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Elderly female patient with blood in her urine and history osteoporosis,…

- - - - kidney
        
        chemical balance
        
        regulate total volume of water
        
        regulate concentration of ions
        
        long term acid-base balance
        
        excrete metabolic waste
        
        positon
        
        against posterior body wall
        
        layers of supportive tissue
        
        renal fascia
        
        outer layer
        
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        peritoneal fat capsule
        
        fatty mass, surrounding kidney cushions it
        
        fibrous capsule
        
        transparent capsule
        
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        internal gross anatomy
        
        renal cortex
        
        superficial region
        
        light colored, granular appearance
        
        Medula
        
        deep
        
        darker, reddish brown
        
        renal vessels
        
        renal artery
        
        segmental artery
        
        interiobar artery
        
        arcuate artery
        
        1 more item...
        
        renal vein
        
        interiobar vein
        
        arcuate vein
        
        cortical radiate vein
        
        Nephrons
        
        functional unit of the kidneys
        
        1 million nephrons
        
        filter blood
        
        parts
        
        renal corpuscle
        
        glomerular capsule
        
        parietal layer
        
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        visceral layer
        
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        cup shape hollow structure
        
        glomerulus
        
        fenestrated endothelium of glomerulus
        
        capillaries
        
        renal tubule
        
        distal convoluted tubule
        
        cuboidal epithelial cells
        
        3 more items...
        
        proximal convoluted tubules
        
        cuboidal epithelial cells
        
        3 more items...
        
        nephron loop
        
        thin segment cells
        
        limbs
        
        ascending
        
        1 more item...
        
        descending
        
        1 more item...
        
        collecting duct
        
        cells
        
        principal cell
        
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        intercalated cells
        
        1 more item...
        
        nephron capillary beds
        
        Glomerulus
        
        parallel
        
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        peritubular capillaries
        
        adjacent renal tubules
        
        1 more item...
        
        vasa recta
        
        bundle of long straight vessels
        
        1 more item...
        
        Juxtaglomerular Complex
        
        distal portion of ascending limb lies against afferent arteriole
        
        3 kinds of cells
        
        macula densa
        
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        granular cells
        
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        extraglomerular mesangial cells
        
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        Classes of nephrons
        
        cortical
        
        85% of nephrons
        
        located in cortex
        
        juxtamedullary
        
        close to medulla
        
        function
        
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      - other organs of urinary system
        
        urethra
        
        thin walled muscular tube that drains urine from the bladder out of the body
        
        sphincter
        
        internal urethral spincter
        
        involuntary
        
        keeps urethra closed
        
        1 more item...
        
        external urethral sphincter
        
        voluntary control
        
        urinary bladder
        
        smooth, collapsible, muscular sac that stores urine temporarily
        
        ureters
        
        slender tubes that transport urine from kidneys to bladder
        
        layers
        
        mucosa
        
        transitional epithelium continuous with mucosae of kidney pelvis
        
        muscularis
        
        smooth muscle sheets
        
        adventitia
        
        covering the ureters external surface, fibrous connective tissue
  - - - processes
        
        tubular reabsorption
        
        reclaim what the body needs
        
        glucose
        
        amino acids
        
        99% of water
        
        Active tubular reabsorption
        
        require ATP
        
        Passive tubular reabsorption
        
        diffusion, facilitated diffusion and osmosis
        
        reabsorption of water and nutrients using active and passive transport
        
        NaK ATPase pumps Na out to interstitial space
        
        Na moves down concentration gradient
        
        glucose, aminos, vitamins reabsorbed by cotransport
        
        water is reabsorb by osmosis through aquaporins
        
        lipid soluble substances diffuse by transcellular route
        
        ions diffuse by paracellular routes
        
        reabsorption in renal tubules and collecting duct
        
        proximal convoluted tubule
        
        Na
        
        primary active transport via basolateral Nak pump
        
        glucose, amino acids, vitamins
        
        second active transport with Na
        
        Cl, K, Mg, Ca
        
        passive paracellular diffusion down gradient
        
        HCO
        
        secondary active transport linked to H secretion and Na reabsorption
        
        water
        
        osmosis
        
        lipid soluble solutes
        
        passive diffusion by concentration gradient because of water
        
        urea
        
        primarily passive parecellular diffusion driven by chemical gradient
        
        nephron loop
        
        water
        
        osmosis
        
        Na, Cl, K
        
        secondary active transport of Cl, Na, K via Na, K, 2Cl cotransporter
        
        Ca, Mg
        
        passive paracellular diffusion driven by electrochemical gradient
        
        distal convoluted tubule
        
        Na, Cl
        
        primary active Na transport and secondary transport via NaCl simporter
        
        Ca
        
        passive uptake via PTH modulated channels
        
        collecting duct
        
        Na, K, HCO, Cl
        
        primary transport Na, passive diffusion Cl, cotransport Cl and HCO, K is aldosterone dependent
        
        Water
        
        osmosis through aquaporins
        
        urea
        
        facilitated diffusion
        
        tubular secretion
        
        movement of substances from blood to filtrate
        
        importance
        
        dispose of substances
        
        eliminating undersirable substances or end products like urea and uric acid
        
        Ridding the body of excess K
        
        controlling blood pH
        
        Glomerular filtration
        
        membranes
        
        fenestrated endothelium
        
        pores
        
        allow blood components except blood cells to pass through
        
        basement membrane
        
        basal laminae
        
        physical barrier
        
        1 more item...
        
        foot process of podocytes
        
        have filtration slits
        
        pressure and filtration
        
        outward pressure
        
        HPgc
        
        pushes water and solutes out of blood into filtrate
        
        inward pressure
        
        HPcs
        
        pressure exerted by filtrate in glomerular capsule
        
        OPgc
        
        pressure exerted by proteins in blood
        
        Glomerular filtration Rate GFR
        
        volume of filtrate formed each min
        
        factors
        
        net filtration pressure
        
        total surface area available for filtration
        
        filtration membrane permeability
        
        regulation of glomerular filtrate
        
        intrinsic control
        
        purpose
        
        maintain GFR
        
        mechanisms
        
        myogenic
        
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        tubulogromerular feedback
        
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        conditions
        
        pressure between 80-180
        
        extrinsic control
        
        purpose
        
        maintain systemic blood pressure
        
        mechanisms
        
        hormonal
        
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        neural
        
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        conditions
        
        arterial pressure lower than 80 or higher than 180
        
        filtrate in to lumen
    - - osmotic gradient
        
        process of making either very diluted or very concentrated urine
        
        osmolarity of interstitial fluid
        
        renal cortex
        
        300 mOsm
        
        renal medulla
        
        300-1200 mOsm
      - Juxtamedullary nephrons ( countercurrent exchange)
        
        flitrate flow opposite direction (countercurrent)
        
        descending limb permeable to water (passive) but not salt
        
        ascending limb is impermeable to water and pumps out salt (active)
      - mechanisms of concentrated urine
        
        overhydrated
        
        lower osmolarity of extracellular fluid
        
        lower ADH release
        
        lower aquaporins in collecting duct
        
        lower H2O reabsorption
        
        1 more item...
        
        dehydrated
        
        higher osmolarity in extracelluar fluid
        
        higher ADH relsease
        
        higher number of aquaporins
        
        higher H2O reabsorption
        
        1 more item...
    - - osteoporosis
        
        definition
        
        disease in which bone resorption outpaces bone deposit
        
        casuses
        
        bone mass to decreases
        
        factors
        
        age
        
        usually 50 and up
        
        decrease sex hormones
        
        androgen
        
        estrogen
        
        insufficient bone stress
        
        diet poor in
        
        calcium
        
        vitamin D
        
        protein
        
        smoking
        
        reduce
        
        estrogen levels
        
        calcium reabsorption
        
        health conditions
        
        diabetes
        
        hypertension
        
        consumption
        
        alcohol
        
        medications
        
        caused
        
        Chronic Kidney disease
        
        less able to convert Vit D
        
        less able to absorb Calcium
        
        loss ability to filter waste and toxins
        
        cause inflammation
        
        leads to bone loss
      - Diabetes Mellitus II
        
        hyposecretion or hyperactivity of insulin
        
        type 1
        
        insulin absent
        
        type 2
        
        insuline present
        
        insulin receptors can not recognize insulin
        
        glucose levels remain high
        
        signs of diabetes
        
        polyuria
        
        excessive glucose in filtrate
        
        huge urine output
        
        decrease blood volume
        
        1 more item...
        
        polydipsia
        
        excessive thirst
        
        polyphagia
        
        excessive hunger and food consumption
      - Hypertension
        
        chronically elevated blood pressure
        
        increase
        
        systolic pressure
        
        diastolic pressure
        
        cause
        
        heart failure
        
        vascular disease
        
        renal failure
        
        stroke
        
        types
        
        primary hypertension
        
        factors
        
        heredity
        
        genes
        
        diet
        
        high intake
        
        3 more items...
        
        obesity
        
        interfere with endothelial cells vasodilation
        
        diabetes mellitus
        
        stress
        
        secondary hypertension
        
        factors
        
        renal arteries
        
        kidney disease
        
        cushings syndrome
- - - - absorb Ca
        
        increase bone mass
    - - factors
        
        DM II
        
        blood glucose levels high
        
        caue
        
        Diabetic Nephrophathy
        
        kidney disease that result from diabetes
        
        symptoms
        
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        treatment
        
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        hypertension
        
        2nd leading cause of kidney failure
        
        pressure affects filtration
        
        increase BP
        
        affects kidneys ability to filter fluid
        
        increase HPgc
        
        cause
        
        arteries in kidneys
        
        narrow
        
        weaken
        
        harden
        
        osteoporosis
        
        renal osteodystrophy
        
        bone desease
        
        mineral imbalance
        
        levels
        
        3 more items...
        
        PTH relseased
        
        remove calcium from bone into the blood
        
        alteration of bone morphology in patients with kidney disease (CKD)
        
        symptoms
        
        bone pain
        
        joint pain
        
        bone deformation
        
        bone fractures
        
        poor mobility
    - - osmoreceptors
        
        excite hypothalamus
        
        release ADH
        
        cause kidney to retain water
    - - nitrogenous waste
        
        urea
    - - blood cell production
    - - volume
        
        altering urine volume
      - pressure
        
        releasing renin
    - - kidneys excrete H+ in urine and retain HCO3
- - - - effects on the kidneys
        
        damage/ weaken kidney vessels
        
        reduce blood flow
        
        not able to remove all waste and extra water
        
        continue to raise blood pressure
        
        kidney failure
      - other effects on the body
        
        heart
        
        heart attack
        
        damage arteries prevent flow
        
        heart failure
        
        over work the heart
        
        brain
        
        stroke
        
        vessels
        
        clog
        
        burst
        
        eyes
        
        vision loss
        
        damage vessels in eyes
    - - effects on the kidneys
        
        kidney failure
        
        dialysis
        
        transplant
      - other effects on the body
        
        extreme thirst
        
        sweet smelling breath
        
        stroke
        
        heart disease
        
        pancreas malfunction
        
        excessive urination
        
        damage blood vessels
        
        higher risk of infections
        
        visual problems
        
        dry cracked skin
    - - long term
        
        factures
        
        spine
        
        hip
        
        chronic pain
        
        disability
        
        movement
        
        death
      - other effectson the body
        
        less
        
        hormone production
        
        lower erythropoietin
        
        lowers red blood cell formation
        
        anemia
        
        protection to organs
        
        spine
        
        brain
        
        support
        
        trunk while standing
        
        fat storage
        
        less yellow marrow
        
        mineral storage
        
        calcium
        
        phosphate
    - - cause
        
        hematuria
        
        bleeding urinary tract
        
        trauma
        
        kidney stones
        
        infections
        
        cancer