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Elderly female patient, with osteoporosis, type II diabetes, and high…

- - - - increase Ca2+ reabsorption in DCT
      - increased activity of osteoclast
        
        calcium taken out of bones
        
        loss in bone density
        
        bone becomes brittle
        
        increases blood calcium levels
- - - - microscopic functional filtration unit of kidney
      - consists of renal corpuscle and renal tubule
        
        renal corpuscle
        
        glomerulus
        
        tangle of capillary loops
        
        blood enters through afferent arteriole
        
        exits by efferent arteriole
        
        glomerular capsule
        
        visceral layer (internal)
        
        permeable
        
        parietal layer (external)
        
        impermeable
        
        capsular space between two layers
        
        1 more item...
        
        renal tubule
        
        proximal convoluted tubule (PCT)
        
        first region of renal tubule
        
        has microvilli that increases surface area and reabsorption capacity
        
        nephron loop (loop of Henle)
        
        contains descending limb and ascending limb
        
        second region of tubule
        
        located within the renal medulla
        
        distal convoluted tubule (DCT)
        
        third region of renal tubule
        
        originates in renal cortex at the end of ascending limb
        
        extends to collecting ducts
      - two types of nephrons
        
        cortical nephrons (85%)
        
        renal corpuscles near peripheral cortex
        
        have shorter nephron loop just penetrating renal medulla
        
        bulk resides within renal cortex
        
        juxtamedullary nephrons (15%)
        
        renal corpuscles adjacent to corticomedullary junction
        
        long nephron loops extending deep into renal medulla
        
        produces concentrated urine
        
        water conservation tactic
    - - each nephron drains into collecting ducts
        
        ducts fuse together and deliver urine into minor calyxes
      - specialized cells
        
        principal cells
        
        responsive to aldosterones and antidiuretic hormones
        
        maintains body's water and Na+ balance
        
        intercalated cells (type A and B)
        
        help regulate urine pH and blood pH
    - - renal cortex
        
        outer layer of kidney
        
        contains glomerulus and convoluted tubules
      - renal medulla
        
        inner layer of kidney
        
        contains nephron loop
  - - - ureter
        
        urinary bladder
        
        urethra
        
        store urine
        
        connected from renal pelvis of kidneys
    - - tubular fluid
        
        urine
        
        tubular fluid renamed to urine once it leaves collecting duct
        
        enters papillary duct and flows from minor calyx, to major calyx, to renal pelvis to ureter
        
        filtrate renamed to tubular fluid in PCT
        
        flows through PCT, nephron loop, DCT and to collecting duct
      - water and solutes filtered in glomerulus from blood
        
        moves across glomerular capillaries and into capsular space to form filtrate
- - - - return of components from tubular fluid to blood
        
        move by diffusion, osmosis, or active transport
      - vital solute and most water reabsorbed
    - - movement of solutes from blood to tubular fluids
        
        usually by active transport
    - - due to pressure differences in filtration membrane, some water and solutes enter capsular space
      - freely filtered
        
        only small substances can easily pass through filtration membrane
        
        water, glucose, amino acids, ions
        
        not filtered
        
        formed elements and most proteins cannot pass through filtration because they are too large
  - - - some nutrients are reabsorbed 100%
      - normally completely reabsorbed in PCT
    - - most are not freely filtered due to size
        
        some small and medium-sized proteins are reabsorbed in the PCT
    - - majority of the sodium are reabsorbed in PCT
      - aldosterone (steroid hormone from adrenal cortex)
        
        increase Na+ reabsorption
        
        water follows and are reabsorbed also
        
        decreases urine production, while increasing blood volume and pressure
      - Atrial natriuretic peptide (hormone from cardiac muscle cells)
        
        inhibits reabsorption of Na+ in PCT and collecting ducts
        
        inhibits aldosterone release
        
        more Na+ and water excretion in urine
        
        increases urine production, while decreasing blood volume and pressure
    - - about 178.5L of water reabsorbed daily
        
        65% reabsorbed in PCT
        
        10% reabsorbed in nephron loop
        
        aldosterone and ADH levels control water reabsorption in DCT and collecting ducts
      - aquaporins (obligatory water reabsorption)
        
        located in PCT and DCT
        
        regulated by antidiuretic hormone (ADH) near end of tubule
        
        ADH increases water reabsorption
        
        smaller volume of more concentrated urine
      - aldosterone increases Na+ reabsorption thus increases water reabsorption
    - - 60% to 80% reabsorbed in tubular fluid
      - principal cells secrete K+ at varying rates
        
        aldosterone stimulates principal cells to secrete K+
        
        elevated K+ stimulates aldosterone
    - - parathyroid hormone regulate excretion of Ca2+
        
        stimulates Ca2+ reabsorption in DCT
        
        Ca2+ blood levels increased
    - - pH of urine and blood regulated in collecting ducts
        
        if blood is acidic
        
        synthesized HCO3- reabsorbed
        
        H+ secreted into filtrate by type A intercalated cells
        
        increase blood pH and decrease urine pH
        
        if blood is alkaline
        
        type B intercalated cells active
        
        secrete HCO3- and reabsorbs H+
        
        lowers blood pH and increases urine pH
  - - - depends on number of transport proteins in membrane
    - - transport maximum of glucose reabsorption 320 mg/min
        
        less than 320 mg/min glucose in tubule, all reabsorbed
        
        greater than 320 mg/min glucose in tubule, excess glucose excreted in urine
- - - - glucose cannot enter cells to be used as fuel
        
        high levels of glucose in blood
        
        glucosuria
        
        can lead to kidney failure
      - insulin allows glucose to enter cells and lower blood glucose levels
  - - - bone becomes brittle
    - - secretion of parathyroid hormone
        
        calcium reabsorption in kidney to prevent loss of calcium
        
        osteoclasts breaks down bone density to raise blood calcium
  - - - can potentially damage blood vessels and organs
        
        blood puts pressure against artery walls and damage it
        
        can damage glomerulus
- - - - once destroyed will not function again
  - - - large stones obstructed in kidney, renal pelvis, or ureter
    - - inadequate fluid intake, reduced urinary flow
      - frequent urinary tract infections
      - abnormal chemical or mineral levels in urine
- - - - water pulled into tubular fluids
        
        more urination
        
        dehydration
        
        secretion of ADH and aldosterones
        
        reduced urinary flow (if little fluid intake)
        
        renal calculi
        
        1 more item...
        
        ADH
        
        increases water reabsorption
        
        aldosterone
        
        reabsorption of Na+
        
        1 more item...
    - - diminished renal functions
        
        treatment of dialysis or kidney transplant
- - - - filtration not functioning properly
        
        large substances flow past filtration membrane
        
        large proteins and formed elements also in urine
        
        blood in urine
        
        high blood pressure most likely the cause of the blood in her urine
  - - - inhibits aldosterone
        
        increase in urine production
        
        decrease blood volume and pressure
- - - - excess glucose excreted in urine
        
        glucosuria
        
        water follows glucose
        
        more urine volume
        
        damages kidneys
- - - - blood in urine
        
        renal failure
- - - - raise blood calcium