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what is the peritubular capillary?
- originates from the efferent arteriole
- low pressure vessels
- adapted for reabsorption rather than filtration
- rejoin venous channels to take blood away from the kidneys
what are struvate stones?
- staghorn stones shaped like calaces
- contains proteus bacteria
- reccurent UTI
what is the juxtaglomerular apparatus?
- juxtaglomerular cells contain renin and constrict afferent
- macula densa in DCT triggers renin release, sense Na osmolality
- extraglomerular mesengial cells - anchor and constrict
- peripolar cells -
what is the loop of Henle?
- concentrates urine
- thin decending - highly permeable to water, moderate to urea,Na,other ions
- osmolality of filtrate reaches highest point at elbow of loop
- thin ascending - impermable to water, absorbs solutes, diluting segment
- thick ascending -
- always absorbs more NaCl than water
what decreases GFR?
decreased kidney perfusion or pressure from afferent constriction, efferent dialation, hypotension, hypovolumia,
what increases GFR?
increased kidney perfusion or pressure due to afferent dialaiton, efferent constriction, hypertension, hypervolumia,
what are the treatable causes of incontenance in elderly?
- Atrophied urethitis, vaginitis
- Psyciatric - depression
- Excessive urine output - hyperglycemia
- Restriced mobility
- Stool impaction
what is the effect of the liver on the renin angiotensin mechanism?
angiotensinogen is released from the liver, this is then converted to angiotensin I by renin
How does aldosterone work?
- released from adrenal cortex in the glomerulosa by high concentrations of angiotensin II or descreased stretch of baroreceptors
- causes increased reabsorbtion of Na and thus fluid in the DCT,
- increases secretion of K
what counteracts aldosterone?
- osmolality of ECF, low potassium, high sodium
- spirolactone is an antihypertensive that antagonizes aldosterone
what does sypmathetic tone do to the kidneys?
contricts afferent, everything decreases, urine output can drop to zero
How does lasix work?
- loop diuretic
- inhibits symport of NaCl,K in thick ascending loop, Mg also leaves can cause hypomagnesia
what is the difference between nephrotic and nephritic?
- nephrotic - proteinuria >= 3.5mg a day
- nephritic - < 3.5
what is the innervation of the urinary system?
- sympatetic from T11-L2 to hypogastric nerve, promotes bladder relaxation of detrusor, contraction of internal sphint
- parasympathetic from S1-S3 promotes bladder empyting contraction of detrusor, relaxation of internal sphinct
- somatic (voluntary) from S2-S4 somatic pudendal nerve
what are the stages of renal failure?
- 1 - damage with gfr > 90
- 2 - damage with gfr 60-89
- 3- gfr 30-59
- 4- gfr 15-29
- 5 - FAIL gfr < 15
what are aquaporins?
special transmembrane protein channels where water crosses the cell membrane thru osmosis
what do you give for hyperkalemia?
give insulin, forces K back into the cells
what goes in and out of PCT?
- Reabsorbs - NaCl, bicarb,K,water,glucose,amino acids
- Secrets-H+, organic acids and bases
in and out of loop of henle
- thin decending - reabsorb water
- thick acending - reabsorbs NaCl,bicarb,K,Ca,Mg secrets H+
in and out of DCT
- early distal - reabsorbs NaCl, Ca, Mg
- last distal and CT - reabsorb NaCl, secretes K+, ADH mediated H2O reabsorbtion
- Intercalculated cells reabsorbs bicarb and K secrets H+