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Kidneys recieve 20% of bld from heart
Nephron composed of 1.Renal Corpuscle-Glomerulus, Bowmans capsule.2.Renal tubule-proximal,loop of henle,distal,collecting
Hilum area that the artery/veins,nerves,lymphatic vessels,and ureter pass through tto enter the kidney
Renal cortex outer region
Renal Medulla inner region
Papilla project into hollow space of the renal pelvis
urine forms in cortical and medullary tissue
urine leaves kidney though renal pelvis and ureter
Nephron physiology 1.maintains bld volume,2,retains glucose.2.excretes waste (urea).3.controlling arterial B/P by renin release.4.regulates RBC development-erythropoietin release
urinine production 1.glomerular filtration2.reabsorption,3,secretion
Filtration pressure 60 mm/Hg
GFR 180L/day (125 cc/min)1-2L urine/day
Proximal tubules lined with microvilli,contains protein pumps/mitochondria-reabsorbs H2o, and solutes.65% is reabsorbed(H2o,Na++,K+,glucose,urea,HCO3)
Descending loop pf Henle contain no microvilli-primarily reabsorbs (H2o,Na++/Cl-,HCP3)
Ascending loop and beginning distal tubule protein pumps and mitochondria-allow for absorbption of Na+/Cl-
Distal/collecting tubules baroreceptors monitor osmolarity of filtrate-absorb(H2O,Na++,HCO3)-secrete -low osmolarity(urea,K+,H+,some drugs)
Late distal tubules respond to hormones-aldosterone/ADH,monitor acid base balance of fluid
Angiotenson II formed by release of renin,stimulates release of aldosterone,(target tissue)distal tubule/collecting duct,Effects-increased reabsorption of Na+,Cl,H20
Aldosterone secreted by adrenal gland-target tissue(distal tubule/collecting duct-effetcs:reabsorbs,Na,Cl,H2o,SECRETES K+, and H+
ADH secreted from posterior pituitary-distal and collecting-effects:increased reabsorption of water
(ANF) atrial natiuretic factor secreted by Rt atrium when pressure in the atria increases-target tissue-distal /collecting,Effects:ADH secretion is inhibited, decreased reabsorption of Na and CL,urine is released
SNS stimulation catecholamines released,=vasoconstriction and decreased renal bld flow
Reabsorption /secretion occur by SIMPLE DIFFUSION(high to low) and OSMOSIS (moves towards highest osmolarity,FACILITATED DIFFUSION 9high-low),ACTIVE TRANSPORT (low -high)
Glucose is almost completely reabsorbed in the proximal tubule-maintained until 180mg/dL-Type 1DM(so much sugar enters,reabsorption becomes inefficient=osmotic diuresis
Urea 1/2 is filtered in glomerulus,reabsorbed in proximal,contributes to osmotic gradient in medulla-necessary for concentration/dilution of urine-1/2 secreted in distal tubule-byproduct of protein metabolism- (urea not excreted becomes ammonia)
BUN test checks blood urea nitrogen-normal BUN=8-21 mg/dl
Creatine waste product of metabolism within muscle cells-normal level=0.6-1.2 mg/dL, larger than urea so its not reabsorbed
Direct indicator of GFR blood level of creatine and urea
Renin angiotensin system renin released from kidneys due to low pressure-acts on angiotensin-produces angiotensinI.then converted in lungs to angio II by ACE-takes 20 mins
ACE-Angiotensin converting enzyme found in lumen of most vessels and high in the lungs-converts angio I to Angio II
Angiotensin II potent vasoconstrictor-stimulates production of aldosterone=kidneys reabsorb Na+=intravascular volume is maintained
Erythropoietin released in kidneys-causes increase in production/maturation of RBC in bone marrow of Vertebra,proximal long bons,pelvis,ribs and sternum
Bladder contains 350-500cc
Micturition voiding
Visceral pain inflammation,distention,ischemia-transmits pain signals from veseral afferent nerve fibers back to spinal cord-DIFFUSE,DULL or CRAMPY,tachu,n/v, diaphoresis
Reffered pain pain originates in a region other then where it is felt
Acute Renal Failure (ARF) a sudden decrease in filtration through the glomeruli-urine output <400-500cc/day (oliguria)
1.Prerenal ARF insufficient bld supply to kidney 40-80%or ARf,reversible.if GFR not maintained=metabolic acidosis(H+ retained),Hyperkalemia occurs (K+ retained)-GFR decreases, nephron tubular cells become ischemic-causes by :Organ problems that originate prior to kidney
Prerenal causes hypovolemia,hemmorrage,dehydration, burns,cardiac failure,shock, sepsis
Renal ARF caused by problems that originate inside the kidney-small vesse/glom damage,tubular cell/interstitial damage-often immune mediated,Type 1DM,systemic lupus,
Post Renal ARF Caused by organ problems on back side of kidneys-obstruction of both ureters,bladder,urethra(rapid edema,retention of K+, acidosis)
Renal ARF steps 1.injury to small vessels/golom injury.2.tubular cell death 3.Interstitial nephritis-(antibiotics,nsaids,diureticshigh BP drugs)
S/S increased WBC,proteinuria,glycosuria,abd distention,HYPOTENSION
BUN to Creatine ratio >20=prerenal or post renal problems, <20=renal problems
Too much ammonia s/s urine smell to breath,pyuria,hematuria,glycosuria,n/v,pruitis,rash,diarrhea,confusion,drowsy,convulsions, coma
Chronic Renal failure progressive, irreversible systemic dx-instability noticed when 80% of nephrons are dead-dialysis or transplant needed-requires dialysis every 2-3 days-most cases caused by systemic diseases,HYPOTENSION,HEPERKALEMIA,QT PROLONGATION
CRF causes HTN,DM,atherosclerosis,glomerulonephritis,lupus,nephrotoxins,infections-most damade affects the glomeruli
Outcomes of CRF cant maintain fluid balance,isothuria,stress on CV system,dysrhythmias,acidosis,decreased vit D procution,Ca++ absorbed by bone,hypocalcemia(prolonged S-Tseg)n prolonged QT-norm is 0.33-0.42 sec,control of BP disrupted,erythropoietein is not produced
S/S HTN,edema,fatigue,pasty yellow skin,thin extremities,Uremic frost (late sign),anemia
Dialysis works like osmosis and equalizes osmolarity across a semipermeable membrane-3-5hr, 3x a wk-flows into dialysate, it cleans it and is returned back to pt
Hemodyalisis complications 1.bleeding from puncture site,lacal infection,narrowing or closing of internal fistula
Peritoneal Dialysis uses peritoneal membrane,dialysate is put in peritoneal cavity, absorbs toxins and then returns out-takes 10-12 hrs-reduces risk of fluid and elctrolyte shifts
Renal Calculi (nephrolithiasis) crystal aggregation in kidneys collecting system,>men,hereditary.Causes=immobilization,meds,dehydration,cns disorders,gout,hyperparathyroidism-made of calcium oxalate and calcium phosohate
Lithrotripsy sound waves break large stones
Struvite stones Ca/ammonium/phos,triphosphate-associated with UTI's,bladder caths
Uric acid stones not common,common in men,runs in families,1/2 have gout
Cystine stones least common (sulfur containing amino acid) due to cystine in filtrate/hereditary
s/s vague,visceral flank pain.within 30-60 mins becomes extremely sharp-radiates to lower quadrants,migrating pain means it has moved to lowest 3rd of ureter
UTI's affects urethra,bladder,kidney,prostate gland-caused by bacteris,viruses and fungi-Bld(hematogenous infection)not common,Urethra (ascending infection)most common-lower UTI's most common
Urethritis >males,symptom of gonnorhea,herpes or chlamydia,associated with cystisis,
Prostitis inflammation secondary to bacterial infection, bowel bacteria are involved,usualy due to catherizations
Pyelonephritis (upper GI) spread towards kidneys,effects 1 or both,Infllammation of the kidney, more common in women,abcess may develop
Intrarenal abcesses form within renal parenchyma-
Epididymitis bacterial infection->sexually active men>20yrs,related to venereal dx-S/S-gradual onset,unilateral scrotal pain,swollen scrotum n testes.TX:elevate scrotum
Testicular Torsion True emergency,testicle twists on spermatic cord,disrupts bld flow.
Nephron structural and functional unit if te kidney
Micturion reflex produces the urge to void
Hemasite small, button-shaped device with a rubber septum that can be punctured with a dialysis needle
Diuril would MOST likely be prescribed to a patient with: congestive heart failure
When triggered by changes in the blood pressure, the juxtaglomerular cells release: renin.
When the solute concentration of the blood increases antidiuretic hormone is released into the bloodstream
The glomerular filtration rate is MOST accurately defined as the: amount of filtrate produced by the kidneys per minute
Furosemide (Lasix) causes diuresis by inhibiting sodium resorption in the kidneys
Disequilibrium syndrome is a condition in which water initially shifts from the bloodstream into the cerebrospinal fluid, causing an increase in intracranial pressure.
The main filter for blood in the kidney is the glomerulus
Azotemia is defined as increased nitrogenous wastes in the blood
Oliguria A marked decrease in urinary output
Created by: rebeccabelleth