Chapter 29 PDF: Structure and Function of Renal & Urological Systems

Summary

This document is a textbook chapter about the renal and urological systems. It explores the structure and function of the kidneys, nephrons, blood vessels, and urinary structures and processes such as filtration and tubular transport. The document also covers hormones and renal function.

Full Transcript

Chapter 29 Structure and Function of the Renal and Urological Systems Structures of the Kidney  Kidneys Retroperitoneal Renal capsule Renal fascia Hilum Structures of the Kidney (Cont.) From Patton, K.T.,& Thibodeau, G.A. (2018). The human body...

Chapter 29 Structure and Function of the Renal and Urological Systems Structures of the Kidney  Kidneys Retroperitoneal Renal capsule Renal fascia Hilum Structures of the Kidney (Cont.) From Patton, K.T.,& Thibodeau, G.A. (2018). The human body in health & disease (7th ed.). Mosby. Structures of the Kidney (Cont.)  Cortex  Medulla  Pyramids  Calyces Minor and major  Renal pelvis  Lobe Structures of the Kidney (Cont.) From Solomon, E. (2016). Introduction to human anatomy and physiology (4th ed.). Saunders. Nephron  1.2 million nephrons per kidney Cortical nephrons Midcortical nephrons Juxtamedullary nephrons  Functional unit of the kidney Nephron (Cont.)  Renal corpuscle Glomerulus Bowman capsule Mesangial cells  Bowman space/capsule Nephron (Cont.) From Patton, K.T., Thibodeau, G.A., & Douglas, M.M. (2012). Essentials of anatomy & physiology. Mosby; Damjanov, I. (2012). Pathology for the health professions (4th ed.). Mosby. Nephron (Cont.)  Glomerular filtration membrane Inner capillary endothelium Middle basement membrane Outer capillary epithelium Contains podocytes Filtration slits Filtrate passes through the three layers and forms the primary urine Nephron (Cont.)  Juxtaglomerular apparatus Juxtaglomerular cells Renin releasing Macula densa Sodium sensing Juxtaglomerular Apparatus Nephron  Renal tubules Proximal convoluted tubule Loop of Henle Distal convoluted tubule Collecting duct Principal cells Intercalated cells Structures of the Kidney Blood Vessels  Renal arteries  Interlobar arteries Afferent arteries  Arcuate arteries  Glomerular capillaries Afferent arteriole Efferent arteriole  Peritubular capillaries  Vasa recta  Renal veins Structures of the Kidney From Patton, K.T., Thibodeau, G.A., & Douglas, M.M. (2012). Essentials of anatomy & physiology. Mosby. Urinary Structures  Ureters 30 cm long Long, intertwining smooth muscle bundles Pass obliquely through posterior aspect of bladder Peristaltic activity Contraction of bladder during micturition compresses the lower end of the ureter to avoid urine reflux Urinary Structures (Cont.)  Bladder Detrusor muscle Trigone  Urethra Internal and external sphincters 3 to 4 cm in individuals with female genitalia 18 to 20 cm in individuals with male genitalia Bladder and Urethra From Patton, K.T., & Thibodeau, G.A. (2018). The human body in health & disease (7th ed.). Mosby. Renal Blood Flow  Receive 1000 to 1200 mL of blood per minute  Glomerular filtration rate (GFR) Filtration of the plasma per unit of time  Autoregulation Tubuloglomerular feedback Renal Blood Flow (Cont.)  Neural regulation Sympathetic fibres regulate size of afferent and efferent arterioles, thus renal blood flow No significant parasympathetic regulation Renalase  Hormones Renin-angiotensin-aldosterone system Natriuretic peptides Urodilantin Nephron Function  Filters plasma  Reabsorbs and secretes Tubular reabsorption and secretion  Forms a filtrate of protein-free fluid  Regulates the filtrate to maintain fluid volume, electrolytes, and pH Nephron Function (Cont.)  Glomerular filtration Permeable to water; impermeable to large molecules (proteins) Tubular reabsorption versus tubular secretion Net filtration pressure Glomerular capillary oncotic/hydrostatic pressure Filtration rate 180 L/day Glomerular Filtration Nephron Function  Tubular transport Proximal convoluted tubule Active reabsorption of sodium Glomerulotubular balance Adjustment of reabsorption of sodium and water Loop of Henle and distal tubule Concentration or dilution of urine  Countercurrent exchange system Production of uromodulin Nephron Function (Cont.) Concentration and Dilution of Urine  Countercurrent exchange system Contributes to production of concentrated urine Fluid flows in opposite direction through parallel tubes Fluid moves up and down the parallel limbs of the loop of Henle The longer the loop, the greater the concentration gradient Hormones and Renal Function  Antidiuretic hormone (ADH)  Aldosterone  Natriuretic peptides Atrial natriuretic peptide B-type natriuretic peptide C-type natriuretic peptide Urodilantin  Diuretics Increase urine output Renal Hormones  Vitamin D Necessary for the absorption of calcium and phosphate  Erythropoietin Released when decreased oxygen to the kidney Stimulates RBC production 1. A patient is experiencing diuresis. An increase in which substance is an accurate explanation? A. Renin B. Aldosterone C. Antidiuretic hormone D. Atrial natriuretic peptide Tests of Renal Function  Clearance and renal blood flow  Clearance and glomerular filtration rate Inulin Cystatin C Creatinine  Blood tests Plasma creatinine concentration Blood urea nitrogen (BUN)  Urinalysis Tests of Renal Function (Cont.)  Urodynamic tests Cystometry Uroflowmetry Postvoid residual Electromyography Video urodynamics  Direct visualization tests Cystoscopy Ureteroscopy 2. The nurse suspects a patient with female genitalia who suffered a CVA is not able to empty the bladder completely when urinating. Which test does the nurse anticipate will be ordered? A. Cystometry B. Uroflowmetry C. Video urodynamics D. Postvoid residual urine Pediatric Renal Function  Decreased ability to remove excess water and solutes  Decreased concentrating ability  Narrow margin for fluid and electrolyte balance  Increased risk of medication toxicity Aging and Renal Function  Decrease in renal blood flow and GFR Altered sodium and water balance  Number of nephrons decrease due to renal vascular and perfusion changes  Response to acid–base changes delayed  Increased risk for medication toxicity  Alterations in thirst and water intake

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