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