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Kidneys
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Nephron composed of
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GU
| Question | Answer |
|---|---|
| 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
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