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

- - - - Fist sized, bean shaped organs that filter bodily fluids
      - Lie on either side of the spine, close to the back
      - Consist of 3 layers (superficial to deep)
        
        Renal Medulla
        
        Renal Pelvis
        
        Renal Cortex
      - Specialized cells called NEPHRONS
    - - Ducts that push urine through peristalsis from the kidneys to the bladder
    - - Carries oxygenated blood down to the kidney's and lower half of the body to be filtered and used in the cells
    - - Hollow muscular organ (much like the stomach) that collects and stores urine for disposal
      - Is flexible, and can hold as much as 1 L of urine, 500 mL comfortably
      - Trigone
        
        Triangle shaped area where the urethra meets the bladder
      - Lateral walls
        
        right and left walls on either side of the trigone
      - Dome
        
        Roof of the bladder
      - Posterior walls
        
        Back wall
    - - Carries the deoxygenated blood from the kidney's and lower half of the body back up to the heart to be reoxygenated
    - - The duct leading from the bladder out of the body, expelling urine
  - - - Remove waste products and drugs from the body by filtering them through specialized neprhon cells
      - Balance bodily fluids
      - Release hormones to regulate blood pressure
      - Help control the production of red blood cells
      - Urea with water and other solutes forms urine and is passed through nephrons down the renal tubes of the kidneys
    - - Two narrow tubes connected to either of the kidneys that move urine via peristalsis down to the bladder
    - - Walls that relax and expand to release and store urine
      - Send neural signals to brain to signal when it's time to urinate
        
        Pontine storage area
        
        Red light
        
        Pontine micturition center
        
        Green light
      - Sphincter muscles
        
        Keep urine from leaking out by closing tightly around the bladder opening
    - - Final tube at the end of the urinary system that allows for urine to be excreted from the body
      - Neural signals tell the bladder and sphincter muscles to relax which allows for urination
  - - - Proximal tube (PCT)
        
        Located solely in the renal cortex of the kidney
        
        Selective re-absorption of glucose, water and other nutrients
        
        Cells of PCT are ciliated and filled with mitochondria for lots of reabsorption(much like the small intestine)
        
        Secreted Out
        
        NaCl
        
        H20
        
        HCO3
        
        Nutrients
        
        K+
        
        Absorbed in
        
        H+
        
        NH3
      - Loop of Henle
        
        AKA Nephron Loop
        
        Descending Limb
        
        Connects to the PCT and Thin ascending segment
        
        H2O is secreted out here in the outer medulla
        
        Think ascending segment
        
        Where the loop turns in the inner medulla and begins to return to the outer medulla
        
        Secretes NaCl
        
        Thick ascending segment
        
        The end of the loop that connects to the distal tubule in the cortex
        
        NaCl is also secreted here as well
        
        Part of the nephron that forms a long loop through the outer and inner medulla of the kidney, where water and salt are primarily reabsorbed into the blood
      - Distal tubule (DCT)
        
        Similar to the PCT, leads to the collecting duct
        
        Located solely in the renal cortex
        
        Reabsorbs
        
        K+
        
        H+
        
        Calcium
        
        Sodium
        
        Chloride
        
        Secretes
        
        NaCl
        
        H2O
        
        HCO3
        
        Regulates the pH of urine
      - Collecting duct
        
        Located at the end of the nepron tube chain, in the inner medulla
        
        Aquaporins
        
        ADH (anti-diuretic hormone) triggers the movement of aquaporins to the side of the cell they aren't on here, allowing reabsorption and secretion to take place
        
        Special protein channels in the cell membranes that help transport water in and out of the cell
        
        Help in the collecting duct so more water can leave the urine
        
        Alcohol and caffeine inhibit ADH it means less water is released when they are consumed
        
        Also located in the descending part of the loop of henle
        
        Secretes
        
        NaCl
        
        Urea
        
        H2O
      - Glomerular Capsule
        
        Surrounds the glomerulus and takes up the filtrate to be processed by the nephron
      - Glomerulus
        
        "Ball of yarn" that releases ions and other particles to be taken into the nephron and filtered
        
        Creates filtrate
        
        Filtrate
        
        Substance that has passed through a filter
        
        Contains
        
        H20
        
        Salts
        
        HCO3
        
        H+
        
        Urea
        
        Glucose
        
        Amino Acids
        
        Sometimes drugs
  - - - Type 2 Diabetes
      - A chronic condition that affects the way the body process' blood sugar
      - The body doesn't produce enough insulin, but is generally characterized as a bodily resistance to insulin
      - Not innate, or genetically inherited, but can occur overtime generally due to a high sugar diet
    - - A condition where the bones become weak and brittle
      - New bone creation doesn't keep up with bone removal, bone remodeling moves faster than creation
      - Density and quality of bone are reduced
      - As bones become more fragile, the risk of fracture is greatly increased
      - Often no symptoms until the first bone break occurs
    - - Abnormally high blood pressure (when the pressure against the arterial walls is too high)
      - Generally classified as anything 140/90 or higher
      - Often has no symptoms, but if left untreated can lead to heart attack or stroke
      - Can be maintained with a low sodium diet, exercise and medication
- - - - THE BLOOD IN HER URINE
      - Her age
      - Her diet needs to be considered
      - The medication she may be taking for her amalgamation of conditions
      - The amount of physical activity she does
    - - Osteoporosis
        
        Chronic Kidney Disease (CKD)
        
        Many of the medications that are out there to treat osteoporosis have a significant effect on renal function
        
        Can cause kidney stones (your body passes more calcium due to your bones breaking down faster than they can grow)
      - Hypertension
        
        Second leading cause of kidney failure
        
        Over time it can cause the arteries surrounding the kidneys to narrow, weaken or harden
        
        Could also be a symptom of kidney disease to begin with
        
        Kidney's help in controlling blood pressure by removing waste products and excess water
      - DM II
        
        Can lead to urinary tract infections
        
        Since the glucose isn't being properly absorbed into her body due to insulin resistance, her kidney's will simply filter it out
        
        Can impact blood flow, nerves and sensory function in the body, messing with the Kidney's ability to filter blood
        
        Overtime, damage to kidney's and waste buildup in the blood
        
        Diabetic Kidney Disease (very common in people with diabetes, high risk)
- - - - The conditions each have a significant impact on the kidneys
      - 2/3 cause some form of kidney disease
      - Hypertension can cause the kidney's to weaken or grow hard which hinders their function
      - The same hindrance of function listed in the upstream causes
    - - The Diabetes seems most likely to be the underlying/root cause for many of her other issues
      - Diabetes is oftentimes linked with Diabetic Kidney Disease which can lead to a rise in hypertension and blood in the urine
      - The osteoporosis most likely stems from her age and the affected osteoclasts/blasts from the diabetes
      - Each of her issues can be treated with it's own independent medicines, which can have an array of side effects
      - Medication is processed in the kidney's, so an abundance could cause damage
    - - DM II causes an excess of glucose to exit the body, which leads to an increase of filtrate in her kidney's which could lead to a ride in blood pressure
      - Hypertension can lead to an increase in calcium secretion which can lead to an acceleration in osteoporosis
      - Hypertension can lead to an increase in risk for DM II and is present in over 50% of patients with diabetes
      - Diabetes increases osteoclast function but decreases osteoblast function which leads to accelerated bone loss and ultimately osteoporosis
    - - Could be caused by Kidney Stones from excessive breaking down or improper removal of minerals
      - Kidney Infection (or UTI)
      - Kidney Disease
      - Kidney disease (which could also be causing the hypertension)
    - - Blood in the urine is a symptom of something underlying
      - Ultimately, with her kidney's at such high risk from her other ailments, her kidney's will eventually shut down
      - No kidney's = no waste processing
      - No waste processing = buildup of waste/toxins in the blood
      - Medication, proper diet, and mild exercise so she doesn't hurt herself would aid in reducing her symptoms
      - Improving her water intake might also aid in her problems as well, as Diabetes can leave you dehydrated in the first place