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An elderly female patient has a history of osteoporosis, chronic type II…

- - - - anatomy
        
        renal cortex
        
        is light coloured and has a granular appearance, the most superficial
        
        renal medulla, cone shaped tissue mass
        
        renal pyramids
        
        appear stripped because they are formed almost entirely of parallel bundles of microscopic urinecollecting tulles and capillaries
        
        renal pelvis
        
        a funnel-shaped tubes continuous with the ureter leaving the hilum. branching extension of the pelvis form two or three
        
        major calyx subdivision to form several
        
        minor caylx
        
        the calyces collect urine, which drains continuously from the papillae, empty into renal pelvis and into the ureter, which moves to bladder to be stored.
        
        the muscle = smooth muscle that contracts rhythmically to propel urine by peristalsis
        
        renal columns
        
        inward extensions of cortical tissue,seperate the pyramids.
      - function
        
        Balance the body's fluids
        
        Release hormones to regulate blood pressure
        
        Control production of red blood cells
      - blood and nerve supply
        
        renal arteries
        
        deliver one fourth of the total cardiac output to the kidney- about 1200 ml each min
        
        divides into five segmental arteries
        
        branches further form several interloper arteries
        
        cortical radiate arteries(interlobular arteries) radiate outward from the acruate arteries to soppy to corticel tissue
        
        afferent arterioles branching from the cortical radiate arteries begin a complex arrangment of microscopic blood vessels
        
        arcuate arteries
        
        arch over the bases of the medialary pyramids
        
        renal viens
        
        blood leaving the renal cortex drains sequentially into the cortical radiate , arcuate, intrerlobar, and finally Renal veins.
        
        exit the kidneys and empty into the inferior vena cava
        
        the inferior vena cava lies to the right of the vertebral column,
    - - narrow tubes carry urine from the kidneys to the bladder.
        
        function: small amounts of urine are emptied into the bladder from the ureters.
    - - hollow organ is located in the lower abdomen.
        
        expand to store urine
    - - function; tube allows urine to pass outside the body.
  - - - kidneys remove urea from the blood through tiny filtering units called nephrons.
        
        nephron
        
        renal corpuscle
        
        consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule.
        
        capillaries is fenestrated(penetrated by many pores, which makes capillaries exceptionally pores.
        
        this plasma-derided fluid or filtrate is the raw material that the renal tubules process to form urine.
        
        glomerular capsule
        
        parietal
        
        simple squamous epithelium, this layer contributes to the capsule structure but plays no part in filtering
        
        visceral
        
        this layer clings onto capillaries, consists of highly modified, branching epithelium cells called podocytes
        
        have openings between the foot processes are called filtration slits
        
        renal tubes and collecting duct
        
        proximal convoluted tubule-formed by cubical epithelial cells with large mitochondria,they have apical or luminal surfaces bear dense microvilli-for reabsorbing water and solutes from the filtrate and secreting substances; drops down into a hairpin loop
        
        nephron loop- then twist again as the
        
        distal convoluted tubule;cubiodial and confined to the cortex before entering entering collecting duct
        
        descending limb
        
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        ascending limb
        
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        classes of nephrons
        
        cortical nephrons
        
        85% of the nephrons in the kidneys. except for small parts of their nephron loops that dip into the outer medulla, located entirely on cortex
        
        juxtamedullary nephrons
        
        near the cortex-medulla junction, ability to produce urine that is concentrated(conserves water)
        
        capillary beds
        
        peritubular capillaries
        
        arise from efferent arterioles, high resistant and low pressure
        
        glomerulus
        
        afferent arterioles
        
        from the cortical radiate arteries that run through the renal cortex
        
        efferent arterioles
        
        feed into either the peritubular capillaries or vasa recta
  - - - filtration membrane
        
        3 layers
        
        fenestrated endothelium of the glomerular capillaries
        
        allow all blood components except blood cells to pass through
        
        basement membrane
        
        lies between the other two layers and is composed of their fused basal laminae. it Forsyths a physical barrier that blocks all but smallest proteins while still permitting most other solutes to pass
        
        foot process of podyocytes
        
        have filtration slits between
      - pressures that affect filtration
        
        outward pressures
        
        promote filtrate formation
        
        hydrostatic pressure in glomerular capillaries
        
        it is the chief force pushing water and solutes out of the blood and across the filtration membrane.
        
        the blood pressure in the glomerulus is extraordinary high (55mm hg compared to and average of 22 mm hg)
        
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        inward pressures
        
        inhibit filtrate formation by opposing HPgc
        
        hydrostatic pressure in the capsular space
        
        pressure exerted by filtrate in the glomerular capsule,HPcs it is much higher than hydrostatic pressure surrounding most capillaries because filtrate is confined in a small space with a narrow outlet
        
        colloid osmotic pressure in glomerular capillaries
        
        exerted by the proteins in the blood that sucks water into the capillaries
      - Glomerulus filtration rate (GFR)
        
        volume of filtrate formed each min by the combined activity of all million glomeruli pf kidneys
        
        factors;
        
        net filtration pressure - is the main controllable factor.of the pressures determining nfp, the most important is hydrostatic pressure in glomerulus. this is pressure can be controlled by changing the diameter of the afferent arterioles
        
        total surface area available for filtration. glomerular capillaries have a huge surface area. glomerular mesangial cells surrounding these capillaries can fin tune grr by contracting to adjust the total surface area available for filtration.
      - regulation of glomerular filtration
        
        intrinsic control
        
        purpose: maintain grr in spit of the change sin the blood pressure
        
        mechanisms: myogenic, tubuloglomerular feedback
        
        operating conditions: mean arterial pressure between 80 and 180mm hg
        
        extrinsic control
        
        purpose: maintain systemic blood pressure
        
        mechanisms
        
        hormonal
        
        renin-angiotensin-aldosterone
        
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        neural
        
        operating conditions
        
        mean atrial pressure far outside of the normal range
    - - takes place in the renal tubs and collecting ducts
        
        reabsorption reclaims almost everything filtered- all of the glucose and amino acids, and some 99% of the water, salts. anything not reabsorbed is urine
      - steps
        
        transcellular route inovolves:
        
        1) transport across the apical membrane
        
        2) diffusion through cytosol
        
        3)transport across the basolateral membrane
        
        4)movement through the interstitial fluid and into the capillaries
        
        paracellular route involves:
        
        movement through leaky tight junctions, particular in the proximal convoluted tubule
        
        movement through the interstitial fluid and into the capillary.
      - depending on the substance it can be two ways
        
        active tubular reabsorption
        
        requires ATP either directly indirectly
        
        passive reabsorption
        
        encompasses diffusion, facilitated diffusion and osmosis- processes in which substances move down the electrochemical gradients
      - reabsorption of sodium
        
        Na + is transported out of the tube cell by primary active transport
        
        1) bulk flow of water sweeps Na into adjacent peritubular capillaries
        
        this bulk flow of water and solutes into the peritubular capillaries is rapid bc the blood there has low hydrostatic pressure and high osmotic pressure
  - - - is a bone disease that occurs when the body loses too much bone, makes too little bone, or both.
        
        As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps.
      - cause of osteoporosis is a lack of certain hormones, particularly estrogen in women and androgen in men.
      - symptoms
        
        Back pain, caused by a fractured or collapsed vertebra
        
        Loss of height over time
        
        A stooped posture
        
        A bone that breaks much more easily than expected
      - Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies.
        
        examples
        
        Sex hormones.
        
        Lowered sex hormone levels tend to weaken bone. The reduction of estrogen levels in women at menopause is one of the strongest risk factors for developing osteoporosis.
        
        veractive parathyroid and adrenal glands.
        
        Thyroid problems.
        
        Too much thyroid hormone can cause bone loss. This can occur if your thyroid is overactive or if you take too much thyroid hormone medication to treat an underactive thyroid.
    - - causes
        
        develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin.
      - How insulin works
        
        Insulin is a hormone that comes from the gland situated behind and below the stomach (pancreas).
        
        The pancreas secretes insulin into the bloodstream.
        
        The insulin circulates, enabling sugar to enter your cells.
        
        Insulin lowers the amount of sugar in your bloodstream.
        
        As your blood sugar level drops, so does the secretion of insulin from your pancreas.
      - Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues.
        
        Glucose comes from two major sources:
        
        liver
        
        food
        
        Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
        
        When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.
      - Complications
        
        Heart and blood vessel disease.
        
        Diabetes dramatically increases the risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis).
        
        Kidney damage.
        
        Diabetes can sometimes lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
      - Symptoms
        
        Increased thirst
        
        Frequent urination
        
        Increased hunger
        
        Unintended weight loss
        
        Fatigue
        
        Blurred vision
        
        Slow-healing sores
        
        Frequent infections
        
        Areas of darkened skin, usually in the armpits and neck
- - - - CKD occurs when damaged kidneys and abnormal hormone levels cause calcium and phosphorus levels in a person's blood to be out of balance. Mineral and bone disorder commonly occurs in people with CKD and affects most people with kidney failure receiving dialysis.
      - .
- - - - Each nephron receives its blood supply through tiny hair-like capillaries, the smallest of all blood vessels.
        
        When the arteries become damaged, the nephrons do not receive the essential oxygen and nutrients — and the kidneys lose their ability to filter blood and regulate the fluid, hormones, acids and salts in the body.
  - - - Kidney damage and uncontrolled high blood pressure each contribute to a negative spiral.
        
        As more arteries become blocked and stop functioning, the kidneys eventually fail.
  - - - If the glomeruli become damaged, the kidney can no longer remove waste and excess fluids efficiently. Blood and protein cannot be filtered and are excreted in the urine.
        
        secondary glomerulonephritis is caused by another disease, such as diabetes, lupus, infection, or drug use.
        
        secondary glomerulonephritis
        
        symptoms
        
        blood or protein in the urine
        
        high blood pressure
        
        swollen ankles or face, because of water retention
        
        urinating frequently during the night
        
        bubbles or foam in the urine, caused by excess protein
        
        Treatment
        
        whether the condition is acute or chronic
        
        antibiotics to kill the pathogens causing the infection.
        
        reduce fluid intake and avoid drinks or food containing alcohol or high levels of protein, salt, or potassium.
        
        Diuretics can help reduce hypertension and the slow decline of kidney function, and blood pressure medication relaxes the blood vessels. Corticosteroids and immune-suppressing drugs control inflammation.
        
        Temporary dialysis may be necessary in cases of acute glomerulonephritis. In dialysis, a machine does the kidney’s job of filtering out waste products from the body. Dialysis also helps to control hypertension and to remove surplus fluid.
        
        kidney transplant may be possible if the individual is otherwise health
        
        Glomerulonephritis can lead to hypertension,
        
        heart failure,
        
        Without treatment, the kidneys might fail completely
        
        pulmonary edema
    - - arterial pressure increases
        
        nephron reduces sodium and water reabsorption thus increasing sodium and water excretion
        
        to return ECFV and blood pressure to normal; the so called “pressure natriuresis” phenomenon.
- - - - Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine.