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An elderly female with history of osteoporosis, chronic type 2 diabetes…

- - - - ANP
        
        Inhibits reabsorption of Na & water
        
        Atrial Stretch
      - RAAS
        
        Increases blood pressure
        
        The enzyme Renin released by the kidney into the blood
        
        Renin coverts angiotensingen to angiotensin I (in liver)
        
        Angiotensin I converted to angiotensin II by ACE
        
        Angiotensin II triggers vasodilation & releases ADH
        
        Angiotensin II causes release of Aldosterone from the adrenal cortex
        
        Aldosterone increases renal sodium & water absorption
        
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    - - Gluconeogenesis
      - Renal threshold for glucose is 9mmol/L
    - - Lungs
      - Kidneys
      - Blood pH: 7.35-7.45
    - - Sodium, potassium, hydrogen
      - Form pH buffer substances
    - - 500 ml/day urine require to clear waste
    - - Urea, Uric acid, Creatinine
      - Ions
        
        Hydrogen
      - Toxins
    - - Erthropoetin
        
        Erythropoeisis (hypoxia)
      - Calcitriol
        
        Increases bone formation
  - - - When blood osmolarity rises above a set point like when the water intake is inadequate
      - Located in posterior pituitary gland
      - Increases the permeability to water of the collecting ducts by increasing the number of epithelial aquaporin channels
      - Drinking water reduces the osmolarity in the blood and hinders the further ADH secretion
    - - Receptor trigger signal transduction
      - Vesicles with aquaporin (proteins) water channels are inserted in the membrane lining lumen of the collecting duct
      - ADH binds itself to the membrane receptor before entering the cell
      - Aquaporin channels then increase the reabsorption of water from the collecting duct into the interstitial fluid
    - - Juxtaglomerular apparatus
        
        Tissue containing cells around the afferent arteriole and supplies blood to the glomerulus releasing renin
    - - A system that has functions that overlap with this of ADH and are opposed by the atrial natriuretic peptide
    - - Is formed in response to renin constricting arterioles and triggers release of the hormone aldosterone, raising blood pressure and reducing the release of renin
  - - - Porous membrane between blood and interior of glomerular capsule
        
        Allows water and solutes smaller than plasma proteins to pass
        
        Normally no cells can pass
      - Glomerulus (collection of capillaries) blood pushed through into the capsule space
      - Contains three layers
        
        Basement membrane: fused basal laminae of two other layers
        
        Foot processes of podocytes with filtrationslits; slit diaphragms repel macromolecules
        
        Fenestrated endothelium of glomerular capillaries
      - Allows molecules smaller than three nm to pass
        
        Water, glucose, amino acids, nitrogenous wastes
      - Plasma proteins remain in blood to maintain colloid osmotic pressure
        
        Proteins in filtrate indicate membrane problem
        
        Prevents loss of all water to capsular space
      - Pressures affect filtration
        
        Outward pressures
        
        Forces that promote filtrate formation
        
        Hydrostatic pressure in glomerular capillaries
        
        Pushes water, solutes out of blood
        
        Efferent arteriole is a high-resistance vessel with a diameter smaller than afferent arteriole
        
        Inward pressures
        
        Forces inhibiting filtrate formation
        
        Hydrostatic pressure in capsular space
        
        Colloid osmotic pressure in capillaries
        
        Net filtration pressure (NFP)
        
        Pressure responsible for filtrate formation
        
        Main controllable factor determining glomerular filtration rate (GFR)
    - - Has active and passive tubular reabsorption
      - Takes back from tubule to the blood capillaries
      - Two routes
        
        Transcellular
        
        Travels through cytosol of tubule cells
        
        Exits basolateral membrane of tubule cells
        
        Solute enters apical membrane of tubule cells
        
        Enters blood through endothelium of peritubular capillaries
        
        Paracellular
        
        Between tubule cells
        
        Limited by tight junctions, but leaky in proximal nephron
        
        Water, Ca2+, Mg2+, K+, and some Na+ in the PCT move via this route
      - All organic nutrients are reabsorbed
      - Water and ion reabsorption is also hormonally controlled
      - Sodium reabsorption
        
        Is active
        
        Na reabsorption proves the energy and
    - - Selected substances are moved from peritublar capillaries through tubule cells out into filtrate
      - move substances from blood capillaries to tubules
      - Importance of secretion
        
        Controlling blood pH by altering amounts of H+ or HCO3– in urine
        
        Eliminates undesirable substances that were passively reabsorbed (example: urea and uric acid)
        
        Disposing of substances, such as drugs or metabolites, that are bound to plasma proteins
  - - - Blood glucose levels remain high after a meal because glucose is unable to enter most tissue cells
      - Produces insulin, but their insulin receptors are unable to respond to it
      - Occurrence
        
        Common age
        
        At risk when
        
        Heart disease
        
        Kidney failure
        
        Amputations
        
        Blindness
        
        Hereditary causes mutation
    - - AKA high blood pressure
      - Affected by
        
        Age
        
        Appears after age of 40
        
        Diabetes mellitus
        
        Obesity
        
        Causes hypertension
        
        Stress
        
        Blood pressure zooms upward during every stressful event
        
        Diet
        
        Dietary factor that contribute to hypertension include high intakes of salt, saturated fat, and cholesterol
        
        Smoking
        
        Nicotine causes intense vasoconstriction
        
        Heredity
        
        Children of hypertensive parents are twice as likely to develop hypertension
    - - Is the weakening of bones
        
        Leads to an increase risk of fracture without symptoms or pain
      - The composition of the matrix remains normal but bone mass declines, and the bones become porous and light
      - Risk Factors
        
        Smooking
        
        Reduces estrogen levels and calcium absorption
        
        Genetics
        
        Osteoporosis runs in families
        
        Poor diet
        
        In calcium, vitamin D, or protein
        
        Hormone-related conditions
        
        diabetes mellitus and hyperthyroidism
        
        Insufficient bone stress
        
        Low body weight or insufficient weight-bearing exercise hinders new bone deposit
        
        Consumption of alcohol or certain medications
        
        steroids and certain cancer drugs can affect it
        
        Decreased sex hormones
        
        Estrogen in females retain osteoclasts and promote deposit of new bone
        
        Secretion decreases after menopause
  - - - Compensate Fluids
    - - Blood Volume and Blood Pressure
    - - Vitamin D production
    - - pH Level of internal environment
    - - Plasma Calcium Levels
    - - Volume and composition of extracellular fluid
- - - - As you get older the body systems become weaker/start to mal-funciton
    - - Heart problems
      - Obesity
      - Heredity
        
        Children of hypertensive parents are twice as likely to develop hypertension
        
        Occurrence of a mutation
      - Kidney failure
  - - - Not taking proper care of herself
      - Diet
        
        Dietary factor that contribute to hypertension include high intakes of salt, saturated fat, and cholesterol
        
        Not maintaining a healthy weight
      - Smooking
        
        Reduces estrogen levels and calcium absorption
        
        Affects both osteoporosis and hypertension
  - - - Feeling tired
      - Weight loss and loss of muscle bulk
      - Urinating frequently
      - Early symptoms can be mild
      - Feeling thirsty
    - - The long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease
      - It's a common condition
      - Symptoms include
        
        Shortness of Breath
        
        Nosebleeds
        
        Headaches
        
        Doesn't normally occur unless the hypertension is nearing severe or life-threatening stages
    - - Doesn't have symptoms until a fracture occurs
      - After a fracture occurs
        
        Back pain
        
        Easily broken bones
        
        Loss of height over time
        
        A slouched posture
- - - - It uses a lot of blood vessels
        
        As the vessels become inadequate and vascular complications appear in the kidneys
        
        When blood vessels become damaged, the nephrons that filter the blood won't receive the oxygen
    - - Weaken
      - Harden
      - Narrow
      - The damaged arteries aren't able to deliver enough blood to kidney tissue
    - - Kidneys lose their ability to filter blood and regulate the fluid, hormones, acids, and salts in the body
    - - Contribue to a negative spiral
        
        As more arteries become blocked and stop functioning, the kidney eventually fail
  - - - Increased bone fragility
      - Increased risk factors
      - Uses 3 main hormones
        
        Calcitonin
        
        Increases calcium and phosphate in the blood
        
        Calcitonin affects the kidneys and bone
        
        Kidneys
        
        Decrease reabsorption of calcium and phosphate
        
        Leads to a decrease in calcium and phosphate concentrations in the body
        
        Bone
        
        Decreased osteoclast activity
        
        Vitamin D
        
        Vitamin D affects the kidneys
        
        Kidneys
        
        Increases absorption of calcium and phosphate
        
        Increases calcium and phosphate concentrations in the blood
        
        Bone
        
        Stimulates the PTH
        
        Which increases calcium reabsorption and decreases phosphate
        
        PTH
        
        PTH affects the kidneys and bone
        
        Decrease reabsorption of phosphate in the distal tubule
        
        Kidneys
        
        Cause it to increased reabsorption of calcium in the renal tubule
        
        Leads to an increase in calcium concentrations and a decrease in phosphate concentrations
        
        Bone
        
        Increase in osteoclast activity and increase in maturation in osteoclasts
        
        Decrease in osteoblasts
  - - - If they go up
        
        Can cause damage to the kidneys
    - - Affecting blood vessels inside the kidneys
        
        Over time, high sugar levels in the blood can cause these vessels to become narrow and clogged
        
        Without enough blood, the kidneys become damaged
        
        Albumin (a type of protein) passes through these filters and ends up in the urine where it should not be
    - - Controlling blood sugar
      - Controlling high blood pressure
      - Limiting how much protein you eat
  - - - The rate of bone resorption accelerates as the rate of bone formation decelerates
        
        Decreased bone mass results and bones become porous and brittle
        
        If bone was decrease and end up breaking then it won't protect the kidneys
  - - - Can cause damage to blood vessel clusters in your kidneys that filter waste from your blood
        
        Can lead to
        
        Kidney damage
        
        Cause high blood pressure
        
        Cause further kidney damage by
        
        Increasing the pressure in the delicate filtering system of the kidneys
      - Complication
        
        Fluid retention
        
        Swelling in arms and legs
        
        High blood pressure
        
        Rise in potassium levels
      - Prevention
        
        Treating your diabetes
        
        Effective treatment of diabetes may delay problems with the kidneys
    - - There isn't enough PTH, Calcitonin or Vitamin D being produce
        
        Without it it affects overall the urinary system (specially the kidneys) and bone mass
    - - Prevention
        
        Manage high blood pressure
        
        If not it's more at risk causing kidney disease
  - - - The kidneys or other parts of urinary tract are allowing blood cell to leak into urine
        
        A bladder or kidney stone
        
        Crystals can become small, hard stones
        
        Kidney disease
        
        Microscopic urinary bleeding
        
        Kidney infections (pyelonephritis)
        
        Bacteria enters the kidneys from your bloodstream or move from your utters to you kidney
        
        Kidney injury
        
        A blow or other injury to your kidneys can cause visible blood in your urine
        
        Urinary tract infections
        
        Bacteria enter the body through the urethra and multiply in bladder
  - - - Unable to filter proper urine
        
        Blood end up in urine
        
        So more infections can occur
      - The weakening of bones won't serve as protection can tear parts of the kidneys
    - - Will continue to damage to blood vessel
        
        Can lead to
        
        Cause high blood pressure
        
        Kidney damage
        
        Lead to improper filtration
- - - - Structure
        
        A hollow smooth, collapsible, muscular sac that stores urine temporarily
        
        Bladder wall has three layers
        
        Detrusor
        
        A thick muscular layer
        
        Consists of intermingled smooth muscle fibers arranged in inner and outer longitudinal layers and a middle circular layer
        
        A mucosa containing transitional epithelium
        
        Outer membrane
        
        Fibrous adventitia (except on its superior surface, where it is covered by the peritoneum)
        
        Approximately holds 500 ml (1 pint) of urine
      - Function
        
        Stores Urine
    - - Structure
        
        Its a passageway between bladder and genitals
        
        In order of...
        
        In men, it carries sperm
        
        In women's, it connects urine to the bladder
        
        Length
        
        In females
        
        It's short
        
        It's tightly bound to the anterior vaginal wall
        
        It's external opening lies anterior to the vaginal opening and posterior to the clitoris
        
        In males
        
        It's long
        
        Has 3 named regions
        
        Membranous urethra
        
        Runs through the urogenital diaphragm
        
        Spongy (penile) urethra
        
        Passes through the penis and opens via the external urethral orifices
        
        Prostatic urethra
        
        Runs within the prostate gland
      - Function
        
        A tube that carries urine from the bladder to the body exterior
        
        Discharge of urine from bladder
    - - Structure
        
        Thin tubes from left and right kidney to the bladder
        
        Peristalsis move urine through tube to bladder
      - Function
        
        Transports Urine
        
        Paired tubes that transport urine from the kidneys to the urinary bladder
    - - Function
        
        Regulatory
        
        Acid-Base, H2O, Electrolyte balance: Na, K, Cl, Ca, HPO4
        
        Regulates blood volume, blood pressure, blood pH
        
        Endocrine
        
        Erythropoietin, Vitamin D, Renin, Prostaglandins, Calcitrole
        
        Excretion
        
        Excretes urine: urea, creatinine, uric acid, bilirubin, drugs, toxins
        
        Filtration of blood through the Nephrons
        
        Metabolic
        
        Ammoniagenesis, Glucogenesis
      - Structure
        
        The kidney is bean shaped
        
        Located on either side of the vertebral column, behind the upper part of the abdominal cavity, and separated from his cavity by the peritoneum
        
        Protected by the ribs and a heavy cushion on fat
        
        External gross anatomy
        
        Supportive tissue surrounding each kidney
        
        3 more items...
        
        Internal gross anatomy
        
        Renal Cortex
        
        2 more items...
        
        Renal Medulla (renal pyramids)
        
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        Renal Pelvis (on center)
        
        2 more items...
        
        Hilum
        
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  - - - Renal tubules
        
        Proximal convoluted tubule
        
        Plasma goes through
        
        Major part of reabsorption occurs
        
        15% of H2O is reabsorbed back into blood stream & regulated by hormones
        
        2 hormones that is regulated by:
        
        Aldosterone
        
        ADH (antidiuretic)
        
        The blood from the Bowmans capsule is sent here and for the most part of reabsorption (ions, water, valuable nutrients, etc) to occur
        
        Made of cuboidal epithelial cells
        
        Substance reabsorbed
        
        HCO3-
        
        Secondary active transport linked to H+ secretion and Na+ reabsorption
        
        Water
        
        Osmosis; driven by solute reabsorption (obligatory water reabsorption)
        
        Cl, K, Mg, Ca, and other ions
        
        Passive paracellular diffusion driven by electrochemical gradient
        
        Lipid-soluble solutes
        
        Passive diffusion driven by the concentration gradient created by reabsorption of water
        
        Virtually all nutrients (glucose, amino acids, vitamins, some ions)
        
        Secondary active transport with Na+
        
        Urea
        
        Primarily passive paracellular diffusion driven by chemical gradient
        
        Sodium ions (Na+)
        
        Primary active transport via basolateral Na+ - K+ pump; crosses apical membrane through channels, symporters, or anitporters
        
        Nephron loop
        
        AKA Loop of Henle
        
        Has 2 Limb
        
        Descending Limb
        
        Water passively flows out
        
        Thin segment
        
        Is permeable to water but non salt-water moves by osmosis into the interstitial fluid
        
        Ascending Limb
        
        Pumps out salts creating salty interstitial fluid in the medulla
        
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        Thick segment
        
        Substance reabsorbed
        
        2 more items...
        
        Located in the Medulla
        
        Distal convoluted tubule
        
        Most of the secretion takes place here, and some reabsorption is also done here.
        
        H2O recovery & Na+ influenced by hormones
        
        Aldosterone Secretion (from adrenal cortex) stimulates Na+ reabsorption
        
        ADH stimulates H2O reabsorption
        
        PTH (parathyroid hormone) regulates Ca2+
        
        Substance reabsorbed
        
        Na+, Cl-
        
        Primary active Na+ transport at basolateral membrane
        
        Secondary active transport at apical membrane via Na+ - Cl- symporter and channels
        
        Aldosterone-regulated at distal portion
        
        Ca2+
        
        Passive uptake via PTH- modulated channels in apical membrane
        
        Primary and secondary active transport (antiport with Na+) in basolateral membrane
        
        Collecting duct
        
        Sends the urine to the unit center of the kidney which goes to the ureter and bladder
        
        H20 reabsorption through aquaporins
        
        Water channels selectively conduct H20, in & out of phospholipid bilayer; prevents passage of ions & other solutes
        
        Fused together for urine delivery through renal papillae --> minor calyces = kidney chambers through urine passes
        
        Renal Papilla
        
        Urine passes through and goes to
        
        Minor Calyx
        
        1 more item...
        
        Substance reabsorbed
        
        Water
        
        Osmosis; controlled (facultative) water reabsorption
        
        ADH required to insert aquporins
        
        Urea
        
        Facilitated diffusion in response to concentration gradient in the deep medulla region
        
        Recycles and contributes to medullary osmotic gradient
        
        Na+, K+, HCO3-, Cl-
        
        Passive paracellular diffusion of some Cl-
        
        Primary active transport of Na+ (requires aldosterone)
        
        Contransport of Cl- and HCO3-
        
        K+ is both reabsorbed and secreted (aldosterone dependent), usually resulting in net K+ secretion
      - Renal Corpuscle
        
        Bowmen's Capsule
        
        Aka Glomerular Capsule
        
        Glomerulus
        
        Have capillaries
        
        They filter H2O & dissolved substances from the plasma of the blood
        
        Increase blood pressure into Bowman's Capsule
        
        Production of filtration/ its a filtration surface
        
        3 Layers make up filtration unit
        
        Basement membrane
        
        Podocytes
        
        Capillary endothelium
        
        Highly fenestrated
        
        Allows most molecules passage but not cells or large proteins
        
        Filtration
        
        Uncharged molecules (salts, glucose, amino acids) can pass through filtration
        
        Podocytes
        
        Foot like processes which integrate forming filter bed
        
        Both cell layers contain negatively charge glycoproteins
    - - Renal corpuscle (glomerulus) --> proximal convoluted tubule --> nephron loop --> distal convoluted tubule --> collecting ducts --> minor calyces --> major calyces --> renal pelvis --> urter --> urinary bladder --> urethra