Elderly Female with history of hypertension, Diabetes type 2 and…
Elderly Female with history of hypertension, Diabetes type 2 and Osteoporosis presents with gross hematuria (blood in urine)
General Anatomy of Urinary System
2 kidneys- maintain body's internal environment. Regulate total volume of water in body and total concentration of solutes in water. regulate concentration of ions in extracellular fluid. ensure long term acid-base balance. excrete metabolic wastes and foreign substances (drugs, toxins). produce erythopoietin and renin (regulates blood pressure and red blood cell production. converts vitamin D to active form. carry out gluconeogenisis during prolonged fasting.
2 ureters- paired tubes that transport urine from kidneys to urinary bladder.
Urinary bladder- temporary storage for urine
urethra- a tube that carries urine from bladder to exterior of body
Proximal convoluted tubule-
thick and thin segments
Distal Convoluted tubule
Path of blood thru renal blood vessels:
Aorta>Renal Artery>Segmental Artery>Interlobal Artery>Arcuate Artery>Cortical Radiate Artery>Afferent Arteriole>Glomerulus (capillaries)>Efferent Arteriole>Peritubular Capillaries or Vasa Recta>Cortical Radiate Vein>Arcuate Vein>Interlobar Vein>Renal Vein>Inferior Vena Cava
Passive process that occurs at the arterial end of a capillary. movement of fluid by bulk flow out of blood thru openings of the capillary. Fluids and small solutes flow thru easily, large solute are blocked. "dumping waste into container"
Takes place in the renal corpuscle and produces cell and protein free filtrate
Selectively moving substances from blood into filtrate "selectively adding waste into container"
takes place in renal tubules and collecting ducts. Excretions become urine.
Movement of fluid in opposite directino, back into blood. "reclaiming what needs to be kept"
takes place in renal tubules and collecting ducts. reclaims almost everything filtered (all glucose, amino acids and 99% of water and salts filtered out. what isn't reabsorbed becomes urine
Proximal convoluted tubule- sodium ions, nutrients (glucose, amino acids, vitamins, ions) chloride, potassium, magnesium, bicarbonate, water, lipid soluble solutes, urea, some drugs
Descending limb- sodium, chloride, potassium, calcium, magnesium
Ascending limb- water
Distal convoluted tube- sodium, chloride, calcium
Collecting duct- sodium, potassium, bicarbonate, chloride, water, urea.
**location for fine tuning for blood pH- hydrogen, bicarbonate, ammonium
Osteoporosis- bone reabsorbtion outpaces bone deposit. bone mass declines, bones become porous and light. extremely fragile. risk factors include decreased sex hormones, insufficient bone stress, diet poor in calcium, vitamin d and protein, smoking, genetics, homone related conditions, consumption of alcohol or certain drugs
Hypertension- chronically elevated blood pressure
primary/essential hypertension- no underlying cause. no cure. risk factors- genetics, diet, obesity, age, diabetes, stress, smoking
secondary- 10% of cases, due to identifiable conditions (obstructed renal arteries, kidney disease, Cushing's syndrome). treat by correcting problem
Type 2 Diabetes- non insulin dependent. produce insulin but insulin receptors unable to respond>insulin resistant. mostly due to lifestyle.can lead to heart disease, amputations, kidney failure and blindness
patient lifestyle- considering her age and her conditions she is most likely less mobile (age and osteoporosis), has a history of poor diet, and potential obesisty (diabetes, hypertension, and osteoporosis), with already decreased organ function. Her heart is most likely functioning at a lower level, kidneys are most likely already suffering.
Hypertension causes the kidneys to filter less fluid less efficiently. This leads to waste build up in blood, fluid retention in the body. Calcium excretion increases. This damage to the kidneys is irreversible and will likely lead to the patient needing dialysis.
Once dialysis is started, it will most likely need to continue for the rest of the patient;s life. The kidneys likely don't regain their function completely.
Osteoporosis exacerbated by kidneys not filtering calcium correctly. Calcium is being excreted from body at a higher rate than normal, not allowing for calcium to be reabsorbed and not allowing bone deposit to happen. Likely causing kidney stones
Diabetes Type 2- largely a lifestyle condition. What is this patient's current weight, is she obese/overweight? Is her diet heavy in sugars? Blood vessels in the kidneys are damaged and not able to filter properly. Patients with DM type 2 have a higher chance of having urinary tract infections
Hypertension- can thicken and narrow renal blood vessels. This damage can cause the kidneys not to filter solutes properly and can complicate a patients health by increasing the chances of waste remaining in the blood.
Diabetes Type 2- diabetes damages renal blood vessels, and with the patient's diagnosis of hypertension, this is already a problem. Her kidneys[ are not able to filter properly. This is can lead to excessive glucose in the kidney acting as a diuretic which could lead to excessive urine output. Decreases blood volume and causes dehydration. BUT- this can also cause nerve damage. the patient may not be able to eliminate properly any more, needing the assistance of a catheter.
Nerve damage leading to either incontinence or urine retention leads to the risk of UTIs. UTIs can cause the patient's primary complaint of hematuria.
If UTI isn't treated, it can lead to hospitalization because of worsening patient condition. Not treating a UTI can completely eliminate any remaining kidney function, cause sepsis, caused infection to spread leading to parts of the urinary tract to die, and cause altered mental status which can complicate her condition even further and more quickly.
Lower kidney function means that Calcium cannot be reabsorbed. While the patient was likely already predisposed to osteoporosis, lower kidney function in conjunction with osteoporosis leads to excessive calcium being held in the kidneys. If the kidneys functioned at a normal level, this would lead the calcium to be excreted. Damaged kidneys, however, are not getting rid of calcium effectively. this may be causing an accumulation of calcium, kidney stones.
Kidney stones can cause hematuria by making abrasions in the urinary tract, causing bleeding. The patient likely already has thickened, thinner renal blood vessels and this complicates the possibility of having kidney stones. Kidney stones can possibly be excreted normally, if they are small enough, but considering the patients condition, she may need surgical assistance to break up or remove them if present.
Gross hematuria- blood in urine visible to the naked eye
Microscopic hematuria- blood in urine visible only via microscope
caused by filters in kidneys not working, allowing for blood to leak into the urine
Patient is suffering from Gross hematuria