GU
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| Kidneys | recieve 20% of bld from heart
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| Nephron composed of | 1.Renal Corpuscle-Glomerulus, Bowmans capsule.2.Renal tubule-proximal,loop of henle,distal,collecting
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| Hilum | area that the artery/veins,nerves,lymphatic vessels,and ureter pass through tto enter the kidney
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| Renal cortex | outer region
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| Renal Medulla | inner region
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| Papilla | project into hollow space of the renal pelvis
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| urine forms in | cortical and medullary tissue
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| urine leaves kidney though | renal pelvis and ureter
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| 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
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| urinine production | 1.glomerular filtration2.reabsorption,3,secretion
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| Filtration pressure | 60 mm/Hg
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| GFR | 180L/day (125 cc/min)1-2L urine/day
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| Proximal tubules | lined with microvilli,contains protein pumps/mitochondria-reabsorbs H2o, and solutes.65% is reabsorbed(H2o,Na++,K+,glucose,urea,HCO3)
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| Descending loop pf Henle | contain no microvilli-primarily reabsorbs (H2o,Na++/Cl-,HCP3)
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| Ascending loop and beginning distal tubule | protein pumps and mitochondria-allow for absorbption of Na+/Cl-
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| Distal/collecting tubules | baroreceptors monitor osmolarity of filtrate-absorb(H2O,Na++,HCO3)-secrete -low osmolarity(urea,K+,H+,some drugs)
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| Late distal tubules | respond to hormones-aldosterone/ADH,monitor acid base balance of fluid
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| Angiotenson II | formed by release of renin,stimulates release of aldosterone,(target tissue)distal tubule/collecting duct,Effects-increased reabsorption of Na+,Cl,H20
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| Aldosterone | secreted by adrenal gland-target tissue(distal tubule/collecting duct-effetcs:reabsorbs,Na,Cl,H2o,SECRETES K+, and H+
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| ADH | secreted from posterior pituitary-distal and collecting-effects:increased reabsorption of water
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| (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
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| SNS stimulation | catecholamines released,=vasoconstriction and decreased renal bld flow
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| Reabsorption /secretion occur by | SIMPLE DIFFUSION(high to low) and OSMOSIS (moves towards highest osmolarity,FACILITATED DIFFUSION 9high-low),ACTIVE TRANSPORT (low -high)
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| Glucose | is almost completely reabsorbed in the proximal tubule-maintained until 180mg/dL-Type 1DM(so much sugar enters,reabsorption becomes inefficient=osmotic diuresis
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| 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)
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| BUN test | checks blood urea nitrogen-normal BUN=8-21 mg/dl
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| Creatine | waste product of metabolism within muscle cells-normal level=0.6-1.2 mg/dL, larger than urea so its not reabsorbed
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| Direct indicator of GFR | blood level of creatine and urea
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| 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
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| ACE-Angiotensin converting enzyme | found in lumen of most vessels and high in the lungs-converts angio I to Angio II
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| Angiotensin II | potent vasoconstrictor-stimulates production of aldosterone=kidneys reabsorb Na+=intravascular volume is maintained
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| Erythropoietin | released in kidneys-causes increase in production/maturation of RBC in bone marrow of Vertebra,proximal long bons,pelvis,ribs and sternum
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| Bladder | contains 350-500cc
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| Micturition | voiding
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| 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
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| Reffered pain | pain originates in a region other then where it is felt
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| Acute Renal Failure (ARF) | a sudden decrease in filtration through the glomeruli-urine output <400-500cc/day (oliguria)
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| 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
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| Prerenal causes | hypovolemia,hemmorrage,dehydration, burns,cardiac failure,shock, sepsis
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| 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,
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| Post Renal ARF | Caused by organ problems on back side of kidneys-obstruction of both ureters,bladder,urethra(rapid edema,retention of K+, acidosis)
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| Renal ARF steps | 1.injury to small vessels/golom injury.2.tubular cell death 3.Interstitial nephritis-(antibiotics,nsaids,diureticshigh BP drugs)
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| S/S | increased WBC,proteinuria,glycosuria,abd distention,HYPOTENSION
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| BUN to Creatine ratio | >20=prerenal or post renal problems, <20=renal problems
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| Too much ammonia s/s | urine smell to breath,pyuria,hematuria,glycosuria,n/v,pruitis,rash,diarrhea,confusion,drowsy,convulsions, coma
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| 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
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| CRF causes | HTN,DM,atherosclerosis,glomerulonephritis,lupus,nephrotoxins,infections-most damade affects the glomeruli
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| 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
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| S/S | HTN,edema,fatigue,pasty yellow skin,thin extremities,Uremic frost (late sign),anemia
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| 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
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| Hemodyalisis complications | 1.bleeding from puncture site,lacal infection,narrowing or closing of internal fistula
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| 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
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| 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
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| Lithrotripsy | sound waves break large stones
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| Struvite stones | Ca/ammonium/phos,triphosphate-associated with UTI's,bladder caths
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| Uric acid stones | not common,common in men,runs in families,1/2 have gout
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| Cystine stones | least common (sulfur containing amino acid) due to cystine in filtrate/hereditary
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| 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
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| 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
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| Urethritis | >males,symptom of gonnorhea,herpes or chlamydia,associated with cystisis,
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| Prostitis | inflammation secondary to bacterial infection, bowel bacteria are involved,usualy due to catherizations
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| Pyelonephritis (upper GI) | spread towards kidneys,effects 1 or both,Infllammation of the kidney, more common in women,abcess may develop
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| Intrarenal abcesses | form within renal parenchyma-
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| 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
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| Testicular Torsion | True emergency,testicle twists on spermatic cord,disrupts bld flow.
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| Nephron | structural and functional unit if te kidney
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| Micturion reflex | produces the urge to void
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| Hemasite | small, button-shaped device with a rubber septum that can be punctured with a dialysis needle
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| Diuril would MOST likely be prescribed to a patient with: | congestive heart failure
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| When triggered by changes in the blood pressure, the juxtaglomerular cells release: | renin.
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| When the solute concentration of the blood increases | antidiuretic hormone is released into the bloodstream
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| The glomerular filtration rate is MOST accurately defined as the: | amount of filtrate produced by the kidneys per minute
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| Furosemide (Lasix) causes diuresis by | inhibiting sodium resorption in the kidneys
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| Disequilibrium syndrome is a condition in which | water initially shifts from the bloodstream into the cerebrospinal fluid, causing an increase in intracranial pressure.
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| The main filter for blood in the kidney is the | glomerulus
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| Azotemia is defined as | increased nitrogenous wastes in the blood
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| Oliguria | A marked decrease in urinary output
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