradigm of crosstalk between the kidneys and other vital organs will be broached. Critical illness carries dramatic consequence on kidney function and understanding the elements of how the kidneys regulate their own mechanics, and what happens when these compensatory mechanisms are overwhelmed, is essential to practitioners in the pediatric intensive care unit.

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Abbreviations

ACE-I:

Angiotensin converting enzyme inh

ADH:

Anti-diuretic hormone

AE1:

Anion exchanger

ANG-II:

Angiotensin 2

ANP:

Atrial natriuretic peptide

AQP:

Aquaporin

ARB:

Angiotensin receptor blockers

AVP:

Arginine vasopressin

CA:

Carbonic anhydrase

Ca2+ :

Calcium

Ca2+-ATPase:

Calcium ATPase

CD:

Collecting duct

Cl− :

Chloride

DCT:

Distal convoluted tubule

ENaC:

Epithelial sodium channel

GBM:

Glomerular basement membrane

GCP:

Glomerular capillary perfusion

GFR:

Glomerular filtration rate

GLUT:

Glucose transporter

H+-ATPase:

Hydrogen ATPase

HCO3 − :

Bicarbonate

HIF-1:

Hypoxia inducible factor

JGA:

Juxtaglomerular apparatus

K+ :

Potassium

LH:

Loop of henle

MCD:

Medullary collecting duct

MR:

Myogenic reflex

Na+ :

Sodium

Na+-K+-ATPase:

Sodium-potassium ATPase

NaCl:

Sodium chloride

NH3 :

Ammonia

NHE3:

Sodium hydrogen exchanger

NO:

Nitric oxide

NPHS1:

Nephrin

NPHS2:

Podocin

PLCE:

Phospholipase C epsilon

PO4 3− :

Phosphate

PT:

Proximal tubule

PTH:

Parathyroid hormone

RAAS:

Renin-angiotensin-aldosterone

RBF:

Renal blood flow

RPP:

Renal perfusion pressure

RvO2 :

Oxygen consumption

RVR:

Renal vascular resistance

SGLT:

Sodium-glucose transporters

SNGFR:

Single nephron GFR

SSAKI:

Severe sepsis associated AKI

TAL:

Thick ascending limb

TAL:

Thick ascending loop of henle

TGR:

Tubuloglomerular feedback

TPRC6:

Transient receptor potential

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Author information

Authors and Affiliations

  1. Department of Pediatric Critical Care, Cincinnati Children’s Hospital and Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45236, USA

    Ravi S. Samraj MD

  2. Pediatric Critical Care, Cincinnati Children’s Hospital and Medical Center, 3333 Burnet Ave MLC 2005, Cincinnati, OH, 45229, USA

    Rajit K. Basu MD

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  1. Ravi S. Samraj MD
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  2. Rajit K. Basu MD
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Correspondence to Rajit K. Basu MD .

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Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. MICHR, University of Michigan Medical Scho, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Samraj, R.S., Basu, R.K. (2014). Applied Renal Physiology in the PICU. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6416-6_12

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