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An elderly female patient with a history of osteoporosis, chronic type 2…
An elderly female patient with a history of osteoporosis, chronic type 2 diabetes mellitus, and high blood pressure. She has come to the doctor today because she has noticed blood in her urine. Her doctor is now primarily concerned about the effect of high blood pressure on her kidneys and the effect of how low kidney function on her already compromised bone mass. What could be going on to explain all of this? How are blood pressure, kidney function and bone mass related?
Upstream Causes:
I can only assume the fact that she has dm 2, all the access glucose in her system is constantly wreaking havoc on her kidneys, her glomerulus in particular, which is in turn causing the blood in her urine. Her filter has stopped working.
Her high blood pressure is just accelerating all of her symptoms and making the whole situation worse. More pressure means more stress on the renal system.
In patients with kidney disease and osteoporosis, there is a possibility to develop secondary hyperthyroidism due to the phosphorus accumulation circulating in the plasma. This could lead to a risk of cardiovascular disease and bone fractures.
Background Info:
Structure of the nephron
Efferent arteriole
Renal Tubule
Descending limb
Proximal convoluted tubule
Ascending limb
Distal convoluted tubule
Tubular Pole
Cortex
Vascular Pole
Medulla
Renal Capsule
Visceral layer
Parietal layer
Glomerular Capsule
Capsular Space
Glomerulus
Collecting Duct
Afferent arteriole
General functions of the urinary system
Put simply the urinary system is also known as the renal system or urinary tract. Some of the anatomy consists of the kidneys, ureters, bladder and urethra.
The purpose of this system is to eliminate wastes from the body, regulate blood volume, blood pressure, control levels of electrolytes and metabolites and lastly regulate blood pH.
The filtration, re-absorption, and secretion of specific molecules in specific areas of the nephron
Tubular reabsorption (mainly water)
The movement of substances from the tubular fluid back into the blood.
Excretion of glucose in urine and reabsorption of glucose
Tubular secretion
The movement of substances from the blood into the tubular fluid
Glomerular filtration (filtrate)
The movement of substances from the blood within the gloerulus into the capsular space
Sugar, amino acids, ions, urea, many hormones, vitamins b and c, and very small amounts of protein get filtered. Platelets, most proteins do not get filtered.
General anatomy of the urinary system
Collecting Duct
Papillary duct
Collecting tubules
Minor calyx
Distal convoluted tubule
Major calyx
Ascending limb of nephron loop
Renal Pelvis
Descending limb of nephron loop
Ureter
Proximal Convoluted tubule
Urinary bladder
Capsular Space
Urethra
Urine leaves body
General information on osteoporosis, DM 2 and hypertension
DM2 is where the blood sugar is so high that the body cannot absorb all of glucose, so some is lost to the urine. (Glycosuria)
Hypertension is described as simple as high blood pressure over long periods of time. This can have drastic effects on the heart and circulatory system, causing early heart failure, heart attack, stroke and eventually death.
Osteoporosis occurs with old age and under use of bones. The body is constantly removing and adding calcium to and from the bones. At elder ages we cannot deposit as much calcium as we used to resulting in weak, brittle, porous bones susceptible to easy fractures.
Downstream Effects:
If none of her conditions gets better, only pain and death await.
Osteoporosis causes her to be lazy, which makes her dm 2 worse as she cant strengthen her body and burn glucose, which makes her kidneys worse.
We should not be loosing calcium and bone mass to our urine but osteoporosis could damage her kidney tissue due to the size.
Her glomerulus is letting platelets and protein into the nephron and surrounding tissue causing the bloody urine
DM2 damages the small blood vessels in the kidneys, causing the kidneys to not be able to clean the blood properly. Resulting in the retention of water and salts.
If her condition stays the same she will die. Her bodies filter is failing her..
High blood pressure causes arteries around the kidneys to weaken or narrow, even harden. These arteries are too damaged to deliver blood to the kidneys.