Effective Circulating Volume Control - Dr. Gawad
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Effective Circulating Volume Control - Dr. Gawad
- 1. CNECNE ESNT-CNE 5th Course, Cairo May 14-17, 2014 CNECNE Control of Effective Circulating Volumer g Back to Basics – Physiology Concepts Mohammed Abdel Gawad Nephrology Specialist Kidney & Urology Center (KUC) Alexandria drgawad@gmail.com
- 2. ESNT-CNE 5th Course, Cairo May 14-17, 2014 TBW is affected by:TBW is affected by: Gender and AgeGender and Age Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006.
- 3. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Total body water CompartmentsTotal body water Compartments Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006.
- 4. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Total body water CompartmentsTotal body water Compartments Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006.
- 5. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Total body water CompartmentsTotal body water Compartments Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 6. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume An odyssey into the milieu intérieur: pondering the enigmas. Schrier RW. J Am Soc Nephrol. 1992;2(11):1549. Effective Circulating Volume refers to that part of the extracellular fluid (ECF) that is in the arterial system and is effectively perfusing the tissues
- 7. ESNT-CNE 5th Course, Cairo May 14-17, 2014 An odyssey into the milieu intérieur: pondering the enigmas. Schrier RW. J Am Soc Nephrol. 1992;2(11):1549. Effective Circulating VolumeEffective Circulating Volume
- 8. ESNT-CNE 5th Course, Cairo May 14-17, 2014 An odyssey into the milieu intérieur: pondering the enigmas. Schrier RW. J Am Soc Nephrol. 1992;2(11):1549. It’s all about TISSUE PERFUSION Make Organs Happy Effective Circulating VolumeEffective Circulating Volume
- 9. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 10. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 11. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 12. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume Control – General ConceptControl – General Concept Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 13. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume Control – General ConceptControl – General Concept BaroreceptorsBaroreceptors Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 14. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Baroreceptors Monitoring - Site • Kimani JK. Ciba Found Symp. 1995;192:215. • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 15. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Not stimulated at all by pressures between 0 and 50 to 60 mm Hg, but above these levels, they respond progressively more rapidly and reach a maximum at about 180 mm Hg Baroreceptors Monitoring - Stimulus Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 16. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Baroreceptors Signaling - Reflex • Kimani JK. Ciba Found Symp. 1995;192:215. • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006.
- 17. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Baroreceptors Signaling - Reflex Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006.
- 18. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Baroreceptors Action on Targets • Kimani JK. Ciba Found Symp. 1995;192:215. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 19. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Baroreceptors Action on Targets • Kimani JK. Ciba Found Symp. 1995;192:215. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 20. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume Control – General ConceptControl – General Concept Renin – Angiotensin – Aldosteron SystemRenin – Angiotensin – Aldosteron System (RAAS)(RAAS) Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 21. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Renin – Angiotensin –Renin – Angiotensin – Aldosteron System (RAAS)Aldosteron System (RAAS)
- 22. ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAASRAAS StimulusStimulus • Kimani JK. Ciba Found Symp. 1995;192:215. •Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 23. ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAASRAAS SignalingSignaling . • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid- Base Companion. Chapter 4, 1999.
- 24. ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAAS – Action on TargetsRAAS – Action on Targets Angiotensin IIAngiotensin II •Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 25. ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAAS – Action on TargetsRAAS – Action on Targets Angiotensin IIAngiotensin II •Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 26. ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAAS – Action on TargetsRAAS – Action on Targets Angiotensin IIAngiotensin II •Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 27. ESNT-CNE 5th Course, Cairo May 14-17, 2014 RAAS – Action on TargetsRAAS – Action on Targets AldosteronAldosteron • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 28. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume Control – General ConceptControl – General Concept Anti-Diuretic Hormone (ADH)Anti-Diuretic Hormone (ADH)
- 29. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Anti-Diuretic Hormone (ADHAnti-Diuretic Hormone (ADH)) • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 30. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Effective Circulating VolumeEffective Circulating Volume Control – General ConceptControl – General Concept Atrial Natriuretic PeptideAtrial Natriuretic Peptide
- 31. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Atrial natriuretic peptide is the only volume regulatory hormone that decreases effective volume Atrial Natriuretic PeptideAtrial Natriuretic Peptide Atrial natriuretic factor: its (patho)physiological significance in humans. de Zeeuw D et al. Kidney Int. 1992;41(5):1115.
- 32. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Pressure Natriuresis • Guyton AC. Science. 1991;252(5014):1813. • Mizelle HL, Montani JP, Hester RL, Didlake RH, Hall JE. Hypertension. 1993;22(1):102. It does not require neurally or humorally mediated sensor mechanisms It does not require neurally or humorally mediated sensor mechanisms
- 33. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Pressure Natriuresis The increase in systemic pressure is transmitted, via the vasa recta capillaries, to the medullary interstitium Cowley AW Jr. Am J Physiol. 1997;273(1 Pt 2):R1.
- 34. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Pressure Natriuresis Guarasci GR, Kline RL. Am J Physiol. 1996;270(2 Pt 2):R469.
- 35. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Sodium reabsorption in different nephron segments
- 36. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Differences between osmoregulation and volume regulation
- 37. ESNT-CNE 5th Course, Cairo May 14-17, 2014 The amount of water in each body compartment is dependent on: 1- osmotic pressure 2- hydrostatic pressure (filtration) + 3- Membrane characteristics Movement of water – Starling’s ForcesMovement of water – Starling’s Forces • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 38. ESNT-CNE 5th Course, Cairo May 14-17, 2014 is the number of particles (mmol) contained in one liter of water, so measured in mmol/L. i.e. it is the concentration by number OsmolalityOsmolality • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 39. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Starling’s ForcesStarling’s Forces Osmotic pressureOsmotic pressure • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 40. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Starling’s ForcesStarling’s Forces Hydrostatic pressureHydrostatic pressure • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 41. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Volume RegulationVolume Regulation Clinical CorrelationClinical Correlation +lymphatic obstruction • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 42. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Volume RegulationVolume Regulation Clinical Correlation – Heart FailureClinical Correlation – Heart Failure • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
- 43. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Volume RegulationVolume Regulation Clinical Correlation – NephroticClinical Correlation – Nephrotic Jürgen Floege, John Feehally. Chapter 15. Comprehensive Clinical Nephrology. 4th Edition. 2010
- 44. ESNT-CNE 5th Course, Cairo May 14-17, 2014 Mohammed Abdel Gawad