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Elderly female patient with a history of osteoporosis, chronic type II…
Elderly female patient with a history of osteoporosis, chronic type II diabetes mellitus, and high blood pressure, has discovered blood in her urine. Doctor is primarily concerned about the effect of high blood pressure on her kidneys and the effect of low kidney function on her already compromised bone mass.
Upstream causes
High blood pressure , along with type II diabetes mellitus , are contributing factors to a decrease in kidney function which can lead to blood leaking from the kidneys in to the urine.
Decrease in kidney function can also lead to an increase of parathyroid hormone which moves calcium out of the bones and into the blood. which can lead to weak bones.
Decrease in kidney function leads to an imbalance of minerals being produced that can also effect various levels of the body.
High blood pressure can also damage blood vessels and filters in the kidney which can lead to a lack of removal of waste from the body.
Downstream effects
Damaged kidneys can cause abnormal hormone levels such as calcium and phosphorous.
This disorder can effect bones by further complicating osteoporosis due to excess calcium taken out of bones which then causes bones to not redevelop properly.
Blood in urine is most likely caused by kidney failure due to the all of the conditions the patient has developed. Diabetes and osteoporosis leads to abnormal hormone levels which has direct effect on the function of kidneys. Hypertension weakens the vessels around the kidneys which also decreases the functionality of the kidneys.
Kidney damage from diabetes mellitus II is called diabetic nephropathy.
Having high blood glucose levels due to diabetes can damage the part of the kidneys that filters your blood. The damaged filter becomes 'leaky' and lets protein into your urine
The kidneys help filter blood, wastes, and extra fluids. In order to do this the kidneys require a lot of blood vessels. Hypertension can cause the kidney to fail over time
uncontrolled high blood pressure can cause arteries around the kidneys to narrow, weaken or harden. Therefore damaged arteries are not able to deliver blood efficiently to the kidney causing failure or disease
Background
Urinary system Anatomy
Kidneys - bean shaped organs , primary urinary organ
Ureter - paired tubes connecting the kidneys and bladder
Urinary bladder - temporary reservoir
Urethra - tube with access to body exterior
uterus - part of female organ system
aorta - carries oxygenated blood
inferior vena cava - carries deoxygenated blood
Urinary system function
Ureter - carries urine from the kidneys to the bladder
Urethra - carries urine fro the bladder to outside of the body
kidneys - filtering the blood and getting rid of waste products, balancing the electrolyte levels in the body, controlling blood pressure, and stimulating the production of red blood cells.
Urinary bladder - temporarily stores urine so urination is infrequent and controlled
Kidney anatomy
Renal cortex - most superficial region, light colored and has a granular appearance
Renal medulla - deep to the cortex , darker, reddish brown, which exhibits cone-shaped tissue masses called medullary , or renal, pyramids.
medullary, renal, pyramids - the pyramids appear striped because they are formed almost entirely of parallel bundles of microscopic urine collecting tubules and capillaries.
renal columns - inward extensions of cortical tissue, separate the pyramids . Each pyramid and its surrounding cortical tissue constitutes one of approximately 8 lobes of a kidney .
renal pelvis - a funnel shaped tube, is continuous with the ureter leaving the helium
Calyces - branching extensions from the pelvis , collect urine which drains continuously from the papillae
Nephrons are the functional units of the kidney
Each kidney contains about 1 millions nephrons acting in parallel to make urine . Each nephron creates a cell and protein free filtrate from blood . from that filtrate it recovers chemicals the Body needs while also secreting into that filtrate selected chemicals that the body needs too get rid of
Cortical nephrons - short nephron loop, glomerulus further from the cortex medulla junction, efferent arteriole supplies peritublar capillaries
Juxtamedullary nephron - long nephron loop, glomerulus closer to the cortex-medulla junction, efferent arteriole supplies vasa recta
Filtration, reabsorption, Secretion
The body first dumps cell and protein free filtered blood into a separate waste container. from this container, it reclaims everything the body needs to keep . finally the kidney selectively adds specific things the container , fine tuning the body chemical balance. anything left in the container becomes urine . urine formation and the adjustment of of blood composition involves three processes
Glomerular Filtration - takes place the renal corpuscle and produces a cell and protein free filtrate. a passive process in which hydrostatic pressure forces fluids and solutes through a membrane.
The glomeruli can be viewed as simple mechanical filters because filtrate formation does not directly consume metabolic energy.
Tubular Reabsorption - is the process of selectively moving substances from the filtrate back into the blood. it takes place in the renal tubules and collecting ducts.
Tubules reabsorption reclaims almost everything filtered, all of the glucose and amino acids, and some 99% of the water; salt and other components. Anything that is not reabsorbed becomes urine.
Tublar secretion - is the process of selectively moving substances from the blood into the filtrate. Like tubular reabsorption It occurs along the length of the tubule and collecting duct.
tubular secretion moves selected substances such as H+, K+, NH4+, creatinine and certain organic bases and acids from peritubular capillaries through the tubule cells into the filtrate.
Diabetes mellitus II
Type 2 diabetes is a chronic condition that affects the way your body metabolizes sugar (glucose) an important source of fuel for your body.
With type 2 diabetes, your body either resists the effects of insulin a hormone that regulates the movement of sugar into your cells or doesn't produce enough insulin to maintain normal glucose levels.
People who are middle-aged or older are most likely to get this kind of diabetes, it used to be called adult-onset diabetes. But type 2 diabetes also affects kids and teens, mainly because of childhood obesity.
Hypertension
Hypertension risk factors include obesity, drinking too much alcohol, smoking, and family history.
High blood pressure is when your blood pressure, the force of your blood pushing against the walls of your blood vessels, is consistently too high.
Damage first begins in the heart. Other possible effects include strokes, vision loss, heart attack, heart failure, kidney disease/failure.
Osteoporosis
means porous bone, is a disease in which the density and quality of bone are reduced. As bones become more porous and fragile, the risk of fracture is greatly increased.
Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone.
Risk factors for osteoporosis include aging, being female, low body weight, low sex hormones or menopause, smoking, and some medications. Prevention and treatment include calcium and vitamin D, exercise, and osteoporosis medications