What are the 5 functions of the kidney

·         Fluid & electrolyte balance

·         Acid/base maintance

·         Remove water soulable wastes

·         Help control BP

·         Maintain RBC levels(secretes erythropoietin) (tissue hypoxia trigger) & activate Vit D

Three components of the urine formation

·         Filtration- where blood enters bowmans capsule initial formation of urine

·         Reabsobtion-Tubulols where we pull back things

·         Secretion- Distal tubules-where we make final adjustments

Glomerular Filtration

• ·         Enters through afferent arteriole(bigger) exits through efferent arteriole(small) different in pressure creats pressure and pushes urine into proximal tubulas

• ·         Glomular capp sit on top of basement membrain

• ·         Bowmans capsule epithelium cells sit along the same basement membrane and stand up away from the membrane on pseudopods(this is how filtration occurs)

POtocyte

holds capillaries away from each other so that fluid can pass through easy

Vasa Recta

is a netrwork of blood velles that surround nephone- how reabspoption and secretion take place, makes possible for kidney to reabsorv and secrete ions water and other components in appropriate amounts

Goal of nephron

- retrun blood to body as perfect as possible

Reabsportion-

·         (get rid of everything)water electrolytes amino acids, acid base elements are returned to the blood

Secretion

- (distal tubules)(get back what looks good) finall adjustment components leave the blood and are excreted in the urine. This is the processes where acid base balance returns.

What are the two mainparts of the bowmans capsule glomerulus action?

• ·         Get rid of waste and retuning good looking blood back to the body

• ·         Controlling urine urine flow/ BP and BV

How do we control urine blood flow/ BP & BV?

·         Juxaglomerular apparatus-control urine urine flow by doing this control BP

·         Juxaglomerular cells- excrete rennin to start rennin system

Process of how Juxtaglomerula controls BP, BV & urine flow

·         Urine reachest distal tubules
o   J cells measure blood flow in afferent arteriole and urine flow composition
o   Renin is released in response to decreased pressure and increased urine NA
·         Rennin release initates the RAA
o   Renin converts angiotensinogen to angio 1
o   Angio 1 meets with angio converting enzyme in lungs
o   Angiotensin 2 strong
Vasocontricts and release aldosterone

Antidiuretic Hormone

·         Osmorectors in hypothalamus sense increase in osmolaity

·         Send message to post pituitary to release ADH

·         ADH makes collecting duct more permable to water

o   What is now reabsorbed from urine to blood

·         ANP

o   Is made by over stretched atria

o   To much preload to much fluid coming back to heart will release anp to stop this

·         BNP

o   Is made from over stretched ventricals

·         ANP & BNP function?

o   Cause kidney to stop reabsorbing NA & Water act as diuretic

o   Sodium and water will be lost in urine, decrease blood volume

o   Decreased after load

o   Decreased bp

o   Decreased stretch of heart

§  Stretch turns this process on and decrease stretch will turn this process off.

A patient with severe Renal disease why does he devolope

Anemia

Weak Bones

o   Anemia- No erythopoeitin

o   Weak bones- Vit D no activated

gold standard for accessing renal function

Serum creatine

Horse shoe Kidney

o   Congenital abnormality

o   Can be benign- kidney don’t seperate

o   Can be addressed surgically

o   Nephrophthisis

o   Onset in child hood

o   Distal tubular atrophy and sclerosis

o   Complex renal problems

o   Extra renal involment

o   Polycystic kidney disease- Most commen 2 types

*Cystes of Tubules*

1. Autosomal Dominant
2. Autosomal Recessive
   

§  Autosomal dominant (adult)

·         Asystmetric one may be fine

·         Associated with vascular disorders

·         AAA & cerebral aneuryms

§  Autosomal Recessive (kids)

·         Bilateral

·         Lungimpairment

·         Portal hyp

·         Liver disease

·         80% mortality first year

o   Cystic disease of the kidney

o   Fluid filled sacs in tubules

Medullar kidney disease

o   Developing cytes in collecting ducts

o   Sponge kidney

§  Urinary stasis infection kidney stone formation

Consequences of cystic dilation of Renal tubules or Tract

o   Hydronephosis- Urine that gets stuck in kidney and just hangs around

o   Increased pressure d/t build up of fluid

o   Compress vessels causing compartment sydrome

o   Stasis of urine

Compartment Syndrome

o   Tissue exspand and decreases the blood flow to this tissue

Obstruction: Renal Calculi- 3 theorys

1. Saturation
2. Matrix
3. Inhibitor
   

o   Saturation theory- urine is supersaturated with stone components

o   Matrix theory- organic materials act as a nidus for stone formation

o   Inhibitor theory-  a deficiency of substances that inhibit stone formation

Types of kidney stones

1. Calcium stones
2. Stuvite
3. Uric acid stones
4. cystine stones
   

o   Calcium stones- most common oxalate

o   Stuvite- mag, ammonium phosphate stones

o   Uric acid stones- gout

o   Cystine stones- genetic

Renal Calculi treatment

o   Increase fluids

o   Decrease diet intake of oxalate and calcium

o   Drugs to bind ca oxulate in gus keeping from abosbing

o   Change ph

UTI

o   Bacterial that  ascending from the bladder most common infection

o   Host defences include- natural offences

o   Washout

o   Protective mucus

o   Local immune response and IGA

o   Normal Flora

o   Uretheral reflex – contribuates to the problem

o   Short ureter goes back in bladder can’t close go back up in kidney