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Elderly female with blood in urine (Background (Hypertension (Causes of…
Elderly female with blood in urine
Background
General anatomy of urinary system
Ureters
Urinary bladder
Urethra
Kidneys
General functions of the urinary system
Ureters
Two tubes that transport urine from the kidneys to the urinary bladder
Urinary bladder
A temporary storage reservoir for urine
Kidneys
Produces erythropoietin and renin
These are important for regulating red blood cell production and blood pressure
Covert vitamin D to its active form
Has specialized capillaries called peritubular capillaries
Urethra
A tube that carries urine from the bladder to the body exterior
Nephron
Structural unit and functional units of the kidneys
Renal corpuscle
Glomerular capsule
Glomerulus
Proximal convoluted tubule
Proximal convoluted tubule cells
Mitochondira
Highly infolded basolateral membrane
Apical microvilli
Nephron loop
Descending limg
Ascending limb
Thin-segment cells
Distal convoluted tubule
Apical side
Basolateral side
Collecting duct
Collecting duct cells
Principal cell
Intercalated cell
Glomerulus
Endothelium of the glomerular capillaries is fenestrated making the capillaries exceptionally porous
Allows large amounts of solute-rich but protein free fluid to pass from the blood into the capsule.
Plasma-derived fluid is the raw material that the renal tubules process to form urine
Main substances excreted in urine
Electrolytes
Inorganic compounds
Calcium
Chloride
Potassium
Bicarbonate
Sodium
Water
Metabolic waste products
Creatinine
Urea
Renal corpuscle
Consists of a tuft of capillaries called glomerulus
Nestled inside the Bowman's capsule
Bowman's capsule
Glomerular capillary walls are made up of 3 layers
Basement membrane
Made up of 3 layers and is fused to the endothelial layer
Prevents proteins from being filtered out of the bloodstream
Epithelium
Consists of podocytes
Attached to the basement membrane by foot processes
Wrap around capillaries and leave filtration slits
Thin diaphragm between slits acts as a final filtration barrier before the fluid enters the glomerular space
Endothelium
Has large pores
Solutes, plasma proteins and fluid can pass through
Blood cells are unable to pass through
Glomerulus and glomerular capsule together make the renal corpuscle
Filtration takes place in the glomerulus
Reabsorption takes place mainly in the proximal convoluted tubule
water, glucose, potassium, and amino acids lost
Glomerular filtration
Takes place int he renal corpuscle
Produces a cell and protein free filtrate
Tubular reabsorption
Process of selectively moving substances from the filtrate back into the blood
Takes place in the renal tubules and collecting ducts
Anything that does not get reabsorbed becomes urine
Urine contains unneeded substances like excess salts and metabolic waste
Tubular secretion
Process of selectively moving substances from the blood into the filtrate
Occurs along the length of the tubule and collecting duct
Osteoporosis
Low bone mass
Structural deteriorations of bone tissue
Leads to bone fragility and increased risk of fractures
Hip, spine, wrist
Can be prevented and treated
More than 53 million people either have it or are at high risk
For women, bone loss is fastest in the first few years following menopause
Mainly affects women
Smaller, thin boned women are at a greater risk
The older you are the greater risk
White and Asian women are at highest risk
African American and Hispanic women have a lower risk
Prevention
Calcium and vitamin D intake
Life time diet low in calcium and vitamin D increases risk
Exercise
Such as walking, hiking, jogging, climbing stairs dancing, etc.
Limit alcohol consumption
Stop smoking
Eat food sources of calcium like milk, yogurt, cheese, dark leafy vegetables
Eat food sources of vitamin D including egg yolks, saltwater fish, and liver
Type II diabetes
Most common type of diabetes
Occurs when blood glucose is too high
Body doesn't make enough insulin or doesn't use insulin well
More likely to develop if you are 45 or older
Have a family history of diabetes
Overweight or Obese
More likely to develop if you had prediabetes or had gestational diabetes
Most common in African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander
Physical inactivity and high blood pressure increases risk of developing type II diabetes
Symptoms
Increased thirst and urinations
Increased hunger
Fatigue
Blurred vision
Numbness or tingling in the hands or feet
Sores that will not heal
Unexplained weight loss
Symptoms often develop slowly (over yesrs)
Manage type II diabetes
Stop smoking
Manage blood pressure, cholesterol, and blood glucose
Lifestyle changes
Healthy meal planning
Calorie limits if overweight
Exercise
May need medication like pills or injectable medications like insulin
Hypertension
Increases risk for heart disease and stroke as well as kidney damage
Two leading causes of death in Americans
Very common
If a patient has diabetes and hypertension they are a higher risk of developing Chronic Kidney Disease
Usually has no symptoms
Usually develops over time
Causes of hypertension
Unhealthy lifestyle choices
Not exercising
Diabetes
Obesity
Pregnancy
Stress
Can cause the arteries that supply blood and oxygen to the brain to burst or be blocked
In midlife, it is linked to having poor cognitive function and dementia later in life
Prevention
Exercise for at lease 150 minutes each week
Do not smoke
Eat a healthy and well balanced diet
Limit sodium and alcohol
Manage stress
Keep a healthy weight
Take medications prescribed by physician to control hypertension to reduce risk of damage to organs
Upstream causes
Type II diabetes mellitus
Body does not produce enough insulin or resists insulin
Small blood vessels in the body are injured
Injured blood vessels in kidneys causes the kidneys to not be able to clean blood properly
Will retain more water and salt
Could result in weight gain and lower extremity swelling
Protein can possibly be found in urine
High blood pressure
High blood pressure can damage blood vessels throughout your body
Reduce blood supply to kidneys
Kidneys may stop removing waste and extra fluid from blood
Extra fluid in body can build up and cause blood pressure to raise even more
More likely to develop heart disease
Blood pressure is the force of blood against walls of your blood vessels
Leading cause of Chronic Kidney Disease
Damages filtering units in kidneys
Kidneys play a role in keeping your blood pressure in a normal/healthy range
Possible glomerulonephritis
Osteoporosis
Risk factors
Age
Fluctuations is hormone levels
Diet
Low activity levels
Genetics
Increased risk of fractures
Can relate to renal osteodystrophy
Low activated vitamin D3 levels due to damaged kidney's inability to convert into calcitriol
High levels of fibroblast growth factor 23
Most important cause of decreased calcitriol levels
Decreased excretion of phosphate by the damaged kidney
Weak bones
Downstream effects
High blood pressure can damage blood vessels throughout the body
This includes the glomeruli
Glomeruli are tiny blood vessels that filter blood and excess fluids
Inflammation of glomeruli can cause blood in the urine
This can lead to kidney failure
Type II diabetes can cause diabetic neuropathy
Affects the kidneys' ability to remove waste and excess fluid
Over time, damages filtration system
Can cause high blood pressure
Protein in urine
Swelling of extremities
Increase need to urinate
Decreased kidney function
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Diabetic neuropathy is common in Type I and Type II diabetes
SOB
Fatigue
Persistant itching
Loss of appetite
Being a smoker increases risk of diabetic nephropathy
Rise in potassium levels in blood
Damage to the blood vessels of the retina
Anemia
Osteoporosis is known as a silent disease
In transplanted patients, osteoporosis is often related to immunosuppressive medications, corticosteroids, decreased levels of physical activity
Bone loss is greatest the first 6 to 12 months due to stress of the transplant surgery, high levels of immunosuppressive and corticosteroid medication dosage and adverse effects of organ failure
Will need to start exercising, change diet, and add dietary supplements
Osteoporosis increases with advancing age
Fibroblast growth factor 23 is secreted from the bones
Depressed urinary tubular function
Elevated fibroblast growth factor 23 causes a decreased vitamin D activation and high PTH secretion
Calcium deficiency and leads to hyperparathyroidism
Leads to fibrous osteopathy with high bone metabolic turnover
Renal excretion of Calcium and potassium declines leading to renal calcification