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Elderly patient w/ osteoporosis, type II diabetes mellitus, and high BP…

- - - - Fibrous Capsule: maintains the kidneys shape & protects it from trauma, helps prevent infectious pathogens from penetrating kidney
        
        Perinephric Fat: external fibrous capsule provides cushioning and stabilization of liver
        
        Renal Fascia: external to perinephric fat; anchors kidneys to surrounding structures
        
        Paranephric Fat: outmost layer; provides cushioning and stabilization for the kidney
        
        Renal Cortex & Medulla
        
        Renal Columns: project into medulla & subdivide kidney into renal pyramids
        
        Corticomedullary Junction: where medulla meets the cortex of the kidney
        
        Renal Papilla: medial top of renal pyramid
        
        Renal Lobe: consists of renal pyramid, renal column portions, and renal cortex external to pyramid base
        
        Renal Sinus: urine drainage area
        
        Minor Calyces: drains urine into major calyx
        
        Major Calyx: multiple minor calyces merging; leads to renal pelvis
        
        Renal Pelvis: major calyces merge to form renal pelvis which passes urine to the ureter
        
        Nephron: functional filtration unit of the kidney
        
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  - - - Glomerular: separating water & dissolved solutes from blood plasma in glomerular capillaries
        
        Endothelium of Glomerulus: allows plasma & dissolved sub. to be filtered while restricting passage of large structures (RBC, WBC, and platelets)
        
        Basement Mem of Glomerulus: restricts passage of large plasma proteins like albumin
        
        Visceral Layer of Glomerular Capsule: where pedicels of podocytes restrict passage of small proteins through filtration slits
      - Allows sub. like water, glucose, amino acids, ions, urea, some hormones, water-soluble vitamins, and ketones to pass through & become part of filtrate
        
        Sub. not filtered such as RBC, WBC, platelets, and large proteins that cannot become part of filtrate
        
        Filtrate is caught in capsular space and funneled into proximal convoluted tubule & components of blood not filtered exit renal corpuscle through efferent arteriole
        
        Mesangial cells phagocytize macromol. caught in basement mem.
      - Glomerular Hydrostatic Pressure: driving force that pushes water & dissolved solutes out of glomerulus & into capsular space - promotes filtration
        
        Higher pressure than BP that is required for filtration to occur; capillaries vulnerable to damage due to high BP
        
        Blood Colloid Osmotic Pressure: pressure exerted by blood due to unfiltered dissolved solutes; tends to pull fluids into glomerulus
        
        Capsular Hydrostatic Pressure: press. in glomerular capsule due to amount of filtrate in capsular space; impedes mov. of additional fluid from blood into capsular space
        
        Glomerular Filtration Rate: rate which vol. of filtrate is formed; net filtration pressure directly influences GFR
      - Urinary Reabsorption
        
        Substances are reabsorbed when they move from tubular fluid back into the blood; sub. not filtered at glomerulus are eliminated from the blood to become component of urine
        
        Establishment of concentration gradient in interstitial fluid drives reabsorption of H2O controlled by ADH
        
        Substance cross simple squamous epi. wall; sub. can pass btwn epi cells of tubular wall by paracellular or transcellular transport
        
        During transcellular transport, sub. crosses luminal mem. (contact w/ tubular fluid) and basolateral mem.
        
        Transport proteins control mov. of sub. using mem. transport processes (simple or facilitated diffusion, osmosis, primary or secondary active transport, and vesicular transport).
        
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        Nutrient Reabsorption
        
        Glucose transported across tubule cell to luminal mem. by Na+; glucose is then moved up concentration gradient into tubule cell by secondary active transport; glucose moved by uniporters out of tubule cell down concent. gradient by facilitated diffusion & returns to blood
        
        Sodium is reabsorbed from tubular fluid along nephron tubule, collecting tubules, and collecting ducts; most reabsorbed in proximal convoluted tubule, rest in nephron loop, some in convoluted tubule; moves passively by facilitated diffusion down concent. gradient out of luminal mem. as K+ moved from interstitial fluid into tubular cell
        
        Amount excreted in urine controlled by aldosterone; aldosterone increases = more Na+ reabsorbed; water naturally follows Na+ by osmosis; creates hypertonic environ.
        
        ANP inhibits reabsorption of Na+ in proximal convoluted tubule & the release of aldosterone; causes increase of Na+ and water excreted in urine; increases GFR which increases urine output
        
        H2O is reabsorbed by paracellular transport btwn cells (aquaporins); amount reabsorbed depends on amount of fluid intake & fluid excreted through other routes
        
        Most reabsorbed in the proximal convoluted tubule
        
        Occurs via osmosis, follows Na+
        
        ADH increases aquaporin channels for H2O reabsorption
        
        K+ is mainly reabsorbed in the proximal convoluted tubule; reabsorbed by paracellular transport, depending on move. of Na+ ; most reabsorbed next in nephron loop ascending limb
        
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        Urinary Secretion
        
        Secretion of K+ in collecting tubules and ducts by principal cells
        
        Aldosteron stim. principal cells to secrete K+ & Na+ conversely reabsorbed
        
        H+ is secreted into tubular fluid as bicarbonate is absorbed into the blood in the distal convoluted tubules, collecting tubules, and collecting ducts
        
        Urea and uric acid are secreted back into tubule at nephron loop by urea uniporters; 100% urea present in tubular fluid enters distal convoluted tubules
        
        Creatinine is secreted in the proximal convoluted tubule
        
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        When pH is more acidic; when basic, H+ reabsorbed as HCO3- is secreted
        
        materials moved selectively into tubules to be eliminated/ excreted from the body
        
        Osteoporosis
        
        Diseases that results in decreased bone mass & leads to weakened bones that are prone to fracture
        
        Severity linked to age, due to losing bone marrow mass & onset of menopause; women lose bone mass earlier & faster in life; loss of estrogen prod. = decrease in stim. of bone growth
        
        Treatments: Vitamin D (help body absorb calcium & phosphorous from food; liver and kidney convert vitamin D to calcitriol); menopausal hormone therapy; bisphosphonates (slow progression of osteoporosis by interfering osteoclast funct.)
        
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        Diabetes Mellitus Type II
        
        Results from either decreased insulin release from beta cells of pancreatic islets or decreased eff. of insulin at peripheral tissues
        
        Increased glucose lvls can cause kidney damage due to damaging of blood vesseles inside kidneys; can cause diff. capillaries to become narrow & clogged
        
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        Hypertension
        
        High BP which can lead to damage to blood vessels & lead to cardiovascular disease/ atherosclerosis
        
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- - - - Patient's osteoporosis can be linked to a deficiency in vitamin D which would cause the lack of conversion to calcitriol by the liver and kidney
        
        Lack of calcitriol can cause more Ca2+ to be lost in the urine, leaving low blood levels of Ca2+ which can contribute to the loss of bone density.
        
        Less Ca2+ reabsorption and filtration leads to less PO4-3 is available to form calcium phosph. = calcium salt deposition in bone; redopsited Ca2+ decreases & blood Ca2+ increases
      - Increased glucose = harder kidney nephrons have to work to filter it; too much can lead to damaging of the blood vessels; BV can narrow and become more susceptible to becoming clogged
        
        Less blood flow to kidney
- - - - Blockage of kidney arteries leads to decreased blood flow and oxygen delivered to kidney tissue
        
        Hinders ability of the kidney to filter the blood
        
        Unable to filter blood, regulate fluid, hormones, acids, and salts in the body
        
        Kidneys unable to regulate BP and cannot secrete aldosterone to be able to increase Na+ release in the urine to decrease BP
        
        Increased Na+ in the bloodstream which can exacerbate the high BP since kidneys cannot excrete it through urine due to not being able to filter
        
        More arteries become blocked and kidneys will eventually fail to filter
        
        Patient placed on dialysis due to kidney failure
        
        Buildup of H+ ions in the blood, turning it to be more acidic since the transfer of HCO3- cannot take place in the tubules since the initial filtration is blocked
      - Renal aneurysm from stretched BV
        
        Cause hematuria, renal infarction, exacerbated hypertension, and aneurysm can rupture and cause death from hemorrhaging
- - - - Waste and fluids build up in blood instead of being filtered through the body & excreted
        
        Exacerbates high BP which can lead to an increase in CV disease and renal failure
        
        Buildup of H+ in the blood, causing the blood to become more acidic over time
        
        Induces acidosis and can lead to multisystem failure/ death if pH gets too low/acidic
        
        Damage continues to ensue until pt. is in need of dialysis to do the filtering of toxic products from the blood since none of these products can be excreted from the urine
        
        Patient develops a more severe form of diabetic kidney disease
        
        Increased damage to kidney, organ failure
- - - - These factors both cause exacerbation of the pt's osteoporosis which will cause increased loss of bone density
        
        Spine & hip fractures can result which could lead to increased chronic pain, long-term disability, and death due to loss of bone density & impaired ability to create vital RBC and WBC for the human body
- - - - Kidney damage would be then be indicative of kidney disease
      - Most likely cause of hematuria would be due to diabetic nephropathy
- - - - Not being able to filter and excrete out certain products like Na+ directly leads to the increase in BP
        
        Due to excessive damage done to the BV, hypertension continues to damage more BV in the pt. which leads to direct damage of the glomerulosa which leads to the hematuria