The Kidneys
Kidney Anatomy
1.) We are going to focus on the cortex (outer layer) of the kidney first!
→ The renal cortex is a nice rim around the entire kidney
→ They contain all of these structures called glomeruli, most of the proximal tubules and some segments of the distal tubule
→ T...
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NURS-208 Final: Lecture 11 (Renal
Pathophysiology)
The Kidneys - Answer Kidney Anatomy
1.) We are going to focus on the cortex (outer layer) of the kidney first!
→ The renal cortex is a nice rim around the entire kidney
→ They contain all of these structures called glomeruli, most of the proximal tubules
and some segments of the distal tubule
→ Then there are the renal columns which are an extension of the cortex and they
extend between the pyramid and the renal pelvis
2.) The medulla forms the inner part of the kidney
→ It consists of regions called pyramids
Right and Left Kidney - Answer There is a little discrepancy of where the kidneys are in
the body.
1.) One of the differences between the right and the left kidneys is that the left kidney is
higher up
→ This is because the liver is in the way of the right kidney
2.) The thing that is most important that really helps us, especially when we take care of
patients, is that you have two kidneys, but you only need one
→ The kidneys only share one blood supply (major vessel = aorta which branches off to
the renal arteries)
↳ If your aorta is damaged (car accident/arteriosclerosis), the kidneys are going to feel
that very quickly
3.) Everyday, you will be a lung and kidney nurse!
→ This is because these organs are usually the ones that every diagnosis touches
4.) The kidneys are located retroperitoneally
Retroperitoneal Bleed - Answer Some patients that take anticoagulants will come in with
something called *retroperitoneal bleed*
1.) That encompasses on an x-ray (or a CAT scan) the abdomen area of the body
2.) When these patients come in they will have some non-specific complaint of pain
→ We would then like to get a diagnostic radiograph of the patient to try and find the
source of this non-specific pain (we would like to see a chest x-ray)
3.) In this chest x-ray we do not really see much there, all of the organs seem to be
normal size, so we ask more questions!
→ This is when we realize we need a stronger diagnostic film
4.) X-rays aren't that great, so the next diagnostic film used (to help us see a little bit
more) is a CAT scan
→ A CAT scan can be taken two ways: We take a picture of you in the CAT scanner (it
outlines with better definition all the organs and the bone), next we hook up contrast
(radio opaque dye) to the patients IV (everyone in the hospital has an IV, it is apart of
the admission agreement, and if you do not want one you have to sign a waver) and
then take another picture in the scanner
,→ What this radio opaque fluid does is it travels throughout the body within 10 seconds
and it maps all the veins and arteries
5.) So you get a really clear picture of just organs with the first film and a really clear
picture of what is happening to the veins and arteries in the second film
→ Especially the non-specific area that the patient is complaining of pain!
→ Sometimes we see leaks or small microvascular tears (hypertension causes small
microvascular tears throughout the entire endothelium, from the head to the toe; the
more velocity you have going through any vessel, if you are diagnosed, even though
you are controlled on medications, you are going to have microvascular tears)
6.) So, a lot of these patients will come in with a retroperitoneal bleed
→ To help them you need to hold the anticoagulant (risk-benefit ratio; we know that we
want to give people anticoagulants to help stop the formation of clots, especially when
they are on bed rest; but, if they are covertly bleeding it is not worth the risk [even
though they are at risk for forming a clot, you cannot make things worse; do no harm]!)
→ We fix this by keeping them for monitoring, make sure they have an IV site, and hold
the anticoagulants
7.) *Covert* = hidden (we do not really know when it happens until the patient has
symptoms); *Overt* = obvious
8.) Before the patient leaves we find out if they are having any other pain and we will
probably repeat that CAT scan with contrast (this means you do two CAT scans)
→ That contrast needs to be a doctors order because it is a diagnostic substance that
can cause the patient some harm
→ The kidneys have to filter out drugs so if they have really bad kidneys we will just
take them off anticoagulants and not risk the CAT scan (we are not trained to know if it
is safe or not)
9.) So if you see someone has a retroperitoneal bleed, you are going to think about the
aorta as well as the structure of the kidney
→ Monitor kidney function!
*When someone has a retroperitoneal bleed, if it is going to be in this space and if there
is microvascular tears in the aorta, the kidney is the first organ that is going to feel that
effect (usually patients who have this retroperitoneal bleed all the sudden stop
urinating).*
Kidney Blood Flow - Answer Blood flow is innervated by the sympathetic nervous
system to the kidney.
1.) These pyramids extend to the renal pelvis and contain the loops of Henle and
collecting ducts
2.) The minor and major calyxes are the chambers that receive the urine from the
collecting ducts and form the entry into the renal pelvis (this is an extension of the upper
ureter as well)
3.) *The structural unit of the kidney is the lobe*
→ Each lobe is composed of a pyramid and an overlying cortex (there is about roughly
14-18 lobes in each kidney)
Filtration - Answer What is filtration?
, 1.) The mass movement of water and solutes. It moves from our plasma to the renal
tubule and this all occurs in the renal corpuscle
2.) About 20% of your plasma volume passes through the glomeruli at any given time
and is filtered
→ This means 180L of fluid is filtered by our kidneys every day (that is a massive
amount of fluid and work that your kidneys do every single day)
3.) If it can filter 180L of fluid a day without problem, you can image that if a patient is
dehydrated, how the function of the kidney will definitely decrease (it wants to do its job)
Effluent - Answer When you have someone that cannot make their own urine and we do
dialysis, when the machine performs the filtration and removes all of the solutes and the
toxins, we do not call that production from the machine urine.
1.) That urine is what you would make on your own
2.) Dialysis patients, who are on dialysis, do not make urine. They make *effluent*!
→ If the machine is making the product it is called effluent, but if the patient is making
the product it is called urine
3.) Effluent is just another word for the dialysis machine removing the waste from the
body (will be placed under output instead of urine for dialysis patients)
Urine Formation - Answer How is urine made?
1.) *Glomerular filtration*
→ The movement of substances from the blood within the glomerulus into the capsular
space
2.) *Tubular reabsorption*
→ The movement of substances from the tubular fluid back into the blood
3.) *Tubular secretion*
→ The movement of substances from the blood into the tubular fluid
How and what is being placed in urine? - Answer Filtration, absorption, reabsorption
and excretion.
1.) Filtration at the glomerulus
2.) Absorption into peritubular capillaries
3.) Reabsorption into tubule for excretion in urine
Kidneys and Glucose Filtration - Answer 1.) You should not find glucose in urine
because the molecule is too large
→ That extra glucose goes into the liver and the liver breaks it down and stores it either
as glycogen or fat
2.) When carrier molecules for glucose become saturated (this sometimes happens in a
state of hyperglycemia; this would be someone who is not making much insulin; a lot of
people do not know that they are not making enough insulin) and a patient notices they
are urinating a lot, one of the big problems is that glucose is being seen by the kidney
every time the heart beats (the kidneys are seeing with every first of blood going
through the renal artery into the glomeruli what is in the blood)
→ The kidney choses what to keep in the blood and what to excrete. It is doing that with
all electrolytes (all electrolytes lead to your pH balance so not only are your kidneys
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