ATN

[aspiringmd1015]

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trying to think about this physiologically only, but in acute tubular necrosis, is the GFR decreasing w/ tubular obstruction bc the bowmans space hydrostatic pressure is increasing(which is normally 0) similar to what happens in post renal azotemia? and if the GFR decreases, then creatinine urine excretion is decreased bc the GFR is decreased as in Filtered load = gfr x plasma conc., w/the filtered load in this case decreasing bc of gfr decreasing?

 

[RnaPolymerase2]

Yes I always think GFR=FF. Decreased GFR= decreased FF, and creatinin =GFR it's a measure of renal function... ATN case.. Cr will increase bcos GFR is decreased in the oliguric phase and once ATN is resolved it will Cr will decrease bcos GFR will increase.

 

[aspiringmd1015]

right, but is the reason behind the decrease in GFR increased hydrostatic pressure in the bowmans space?

 

[RnaPolymerase2]

(Medscape)The reduction in the glomerular filtration rate (GFR) that occurs from ischemic injury is a result not only of reduced filtration due to hypoperfusion but also of casts and debris obstructing the tubule lumen, causing back-leak of filtrate through the damaged epithelium (ie, ineffective filtration).

 

[aspiringmd1015]

right, but that obstruction, causing the backleak, isn't that an increase in Pc of the bowmans space?

 

[RnaPolymerase2]

Yes your right the obstruction increases tubular pressure and decreasing the GFR.