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Urinary System: An elderly female patient has a history of osteoporosis,…
Urinary System: An elderly female patient has a history of osteoporosis, chronic type 2 diabetes mellitus, and high blood pressure. She noticed blood in her urine. Her doctor is concerned about the effect of high blood pressure on kidneys and the effect of low kidney function on her already compromised bone mass.
Downstream Effects
Hypertension
The kidneys contribute to BP regulations by controlling sodium excretion and extracellular fluid. Excessive sodium intake is linked to the start of hypertension.
Osteoporosis
Extra parathyroid hormone is released in the blood to move calcium from inside the bones to the blood . chronic kidney disease causes mineral and bone disorders because the kidneys do not properly balance the mineral levels in the body
DM II
Because the kidneys are highly adaptive, kidney disease is often not recognized until there is considerable loss of nephrons
As kidney function deteriorates every body system becomes affected. Retained substances include urea, creatine, phenols, hormones, electrolytes and water. This leads to the need for dialysis
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Upstream Causes
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Osteoporosis- is a chronic, progressive metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to increase bone fragility
Chronic type 2 diabetes mellitus- involves progressive, irreversible loss of kidney function
Leading causes are hypertension and diabetes. Less common are glomerulonephritis, cystic diseases, and urologic diseases. The increasing prevalence of CKD has been attributed to the increase in risk factors, including an aging population and a rise in rates of obesity
Background
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Nephrons
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Each nephron creates a cell- and protein free filtrate from blood. The filtrate recovers chemicals the body needs while also secreting chemicals the body needs to get rid of
Each nephron consists of a renal corpuscle and a renal tubule. The corpuscle are located in the renal cortex, while the tubules begin in the cortex and then pass into the medulla before returning to the cortex
Classes of Nephrons
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Juxtamedullary- originate close to the cortex medulla junction. Play an important role in producing urine that is concentrated
Nephron capillary beds
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2nd capillary bed (combination of peritubular capillaries and vasa recta) reclaims most of the filtrate
Filtration, absorption, and secretion are the key process of urine formation
Glomerular filtration- takes place in the renal corpuscle and produces a cell- and protein free filtrate
Tubular reabsorption- process of selectively moving substances from the filtrate back into the blood. Reclaims almost everything filtered ( glucose, amino acids, 99% of water, salt and other components).
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Function of the Kidneys
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Control BP, produce erythropoietin, activate vitamin D, and regulate acid-base balance