what are all the organs involved in formation and release of urine?
Kidneys (2) which produce urine to get rid of unwanted waste substances. urine goes from the kidneys via the Ureters(2) to the Bladder which stores urine, and excretes it via the Urethra
what do the Kidneys do?
Filter blood plasma, separate wastes from useful chemicals, and eliminate waste.
Regulate blood volume and pressure by
eliminating or conserving water.
Regulate osmolarity, secrete Renin and
Erythropoietin, which control blood
pressure and RBC count, respectively.
[ Kidney's decide on decrease or increase production of RBC
And on blood pressure. and pH ]
what else do the kidneys do ?
Degradation of insulin and glucagon.
Synthesis of ammonia, for acid/base balance.
Regulation of acid/base balance.
Removal of toxic substances and certain drugs, ex. penicillin.
why did hypertension used to be the number one cause of inter cranial bleeds ?
Hypertension used to be number 1 cause of intracranial bleed. Cuz of errectile dysfunction side effect. Hard to get pt compliance .Now erectile dysfunction is not a side effect of med.
what is difference between waste and metabolic waste?
Waste: Any substance that can't be used by the body, or is present in excess of body needs.
Metabolic Waste: Waste residue produced by the body.
Are feces Waste or Metabolic Waste?
Waste; it was not produced by the body and never entered body tissue
what is an example of Metabolic waste how is it measured?
Nitrogenous waste is metabolic waste,
and that includes urea, uric acid, and
creatinine, all expelled through urine.
Level of nitrogenous waste in the blood
is expressed as Blood Urea Nitrogen.
IF you have Aotemia what do you have?
Elevated BUN is called Azotemia, which
might reflect renal insufficiency.
[ BUN increases in damaged kidney.
Azotemia not symptomatic and but once you get over a certain BUN count and dramatically increases we get vomiting and nausea and cardiac arrhythmia. ]
What could Azotemia lead to ?
Azotemia could lead to Uremia, causing
vomiting, diarrhea, dsypnea and cardiac arrhythmia.
Untreated, this can lead to convulsions,
coma, and death.
Treatment would involve either kidney transplant or hemodialysis.
what is the average wait for kidney in US?
Why does Kidney failure could ( renal insufficiency) also lead to anemia ?
Decreased erythropoetin production =
decreased RBC count.
how does kidney work ?
what is nephron?
Nephron: Functional excretory unit. About 1.2 million/kidney.
what is Renal Capsule
Connective tissue surrounding the kidney for protection against infection or trauma.
What is Renal Cortex and Medulla
glandular tissue that forms the urine.
what are renal columns
Extension of the cortex that
divide the medulla into Renal Pyramids.
What is Nephroptosis?
Nephroptosis: Kidneys drop too low, resulting in pain, obstruction of urine flow.
Happens with chronic exposure to vibration; truck drivers, motorcyclists, etc.
What is Renal Fascia
is connective tissue binding the
kidneys to the abdominal wall. So, they are basically 'hanging' in the abdomen. When a person stands up, kidneys drop about 3cm.
what Is renal insufficiency? what are the possible causes ?
Damage to more than 2/3 of the kidneys (from chronic kidney disease) results in renal insufficiency. Urine output decreases, resulting in loss of homeostasis, azotemia and acidosis. (Acidosis is build up of H+ ions, which the kidneys normally clear).
Causes: diabetes mellitus, hypertension, trauma, chronic kidney infections, atherosclerosis, heavy metal poisoning, etc.
how much blood gets filtered ?
2500 pints go through the kidney daily. Azotemia is asymptomatic and when it is symptomatic its called uremia.
Why does diabetes result in increased urine output?
Diabetes mellitus = elevated blood glucose levels. This results in more glucose being filtered through the kidneys than can be reabsorbed.
Urinary excretion of glucose (glucosuria) causes an 'osmotic diuresis' (diuresis means increase in urine output). In osmotic
diuresis, extra glucose (solute) in the urine means more water must be added to try and dilute the glucose/urine solution.
what is Stage 1 of chronic Kidney disease
slight kidney damage with normal or increased filtration
GFR fore than 90 mL/min/1.73m2
what is Stage 2 of chronic kidney disease
mild decrease in kidney function 60-89 mL/min/1.73m2
what is Stage 3 of chronic kidney disease?
moderate decrease in kidney function 30-59 mL/min/1.73m2
what is Stage 4 of chronic kidney disease
Severe decrease in kidney function 15-29 mL/min/1.73m2
what is Stage 5 of chronic kidney disease
Kidney failure. less than 15 ( or dialysis) mL/min/1.73m2
what is Dialysis
Dialysis is filtering of the blood and is done for renal insufficiency (kidney disease or other problem)
what are the two types of dialysis
Peritoneal dialysis: Infusion of glucose/salt solution into abdominal cavity. Peritoneal membrane lines the abdominal cavity, can act as a dialyzing membrane.
Hemodialysis is more efficient. Blood circulates through a machine that filters it. Requires 3 to 4 hospital visits/week, 3-6 hours/visit.
what is end stage renal failure ?
End-stage renal failure, where the kidneys are completely or almost completely non-functional, requires a kidney transplant.
Average waiting period for kidney transplant in US = 900 days.
what are some Dialysis Issues?
Dialysis can give patients 'normal' lives, but many potential problems exist, including bone disease, hypertension, atherosclerosis,
heart disease, and sexual dysfunction.
Infection is always a risk, as is clotting and hemorrhage.
Dialysis interferes with normal growth and development in children.
why are those the side effects to Dialysis ?
Bone disease (osteomyelitis) or endocarditis (heart disease) could result from infection. Kidney also produces active form of vitamin D,
promoting calcium absorption, (strong bones).
Too much fluid removal during dialysis could result in fatigue, chest pain, low BP, leg cramps.
Low BP causes dizziness and nausea.
Sexual dysfunction could result from the renal disease itself, or the meds prescribed for it.
what is PKD
Polycystic Kidney Disease (PKD): development of numerous cysts on both kidneys. Usually inherited.
Cysts are fluid filled sacs whose growth results in massive enlargement of the kidneys causing significant to complete renal failure.
Most common of all life-threatening genetic diseases. Symptoms next slide.
Treatment is mostly supportive (no cure).
what are symptoms of PKD ?
Abdominal discomfort, UTI's, hypertension,renal pain, renal insufficiency, hematuria (presence of RBC's in urine).
50% of patients have end stage renal disease (failure) or ESRD by age 60.
Ureterolithiasis: Kidney stones, occurring in about 20% of patients (can occur independent of PKD, of course).