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Urinary: Elderly female with type 2 Diabetes and blood in her urine…
Urinary: Elderly female with type 2 Diabetes and blood in her urine
urinary system
functions
1) regulation of extracellular fluid (plasma) volume and blood pressure (they do this by increasing ion concentration which then increases water conservation and results in an increase in blood pressure). 2) Regulation of osmolarity (ex. sti mulating thirst). 3) Maintenance of ion balance. 4) homeostatic regulation of pH by absorbing or secreting bicarbonate and H+. 5) Excretion of wastes. 6) Production of hormones such as erythropoietin and renin
anatomy
2 kidneys (right lower then left), each with their individual ureter tubs that both enter the bladder. Connected to the bladder is the urethra where urine come out. The kidneys also have renal arteries and veins.
Kidney
General anatomy
The ureter from the bladder becomes the renal pelvis which is in the center of the kidney. Then the renal pelvis breaks off into smaller sections each with an medulla on its end. Surrounding the medullas is the renal cortex. Connecting the renal cortext and the medulla are the nephrons. And surrounding the entire kidney is the capsule.
nephron
anatomy
From the arteries the nephron begins with the bowmans capsule. Inside of the capsule is the glomerulus. following the capsule is the proximal tubule. Next is the descending and ascending loops of henle respectively. Then comes the distal tubule followed by the collecting duct.
Filtration, Re-absorption, Secretion
Cl- is reabsorbed in the proximal tubule, ascending limb of henle and distal tubule.
K+ is reabsorbed in the proximal tubule and ascending limb of henle. However, it is regulated by either reabsorption or secretion in the distal tubule
Ca2+ is reabsorbed in the proximal tubule and secending limb of henle. However, its absorption is regulated in the distal tubule.
glucose is 100% reabsorbed in the proximal tubule (unless there are underlying issues such as diabetes).
Na+ is reabsorbed in the proximal tubule and ascending limb of henle. However, its absorption is regulated in the distal tubule.
Urea is reabsorbed in the proximal tubule, secreted in the ascending limb of henle, then once again reabsorbed in the distal tubule.
PAH1 is secreted in the proximal tubule.
Glomular filtration rate
Thanks to autoregulators such as the myogenic response (intrinsic ability of vascular smooth muscle to respond to pressure changes) and tubloglomer feedback (paracrine signaling mechinisms in which changes in fluid flow through the loop of henle influence GFR), the glomular filtration rates says approximently at 180 L/day.
Systematic Connections
When hypertension occurs blood pressure decreases causing GFR to decrease. When GFR decreases NaCl transport across the macula densa cells will also decrease. This triggers the macula densa cells to release paracrines. These paracrines will act on the granular cells to produce renin. The renin then induces a cascade that results in the production of ANG II. In order to once again lower blood pressure, ANG II increases vasopressin secretion, stimulates thirst, works as a potent vasoconstrictor, increases the sympathetic output of the heart vessels, and increases the proximal tubules Na+ reabsorption.
The Juxtamedullary nephron creates the counter current between the nephron and the blood stream. This counter current aids the osmotic gradient by allowing water to pass from the decending limb of henle to the blood stream.
Osmolarity and electrolyte balence are influenced by ADH and aldosterone.
ADH allows auqaporins to enter the apical membrane of the nephron. These aquaporins generally aid water to move from the ICF into the nephrone lumen. This dilutes the osmolarity of the electolytes in the tubule lumen.
Aldosterone combines with a cytoplasmic receptor and that initiates the transcription of protein channels in the nucleus. These new protein channels now function to increase Na+ reabsorbtion and K+ secretion. This greatly influences the electrolyte concentration in the tubule lumen.
Conditions
Type 2 diabetes mellitus
Diabetes will increase the amount of glucose in her blood thus increasing the amount of glucose that the glomerulus has to filter. These may lead to glucose in the urine.
Excess glucose in the blood can damage kidneys over time. If the kidneys are damaged the blood is not properly filtered and wastes can build up.
Diabetes can effect a persons nerves. A nervous signal that could be interrupted is the one from your bladder telling your brain its full. If urine sits too long in the bladder infections can occur.
High blood pressure
The kidneys require a constant blood pressure in order to filter so high blood pressure does not provide the best situation for proper filtration.
Over time high blood pressure can damage or weaken arteries. The kidneys, like all other organs, rely on their blood supply and pressure. If left untreated there is a threat of kidney failure.
Potential results
Damage
High blood pressure effects the kidneys ability to function because kidneys require a steady pressure. Diabetes can cause an excess of glucose to build up within the kidneys which also effects their ability to function. If the arteries of the kidney and the kidney itself are be degrading then their function will be sub-optimal and they will eventually fail.
glucose in urine
The body is not absorbing all the nutrients the patient is putting into it. Glucose is also harmful for kidneys.
Weight gain
Much of the time a very over weight person will develope both hypertension, from the strain and pressure all the excess weigh puts on their cardiovascular system, and diabetes, from all the wear the pancreas took from having to produce enough insulin to maintain their diet.
Diabetic Kidney Disease
The patients glomerlus can become weakened (possibly from excess glucose or high blood pressure). Because of the weakness of the filter the kidneys now leak more than a small amount of proteins. The excess of proteins in the urine presents as blood in the urine.
Infection
Due to the lack of communication between the brain and the bladder via the nervous system urine could sit in the bladder for too long. In some cases the urine sitting too long can become infected. This infection would be a urinary tract infection. Urinary tract infections can be characterized by blood in urine.
The worst result from any of these possibilities is kidney failure