Please enable JavaScript.

Coggle requires JavaScript to display documents.

Renal System (Diuretics (Osmotic diuretics (Act at: PCT, LoH, CD, Sugars…

- - - - Inhibit aldosterone
      - Directly inhibit ENaCs
- - - - Reflects concentration (dehydration)
    - - Proteinuria - caused by:
        
        Glomerulonephritis
        
        Diabetes
        
        Pre-eclampsia
    - - Suggests bacterial presence (gram -ive)
    - - Could suggest : diabetic ketoacidosis (DKA) :
    - - Suggests immune reaction
  - - - Calcium oxalate - 70-80% of all stones
      - Calcium phosphate -15%
      - Struvite (magnesium ammonium phosphate) - 10%
      - Uric acid - 5-8%
  - - - ACE inhibitors
      - Diuretics
      - Some antidepressants
      - HRTs
      - Sedatives
    - - Parasympathetic stimulation to pelvic nerve (S2-4) -> release of ACh -> binds to M3 muscarinic ACh receptors on detrusor muscle -> contraction
      - Internal urethral sphincter
        
        Smooth muscle
        
        Under involuntary control
        
        Autonomic nerve supply (parasympathetic relaxes sphincter, sympathetic contracts sphincter)
      - External urethral sphincter
        
        Striated muscle
        
        Under voluntary control
        
        Somatic nerve supply
        
        Pudendal nerve (S2-S4)
    - - Stress incontinence
        
        Urine leaks out when bladder is under pressure (e.g. cough)
        
        Cause: damage/weakness of pelvic floor muscles or urethral sphincter
      - Urge incontinence
        
        Urine leaks with/soon after feeling of a sudden, intense urge to pass urine
        
        Cause: detrusor muscles contract too often
      - Overflow incontinence (chronic urinary retention)
        
        Unable to fully empty bladder, which causes frequent leaking
        
        Cause: obstruction, detrusor muscles not contracting fully
      - Functional incontinence
        
        Physical/mental impairment prevents making it to the toilet in time
- - - - Blood supply:
        Aorta → Renal arteries (L&R) → Segmental arteries → Interlobar arteries → Arcuate arteries → Interlobular arteries → Afferent arterioles → Glomerulus → Efferent arterioles → Peritubular capillaries
      - Position
        
        Hila at L1 (right just below, left just above)
        
        Left kidney reaches rib 11
        Right reaches rib 12 (slightly lower due to liver)
      - Drain into the para-aortic (lumbar) nodes
      - Layers surrounding kidneys (inner to outer)
        
        Renal Capsule
        
        Perinephric fat
        
        Renal fascia
        
        Paranephric fat
    - - Nephron
        
        DCT
        
        Final regulation of extent of Na+, K+ and H+ excreted in urine
        
        PCT
        
        Major absorption & excretion
        
        Collecting duct
        
        Final regulation of H2O excretion, and thus urine concentration
        
        Glomerulus
        
        Filtration of fluid & smaller molecules
        
        Loop of Henle
        
        Generating HYPOtonic tubular fluid & HYPERtonic medulla environment
        
        Descending limb: permeable to water
        
        Ascending limb: impermeable to water (permeable to ions)
      - Cortex
      - Medulla
        
        Renal pyramids
        
        1 lobe = 1 pyramid + overlying cortex
        
        Separated by renal columns
        
        Drain into renal papillae (apices of pyramids)
        
        Papillae drain into minor calyces -> major calyces -> renal pelvis
  - - - Sympathetic: Hypogastric nerve (T12-L2)
      - Parasympathetic: Pelvic splanchnic nerves (S2-S4)
      - Somatic: Pudendal nerve (S2-S4)
    - - Arterial: superior vesical arteries - branches of the internal iliac artery
      - Venous drainage: Vesical venous plexus (empties into internal iliac veins)
  - - - Mesodermal germ layer structure
      - Contributes to the renal tubules, ureter, reproductive ductal system, uterine canal and vagina
    - - Endodermal germ layer structure
      - Contributes to the urinary bladder, urethra, vagina and external genitalia
- - - - low PO2 in renal tissues -> EPO secretion by peritubular cells in kidney
      - stimulates differentiation of RBC precursors in bone marrow
    - - Raises blood calcium levels by increasing absorption of calcium from digestive tract
      - Active form of vitamin D
  - - - Produced in: hypothalamus
        Released from: posterior pituitary
      - Increases water permeability in DCT & CD by increasing transcription of aquaporin-2 into apical membrane
    - - RAAS
        
        1) Renin is released by kidneys in response to decreased blood volume
        
        2) Renin causes angiotensinogen (from liver) to split & produce angiotensin I
        
        3) Lungs convert angiotensin I to angiotensin II
        
        4) Angiotensin II
        
        increases sympathetic activity
        
        increases Na+ & Cl- tubular reabsorption & K+ excretion
        
        stimulates adrenal gland to release aldosterone
        
        causes an increase in peripheral vasoconstriction
        
        stimulates posterior pituitary to secrete ADH
    - - Affects kidneys
        
        Increases renal tubular reabsorption of Ca+
        
        Increases renal tubular (PCT) phosphate excretion
        
        Increases conversion of Vit D to active (1,25-D) form
      - Synthesised & released by chief cells of parathyroid gland