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An elderly female patient has a history of osteoporosis, chronic type II…

- - - - microscopic functional filtration unit of kidney
    - - composed of glomerulus and glomerular capsule
        
        Glomerulus
        
        tangle of capillary loops, glomerural capsule
        
        Glomerular capsule
        
        has internal permeable visceral layer
        
        external impermeable parietal layer
        
        capsular space between two layers
    - - remaining portion of nephron of three continuous parts
        
        Proximal convoluted tubule (PCT)
        
        first region of renal tubule
        
        Nephron loop
        
        contains descending limb and ascending limb
        
        Distal convoluted tubule (DCT)
        
        originates in renal cortex at the end of ascending limb
    - - each nephron drains into collecting ducts
    - - Principal cells
        
        responsive to hormone aldosterone and anti-diuretic hormone
        
        responsible for maintaining body's water and Na+ balance
      - Intercalated cells
        
        Types 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 loop just penetrating medulla
        
        bulk residing within cortex
      - Juxtamedullary nephrons
        
        renal corpuscles adjacent to corticomedullary junction
        
        long nephron loops extending deep into medulla
        
        play important role in kidneys' ability produce concentrated urine
  - - - Glomerulus
      - Glomerular capsule
      - Visceral layer
      - Parietal layer
      - Capsular space
    - - Proximal convoluted tubule
      - Distal convoluted tubule Nephron loop
      - Descending Limb
      - Ascending Limb
  - - - Filtration - in glomerular capillaries
        
        Some water and solutes entering capsular space of renal corpuscle
        
        Separated fluid termed filtrate
      - Tubular re-absorption- return of components from within tubular fluid to blood within peritubular capillaries
        
        Move by diffusion, osmosis, or active transport
        
        all vital solutes and most water reabsorbed
        
        excess solutes, waste products, some water remaining in tubular fluid
      - Tubular secretion- movement of solutes from blood to tubular fluid
        
        usually by active transport
        
        materials moved selectively into tubules to be excreted
    - - categories of substances in blood
        
        freely filtered
        
        small substances
        
        water, glucose, amino acids, ions
        
        can pass easily through filtration membrane
        
        not filtered
        
        formed elements and most proteins
        
        cannot pass through filtration membrane
    - - nutrient re-absorption
        
        some substances 100% reabsorbed
        
        two major classes: nutrients and filtered plasma protiens
        
        Nutrients normally completely reabsorbed in PCT
      - Transport of protien
        
        most not freely filtered
    - - sodium resbsorption
        
        majority reabsorberd in PCT
        
        Reabsorption regulated by hormones near end of tubule
        
        Aldosterone- steroid hormone produced by adrenal cortex
        
        Atrial natriuretic peptide- hormone released from cardiac muscle cells
      - Water reabsorption
        
        180 L filtered daily, all but 1.5 L reabsorbed
        
        65% reabsorbed in PCT
        
        Nephron loop = only 10% of filtered water reabsorbed
        
        DCT and collecting ducts = controlled by aldosterone and ADH
      - Movement of potassium
        
        60% to 80% reabsorbed in tubular fluid
        
        net secretion or reabsorption in collecting ducts
      - Calcium and phosphate balance
        
        parathyroid hormone regulates excretion of Ca2+
      - Bicarbonate ions, hydrogen ions, and pH
        
        if blood in acidic state
        
        pH of urine and blood regualted in collecting ducts
        
        if blood in alkaline state
- - - - Moving calcium from inside the bones into the blood
  - - - Over time, this can damage your kidneys, and waste and fluids build up in your blood instead of leaving your body
  - - - making removal of waste from the body difficult
- - - - the damaged arteries are not able to deliver enough blood to the kidney tissues
  - - - body will retain more water and salt than it should, which will result in weight gain and ankle swelling
  - - - the kidneys
        
        stop activating calcitriol. the low levels of calcitriol in the body create an imbalance of calcium in the blood
        
        do not remove the phosphorus in the blood properly, so phosphorus levels rise in the blood. the extra phosphorus pulls calcium out of the bones, causing them to weaken
  - - - Urinary tract infections occur when bacteria enter your body through the urethra and multiply in the bladder