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An elderly female patient has a history of osteoporosis, chronic type II…
An elderly female patient has a history of osteoporosis, chronic type II 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 low kidney function on her already compromised bone mass. What could be going on that explains all of this? How are blood pressure, kidney function, and bone mass related?
Background
general Functions
2 ureters
carries urine from rrenal pelvis to urinary bladder
bladder
temporary stores and release urine
transitional epithelium change shape and allow bladder to distend
2 sphincter muscles
internal
contracts to prevent leaking
relaxes to void involuntary smooth muscle
external
voluntary skeletal muscle
controlled by somatic motor reflex
external and internal sphincters must relax for bladder to empty into urethra.
urethra
carries urine from the urinary bladder to urinary orifice
2 Kidneys
maintenance of body fluid osmolarity
balance body fluids
regulation of plasma pH
collecting ducts
principal cells
resposive to aldosterone and antidiuretic hormone
maintains body's water and Na+ balance
intercalated discs
regulate pH and blood pH
General anatomy
2 kidneys
Nephron
structural unit of kidney
drains to collecting duct
Collecting duct
principal cells
intercalated cells
2 ureters
urinary bladder
Sphincter muscles
urethra
Structure of a Nephron
Renal corpuscle
glomerulus
glomerular capillaries
Afferent arteriole- blood enters through
efferent arteriole- blood exits through
glomerular capsule
internal permeable visceral layer
overlies glomerular capillaries
external parietal layer
composed of squamous epithelium
cellular space between both layer
receives filtrate
modified to form urine
renal tubule
Proximal convoluted tubule (PCT)
microvilli increases surface area & reabsoption
originates at tubular pole of renal corpuscle
Nephron loop
descending limb
ascending limb
distal convoluted tubule
originates in renal cortex at end of ascending limb
extends to collecting duct
3 phases of renal processes
Filtration
occurs in renal corpuscle level
water and solutes enters capsular space of renal corpuscle due to pressure difference across membrane
water, glucose, amono acids, ions, urea, hormones, vitamins B & C, ketones, small amount of proteins
Reasbsorption
components return from within the tubular lfuid to blood within vasa recta and peritubular capillaries
moves by diffusion, osmosis, or active transport
excess solutes and waste products remaininig in the tubular fluid
hormones reabsorption
aldosterone
increase in Na+ reabsorption
decrease urine production, increase blood volume and pressure
water followed by osmosis
atrial natriuretic peptide
inhibits reabsorption of Na+ in PCT and collecting ducts
inhibits release of aldosterone
more water and Na+ excreted in urine
increase urine production, decreases blood presssure and volume
water reabsorption
65% reabsorbed in PCT
ADH
increase water reabsorption
darker urine color
Potassium reabsorption
60-80% absorbed in tubular fluid
Calcium and Phosphate
PTH regulates excretion of Ca2+
Ca2+ blood levels increased
secretion
solutes move from blood to tubular fluids
through active transport
(Acidic blood) Bicarbonate ions, Hydrogen ions, pH
pH of urine and blood regulated in collecting ducts
synthesized bicarbonate ions reabsorbed into blood
Hydrogen ions secreted into filtrate by type A intercalated discs
high blood pH and low urine pH
(Alkaline blood) Bicarbonate ions, Hydrogen ions, pH
type B intercalalted cells are active
Bicarbonate ions are secreted
Hydrogen ions are reabsorbed
low blood pH & high urine pH
General information on osteoporosis, DM II, and hypertension
Osteoporosis
Bones are porous, brittle and prone to fracture
density and quality of bone are reduced
loss of bone occurs silently and progressively
DM II
has increase risk of osteoporosis related disease
metabolic diseases characterized by hyperglycemia due to defects in insulin secretion and/or action.
long term damage, dysfunction and failure of various organs
reduces bone strength
Hypertension
in Arterial hypertension, high rate of bone loss
increased excretion Calcium in urine
raised level of PTH
Upstream causes
Osteoporosis
abnormalities of calcium, phosphorus, parathyroid hormone or vitamin D metabolism
kidneys play an important role in maintaining healthy bone mass and structure by balancing phosphorus and calcium levels in the blood
Calcitriol helps the kidneys maintain blood calcium levels and promotes the formation of bone.
Chronic type II Diabetes mellitus
body cannot use the produced insulin properly
In DM II, the high sugar levels in the blood can cause the vessel of kidneys to become narrow and clogged
Albumin is passed through the filtering unit of kidney and goes to the urine
HIgh blood Pressure
When the force of blood against
the walls of blood vessels as the heart pumps blood around the body is high it is high blood pressure
leading cause of chronic kidney disease
high blood pressure damages blood vessels throughout body
kidneys stop removing wastes and extra fluid from blood. This extra fluid in the blood vessels build up and raise blood pressure even more.
diseased kidney are unable to maintain the blood pressure
Other factors
Age
eleder female
Blood in urine
low kidney functions
Downstream causes
effects of high blood pressure on kidneys
high blood pressure can cause arteries around the kidneys to narrow, weaken & harden
amaged arteries cannot deliver enough blood to the kidney tissue.
nephrons do not receive the essential oxygen and nutrients
effects of DM II on kidneys?
Hyperglycemia damages the heart, kidney, nerves, blood vessels
albumin passes through filters into the urine
damages the nerves, as a result when the bladder is full the nerves dosent send signals to the brain. The pressure in bladder damages te kidneys
urine storing in urinary tract leads to urinary tract infections because the bacterias grows fast as a result of high sugar level in the urine and leads to an infectio.
effects of osteoporosis on kidneys
imbalance in phosphorous and calcium levels
causes mineral and bone disorder
Hematuria
cause of blood in urine
due to infections, kidney disease, cancer, and rare blood disorders
if not treated properly, the kidney will be damaged totally and dialysis will be required and eventually the kidneys wont be functioning well.