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Renal & Endocrine system - Coggle Diagram

- - - - Urine contains metabolic waste products including nitrogenous compounds; urea and uric acid, excess irons and sometimes excreted drugs.
      - Kidney functions
        
        Regulation of blood volume and composition- by excretion of water, nitrogenous waste products (urea from protein, uric acid from nucleic acids, creatinine from muscle creatine and haemoglobin breakdown products), some bacterial toxins, inorganic salts (electrolytes) and helps control blood pH.
        
        Removal of toxins, metabolic waste and excess ions through the formation and excretion of urine.
        
        Contribute to metabolism
        
        Production and secretion of erythropoietin (hormone that stimulates formation of red blood cells)
        
        Performing gluconeogenesis (synthesis of new glucose molecules) during episodes of fasting or starvation
        
        Participates in the conversion of vitamin D to the active form and calcium balance
        
        Production and secretion of renin (enzyme in the long term control of blood pressure)
      - Kidney Structure
        
        Outer fibrous capsule which surrounds the kidney
        
        Cortex, reddish, brown layer of tissue immediately below the capsule and surrounding the renal pyramids
        
        The medulla, innermost layer which consists of pale conical-shaped, striated structures, the renal pyramids
        
        Each pyramid has a renal papilla
    - - Urine is excreted by the process of micturation
- - - - Progesterone
        
        The mother provides precursors for placental progesterone production
        
        Placental progesterone is used for fetal synthesis of testosterone, corticosteroids and mineralocorticoids
        
        Stimulates respiration, relaxes smooth muscle (of blood vessels, uterus and gut), increases body temperature, increases sodium and chloride excretion, and acts as an immunosuppressant in the placenta
        
        Progesterone levels increase gradually at first - placenta becomes the main site of steroid hormone synthesis and is capable of producing enough progesterone to support the pregnancy by 5–6 weeks.
        
        Production of 17α-hydroxyprogesterone, by the corpus luteum, normally plateaus or decreases between 6 and 9 weeks as placental production of progesterone increases.
        
        By the end of the first trimester, levels of progesterone are 50% higher than luteal levels and by term, the levels have increased threefold to about 200 mg/day.
      - Oestrogens
        
        The fetus is the source of some of the precursors for the production of placental oestrogens
- - - - The hormone Thyroxine crosses the placenta in small quantities to maintain normal fetal thyroid function.
      - This is essential for the normal development of the fetal nervous sytstem. (Cunningham et al. 2018)
      - Production of thyroid hormone by the mother increases during the first half of pregnancy, plateauing at around 20 weeks.
        Thyroid disfunction is the second most common endocrine disorder in pregnant women
    - - Four main disorders of the thyroid
        
        Hypothyroidism
        
        Complications in pregnancy
        
        Maternal
        
        Anaemia
        
        Cardiac dysfunction
        
        Pre-eclampsia
        
        Placental abruption
        
        Fetus
        
        Miscarriage (1:5)
        
        Prematurity / low birth weight
        
        Congenital malformations
        
        Perinatal death
        
        Still birth
        
        Neuro developmental delay
        
        Congenital hypothyroidism
        
        Hyperthyroidism
        
        Complications in pregnancy
        
        Maternal
        
        Pre-eclampsia
        
        Hyperthyroid storm (fever, anxiety, profuse sweating, weightloss, fatigue etc.)
        
        Fetus
        
        Intra-uterine growth restrictions
        
        Still birth
        
        Pre-term birth
        
        Iodine deficiency
        
        Postpartum thyroiditis
  - - - The main role of oestrogens in pregnancy is to stimulate uterine growth and increase blood flow.
      - By the 7th week of pregnancy, more than half of the oestrogen entering the maternal circulation is produced by the placenta.
      - This stops promptly after the birth of the placenta (Cunningham et al. 2018)
      - Oestrogen, progesterone, placental lactogen, prolactin, cortisol and insulin, appear to all have a role to play and work together to stimulate the growth and development of milk-secreting cells (Marshall & Rayner, 2020)
    - - Progesterone is essential for the establishment and maintenance of pregnancy; it does this by promoting myometrial relaxation, cervical closure and decidual quiescence.
      - Progesterone is mainly derived from the corpus luteum in the first weeks of pregnancy, but as the placental size increases, it takes over production (Burton et al. 2017).
      - As progesterone is withdrawn it is targeted to the cells of the myometrium, cervical and decidua, this signals the myometrium to begin contracting, cervical softening and dilatation, initiating the birth processes.
- - - - Developing high blood pressure.
      - Developing pre-eclampsia. CKD increases the risk of pre-eclampsia.
      - Worsening of kidney function. In general the better your kidney function at the start of the pregnancy, the less likely it is to get worse later.
    - - Fetal growth restriction
      - Pre term delivery
      - Perinatal death
- - - - Bacteria in urinary tract from bowel (personal hygiene)
      - 105 /ml of same bacterial species in an MSU in absence of symptoms - asymptomatic bacteriuria (ABU)
    - - Developed by ≥ 30% of women with ABU
      - Can lead to Acute Pyelonephritis - inflammation of the kidney tissue, calyces and renal pelvis.
        
        More serious condition
        
        If severe or inadequately treated, septicaemia may result in acute renal failure, multiple organ failure and death
        
        Repeated episodes may result in development of renal scars
      - Pre-term labour
      - Untreated infection may cause kidney damage