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An elderly female patient has blood in her urine. She has a history fo…

- - - - Ducts project medially toward renal papilla.
        
        Ducts fuse together and deliver urine into minor calyces via papillae of medullary pyramids.
    - - Principal cells
        
        Responsive to hormones aldosterone and antidiuretic hormone.
        
        Responsible for maintaining body's water and Na balance.
      - Intercalated cells (A and B)
        
        Both specialized epithelial cells.
        
        Help regulate urine pH and blood pH.
  - - - cortical nephrons: oriented with renal corpuscle near peripheral cortex
        
        Have short nephron loops just penetrating medulla.
        
        Bulk resides within the cortex.
        
        This is 85% of nephron.
      - Juxtamedullary nephrons
        
        Renal corpuscle adjacent to cortiocomedullary junction.
        
        Long nephron loops extend deep into medulla.
        
        Play important role in kidney's ability to produce concentrated urine.
  - - - Moves across wall of glomerular capillaries and into capsular space.
  - - - Then enters collecting duct.
  - - - Flows from minor calyx, to major calyx, to renal pelvis too ureter.
        
        Ureter connects to urinary bladder.
        
        Stored and excreted from body through urethra.
  - - - About every 10-15 seconds small amounts of urine are emptied into the bladder from ureter.
  - - - The bladder walls relax and expand to store urine. They contract to expel urine.
        
        Two sphincter muscles: circular muscles keep urine from leaking
        
        They act like a rubber band around opening of bladder.
  - - - At same time the brain signals sphincter muscles to relax to let urine out.
- - - - All of corpuscle and most of tubule resides in cortex.
        
        Renal Corpuscle: composed of glomerulus and glomerular capsule
        
        Glomerulus: tangle of capillary loops and glomerular capillaries
        
        Blood entering by afferent arteriole.
        
        Blood exits by efferent arteriole.
        
        Renal Capsule
        
        Has internal permeable visceral layer: directly overlies glomerular capillaries
        
        External impermeable parietal layer: composed of simple squamous epithelium
        
        Capsular space between two layers: receives filtrate which is modified to form urine
        
        Renal Tubule: remaining portion of nephron and has 3 continuous parts
        
        Proximal Convoluted Tubule: first region of renal tubule
        
        Originates at tubular pole of renal corpuscle.
        
        Lined by simple cuboidal epithelium.
        
        Has microvilli that increase surface area and reabsorption activity.
        
        Nephron Loop: contains descending and ascending limbs
        
        Connects at " hairpin turn" within the medulla.
        
        Lining changes from simple cuboidal epithelium to simple squamous, then goes back to simple cuboidal.
        
        Distal Convoluted Tubule
        
        Originates in renal cortex of ascending limb.
        
        Extends to collecting duct.
        
        Lined by simple cuboidal epithelium without microvilli.
- - - - This happens due to pressure differences across filtration membrane.
        
        Separated fluid termed filtrate.
        
        Filtrate: filtered plasma with certain solutes and minimal amounts of proteins.
        
        Caught within capsular space and fueled into proximal convoluted tubule.
        
        Blood components exiting renal corpuscle through efferent arteriole.
        
        Categories of substances in blood:
        
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  - - - Some substances reabsorbed from tubular fluid back into blood.
        
        Some substances not originally filtered in glomerulus become components of urine through tubular secretion.
    - - Maximum rate of movement across tubule epithelium in the given time.
        
        Depends on number of proteins in membrane.
        
        Transport maximum for glucose is 320mg/min.
    - - Some substances are 100% reabsorbed.
        
        Two major classes: nutrients and filtered plasma proteins
        
        Nutrients normally completely reabsorbed in PCT. Each nutrient with it's own specific transport proteins.
        
        Transport protein: most not freely filtered due to size and charge
        
        Reabsorbed from tubular fluid in PCT back into blood.
    - - Reabsorption regulated by hormone near end of tubule
        
        Aldosterone: steroid produced by adrenal cortex
        
        Increase in Na absorption.
        
        Water following by osmosis is also reabsorbed.
        
        Decrease in urine production, increasing blood volume and pressure.
        
        Atrial natriuretic peptide: hormone released from cardiac muscle cells
        
        Inhibits reabsorption of Na in PCT collecting ducts.
        
        Inhibits release of aldosterone.
        
        More Na excreted in urine.
        
        Increase in urine production, decrease in blood volume and pressure.
    - - 65% reabsorbed in PCT. Aquaporins here are constant (obligatory water reabsorption)
        
        DCT and collecting ducts are controlled by aldosterone and ADH.
        
        Aldosterone increases Na/K pumps and Na channels.
        
        Increasing water reabsorption.
        
        Aquaporins regulated by ADH near end of tubule (facultative water reabsorption)
        
        Antidiuretic hormone: increases water reabsorption
        
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    - - Net secretion or reabsorption in collecting ducts
        
        Principal cells secreting K at varying rates
        
        Based on aldosterone level which stimulates principal cells to secrete K.
        
        Most powerful stimulant for aldosterone: elevated K levels
    - - Parathyroid hormone regulates excretion of calcium.
        
        Stimulates calcium reabsorption in DCT
        
        Calcium blood levels increase
    - - pH of urine and blood regulated in collecting ducts
        
        If blood is in acidic state
        
        Synthesized HCO reabsorbed into blood
        
        Hydrogen scented into filtrate by type A intercalated cells.
        
        Increase in blood pH and decrease in urine pH.
        
        If blood is in alkaline state
        
        Type B intercalated cells active
        
        Secrete HCO and reabsorb H
        
        Lower blood pH and increase in urine pH.
  - - - All vital solutes and most water reabsorbed
        
        Excess solutes, waste products and some water remain in tubular fluid
  - - - Materials moved selectively into tubules.
- - - - As we age some of our bone cells begin to dissolve the bone matrix (resorption)
        
        New bone cell deposits osteoid (formation). This process is called remodeling.
        
        Symptoms include back pain cause by a fracture or collapsed vertebra.
        
        Other symptoms include loss of height over time, stooped posture and nones break more easily than expected.
  - - - Your body could also not produce enough insulin to maintain normal glucose levels.
        
        This is called insulin resistance and results in glucose building up in the blood.
        
        Symptoms include excessive urination, thirst and hunger
        
        Other symptoms include weight loss and increased susceptibility to infections (yeast/ fungal).
  - - - Pressure depends on resistance of blood vessels and how hard the heart has to work.
        
        High blood pressure is a common condition in which long term force of blood against your artery walls is high enough that it may cause health problems.
        
        The more blood your heart pumps and the narrower your arteries the higher your blood pressure.
        
        You can have hypertension for years without any symptoms.
        
        Even without symptoms, damage to blood vessels and your heart continues and can be detected.
        
        Some people have symptoms that include headaches, shortness of breath or nosebleeds.
- - - - The urinary system keeps everything in balance by removing waste like urea, extra salt and extra water.
  - - - Make erythropoietin, a hormone which helps make red blood cells
        
        Make vitamin D active and regulate blood pressure
        
        The kidneys remove waste from blood through tiny filtering units called nephron.
        
        Ureter: urine passes from renal tube through ureter and into bladder
        
        Bladder: very flexible and us used as storage until the urine is allowed to pass through urethra and out of body
        
        When you urinate stretch receptors in the bladder re activated which sends signals to our brain and tells us that the bladder is full.
        
        Muscle fibers around the opening of urethra from a ring like muscle that controls passage of urine.
        
        Nervous control of the bladder involves centers located in brain and spinal cord.
        
        The ring like muscles relax and detrusor muscle contracts allowing urine to flow
        
        Urethra: female and male are very similar except for the length.
        
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- - - - Diabetic kidney disease: raised blood glucose levels cause glomeruli proteins to link together triggering scarring process. As condition worsens the kidneys become less able to filter blood.