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elderly female pt presented with pmhx of osteoporosis, chronic type II…
elderly female pt presented with pmhx of osteoporosis, chronic type II diabetes mellitus, and high blood pressure. Chief complaint: blood in urine. Doctor's primary concerns: effect of high blood pressure on her kidneys and the effect of low kidney function on her already compromised bone mass.
structure of a nephron
cortical nephron
glomerulus
glomerular capsule
renal tubule
nephron loop (loop of Henle)
distal convoluted tubule (DCT)
proximal convoluted tubule (PCT)
collecting duct
juxtamedullary nephron
have long nephron loops that descend deep into the renal medulla
have vasa recta that traverse their nephron loops
85% of nephrons in kidney, have nephron loops that descend only slightly into renal medulla
general anatomy of urinary system
urinary bladder
urethra
ureters
nephrons
kidneys
general information on osteoporosis, DM II, and hypertension
DM II
chronic condition that affects the way the body processes blood sugar (glucose)
hypertension
a condition in which the force of the blood against the artery wall is too high
osteoporosis
new bone formation doesn't keep up with old bone removal
general functions of urinary system
maintain homeostasis by regulating water balance and by removing harmful substances from the blood
the filtration, reabsorption, and secretion of specific molecules in specific areas of the nephron
nephron loop (loop of henle)
ascending
reabsorbs
ions (Na+, K+, Cl-, urea)
descending
reabsorbs
H20 impermeable to ions
distal convoluted tubule (DCT)
reabsorbs
Na+, Cl-, Ca+
secretes
not much
proximal convoluted tubule (PCT)
secretes
H+, urea, NH3, K+,
reabsorbs
Na+, K+, Ca+, Mg+, Cl-, HCO3-, amino acids, protein, vitamins
collecting duct
secretes
H+, urea, K+
what are the effects of DM II on kidneys?
blood vessel damage
cannot clean blood properly
protein in urine
what are the effects of osteoporosis on kidney function?
kidneys do not properly balance mineral levels in body
chronic kidney disease (CKD)
what are the effects of high blood pressure on kidneys?
can cause arteries around the kidneys to narrow, weaken or harden
these damaged arteries are not able to deliver blood sufficiently to the kidney tissue
how do these separate conditions affect each other?
DMII with it's poor blood sugar control and take insulin have the highest fracture risk and osteoporosis causes low bone density mass
in hypertension patients, excess urinary calcium secretion induces secondary parathyroidism to increase serum calcium level by calcium release from bone, therefore accelerates osteoporosis
insulin resistance from DMII may involve processes that increase the risk of hypertension
what further effects can each of these have?
what is likely causing blood in her urine?
glomeruli damage resulting from diabetes
If nothing changes, what will happen to this patient over time?
cardiovascular disease, kidney disease
relation to kidney function
osteoporosis
damaged kidneys and abnormal hormone levels cause calcium and phosphorus levels in a person's blood to be out of balance
DM II
poorly controlled diabetes can damage blood vessel clusters in kidneys
can lead to HBP
high blood pressure
kidneys help filter waste and extracellular fluid from blood
uncontrolled HBP can cause blood vessels to narrow, weaken or harden therefore, not able to deliver enough blood to tissue
what other factors or sx should be considered?
age
as people age, there is a slow, steady decline in the weight of the kidneys. After age 30-40, about 2/3 of people undergo a gradual decline in the rate at which kidneys filter blood