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what is the peritubular capillary?
- originates from the efferent arteriole
- low pressure vessels
- adapted for reabsorption rather than filtration
- rejoin venous channels to take blood away from the kidneys
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what are struvate stones?
- staghorn stones shaped like calaces
- contains proteus bacteria
- reccurent UTI
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what is the juxtaglomerular apparatus?
- juxtaglomerular cells contain renin and constrict afferent
- macula densa in DCT triggers renin release, sense Na osmolality
- extraglomerular mesengial cells - anchor and constrict
- peripolar cells -
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what is the loop of Henle?
- concentrates urine
- thin decending - highly permeable to water, moderate to urea,Na,other ions
- osmolality of filtrate reaches highest point at elbow of loop
- thin ascending - impermable to water, absorbs solutes, diluting segment
- thick ascending -
- always absorbs more NaCl than water
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what decreases GFR?
decreased kidney perfusion or pressure from afferent constriction, efferent dialation, hypotension, hypovolumia,
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what increases GFR?
increased kidney perfusion or pressure due to afferent dialaiton, efferent constriction, hypertension, hypervolumia,
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what are the treatable causes of incontenance in elderly?
- Delerium
- Infection
- Atrophied urethitis, vaginitis
- Pharma
- Psyciatric - depression
- Excessive urine output - hyperglycemia
- Restriced mobility
- Stool impaction
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what is the effect of the liver on the renin angiotensin mechanism?
angiotensinogen is released from the liver, this is then converted to angiotensin I by renin
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How does aldosterone work?
- released from adrenal cortex in the glomerulosa by high concentrations of angiotensin II or descreased stretch of baroreceptors
- causes increased reabsorbtion of Na and thus fluid in the DCT,
- increases secretion of K
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what counteracts aldosterone?
- osmolality of ECF, low potassium, high sodium
- spirolactone is an antihypertensive that antagonizes aldosterone
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what does sypmathetic tone do to the kidneys?
contricts afferent, everything decreases, urine output can drop to zero
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How does lasix work?
- loop diuretic
- inhibits symport of NaCl,K in thick ascending loop, Mg also leaves can cause hypomagnesia
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what is the difference between nephrotic and nephritic?
- nephrotic - proteinuria >= 3.5mg a day
- nephritic - < 3.5
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what is the innervation of the urinary system?
- sympatetic from T11-L2 to hypogastric nerve, promotes bladder relaxation of detrusor, contraction of internal sphint
- parasympathetic from S1-S3 promotes bladder empyting contraction of detrusor, relaxation of internal sphinct
- somatic (voluntary) from S2-S4 somatic pudendal nerve
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what are the stages of renal failure?
- 1 - damage with gfr > 90
- 2 - damage with gfr 60-89
- 3- gfr 30-59
- 4- gfr 15-29
- 5 - FAIL gfr < 15
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what are aquaporins?
special transmembrane protein channels where water crosses the cell membrane thru osmosis
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what do you give for hyperkalemia?
give insulin, forces K back into the cells
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what goes in and out of PCT?
- Reabsorbs - NaCl, bicarb,K,water,glucose,amino acids
- Secrets-H+, organic acids and bases
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in and out of loop of henle
- thin decending - reabsorb water
- thick acending - reabsorbs NaCl,bicarb,K,Ca,Mg secrets H+
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in and out of DCT
- early distal - reabsorbs NaCl, Ca, Mg
- last distal and CT - reabsorb NaCl, secretes K+, ADH mediated H2O reabsorbtion
- Intercalculated cells reabsorbs bicarb and K secrets H+
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