• FLUID HOMEOSTASIS
• REGULATE BLOOD:
  • COMPOSITION
  • CONCENTRATION
  • VOLUME
  • pH
  • PRESSURE
• MAKES:
  • EPO (ERYTHROPOETIN) (HORMONE)
  • RENIN (ENZYME)
• EXCRETION OF FLUID WASTE

• FILTRATION
• REABSORPTION
• SECRETION

RENAL ARTERY>SEGMENTAL ARTERY>INTERLOBAR ARTERY>ARCUATE ARTERY>CORDICAL RADIATE ARTERY>AFFERENT ARTERIOLE>GLOMERULUS> EFFERENT ARTERIOLE>PERTIBULAR CAPILLARIES> VASA RECTA>CORDICAL RADIATE VEIN>ARCUATE VEIN>INTERLOBAR VEIN>RENAL VEIN

• BOWMANS CAPSULE
• GLOMERULUS
• AFFERENT ARTERIOLE=BLOOD MOVES INTO GLOMERULUS
• EFFERENT ARTERIOLE=BLOOD MOVES OUT
• PROXIMAL CONVOLUTED TUBULE(CLOSEST TO BOWMANS CAPSULE)
• DISTAL CONVOLUTED TUBULE
• LOOP OF HENLE (CONNECTS THESE 2)
• PERITUBULAR CAPILLARIES
• COLLECTING DUCT
• CORTICAL NEPHRON, VEIN, ARTERY, VENULE, VASA RECTA

• HAPPENS IN THE GLOMERULUS
• MOVEMENT OF FLUID FROM INSIDE THE GLOMERULUS INTO THE BOWMANS CAPSULE
• FILTRATION MEMBRANE: PODOCYTES & FENESTRE
• FILTRATION ONLY WORKS IF THERE IS A DIFFERENCE IN PRESSURE BETWEEN THE FLUID IN THE GLOMERULUS & THE FLUID ON THE OTHER SIDE OF THE PODOCYTES
  • INCREASE OF PRESSURE IN GLOMERULUS CAUSES FILTRATION TO OCCUR

• FILTRATION SLITS, PART OF THE BOWMANS CAPSULE

• LITTLE HOLES FOUND ON THE GLOMERULUS
• MAKES THEM EXTRA LEAKY

• MAIN SITE AT PCT(PROXIMAL CONVOLUTED TUBULE)
• H2O FOLLOWS NA WHEN IT CAN, WHEN ITS ALLOWED, & WHEN CELL MEMBRANE ALLOWS IT
• NA GETS PUMPED VIA ACTIVE TRANSPORT
• CELL MEMBRANES HAVE AQUAPORINS ALLOWING H2O TO FOLLOW NA

• PROTEIN PUMPS OUT CL- AS LONG AS NA IS BEING PUMPED OUT

• NA/K PUMP
• NA PUMPED OUT, PUMPS K IN THE OPPOSITE DIRECTION

• WHERE THE MAJORITY OF REABSORPTION OCCURS
• 65% NA= REABSORB VIA ACTIVE TRANSPORT
• 65% H2O=REABSORB VIA OSMOSIS (IF PCT IS COMPLETELY PERMEABLE TO WATER)
• 99-100% ORGANIC MOLECULES= REABSORBED BY COTRANSPORT WITH NA
• 60% CL & 90% HCO3= REABSORBED BY ELECTRICAL TRANSPORT WITH NA
• FILTRATE ENTERING PCT IS SIMILAR TO BLOOD PLASMA IT WAS BEFORE
• FILTRATE ENTERING LOOP OF HENLE IS NOT REMOTELY SIMILAR TO THE BLOOD PLASMA IT WAS BEFORE

• DESCENDING LIMB IS HIGHLY PERMEABLE TO WATER & MODERATELY PERMEABLE TO UREA, NA+, & MANY OTHER IONS
• ASCENDING LIMB IS PERMEABLE TO SOLUTES BUT IMPERMEABLE TO WATER
• NA/CL IS PUMPED OUT OF ASCENDING LIMB WHICH INCREASES THE CONCENTRATION WITHIN THE LOOP (THE U)
  • THIS CAUSES H2O TO GO OUT OF THE DESCENDING LIMB VIA OSMOSIS BECAUSE IT WANTS TO FOLLOW THE NA

• PCT SECRETIONS:
  • H+ VIA COUNTERTRANSPORT W/NA
  • K+, SOME DRUGS/TOXINS, URIC ACID, AMMONIUM (NH4)
• DCT SECRETIONS:
  • H+ VIA COUNTERTRANSPORT W/NA
  • K+

• GLOMERULAR CAPILLARY PRESSURE
• CAPSULAR HYDROSTATIC PRESSURE
• BLOOD COLLOID OSMOTIC PRESSURE

• BLOOD PRESSURE INSIDE CAPILLARY TENDS TO MOVE FLUID/SOLUTES OUT OF CAPILLARY INTO BOWMANS CAPSULE

• INWARD PRESSURE THAT OPPOSES FILTRATION
• PRESSURE DUE TO THE FORCE OF FILTRATE VOLUME ON THE WALL OF THE BOWMAN CAPSULE

• INWARD PRESSURE/OPPOSES FILTRATION
• DUE TO OSMOTIC PRESSURE OF BLOOD IN GLOMERULUS CAPILLARIES
• PRESENCE OF PROTEINS DRAWS WATER BACK IN TO THE GLOM CAPS FROM BOWMANS AS FLUID TRIES TO LEAVE

• MADE BY: HYPOTHALAMUS, RELEASED BY POSTERIOR PITUITARY GLAND
• TARGET: DISTAL CONVOLUTED TUBE/COLLECTING DUCT
• COMMAND: INCREASE H2O REABSORPTION BY MAKING AQUAPORIN-2
• URINE: VOLUME DECREASES, CONCENTRATION INCREASES

• MADE BY: ADRENAL GLAND
• TARGET: DCT/CD
• COMMAND: INCREASE SODIUM REABSORPTION, MORE NA FOR ACTIVE TRANSPORT
• URINE: VOLUME: STAYS THE SAME
• URINE: CONCENTRATION: DECREASES. H2O FOLLOWS IF ADH IS PRESENT

• MADE BY: RIGHT ATRIUM WHEN IT IS OVERSTRETCHED
• TARGET: DCT/CD AND POST PIT.
• COMMAND: DECREASES SODIUM REABSORPTION & ADH RELEASE "DUMP EM BOTH"
• URINE: VOLUME INCREASES, CONCENTRATION STAYS THE SAME

• FUNDUS
• TRIGONE: 3 HOLES, 2 FOR URETERS, 1 FOR URETHRA
• PARIETAL PERITONEUM

• MEN: 20 CM
• WOMEN: 3 CM

3 MUSCLES IN PLAY

• EXTERNAL URETHRAL SPHINCTER(SKELETAL MUSCLE)
• INTERNAL URETHRAL SPHINCTER(SMOOTH MUSCLE)
• DETRUSOR MUSCLE: WALL OF BLADDER: 3 LAYERS: 2 LONGITUDINAL LAYERS WITH A CIRCULAR LAYER IN BETWEEN

1. URINE COMES IN (250-300ML), STRETCHES WALL, STARTS REFELX
2. DETRUSOR MUSCLE RECEIVES STIMULUS, CONTRACTS
3. INTERNAL URETHRAL SPHINCTER: RELAXES
4. EXTERNAL URETHRAL SPHINCTER: CONTRACTS UNTIL IT IS TIME TO URINATE
5. CAN ACCOMMODATE MORE THAN ONCE

• KIDNEY STONES
• COMMON CAUSE OF BLOOD IN THE URINE & PAIN IN THE ABDOMEN
• DEVELOPED BY DECREASED URINE VOLUME OR INCREASED EXCRETION OF STONE-FORMING COMPONENTS (CALCIUM, OXALATE, URATE, CYSTINE, XANTHINE, & PHOSPHATE)

• DISORDER THAT CAUSES AN IMBALANCE OF WATER IN THE BODY
• LEADS TO INTENSE THIRST EVEN AFTER DRINKING FLUIDS

• INFLAMMATION OF THE GLOMERULI

• GRADUAL LOSS OF KIDNEY FUNCTION
• CAUSES DANGEROUS LEVELS OF FLUID, ELECTROLYTES, & WASTES BUILD UP IN YOUR BODY

• SOMETHING THAT PROMOTES THE FORMATION OF URINE BY THE KIDNEY (REDUCE THE AMOUNT OF WATER IN THE BODY)

• LACK OF VOLUNTARY CONTROL OVER URINATION OR DEFACATION

• PROCESS BY WHICH WASTE PRODUCTS ARE FILTERED DIRECTLY FROM THE PATIENTS BLOOD

• DIALYSATE PLACED INTO ABDOMINAL CAVITY (PERITONEUM) & DRAINED OUT BY GRAVITY FLOW
• PERITONEAL MEMBRANE ACTS AS FILTER

• LATE STAGES OF CHRONIC RENAL FAILURE WHICH THERE IS IRREVERSIBLE LOSS OF THE FUNCTION OF BOTH KIDNEYS

• COUNTERCURRENT EXCHANGE
  • TRADE OF SUBSTANCES (NA & CL FOR H2O)
• COUNTERCURRENT MULTIPLICATION
  • DEALS WITH CHANGES IN THE CONCENTRATION OF FILTRATE
  • AS FILTRATE FALLS DOWN THE DESCENDING LIMB, LOSES H2O=INCREASE IN CONCENTRATION
  • AS IT MAKES THE U-TURN INTO THE ASCENDING LIMB, LOSES SOLUTE (NA/CL) BECOMES MORE DILUTED

• COLLECTING DUCT & DESCENDING LIMB PERMEABLE TO UREA
• UREA LEAKS OUT OF CD, ENTERS ISF(INCREASING CONCENTRATION), THEN ENTERS DESCENDING LIMB, ENTERS CD AND REPEATS
• HELPS MAINTAIN OSMOTIC GRADIENT
• WRINGS OUT MORE H2O BY INCREASING CONCENTRATION IN THE ISF

1. BP DECREASED (LOWERED KIDNEY PERFUSION)
2. JUXTAGLOMERULAR CELL OF KIDNEY RELEASES RENIN
3. RENIN CONVERTS ANGIOTENSINOGEN TO ANGIOTENSIN I
4. ANGIOTENSIN I CONVERTED TO ANGIOTENSIN II VIA ACE (ANGIO CONVERTING ENZYME)
5. ANGIOTENSIN II IS A POWERFUL VASOCONSTRICTOR
   1. INCREASES ALDOSTERONE RELEASE
   2. INCREASES ADH RELEASE
   3. INCREASES BLOOD VOLUME
   4. INCREASES BLOOD PRESSURE
   5. INCREASED VESSEL WALL TENSION, BODY RETAINS H2O & NA+

• SMOOTH MUSCLE CELLS AROUND THE AFFERENT ARTERIOLE
• CONTAINS GRAINS
• FILLED WITH RENIN
• MONITORS BLOOD PRESSURE

• CELLS IN THE DISTAL CONVOLUTED TUBULE
• MONITOR FILTRATE CONCENTRATION