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:star: URINARY Patient Diagnosis: Elderly woman; history…

- - - - Kidneys by not being able to flush out waste causes it to build up in body.
      - Kidney damage from diabetes can also cause diabetic neuropathy.
      - Therefore diabetes starts to cause damage on kidneys bc it can't be filtered.
    - - passes through special cells to measure blood pressure in blood vessels leading to your kidneys (renal arteries).
      - Then it adjusts amount of hormone & renin that they secrete.
      - Renin controls production of angiotensin, aldosterone: both affect blood pressure.
    - - Being elderly
      - Blood in urine
- - - - They then don’t get enough blood albumin.
      - Albumin then ends up being excreted in large amounts instead of being reabsorbed into body.
    - - High blood volume passes through kidneys which causes arteries around kidneys to narrow/weaken.
      - Damaged arteries then are not able to deliver enough blood to kidney tissue.
      - If blood vessels are damaged they may no longer work properly; so kidneys are not able to remove all waste and extra fluid from body.
- - - - disease or a progression of disease. Can be acute or chronic illness
    - - recovery or partial recovery
  - - - adjusts blood flow
      - alter glomerular capillary surface area
    - - coordinated control of the diameter of the renal
    - - Mesangial cells
  - - - Myogenic mechanism as blood pressure rises:
        
        stretching triggers smooth muscle fiber in afferent arteriole wall to contract
        
        afferent and efferent arterioles are equal in size, leads to decrease of blood pressure within the capsule
      - Myogenic mechanism as blood pressure drops
        
        smooth muscle fibers relax and blood flow increases
        
        afferent is larger than efferent arteriole, leads to increase in blood pressure within the capsule
    - - What it is/does:
        
        negative feedback by macula densa cells
        
        regulate nitric oxide release from juxtaglomerular cells
        
        controls diameter of afferent arteriole
        
        detects changes in Na+ and Cl- in filtrate
- - - - Organ that excretes urine
    - - tiny structure within the kidney where urine production beings
    - - protective outer covering of the kidney
    - - space between the parietal peritoneum, the muscles and bones of the peritoneum
    - - a circular muscle that surrounds a tube such as a urethra and constricts the tube when it contracts
    - - a natural waste product of metabolism that is excreted in urine
    - - two tubes that transfer urine from the kidneys to the urinary bladder
    - - a tube that conducts urine away from the bladder for expulsion
    - - temporary storage receptacle for urine
    - - passing of urine
    - - water and soluble substances excreted by the kidneys
    - - to urinate
- - - - efferent arteriole
        
        carries blood away from the glomerulus
      - carries blood toward the glomerulus
      - glomerulus
        
        The ball of capillaries at the beginning of the nephron where blood filtration takes place
        
        distal convoluted tubule
        
        last part of the renal tubule; where secretion of ions, acids, drugs, and toxins takes place
        
        proximal convoluted tubule
        
        first section of the renal tubule that the blood flows through; reabsorption of water, ions, and all organic
        
        loop of henle
        
        section of the nephron tubule that conserves water and minimizes the volume of
        
        bowman's capsule
        
        the cuplike structure that surrounds the glomerulus
        
        collecting duct
        
        where processed filtrate, called urine, is collected from the renal
    - - Mass movement of H20 and solutes from plasma to renal tubule. Occurs in the renal corpuscle.
      - Glomerular Filtration small molecules include:
        
        Water, wastes & nutrients
      - Glomerular capsule (filtrate):
        
        Glomerular Filtration small molecules are forced by pressure out of the blood inside the glomerulus
    - - Being reabsorbed again. Reabsorbed substances are returned to blood.
      - Peritubular Capillary Network
        
        Tubular Reabsorption - nutrients, H2O and some urea moves from the convoluted tubules into blood
      - Tubular reabsorption = selective process, only molecules recognize by carrier molecules, actively reabsorbed
    - - occurs in the kidneys, where the blood is filtered in specialized structures known as nephrons
      - Tubular Secretion - Specific substances such as Hydrogen ions (H+), creatinine and drugs such as penicillin
        
        move from the blood into :
        Convoluted Tubules
      - urine can contain substances that under go glomerular filtration, but haven't reabsorbed and substances are added
    - - The long nephron loops of the juxtamedullary nephrons are located in the renal medulla.
      - The long nephron loops create medullary osmotic gradient; act as countercurrent multiplers
      - The vasa recta preserve medullary osmotic gradient; act as countercurrent exchangers.
      - The collecting ducts use medullary osmotic gradient to concentrate urine.
- - - - Decreased Na+ blood plasma levels
      - Increased K+ blood plasma levels
    - - Increased K+ secretion in tubular fluid
      - Increased Na+/H2O reabsorption into the blood
      - Decreases Na+ lost in urine and increases K+ lost in urine
  - - - Activation of thirst center
      - Increased water reabsorbtion
      - Vasoconstriction
      - Low blood volume
    - - low blood volume
      - increased blood osmolarity
- - - - Conditions associated with type 2 diabetes
        
        reduced HDL cholesterol
        
        hypertriglyceridaemia
        
        hypertension
        
        central obesity
    - - Insulin resistance predates hyperglycaemia
      - Development of insulin resistance associated w/ increasing age, obesity and genetic susceptibility
      - Insulin resistance initially stimulates excessive insulin production by beta cells
      - Excessive demand for insulin leads to deposition of amyloid
      - Amyloid fibrils, glucotoxicity and lipotoxicity damage beta cells and reduce their capacity for insulin production
      - Beta cell function may also be impaired by genetic factors
  - - - obesity
      - a diet high in fat and sodium
      - chronic inflammation
      - inactivity
    - - increased renal tubular sodium retention
      - elevated intracellular calcium concentration
      - activation of the sympathetic nervous system
      - vascular smooth muscle cell proliferation