An elderly female patient with a history of osteoporosis, high blood pressure, and chronic type II diabetes mellitus had blood in her urine, her doctor is now concerned about the effect of high blood pressure on her kidneys and the effect of low kidney function on her compromised bone mass. What explains this? How are blood pressure, kidney function, and bone mass related?

Downstream effects

Upstream causes

Background information

Anatomy of the urinary system

kidneys

bladder

ureters

urethra

Functions of the urinary system

maintains the electrolyte, acid-base, and fluid balances of the blood

major homeostatic organ of the body

manufactures urine

filters the blood

receives urine via ureters and discharges it in the urethra

stores urine

can store up to 1L of urine

tube that transmits urine from the bladder to the exterior of the body

carries urine from the kidneys to bladder

has two, one for each kidney

removes nitrogenous waste from the body

keeps chemicals and water in balance

sphincter muscles

controls the exit of urine

nerves that alert and empty the bladder

regulate blood volume/pressure

regulate blood pH

bean shaped

Nephron

basic unit in the kidney

produces urine

filters the blood

renal corpuscle

glomerulus

glomerular capsule

renal tubule

proximal convoluted tubule

nephron loop

distal convoluted tubule

collecting duct

two types

cortical

juxtamedullary

tangle of capillary loops

blood enters by afferent arterioles

blood exits by efferent arterioles

internal permeable visceral layer

external impermeable parietal layer

capsular space in between

1st region

simple cuboidal epithelium

tubular pole of renal corpuscle

contains descending and ascending limb

simple cuboidal epithelium to simple squamous then back to simple cuboidal epithelium

renal cortex at the end of ascending limb

extends to collecting duct

simple cuboidal epithelium without microvilli

nephron drains here

principal cells

intercalated cells

85% of nephrons

located at renal corpuscle near peripheral cortex

shorter nephron loop

longer nephron loop

renal corpuscles adjacent to corticomedullary junction

Filtration, absorption, and secretion

filtration

takes place in glomerulus

water and solutes filtered from blood plasma

filtrate

separated fluid

absorption

secretion

return of components from tubular fluid to blood within peritubular and vasa recta capillaries

takes place mainly in proximal convoluted tubule

moves by diffusion, osmosis, or active transport

all solutes and more water reabsorbed

solutes move from blood to tubular fluid

by active transport

General info

osteoporosis

DM II

hypertension

porous bone disease

low bone mass

structural deterioration of bone tissue

weak and brittle bones

fractures occur often in the hip, wrist, or spine

not enough insulin

chronic disease

high levels of sugar in the blood

also called adult onset diabetes

also called high blood pressure

force of blood against the artery walls are too high

blood pressure above 140/90

very common

How it relates to kidney function?

What other factors or symptoms should be considered in her case?

osteroporosis

high blood pressure

chronic type II diabetes mellitus

Effects of...

high blood pressure

DM II

osteoporosis

What is causing blood in her urine?

If nothing changes, what will happen to this patient overtime?

How do these separate conditions affect each other?

What further effects can each of these have?

unbalance of calcium and phosphorus if the kidney isn't functioning right

calcium and phosphorus helps build and maintain the bones

cause arteries around kidneys to narrow, weaken, or harden

Urinary Tract Infection

stones in the kidney/bladder

kidney diseases

cancer

kidney disease

low vitamin D levels

body retains more salt/water than it should

reduced glomerular filtration rate

low bone mineral density

kidney damage

damaged arteries not able to deliver blood to kidney tissues

ankle swelling

unable to clean the kidneys properly

weight gain

can lead to kidney failure

blood in the urine

kidneys won't filter the blood anymore

she would need dialysis