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Urinary/Fluids (Nephron: Microscopic, functional filtration unit of kidney…

- - - - Tangle of capillary loops (glomerular capillaries)
      - Blood enters via afferent arterioles
      - Blood exits via efferent arterioles
    - - AKA: Bowman's capsule
      - Two layers
        
        Internal permeable visceral layer
        
        Inner layer
        
        External impermeable parietal layer
        
        Outer layer
        
        Simple squamous epithelium
      - Capsular space
        
        Between two layers
        
        Receives filtrate and modified to form urine
    - - Intrinsic
        
        Control within the kidney itself
        
        AKA: Renal autoregulation
        
        Myogenic mechanism
        
        Contraction and relaxation of smooth muscle in the afferent arteriole
        
        High BP, vasoconstriction
        
        Low BP, vasodilation
        
        Tubuloglomerular feedback mechanism
        
        Based on the concentration of NaCl
        
        Used as a back up with myogenic mechanism is not enough
        
        The concentration of NaCl is detected by the JG apparatus
        
        The macula densa releases a signaling molecule (ATP) as a response
        
        ATP binds and stimulates the afferent arteriole to constrict or dilate
      - Extrinsic
        
        External to the kidney
        
        Involves the use of neurons and hormones for regulation
        
        Decrease in GFR
        
        Sympathetic reactions (Fight or flight)
        
        Causes granular cells to release renin
        
        Renin is used in the production of angiotensin II
        
        Angiotensin II causes mesangial cells to contract
        
        Decrease surface area
        
        Vasoconstriction of afferent arteriole
        
        Decrease in urine/ retention of fluids
        
        Increase in GFR
        
        Affected by ANP
        
        ANP: Realeased from atrial cardiac muscle
        
        Relaxes the afferent arteriole
        
        Inhibits the release of renin
  - - - First region
      - Originates: Tubular pole of the renal corpuscle
      - Cuboidal epithelium
      - Tall, apical microvilli
        
        Used for reabsorption
        
        Fuzzy due to brush border
    - - AKA: Loop of Henle
      - Originates: Sharp bend in the PCT
      - Two limbs
        
        Descending limb
        
        PCT and extends to "hairpin" loop
        
        Ascending limb
        
        "hairpin" loop to DCT
      - Two segment types
        
        Thin segment
        
        Simple, squamous epithelium
        
        Thick segment
        
        Simple, cuboidal epithelium lining
      - In medulla
    - - In cortex
      - Extends to collecting tubule
      - Simple, cuboidal epithelium
      - Short, apical microvilli
      - Lumen is clear, not fuzzy
  - - - Renal corpuscle is in cortex
      - Short nephron loop
        
        Barely extends in the medulla
      - 85% of nephrons
    - - Next to corticomedullary junction
      - Long nephron loop extends to medulla
      - Establish a Na+ concentration gradient in interstitial fluid
        
        Regulation of urine concentration of ADH
        
        Lies outside of nephron loop, collecting tubules, collecting ducts
      - 15% of nephrons
  - - - Collecting ducts
        
        Papillary ducts
        
        Near renal papilla
  - - - Responsive to aldosterone
      - Responsive to Antidiuretic
    - - Help regulate urine and blood pH
  - - - AKA juxtaglomerular cells
      - Modified smooth muscles of afferent arteriole
      - Functions
        
        Contract when stimulated either by stretch or sympathetic division
        
        Synthesize, store and release renin enzyme
        
        Renin required to produce angiotensin II hormone
    - - Modified epithelial cells of DCT
      - DCT comes in contact with granular cells
      - Located on tubule side next to afferent arteriole
      - Detects changes in NaCl concentration of fluid in lumen of DCT
        
        Signals to release renin via granular cell
  - - - Separation of water and solutes from blood plasma
      - Enters capsular space of renal corpuscle
      - Pressure difference causes filtration
    - - Movement by diffusion, osmosis, or active transport
      - From lumen of renal tubules, collecting tubules, collecting ducts
      - All vital solutes and most water reabsorbed
      - Most reabsorption via PCT
      - Excess water, solutes, waste products remain in tubular fluid
    - - Movement of solutes (active transport) out of blood
      - Via peritubular or vasa recta
      - Materials are moved selectively in tubules
      - "Secretion before excretion"
      - Most secretion via DCT
    - - Via urethra
      - Wastes eliminated from the body (urine)
- - - - Causes
        
        Dehyhdration
        
        Diabetes I. (Hyposecretion of ADH)
        
        IV (Saline)
      - Effects
        
        Cell shrinkage
        
        Neurological impairment
        
        Excess fluid = High BP
      - Symptoms
        
        Confusion
        
        Coma
        
        Paralysis of breathing muscles
        
        Death
    - - Causes
        
        Excess water intake
        
        Hypersecretion of ADH
        
        Diuretic abuse
        
        Severe diarrhea
        
        Burns
        
        Excessive sweating
        
        Hyposecretion of aldosterone
      - Effects
        
        Cell swelling
        
        Decrease in blood vol. = decrease in BP
      - Symptoms
        
        Nausea
        
        Lethargy
        
        Confusion
        
        Headache
        
        Muscle cramps
        
        Seizures
        
        Coma
        
        Death
    - - Most abundant in ECF (99%)
      - Regulation
        
        Aldosterone
        
        Retains water and Na
        
        Maintains Na blood plasma concentration
        
        ADH
        
        Retains water
        
        Dec. Na concentration
        
        ANP
        
        Inc. excretion of water and Na
        
        Dec. Na concentration
  - - - Causes
        
        Excess Cl in diet
        
        IV (containing NaCl)
        
        Diarrhea
        
        Hyperaldosteronism
        
        Hyperparathyroidism
        
        Kidney disease
        
        Metabolic acidosis
      - Effects
        
        Dec. nerve excitability
        
        Changes in concentrations of other ions
      - Symptoms
        
        Asymptomatic
        
        Irregular breathing
        
        Weakness
        
        Intense thirst
    - - Causes
        
        Heavy sweating
        
        Vomiting
        
        GI suction
        
        Kidney disease
        
        Metabolic alkalosis
      - Effects
        
        Inc. nerve excitability
        
        Change in concentration of other ions
      - Symptoms
        
        Asymptomatic
        
        Tetany
        
        Hyperactive reflexes
        
        Muscle cramps
        
        Seizures
        
        Coma
        
        Respiratory failure
        
        Arrhythmias
    - - Most abundant in ECF
      - Associated with Na
      - Found in HCL is stomach
  - - - Causes
        
        Aldosterone hypersecretion
        
        Renal failure
        
        Acidosis
        
        Decreased insulin
        
        Extensive cellular trauma (Crushing/Burn)
        
        Hemolytic anemia
        
        Transfusion of old blood
      - Effects
        
        Rise in K = Diffusion of K in cells
        
        Alter resting potential
        
        Interferes with action potential
      - Symptoms
        
        Nausea
        
        Vomiting
        
        Diarrhea
        
        Skeletal muscle weakness
        
        Tingling skin
        
        Numbness of hands/feet
        
        Irregular heartbeat
        
        No symptoms (Asympomatic)
    - - Effects
        
        Cells hyperdepolarized
        
        Interferes with neuron and muscle functions
      - Causes
        
        Diuretic abuse
        
        Hypersecretion of aldosterone
        
        Chronic vomiting
        
        Diarrhea
        
        Heavy sweating
        
        Alkalosis
        
        Increased insulin
        
        Formation of more tissues
      - Symptoms
        
        Nausea
        
        Vomiting
        
        Nervous/muscle tissues are less excitable
        
        Decrease mucle tone
        
        Flaccid paralysis
        
        Dec./irregular heartbeat
        
        Respiratory arrest (diaphragm paralysis)
    - - Most abundant in ICF (98%)
      - Regulation
        
        Aldosterone
        
        Causes K secretions by kidneys (urine)
        
        Dec. K concentration
  - - - Causes
        
        Hyperthyroidism
        
        Hyperparathyroidism
        
        Bone loss (Cancer)
        
        Immobilization
        
        Excessive vitamin D or calium
        
        Renal failure
      - Effects
        
        Interferes with muscles and nerves
        
        Underexcitability of muscles and nerves
      - Symptoms
        
        Asymptomatic
        
        Fatigue
        
        Depression
        
        Muscle weakness
        
        Loss of appetite
        
        Nausea
        
        Vomiting
        
        Constipation
        
        Abnormal heartbeat
        
        Calcification of soft tissues
    - - Causes
        
        Vit. D deficiency
        
        Diarrhea
        
        Pregnancy
        
        Lactation
        
        Increased calcitonin
        
        Hyperparathyroidism
        
        Hyperthyrodism
      - Effects
        
        Overexcitability of muscles/nerves
      - Symptoms
        
        Numbness
        
        Tingling
        
        Muscle spasms
        
        Inc. heart rate
        
        Tetany
        
        Laryngospasms and suffocation
    - - Most abundant in ECF
      - 99% stored in teeth/bones
      - Needed in blood clotting, muscles, and bones
  - - - Causes
        
        Kidney impairment
        
        Inc. supplements
        
        Laxatives/edemas
        
        Respiratory acidosis
        
        Cellular damage
      - Effects
        
        Precipitations of Ca (hypocalcemia)
      - Symptoms
        
        Asymptomatic
        
        Hypocalcemia
        
        Affects: muscles, nerves, bone calcification
    - - Causes
        
        Insufficient phosphate intake
        
        Hyperparathyroidism
        
        Respiratory alkalosis
      - Effects
        
        Many affects due to dec. in ATP
      - Symptoms
        
        Weakness/ dysfunction of nervous system, skeletal and cardiac muscles
    - - Most abundant in ICF
  - - - Causes
        
        Kidney impairment
        
        High intake of magnesium (edema/antiacid)
      - Effect
        
        Changes in neuromuscular, cardiovascular, and CN system
      - Symptoms
        
        Depressed neuromuscular activity
        
        Hypotension
        
        Cardiac arrest
        
        Weakness
        
        Lethargy
        
        Respiratory depression
    - - Cause
        
        Impaired absorption from GI tract
        
        Inc. loss of Mg via kidneys
        
        Redistribution
        
        Chronic alcoholism
      - Effect
        
        Changes in neuromuscular, cardiovacular, and CN system
      - Symptoms
        
        Muscle twitches
        
        Tremors
        
        Hyperactive reflexes
        
        Mental confusion
        
        Depression
    - - Most abundant in ICF
        
        2nd most abundant compared to K
      - In bones and cells
      - Important in muscle relaxation/ enzymatic reactions
- - - - Transcellular tranport
        
        Luminal membrane
        
        Contact with tubular fluid
        
        Basolateral membrane
        
        Rests on the basement membrane
        
        Transport depends on whether it is being reabsorbed/ secretion
      - Paracellular transport
    - - Control movement of substances
      - Simple/facilitated diffusion
      - Osmosis
      - Primary/ Secondary active transport
      - Vesicular transport
  - - - Normally reabsorbed in PCT
      - Reabsorbed via specific transport proteins
      - Glucose is transported into the tubule cell across the lumen
        
        Na/glucose symporter proteins
        
        Na moves down the concentration gradient
        
        Glucose moves up the concentration gradient via secondary active transport
        
        Moved by uniporters via facilitated diffusion
    - - Not freely filtered
        
        Negatively charged
        
        Size
        
        Small proteins can pass
        
        Larger proteins do not pass at all
        
        Can show in filtrate but it is evidence of further issues
        
        Transportation
        
        Pinocytosis
        
        Phagocytosis
    - - Reabsorption rate is at 98-100%
      - Reabsorbed through the entire nephron loop
      - Majority of the reabsorption via PCT
      - Concentration low in tubule cell
      - Concentration high in lumen and interstitial fluid
      - Na/K pumps
      - Effects Na concentration: Aldosterone and ANP
    - - Aquaporin channels used for reabsorption
      - Obligatory water reabsorptions
        
        Movement of water in PCT as a result of Na concentration (osmosis)
      - Facultative water reabsorption
        
        Tubular reabsorption in response to ADH
  - - - Both reabsorbed and secreted
      - PCT: 60 to 80% reabsorbed via paracellular transport
      - Depends on the movement of Na
      - Amount of K lost in urine is dependent upon the activity of principal cells in collecting tubules (aldosterone)
    - - 99% of calcium is stored in bone as calcium phosphate
      - 60% of the Ca in blood becomes part of filtrate
      - Remainder of the Ca is bound to protein so it is not filtered
      - 90-95% of phosphate is filtered via glomerular capillaries
    - - Significant role in regulating pH
      - Bicarbonate moves freely across the filtration membrane
      - Hydrogen is filtered with the remaining blood
      - Filtered bicarbonate must be reabsorbed to keep blood from being too acidic
      - 80-90% reabsorbed via PCT
      - pH regulated by collecting tubules
  - - - Urea
        
        small, water soluble molecule produced from protein break-down in liver
      - Uric acid
        
        Produced from nucleic acid breakdown primarily in the liver
      - Creatinine
        
        Produced from metabolism of creatine in muscle tissue
    - - Drugs
      - Metabolic wastes
      - Hormones
- - - - AKA: Renal capsule
      - Innermost layer
      - Protects from trauma
      - Dense irregular connective tissue
      - Prevents infection
    - - Middle inner layer
      - AKA: Perineal fat or Adipose capsule
      - Cushion and support
    - - External to perinephric fat
      - Middle outer layer
      - Dense irregular connective tissue
      - Anchors kidneys
    - - Outermost layer
      - AKA: Pararenal fat or paranephric body
      - Adipose connective tissue
      - Provides cushioning and support
  - - - Renal column
      - Corticomedullary junction: Where cortex and medulla meet
    - - Renal Pyramid: 8 to 15 renal pyramids
        
        Renal Pyramid apex is called Renal Papilla
      - Renal Sinus
        
        Minor calyces
        
        Major calyces
        
        Renal pelvis
  - - - T10-12 is sympathetic
      - CN X (Vagus Nerve)
- - - - Metabolic
        
        Loss of HCO3 or increase in H+
        
        Causes
        
        Excess alcohol
        
        Metabolic dysfunction (Lactic acid, Kidneys, etc)
      - Respiratory
        
        Most common imbalance
        
        Impaired elimination of CO2
  - - - Metabolic
        
        Inc. HCO or dec. in H+
        
        Causes
        
        Vomiting
        
        Large amounts of antiacids
        
        Diuretic overuse
      - Respiratory
        
        Caused by hyperventilation
        
        Dec. CO2 which causes dec. in H+
- - - - Bladder
        
        Urethra