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Renal Cortex
contains 85% of all nephrons
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Renal Medulla
Contains renal pyramids and columns; the nephrons in this area concentrate the urine
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Renal Pelvis
The expanded proximal end of the ureters
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Ureters
Drain urine into the bladder
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Renal Function
Filters plasma at glomerulus. Reabsorbs 99% of filtered fluid. Regulates filtrate to maintain body fluid volume, electrolyte composition, and pH
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Glomerulus
tuft of capillaries where filtration occurs
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Proximal tubule
branches from bowmans capsule where 2/3 of electrolytes are reabsorbed; also where all glucose and amino acids are reabsorbed
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Loop of Henle
Descending and ascending loops of the renal tubule; reabsorbs Na+, K+, Cl-
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Distal convoluted tubule
Reabsorbs Na+, Cl- . Reabsorbs or secretes K+ (is hormally controlled)
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Collecting Duct
tubules that receive urine from several renal tubules; eventually direct urine to the renal pelvis
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glomerular filtration
nephrons filter plasma at glomerulus into bowmans space. permeable to water but not large plasma proteins. Capillary pressure, molecular size, and electrical charge affect filtration/permiability
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juxtaglomerular apparatus
- a specialized region where distal tubule contacts afferent and efferent arterioles of its nephron.
- specialized cells that stimulate the secretion fo the adrenal hormone aldosterone.
- synthesizes renin and plays a major role in renal autoregulation and bp
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macula densa
- part of the thick ascending limb of the nephron
- senses plasma sodium concentration and passes the message to renin-secreting cells
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glomerulotubular balance
feedback between distal tubules and glomerular capillaries that help maintain homeostasis of gfr, overall blood volume, electrolyte concentration, by changing the amount of urine, or isotonic hypotonic hypertonic
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NaCl
increased NaCl in distal tubule decreases GFR, and decreased NaCl increase GFR. it also changes diameter of afferent and efferent arterioles.
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erythroproietin
stimulates red blood cell proliferation in bone marrow in response to kidney hypoxia, injections available
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atrial NAtriuretic peptide
Secreted from cardiocytes in right atrium. When right atrial blood pressure increases, ANP inhibits secretion of renin, inhibits angiotensin-induced secretion of aldosterone, relaxes smooth vascular muscle, and inhibits sodium and water absorption. .. this increases urine formation, thus decreases blood volume and pressure
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Vitamin D
needed for the absorption of calcium and phosphate by the intestines which is stimulated by the kidneys.
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urinalysis
analyzes the composition of urine
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BUN/Cr Ratio
- Blood urea nitrogen/creatinine
- Cr is a by product of muscle metabolism that is filtered out by the kidneys
- BUN is the measure of levels of nitrogen in the blood in the form of urea, that is secreted by liver and removed by kidneys
- High ratios indicate decreased GFR/kidney funtion
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creatinine clearance
volume of blood plasma that is cleared of creatinine per unit time; a useful measure for approximating gfr
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IVP Introvenous Pyelograms
Pictures of the KUB with radio opaque dye
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polycystic kidney disease
- cysts develop (fluid filled spaces from accumulation with obstruction) lead to chronic renal failur
- autosomal recessive children
- autosomal dominant in adults 30-40
- s&s: flank pain, urinary tract infections, hematuria
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Pyelonephritis
- infection of the renal pelvis and interstitium
- acute: usually bladder infection that ascended to renal pelvis recover if treated
- Chronic: persisten infections leading to scarring and renal failure, may be due to obstructive pathologic conditions
- s&s: acute-fever chills flank pain cva tenderness dysuria .. chronic-minimal: htn, frequency dysuria flank pain
- usually require iv antibiotics
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glomerulonephritis
- inflammation of glomeruli
- causes drugs toxins immunologic abnormalities ischemia free radicals
- acute: strep infections hematuria proteinuria, decreased gfr, oligouriaa
- chronic: hematuria, proteinuria with progressive decline in gfr often autoimmune
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Kidney Stones
- Crystallized marerial forms in renal calyces and pelvis
- cause not completely understood
- 1% of population, and recur in 30-50% of them within 5 years
- s&s: renal colic, flank/groin pain, n&v, microscopic hematuria
- management: narcotic analgesia for acute attack, lithotripsy to break up stones, prevent new ones from forming (dilute urine, dietary changes)
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UTI
frequency urgency dysuria lower back pain cloudy urine hematuria ...E coli, anibiotics
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cystitis
inflammation of bladder (infection, irritation from stones, trauma, chemical irritants)
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nephrotic syndrome
increased permeability of glomerular basement membrane to protein: proteinuria
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Acute Renal Failure
- acute renal failure: generally reversible, classified by causes
- Prerenal-related to decreased renal blood flow,
- Post renal-related to outflow obstruction,
- intrarenal- nephron damage, few cells actually die but become non functional for awhile. recover 2 weeks to 12 months can become chronic
- s&s: oliguric: urine output<400cc/day, diruetic: dilute urine in normal to > amounts, recovery: renal function adequate to avoid dialysis but not normal, Cr BUN^,
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Chronic Renal Failure
- 50% ESRD 2ndary to diabetes
- s&s: decreased renal reserve, renal insufficiency: 75% nephrons damaged polyuria nocturia, ESRD
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ESRD
- 90% nephrons destroyed, hypervolemia, hyperkalemia, hyperphospatemia, metabolic acidosis, uremia, hypocalcemia and osteodystrophy with osteoporosis, anemia
- treatment: glucose control, diet: low protein k Na, supplement Calcium, transplant, dialysis
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types of dialysis
- hemodialysis: AV shunt ofr access blood pumped through array of semipermeable membranes surrounded by dialysate
- peritoneal dialysis: Dialysate placed into abdominal cavity (peritoneum, acts as filter) and drained out by gravity flow
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bladder
surrounded by smooth muscle, sac for urine collection, parasympathetic control, external urethral spincter is under voluntary control
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urge
loss of urine preceded by a stron unexpected urge to void; involuntary bladder contractions
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stress
loss of urine with activities that result in increased intra-abdominal pressure; weak pelvic muscle floor
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mixed:
combo of urge and stress
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overflow
involuntary loss of urine associated with a distended bladder; bladder unable to empty normally due to partial obstruction
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functional
related to other factors besides urinary tract (confusion, mobility, illness)
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reflex incontinence
no sensory warning or awareness; neurological
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