1. ...maintains the volume and composition of body fluid by filtration of blood and selective reabsorption or secretion of filtered solutes
2. Removes waste
3. Filters fluid
1. Functional units of the kidney
1. Filters fluid
2. Uncontrolled filtration
PROXIMAL CONVOLUTED TUBULE
1. Controlled absorption of glucose, sodium, and other solutes goes on in this region
LOOP OF HENLE
1. This region is responsible for concentration and dilution of urine by utilizing a counter-current multiplying mechanism
2. Water-impermeable but can pump sodium out, which in turn affects the osmolarity of the surrounding tissues and will affect the subsequent movement of water in or out of the water-permeable collecting duct.
DISTAL CONVOLUTED TUBULE
1. Absorbs water back into the body with water-permeable collecting duct
Blood entering the glomerulus is filtered through the capillary cell membranes, a thin basal lamina and the thin membrane of the visceral layer of BOWMAN'S CAPSULE.
Blood pressure drives filtration with some local control given by constriction of the afferent or efferent arterioles.
Water, small molecules (glucose, amino acids, urea), electrolytes (sodium, chloride, potassium) some small proteins are freely filtered at the glomerulus while blood cells and large plasma proteins (larger than ~70,000 MW) are retained in the blood stream. The resultant ultrafiltrate in the nephron is altered by the processes of secretion and reabsorption before exiting the kidney.
Urine collects in the renal pelvis and then flows with the assistance of PERISTALSIC CONTRACTION of the ureter to the bladder.
When there is 150-300 ml of urine in the bladder, stretch receptors become active and a SPINAL REFLEX to void the bladder is initiated.
Increased filling causes increased pressure and a further increase in the frequency of the reflex. Higher brain centers can override the urgency to urinate for a time or actually facilitate it
MICTURATION REFLEX is initiated and the internal bladder sphincter relaxes and the detrusor muscle of the bladder contracts to expel the urine via the urethra. The female urethra is about 9.5 cm long and the male urethra is some 20 cm long
FUNCTIONS OF THE KIDNEY
3. Activation of Vit. D
1. Hormone released in response to hypoxia, anemia
2. Stimulates RBC production
1. Released by nephron with decrease in arterial pressure or increase in urine Na+ conc. Acts as catalyst in converting Angiotensin I to II.which stimulates adesterone to be released and also vasoconstrtiction
RENIN>ANGIOTENSIN I>ANGIOTENSIN II>ALDOSTERONE
AMBER OR STRAW
NORMAL COLOR OF URINE
4.6 to 8 (although it is normally acidic)
less than 0.1 gm
less than 0.3 gm
600 to 2500 ml may be voided
24 HOURS URINATION PG. 1167
BLOOD AND URINE DX STUDIES
2. Urine Culture
3. Creatinine Clearance
4. Urea Clearance
5. Serum Osmolality
6. Uric Acid Level
7. Serum protein
1. Intravenous pyelogram (IVP)
2. Isotope renography (radio-isotope scan of the kidneys)
3. Ultrasound of the kidneys or abdomen
4. CT scan of the kidneys or abdomen
5. Abdominal MRI
an infection that can happen anywhere along the urinary tract -- the kidneys, the ureters, the bladder, or the urethra
1. usually caused by a bacteria from the anus entering the urethra and then the bladder. This leads to inflammation and infection in the lower urinary tract.
2. Women, Elderly people, People with diabetes
Pregnancy and menopause
Prostate inflammation or enlargement
Not drinking enough fluids
Pressure in the lower pelvis
Pain or burning with urination
Frequent or urgent need to urinate
Need to urinate at night
Blood in the urine
Foul or strong urine odor
urine culture (clean catch)
1. Escherichia coli (about 80% of uncomplicated and 20% of complicated cases) Most common cause of UTI
2. Klebsiella, Proteus
3. Pseudomonas, Staphylococcus saprophyticus
4. Candida (most common fungal)
5. Schistosoma (most common parasitic)
3. Sulfa drugs (sulfonamides)
6. Doxycycline (should not be used under age 8)
7. Quinolones (should not be used in children)
1. Chronic bladder problem
3. Inflamed and irritated bladder wall
2. Theories autoimmune, hereditary, infectious or allergic condition.
1. A persistent, urgent need to urinate.
2. Frequent urination that occurs during the day and night
3. Only passing small volumes of urine each time, 16x/day
4. Pain in your lower abdomen (suprapubic) or between the vagina and anus in women or the scrotum and anus in men (perineal).
5. Pain during sexual intercourse
6. Chronic pelvic pain
7. Urine cultures are usually free of bacteria
1. URINE CULTURE
An infection of the kidney and the ducts that carry urine away from the kidney (ureters).
1. Bacterial infection
2. Viral or fungal infection
1. ACUTE UNCOMPLICATED PYELONEPHRITIS
2. CHRONIC PYELONEPHRITIS
3. REFLUX NEPHROPATHY
ACUTE UNCOMPLICATED PYELONEPHRITIS
sudden development of kidney inflammation
a long-standing infection that does not clear
an infection that occurs in the presence of an obstruction
Flank pain or back pain
Severe abdominal pain (occurs occasionally)
Chills with shaking
Flushed or reddened skin
Moist skin (diaphoresis)
General ill feeling
Increased urinary frequency or urgency
Need to urinate at night (nocturia)
Cloudy or abnormal urine color
Blood in the urine
Foul or strong urine odor
Mental changes or confusion
urinalysis commonly reveals white blood cells (WBCs) or red blood cells (RBCs).
A urine culture (clean catch) or urine culture (catheterized specimen) may reveal bacteria in the urine.
A blood culture may show an infection.
An intravenous pyelogram (IVP) or CT scan of the abdomen may show enlarged kidneys with poor flow of dye through the kidneys. (IVP and CT scan of the abdomen can also indicate underlying disorders.)
1. Inflammation of the kidney resulting in hampering the kidneys' ability to remove waste and excess fluids.
2. Can be acute, referring to a sudden attack of inflammation, or chronic, which comes on gradually.
3. Can be part of a systemic disease, such as lupus or diabetes, or it can be a disease by itself — primary _____________
1. Infections or Immune diseases causing antigen antibody complexes to damage the kidney is thought to be the most common cause
Inflammation of the blood vessels (vasculitis)
Conditions that scar the glomeruli.
1. Tea-colored urine from red blood cells in urine (hematuria)
2. Foam in the toilet water from protein in urine (proteinuria)
3. High blood pressure (hypertension)
4. Fluid retention (edema) with swelling evident in face, hands, feet and abdomen
5. Fatigue from anemia or kidney failure
6. Less frequent urination than usual
CBC and CMP
CT scan kidneys
An autoimmune disease characterized by glomerulonephritis (inflammation of the capillary loops in the glomeruli of the kidney), pulmonary hemorrhage (bleeding in the lungs), and autoantibodies to the glomerular and alveolar basement membranes (anti-GBM) antibodies.
2. FATAL IF LEFT UNTREATED
Crackles and rhonchi
Acute renal failure
chest x rays
renal (kidney) biopsy
Serology for circulating anti-GBM antibodies
Immunosuppressive drugs: Cytoxan, Imuran
1. Another form of glomerular dysfunction.
2. Primarily massive proteinuria, specifically defined as 3.5 grams or more in 24 hours. In some cases, patients may excrete as much as 10 grams in 24 hours
1. Clinical condition of edema and proteinuria in which the renal histology (light microscopy) demonstrates fatty degeneration of the tubules associated with normal appearing glomeruli..
2. Characterized by massive loss of urinary protein (primarily albuminuria) leading to hypoproteinemia (hypoalbuminemia) and its result, edema
2. PNS is believed to have an immune pathogenesis, but the precise nature of the process has yet to be defined.
Decreased vitamin D
Urinalysis may show protein, renal tubular cells, blood, white blood cells, and casts.
Protein in the urine test may be positive.
Urine for albumin
Elevated BUN and creatinine
The creatinine clearance may be decreased.
Potassium may be elevated.
Kidney biopsy reveals glomerulosclerosis which may indicate the cause.
Diuretics to relieve edema
Low Na+ and protein diet
Treatment for hyperlipidemia
Immunosupressive agents: Cytoxan
1. Prevalence of urolithiasis is approximately 2 to 3 percent in the general population, and the estimated lifetime risk of developing a kidney stone is about 12 percent for white males.
2. COMMON IN MALES
5. Occurs more frequently in hot, arid areas than in temperate regions.
1. Decreased fluid intake and consequent urine concentration are among the most important factors influencing stone formation.
2. Certain medications, such as triamterene (Dyrenium), indinavir (Crixivan) and acetazolamide (Diamox), are also associated with urolithiasis.
3. Dietary oxalate is another possible cause, but the role of dietary calcium is less clear, and calcium restriction is no longer universally recommended
Classic presentation of renal colic is excruciating unilateral flank or lower abdominal pain of sudden onset that is not related to any precipitating event and is not relieved by postural changes or nonnarcotic medications
Intravenous pyelogram (IVP)
Isotope renography (radio-isotope scan of the kidneys)
Ultrasound of the kidneys or abdomen
CT scan of the kidneys or abdomen
Renal failure Ureteral stricture Infection, sepsis Urine extravasation Perinephric abscess Pyelonephritis
1. Cancer of the sac that collects and holds urine until it exits your body.
2. MOSTLY ADULTS
Exposure to certain toxic chemicals and drugs also makes it more likely to develop the disease
Treatment with the anti-cancer drugs cyclophosphamide (Cytoxan) and ifosfamide
Infection with parasites. In Egypt, a chronic parasitic infection (schistosomiasis) can lead to squamous cell carcinoma
Use of the herb Aristolochia fangchi. This Chinese herb, which is included in some weight loss supplements
Use of chlorine in water and artificial sweetners such as Saccharin and Cyclamate
Pain during urination
Frequent urination or feeling you need to urinate without being able to do so
Slowing of your urinary stream
Urine for cytology
Dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of micturition
Spinal cord diseases,
Neural tube defects including spina bifida.
Common complication of major surgery in the pelvis, such as for removal of tumors.
urinary frequency and urgency,
painful urination (dysuria)
urinary tract infection (UTI) caused by urine being held too long in the bladder.
Stones may also form in the urinary tract of individuals with a neurogenic bladder
ACUTE RENAL FAILURE
Sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes.
a problem in a part of the body before the kidneys that is causing a ↓ in renal blood flow
Intra-renal azotemia (intrinsic)
A PROBLEM WITHIN A KIDNEY
OBSTRUCTION AFTER THE KIDNEY
elevation of the nitrogenous waste products (creatinine and urea nitrogen)
clinical syndrome resulting from azotemia and is characterized by anorexia, N/V, and mental status changes
Hypotension from any cause
-CHF or severe pulmonary dz
-Volume depletion: vomiting, diarrhea, burns, dehydration, hemorrhage
-Hypercalcemia (which may result in afferent arteriolar vasconstriction)
-Medications: cyclosporine, ACE-I, NSAIDs, osmotic diuretics
Ischemia: thromboembolism, hypoperfusion from systemic hypotension, vasoconstriction
endogenous: myoglobin, Hgb, uric acid, Ca-Phos compounds
exogenous: AG, PCN, cepholasporins, acyclovir, ampho B, cisplatin, methotrexate, ciprofloxacin, IV dyes
-Inflammation: acute glomerular nephritis (GN), acute tubular nephritis (ATN), pyelonephritis, infection
-Tumor: tumor infiltration, myeloma kidney
-malignancy - cervical cancer
-ureter obstruction: stone or crystals (uric acid, Ca oxalate), papillae, fibrosis, tumor
*may require renal imaging to determine obstruction