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Pathophysiology

Denver School of Nursing. Pathophysiology. BIO 206 & 308 – Week 9 CH28 & 29 Renal Phys & Path. Chapter 28 - Urinary System. Anatomy of the Urinary System Ureter Urinary bladder Urethra Kidney Physiology of the Urinary System: Renal function Filtration Reabsorption Secretion

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Pathophysiology

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  1. Denver School of Nursing Pathophysiology BIO 206 & 308 – Week 9 CH28 & 29 Renal Phys & Path

  2. Chapter 28 - Urinary System • Anatomy of the Urinary System • Ureter • Urinary bladder • Urethra • Kidney • Physiology of the Urinary System: • Renal function • Filtration • Reabsorption • Secretion • Regulation of Urine Volume

  3. Anatomy of the Urinary System Lets start with the basics  • Image from: http://fromyourdoctor.com

  4. Anatomy of the Urinary System • Image from: http://www.infovisual.info

  5. Anatomy of the bladder • Image from: http://www.infovisual.info

  6. Image from: http://www.faqs.org

  7. Anatomy of the Kidney • What is the medical term for where the kidney is located?? • Image from: http://health.allrefer.com

  8. Anatomy of the Kidney • What is the medical term for where the kidney is located = Retroperitoneal • Image from: http://anatomytopics.wordpress.com

  9. Anatomy of the Kidney • Image from: http://www.stockmedicalart.com

  10. The Kidney • Image from: http://academic.kellogg.edu

  11. The Nephron • Image from: http://academic.kellogg.edu

  12. Nephron • 1.2 million nephrons per kidney • Functional unit of the kidney • Cortical nephrons • Juxtamedullary nephrons

  13. Nephron • Renal corpuscle • Glomerulus • Bowman capsule • Mesangial cells • Bowman space

  14. Nephron

  15. Glomerulus

  16. Nephron • Glomerular filtration membrane • Inner capillary endothelium • Basement membrane • Outer capillary epithelium • Also referred to as podocytes or visceral epithelium • Filtration slits • Filtrate passes through the three layers and forms the primary urine

  17. Nephron • Juxtaglomerular apparatus • Juxtaglomerular cells • Macula densa

  18. Juxtaglomerular Apparatus

  19. Nephron • Renal tubules • Proximal tubule • Loop of Henle • Distal tubule • Collecting duct • Principal cells : water & ECV…reabsorb NA+ • Intercalated cells : acid-base…reabsorb K+ & HCO3-,secrete H+

  20. The Renal Corpuscle • Image from: http://academic.kellogg.edu

  21. Urinary System This is really the critical testable material • Physiology of the Urinary System: • Renal function • Filtration • Reabsorption • Secretion • Regulation of Urine Volume • Renin Aldosterone Angiotensin system (RAAS)

  22. Urinary System Filtration = the movement of water and protein-free solutes from the blood plasma of the arteries in the glomerulus, across the glomerular capsular membrane, into the capsular space of the Bowman’s capsule.

  23. Renal Physiology • Image from: http://oracle3927.tripod.com

  24. Urinary System Filtration = the movement of water and protein-free solutes from the blood plasma of the arteries in the glomerulus, across the glomerular capsular membrane, into the capsular space of the Bowman’s capsule. As the filtrate moves through the renal tubule, the osmolarity of the filtrate changes.  As it moves deeper into the medulla, the osmolarity increases, and when it ascends the loop of Henle, it decreases, then once again increases while going down the collecting duct.  Why does the kidney have this roller coaster of osmolarity?!?!?

  25. Why is it important to maintain fluid balance?

  26. Renal Physiology • Image from: Southwest University: http://faculty.southwest.tn.edu

  27. Renal Physiology EFP = Effective Filtration Pressure The EFP is regulated and controlled by the exact same mechanism that regulated all ion movement in the body  the concentration gradient. The EFP is determined by the 4 different concentration gradients / pressures that exist in the kidney: 1) Glomerular Hydrostatic pressure (Systemic blood pressure and the resistance to blood flow in the glomerular capillaries) 2) Glomerular Osmotic pressure 3) Capsular Hydrostatic Pressure (2 & 3 are the forces that move fluid back into the Glomerulus) 4) Capsular Osmotic Pressure = negligible amount The Net EFP equals Glomerular HP – (Glomerular OP + Capsular HP) GFR = Glomerular Filtration Rate GFR is the rate of movement of fluid out of the glomerulus and into the capsular space. GFR is directly proportional to the EFP but can also be changed by: 1) Vasodilation / vasoconstriction of the afferent and efferent arterioles 2) Changes in the systemic Blood Pressure

  28. Renal Physiology EFP = Glomerular HP – (Glomerular OP + Capsular HP) These two on left are the same. If these increase then filtration will increase (and vis versa) These two on right will decrease filtration if they increase in pressure. (and vis versa) • Image from: Southwest University: http://faculty.southwest.tn.edu

  29. Ch. 28 Urinary System Reabsorption = the tubular reabsorption is the movement of ions (electrolytes) out of various segments of the tubule back into the blood. These ions enter the “peritubular blood vessels.” • Image from: Southwest University: http://faculty.southwest.tn.edu

  30. Renal Physiology • Image from: Southwest University: http://faculty.southwest.tn.edu

  31. Renal Physiology It is this hyperosmotic condition in the medulla that allows passive transport to occur. • Image from: http://oracle3927.tripod.com

  32. Renal Physiology • Image from: Southwest University: http://faculty.southwest.tn.edu

  33. Phys & Path of RAAAAASA!!! • Image from: Crazy Micah Style notes…

  34. Phys & Path of RAAAAASA!!!

  35. Phys & Path of RAAAAASA!!!

  36. We are RAAAAASA PROs, Right?!?!

  37. Urinary Physiology • Image from: http://www.cvphysiology.com

  38. Renal Physiology • Image from: Southwest University: http://faculty.southwest.tn.edu

  39. Countercurrent Exchange System

  40. Concentration and Dilution of Urine • Urea • Aldosterone • Antidiuretic hormone (ADH) • Atrial natriuretic peptide • Diuretics

  41. Acidification of urine • Hydrogen excretion Ammonia excretion

  42. Renal Hormones • Urodilatin(natriuretic peptide) • Inhibits sodium and water reabsorption • Vitamin D • Necessary for the absorption of calcium and phosphate • Erythropoietin • Released when decreased oxygen to the kidney

  43. Tests of Renal Function • Clearance and glomerular filtration rate • Inulin • Creatinine • Clearance and renal blood flow • Blood tests • Plasma creatinine concentration • Blood urea nitrogen (BUN)

  44. Tests of Renal Function • Urodynamic tests • Cystometry, uroflowmetry, postvoid residual, electromyography, video urodynamics • Direct visualization tests • Cystoscopy, ureteroscopy

  45. Chapter 29 Alterations of Renal and Urinary Tract Function

  46. Urinary Tract Obstruction • Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract • The obstruction can be caused by an anatomic or functionaldefect • Obstructive uropathy

  47. Urinary Tract Obstruction • Severity based on: • Location • Completeness • Involvement of one or both upper urinary tracts • Duration • Cause

  48. Urinary Tract Obstruction • Hydroureter • Hydronephrosis

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