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Exam (elaborations) NUR 5315 Advanced Pathophysiology Renal And Urologic System Core Knowledge Objectives With Advanced Organizers (NUR5315)$16.49
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nur 5315 advanced pathophysiology renal and urologic system core knowledge objectives with advanced organizers nur5315
nur 5315 advanced pathophysiology renal and urologic system co
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NUR 5315 Advanced Pathophysiology Renal And Urologic System Core Knowledge Objectives With Advanced Organizers (NUR5315)
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N5315 Advanced Pathophysiology
Renal and Urologic System
Core Knowledge Objectives with Advanced Organizers
Anatomy and physiology of the Renal System
I. Discuss the physiologic relationship between phosphorus and calcium.
A. Calcium: the major cation associated with the structure of bones and teeth, serves as cofactor for blood
clotting, and is required for hormone secretion and the function of cell receptors
1. Plasma membrane stability and permeability, transmission of nerve impulses, and contraction of
muscles are directly related to calcium ions
2. Intracellular calcium primarily located in the mitochondria
3. Ionized calcium has the most important role in physiologic functions
B. Phosphate: acts as an intracellular and extracellular anion buffer in the regulation of acid-base balance
and in the form of ATP it provides energy for muscle contraction
C. Calcium and phosphate has strict direct relationship (increase and decrease together) regulated by PTH,
vitamin D, and calcitriol
1. Together these substances determine the amount of dietary calcium and phosphate absorbed from
the intestine, the deposition and absorption of calcium and phosphate from the bone, and renal
reabsorption and excretion of calcium and phosphate by the kidney
2. PTH secreted in response to low levels of calcium by the parathyroid gland
a. Renal regulation requires PTH: stimulated reabsorption of calcium and inhibits reabsorption
of phosphate
b. Increase Ca and increased excretion of phosphate
3. Vitamin D (cholecalciferol)
a. Must be activated by the liver and the kidney
b. Renal acitivation begins when low levels of Ca stimulate secretion of PTH PTH acts to
increase calcium reabsorption and enhance renal excretion of phosphate low calcium and
increases PTH cause renal activation of Vitamin D activated Vitamin D increases
absorption of calcium and phosphate in the small intestine, enhance bone calcification, and
increase renal tubular reabsorption of calcium and phosphate
c. In renal failure, Vitamin D is not activated and serum calcium levels decrease and phosphate
levels increase
4. As calcium levels increase, opposite adapation occurs, leading to suppression of PTH, decreased
Vitamin D activation, decrease intestinal absorption, and increased renal phosphate reabsorption
5. Calcitonin: thyroid gland, primarily decrease Ca levels by inhibiting osteoclast activity in bone
6. In acidosis, ionized Ca increases ; in alkalosis ionized Ca decreases (more protein available to
bind with decreased H)
II. Discuss how calcium and phosphorus homeostasis is altered by renal disease and the pathologic
consequences.
III. Examine the basic anatomy and physiology of the kidney.
Structure or Description of Role and Function
Physiologic Process
Kidney Structure The kidney’s lay in the retroperitoneal space of the abdominal cavity, one on
each side of the spine
Functions include:
-the excretion of metabolic waste products
-the maintenance of water balance
-the regulation of acid base balance
, -blood pressure regulation
-secretion of erythropoietin which stimulates the growth of red blood cells.
Disorders which affect the kidney may result in a decrease in the production of
erythropoietin resulting in anemia.
-activates vitamin D
Renal capsule: the outer most portion of the kidney and is made of a fibrous
tissue
Renal fascia: a fatty layer of tissue that adheres each kidney to the posterior wall
of the abdomen
Renal cortex: directly below the renal capsule and extends between the
medullary pyramids and houses the renal corpuscles and the proximal and distal
tubules of the nephron. The renal medulla is pyramid-shaped. It is the inner
darker portion of the kidney tissue consisting of renal pyramids, which contain
the secreting and collecting tubules. Renal calyces extend from the medulla and
are responsible for collecting urine from the medulla. The renal calyces extend
from the medulla and merge together to form the renal medulla. The renal
medulla gives rise to the ureter, which extends to the bladder.
Nephron Structure Nephron is the functional unit of the kidney. There are two types of nephrons:
Nephron Function: the cortical nephron which is located in the renal cortex and the juxtamedullary
● Glomerular nephron which lays close to and extends into the medulla. Nephron has three
Filtration main functional parts
● Filtration Rate (1) The glomerulus: a collection of capillaries which receives blood from the
● Tubular renal artery and is responsible for filtering the blood
Transport (2)The bowman’s capsule partially encases the glomerulus and extends to form
the tubule system. Together the glomerulus and bowman’s capsule are termed
● Proximal
the renal corpuscle.
Convoluted
(3)The tubule system is a collection of tubules which originate from the
Tubule bowman’s capsule.
● Loop of Henle
and Distal The proximal tubule: comes directly off of the bowman’s capsule and is the
Convoluted recipient of the filtrate which flows from the glomerulus into the bowman’s
Tubules capsule and then into the proximal tubule
- Reabsorbs all of the glucose: A serum glucose above 180 mg/dL will exceed
the renal threshold for glucose and result in glucosuria and the damage
associated with diabetes mellitus
-It reabsorbs amino acids.
-It also reabsorbs most of the HCO3, Na, Cl, phosphate, potassium, and water.
-The proximal tubule when stimulated by the parathyroid hormone will excrete
phosphate
-It is also the site of action for angiotensin II which stimulates Na, water and
bicarbonate reabsorption.
The descending loop of Henle: extends from the proximal tubule, is
impermeable to Na, passively reabsorbs water and concentrates urine.
The ascending loop of Henle: extends from the descending loop of Henle
-It actively reabsorbs sodium, potassium and chloride
-It induces the reabsorption of magnesium and calcium and it is impermeable to
water; therefore, it makes the urine more dilute.
, The distal convoluted tubule: extends from the ascending loop of Henle
-It actively reabsorbs Na, is impermeable to water and causes the urine to be
more dilute.
-In the distal convoluted tubule, the parathyroid hormone increases calcium
reabsorption.
The collecting tubule: extends from the distal convoluted tubule and connects
with the renal pyramids.
-It reabsorbs sodium in exchange for potassium and hydrogen.
-This process is regulated by the hormone aldosterone, and this is the site of
action for antidiuretic hormone as well.
The kidneys receive approximately 1000ml of blood per minute which is a
sizable portion of the cardiac output→As the blood enters the glomerulus, 20%
of this plasma is filtered out of the capillaries and enters the Bowman’s
capsule→ The filtrate then enters the proximal tubule at a rate of approximately
125ml per minute: this is known as glomerular filtration rate (GFR).
The remaining 80% of plasma is not filtered into the Bowman’s capsule but
instead flows out of the glomerular space and into the efferent arterioles. The
efferent arterioles then divide into millions of capillaries that surround the
tubules and are called peritubular capillaries. This network of capillaries in
conjunction with epithelial cells of the tubules is responsible for solute exchange
and water regulation.
Renal Blood Vessels Podocytes: epithelial cells in the bowman capsule which wrap around the
Renal Blood Flow: capillaries of the glomeruli
● Autoregulation -They form long processes (foot projections) called pedicels which wrap around
● Neural the glomerular capillaries and leave slits between them. Blood is filtered through
regulation these slits.
● Hormone -The juxtaglomerular apparatus (JGA): is located in the area just proximal to the
regulation renal corpuscle, between the afferent & efferent arterioles and where the distal
tubule loops up and makes contact with the afferent arteriole.
-The JGA is a collection of cells consisting of the juxtaglomerular cells, the
macula densa, and the mesangial cells.
(1) The juxtaglomerular cells are located in the wall of the afferent arterioles.
They monitor renal pressure and help to maintain normal GFR through the
release of renin. When renal perfusion is decreased these cells are responsible
for releasing renin to help increase GFR. The end result of renin is the release of
angiotensin II which constricts the efferent arteriole thereby increasing pressure
to the glomerulus
(2) The macula densa is a group of epithelial cells located in the distal
convoluted tubule that are in close contact with afferent and efferent arterioles.
They help to regulate GFR.
(3) The mesangial cells are located in the section between the afferent and
efferent arterioles and among the glomerular capillaries. They function as
macrophages and are able to contract to regulate blood flow of the glomerular
capillaries. These cells contain receptors for angiotensin II and natriuretic factor.
When the cells are stimulated by angiotensin II they contract, provoking a
vasoconstriction and thereby reducing glomerular blood flow. When they are
stimulated by natriuretic peptide the cells relax, allowing vasodilation and
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