2Nd Trimester--A&p--Urinary System

Front 1

Kidneys include 4 other structures:

Back 1

1 Renal cortex
2. Renal medulla
3. calyces
4. renal pelvis

Front 2

Renal cortex

Back 2

Outer portion of kidney that is reddish and contains glomeruli and capillaries.

Front 3

Renal medulla

Back 3

Inner portion kidney that contains the tubes. These tubes form 8-18 renal pyramids, and their tips, called renal papillae, face the center of the kidney

Front 4

Calyces

Back 4

Urine drains from papillary ducts thru a minor calyx and from here thru a major calyx into pelvis

Front 5

Renal pelvis

Back 5

funnel shaped basin that connects to a ureter

Front 6

Blood supply to kidney

Back 6

Blood is brought to kidneys by right and left renal arteries from abdominal aorta. After entering the kd, the renal artery subdivides into smaller and smaller branches, which eventually thru afferent arterioles contact with nephrons. Blood leaves KD by vessels that finally merge to form renal veins, which carry blood into inferior vena cava for return to the heart.

Front 7

Renal veins

Back 7

carry blood into inferior vena cava for return to the heart.

Front 8

What perfect of the resting cardiac output flows into the kidneys?

Back 8

25%; 1200 mL of blood per minute.

Front 9

Nephron

Back 9

Functional unit of kidneys

Front 10

Nephrons include 4 units of kd measurement

Back 10

1. Glomerulus
2. Bowman's capsule
3. Renal tubules
4. Juxtaglomerular apparatus

Front 11

Glomerulus includes

Back 11

afferent arteriole, efferent arteriole, and coil of capillaries.

Front 12

Bowman's capsule

Back 12

around glomerulus and connects with hernal tubule

Front 13

renal tubules

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include proximal convoluted tubule (PCT), Henle's loop, distal convoluted tubule (DCT), and collecting duct

Front 14

Juxtaglomerular apparatus

Back 14

Is located between afferent and efferent arterioles on DCT and regulates blood pressure by secretion of renin

Front 15

Glomerular filtration

Back 15

In the first step of urine production, water and most solutes in plasma pass from blood thru filtration membrane of capillaries of glomeruli into the bowman's capsule, which empties into renal tubules. However, they are impermeable to blood cells and large molecules like protein. In some renal glomerular disease, the pathological change of filtration membrane can cause blooduria and proteinuria, etc.

Front 16

Tubular re-absorption

Back 16

About 160-180 L of filtrate are formed each day in the KD and only about 1% of urine are eliminated daily. Clearly, about 99% if water and many substances such as nutrients and ions are reabsorbed by renal tubules and return to blood circulation. The waste products like urea are kept within tubule to be eliminated.

Front 17

Water reabsorption is regulated by

Back 17

ADH: antidiuretic hormone.

Front 18

Tubular secretion

Back 18

some substances like K and H are actively moved from the blood into nephrons. K balance in the body is important, lower K may develop cardiac arrhythmia, and at higher level cardiac arrest. Also, by active secretion of H, KD regulate acid-base (pH) balances of body fluids, and dysfunction of secretion of H may cause renal tubule acidosis.

Front 19

Urine concentration

Back 19

As the filtrated fluid passes thru the DCT and collecting duct, water is drawn out by the concentrated fluids around the nephron and returned to the blood. This process is ALSO regulated by ADH.

Front 20

Volume of urine

Back 20

Under the normal condition and the regulation of ADH, the urine excretion is about 1000-2000 ml/24 hours. The amount of water taking in influences the amount of urine. Abnormal situations include polyuria >2500 ml/24 hrs, which is seen in diabetes mellitus and insipidus, etc. Oligaria <500 ml/24 hrs and anuria <100 ml/24 hrs can be seen in acute and chronic renal failure, or obstruction of the urinary tract

Front 21

Excretion of wastes and unwanted substances

Back 21

By forming urine, the KD help body to excrete wastes from metabolism such as urea, creatinine, bilirubin, foreign substances likes drugs, and some excess substances like ions, etc.

Front 22

Maintenance of the balance of water and some ions

Back 22

Normally, the water taken in or produced is about equal to the amoun lost, which is mainly regulated by the KD. KD also help regulate the blood levels of some ions such as Na, K, Ca, Cl, and HPO4.

Front 23

Regulation of acid-base balance

Back 23

acids are constantly produced by metabolism. The KD excrete hydrogen ions and conserve bicarbonate ions to keep stable pH in the blood.

(secretion H, reabsorption HCO3)

Front 24

Red blood cell production & EPO

Back 24

When the KD do not get enough oxygen they release erythropoietin (EPO), which stimulates the production of RBCs.

Front 25

Vitamin D synthesis

Back 25

Together with the skin and liver, the KD synthesize calcitrol, the active form of Vit D

Front 26

Ureters

Back 26

The ureterst are 25-30 cm long, which expand from the KD down to the urinary bladder. The wall of the ureter includes an inner layer of mucus membrane, a middle layer of smooth muscle, and an outer layer of connective tissue. Urine is transported by peristaltic contractions of smooth muscle, the fluid pressure of the urine and gravity also contribute.

Front 27

Urinary bladder

Back 27

It is located in the pelvic cavity behind the pubic symphysis. In males, it is directly in front of the rectum. In females, it is in front of the vagina and below the uterus. Consists of inner layer of mucus membrane, a layer of connective tissues, three layers of a coating of smooth muscle, and the peritoneum covering the upper portion of the bladder. The urinary bladder stores urine prior to its elimination. When the volume of urine exceeds 200-400 ml, the pressure stimulates stretch receptors in its wall to produce sensation of fullness thru a reflex. Upon contraction of the bladder wall and relaxation of the sphincters, urination takes place. Urinary incontinence and retention are two abnormal conditions

Front 28

Urethra

Back 28

Tube that extends from the bladder to the outside. In males it is about 20cm in length and part of both the productive and urinary system. Female urethra is only 4cm. The opening of urethra lies between clitoris and vaginal opening. Because of the different structure, women are susceptible to infection.

Front 29

Primary glomerular disease

Back 29

This is a group of etiologically unknown glomerular diseases. An autoimmune reaction following uppoer respiratory or skin infection may involve glomeruli.

Front 30

Main types of primary glomerular diseases (5)

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1. Acute glomerulonephritis
2. Chronic "
3. Rapidly progressive " (RPGN)
4. Nephrotic syndrome
5. Asymptomatic proteinuria and blooduria

Front 31

Acute glomerulonephritis (acute nephritis)

Back 31

Usually occurs 7-21 days following infection; the patients present with edema, hypertension, hematuria, proteinuria, and casturia. The course lasts several months and the prognosis is good in most cases.

Front 32

Chroni glomerulonephritis (chronic nephritis)

Back 32

Some patients are protracted from acute nephritis, bu the rest of the cases have no such history. The changes of urinalysis are similar to acute nephritis, but edema is dependent, hypertension is persistent, accompanied with anemia and different degree of impairment of renal functions.

Front 33

Rapidly progressive glomerulonephritis (RPGN)

Back 33

Clinical conditions are severe, and progress to chronic renal failure in several months

Front 34

Nephrotic syndrome

Back 34

The typical symptoms include heavy proteinuria, obvious edema, hyperlipidemia, and hypoalbuminia. Patients usually have no hypertension and obvious blooduria.

Front 35

Asymptomatic proteinuria and blooduria

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Detective protein or blood in the urine without any clinical symptoms.

Front 36

Urinary Tract infection UTI

Back 36

Mainly caused by bacterial infection. Escherichia coli is the most common pathogen. UTI can affect upper or lower urinary tracts

Front 37

Most common types of UTI (2)

Back 37

Cystitis
Pyelonephritis

Front 38

Cystitis

Back 38

Usually acute or recurrent. Patients are present with dysuria, frequency and urgency or urination, low ab pain, may develop gross hematuria, or cloudy urine (pyuria) and positive urine culture.

Front 39

Pyelonephritis

Back 39

Usually occurs with cystitis. Except above clinical manifestations, patients with acute pyelonephritis also present with fever, chills, headache, low back pain, nausea, and vomiting. In chronic cases, anemia, hypertension, and renal dysfunction appear.

Front 40

Chronic renal failure (CRF)

Back 40

CRF is defines as progressive and irreversible loss of renal function. End stage renal disease (ESRD) is advanced CRD requiring dialysis or renal transportation. CRF is caused by many renal or systemic diseases, and diabetes (39.2%), hypertention/large vessel disease (28.2%) and glomerulonephritis (11%) are most common. Clinical manifestations caused by structural and functional loss of nephrons involve in all systems of the body, which include edema, metabolic acidosis, anemia, hypertension, nausea and vomiting, heart failure, pulmonary edema, pericarditis, pleuritis, renal osteodystrophy, dementia or coma.

Front 41

Dialysis

Back 41

When the patient's renal function is too low to excrete the waste products, accumulation and intoxication of wastes in the body occur and that is called uremia. Under this condition, blood must be cleaned artificially. Dialysis is used for the removal of certain solutes from a solution thru a selectively permeable membrane, waste products diffuse from the blood into the dialysis solution.

Front 42

There are two main types of dialysis for clinical use.

Back 42

Hemodialysis (HD)
Peritoneal Dialysis (PD)

Front 43

Hemodialysis (HD)

Back 43

Most common method in US. Using an artificial kidney machine to perform dialysis, avg patient undergoing requires 3.5-4 hours of dialysis 3 times per week

Front 44

Perotoneal dialysis (PD)

Back 44

Using peritoneal membrane to perform dialysis. Can be divided into 2 types:
Continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (COPD).

Front 45

CAPD

Back 45

Continuous ambulatory peritoneal dialysis. Dialysate of 2-3 L is left in the peritoneal cavity and changed 4-6 times daily.

Front 46

COPD (Dialysis)

Back 46

Continuous cyclic peritoneal dialysis. Patient connected to a cycler machine that allows inflow of small volumes of dialysate with shorter drewll time thru the night. Survival of these patients matches those undergoing HD.