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An elderly female patient has a history of chronic type II diabetes…
An elderly female patient has a history of chronic type II diabetes mellitus, and high blood pressure. She has come to the doctor today because she has notice blood in her urine. Her doctor is now primarily concerned about the effect of high blood pressure on her kidneys. What could be going on that explains all of this? How are blood pressure and kidney function related?
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structure of kidney
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renal column: bands of cortical tissue that extend into medulla and separate adjacent renal pyramids
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filtration, reabsorption and secretion in nephron
filtration: glomerulus --> Bowman's capsule:
- water, small ions/ molecuules, glucose
- NOT PROTEINS
-BULK FLOW
Takes place in glomerulus/ bowman's capsule: H2O, glucose, all ions and no protein
reabsorption: tubule --> capillary; selective transport:
- passive (osmosis)
-facilitated (co/counter transport)
-active transport
Proximal convoluted tubule: H2O, glucose, Na+, K+, HCO3-
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secretion: capillary --> tubule
- passive (osmosis)
- facilitated (co/counter transport)
-active transport
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Link from Renin to GFR, macula densa cells and HTN
Renin: enzyme released by cells of juxtaglomerular complex when renal blood flow decreases; converts angiotensinogen to angiotensin I
purpose of renin: big effect is at regulation that triggers aldosterone --> regulation at distal convoluted tubule
affects macula densa bc of distal convoluted tubule looping around and affecting GFR via increasing blood volume by stimulating sympathetic nervous system to inc arterial pressures throughout body
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structure of nephron:
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glomerulus: knot of capillaries that projects into enlarged, proximal end of nephron; site of filtration, first step in production of urine
proximal convoluted tubule: segment of nephron between the glomerular capsule (Bowman's capsule) and nephron loop; major site of active reabsorption from filtrate
nephron loop: segment of nephron that creates the concentration gradient in renal medulla; composed of descending limb and ascending limb
distal convoluted tubule: segment of nephron closest to connecting tubules and collecting duct; an important site of activation secretion
juxtaglomerular complex: macula densa, extraglomerular mesangial cells, and juxtaglomerular cells; a complex responsible for release of renin and erythropoietin
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Hypertension
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high arterial pressure can lead to inc rate of filtration, reabsorption and secretion which also can cause renal failure and vice versa
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why patient is seeing blood in their urine: This is most likely because the kidneys are failing and are unable to reabsorb large solutes/ hemoglobin --> the pores are allowing larger solutes to get through and is getting lost in urine
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