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The Excretory System
Excretion- removal of waste produced during body functions
Occurs through1 Intestine- digestive wastes salts
2 Skin (sweat glands)- water electrolytes
3 Lungs- carbon dioxide water
4 Kidneys- toxins water N cmpds electrolytes
Urinary System Functions
A maintain water concentration in bloodB maintain concentration of ions like Na amp
KC form urineD influence rate of secretion of hormones
like ADHE alter pH (acid- base balance)
Why bother with all of these
Basic Anatomy of the Urinary System
Gross Anatomy- KIDNEY
1 lie in retroperitoneal position
2 Fat cushion holds it in position
3 medial surface with concave hilus
Not that typehellip
Gross Anatomy- KIDNEY
4 Cortex- outer and lighter
5 Medulla- inner and darker
1 Cortex region of kidney 2 Medulla region of kidney
Gross Anatomy- KIDNEY
6 Most of the medulla is made up of RENAL PYRAMIDS with a base facing outward and papilla facing the hilus
Gross Anatomy- KIDNEY
7 Cortical tissue dips into the medulla between the pyramids forming RENAL COLUMNS
Gross Anatomy- KIDNEY
8 Each renal papilla juts into a cup-like CALYXndash Urine leaving the renal papilla collects here before
leaving the body
Gross Anatomy- KIDNEY
9 The calyces join to form the renal pelvis It narrows as it exits the hilum to become the ureter
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Excretion- removal of waste produced during body functions
Occurs through1 Intestine- digestive wastes salts
2 Skin (sweat glands)- water electrolytes
3 Lungs- carbon dioxide water
4 Kidneys- toxins water N cmpds electrolytes
Urinary System Functions
A maintain water concentration in bloodB maintain concentration of ions like Na amp
KC form urineD influence rate of secretion of hormones
like ADHE alter pH (acid- base balance)
Why bother with all of these
Basic Anatomy of the Urinary System
Gross Anatomy- KIDNEY
1 lie in retroperitoneal position
2 Fat cushion holds it in position
3 medial surface with concave hilus
Not that typehellip
Gross Anatomy- KIDNEY
4 Cortex- outer and lighter
5 Medulla- inner and darker
1 Cortex region of kidney 2 Medulla region of kidney
Gross Anatomy- KIDNEY
6 Most of the medulla is made up of RENAL PYRAMIDS with a base facing outward and papilla facing the hilus
Gross Anatomy- KIDNEY
7 Cortical tissue dips into the medulla between the pyramids forming RENAL COLUMNS
Gross Anatomy- KIDNEY
8 Each renal papilla juts into a cup-like CALYXndash Urine leaving the renal papilla collects here before
leaving the body
Gross Anatomy- KIDNEY
9 The calyces join to form the renal pelvis It narrows as it exits the hilum to become the ureter
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Urinary System Functions
A maintain water concentration in bloodB maintain concentration of ions like Na amp
KC form urineD influence rate of secretion of hormones
like ADHE alter pH (acid- base balance)
Why bother with all of these
Basic Anatomy of the Urinary System
Gross Anatomy- KIDNEY
1 lie in retroperitoneal position
2 Fat cushion holds it in position
3 medial surface with concave hilus
Not that typehellip
Gross Anatomy- KIDNEY
4 Cortex- outer and lighter
5 Medulla- inner and darker
1 Cortex region of kidney 2 Medulla region of kidney
Gross Anatomy- KIDNEY
6 Most of the medulla is made up of RENAL PYRAMIDS with a base facing outward and papilla facing the hilus
Gross Anatomy- KIDNEY
7 Cortical tissue dips into the medulla between the pyramids forming RENAL COLUMNS
Gross Anatomy- KIDNEY
8 Each renal papilla juts into a cup-like CALYXndash Urine leaving the renal papilla collects here before
leaving the body
Gross Anatomy- KIDNEY
9 The calyces join to form the renal pelvis It narrows as it exits the hilum to become the ureter
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Basic Anatomy of the Urinary System
Gross Anatomy- KIDNEY
1 lie in retroperitoneal position
2 Fat cushion holds it in position
3 medial surface with concave hilus
Not that typehellip
Gross Anatomy- KIDNEY
4 Cortex- outer and lighter
5 Medulla- inner and darker
1 Cortex region of kidney 2 Medulla region of kidney
Gross Anatomy- KIDNEY
6 Most of the medulla is made up of RENAL PYRAMIDS with a base facing outward and papilla facing the hilus
Gross Anatomy- KIDNEY
7 Cortical tissue dips into the medulla between the pyramids forming RENAL COLUMNS
Gross Anatomy- KIDNEY
8 Each renal papilla juts into a cup-like CALYXndash Urine leaving the renal papilla collects here before
leaving the body
Gross Anatomy- KIDNEY
9 The calyces join to form the renal pelvis It narrows as it exits the hilum to become the ureter
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Gross Anatomy- KIDNEY
1 lie in retroperitoneal position
2 Fat cushion holds it in position
3 medial surface with concave hilus
Not that typehellip
Gross Anatomy- KIDNEY
4 Cortex- outer and lighter
5 Medulla- inner and darker
1 Cortex region of kidney 2 Medulla region of kidney
Gross Anatomy- KIDNEY
6 Most of the medulla is made up of RENAL PYRAMIDS with a base facing outward and papilla facing the hilus
Gross Anatomy- KIDNEY
7 Cortical tissue dips into the medulla between the pyramids forming RENAL COLUMNS
Gross Anatomy- KIDNEY
8 Each renal papilla juts into a cup-like CALYXndash Urine leaving the renal papilla collects here before
leaving the body
Gross Anatomy- KIDNEY
9 The calyces join to form the renal pelvis It narrows as it exits the hilum to become the ureter
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Gross Anatomy- KIDNEY
4 Cortex- outer and lighter
5 Medulla- inner and darker
1 Cortex region of kidney 2 Medulla region of kidney
Gross Anatomy- KIDNEY
6 Most of the medulla is made up of RENAL PYRAMIDS with a base facing outward and papilla facing the hilus
Gross Anatomy- KIDNEY
7 Cortical tissue dips into the medulla between the pyramids forming RENAL COLUMNS
Gross Anatomy- KIDNEY
8 Each renal papilla juts into a cup-like CALYXndash Urine leaving the renal papilla collects here before
leaving the body
Gross Anatomy- KIDNEY
9 The calyces join to form the renal pelvis It narrows as it exits the hilum to become the ureter
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Gross Anatomy- KIDNEY
6 Most of the medulla is made up of RENAL PYRAMIDS with a base facing outward and papilla facing the hilus
Gross Anatomy- KIDNEY
7 Cortical tissue dips into the medulla between the pyramids forming RENAL COLUMNS
Gross Anatomy- KIDNEY
8 Each renal papilla juts into a cup-like CALYXndash Urine leaving the renal papilla collects here before
leaving the body
Gross Anatomy- KIDNEY
9 The calyces join to form the renal pelvis It narrows as it exits the hilum to become the ureter
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Gross Anatomy- KIDNEY
7 Cortical tissue dips into the medulla between the pyramids forming RENAL COLUMNS
Gross Anatomy- KIDNEY
8 Each renal papilla juts into a cup-like CALYXndash Urine leaving the renal papilla collects here before
leaving the body
Gross Anatomy- KIDNEY
9 The calyces join to form the renal pelvis It narrows as it exits the hilum to become the ureter
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Gross Anatomy- KIDNEY
8 Each renal papilla juts into a cup-like CALYXndash Urine leaving the renal papilla collects here before
leaving the body
Gross Anatomy- KIDNEY
9 The calyces join to form the renal pelvis It narrows as it exits the hilum to become the ureter
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Gross Anatomy- KIDNEY
9 The calyces join to form the renal pelvis It narrows as it exits the hilum to become the ureter
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
10 BLOOD VESSELS
Renal artery brings frac14 of all blood to kidneyminBranches into
Interlobar arteries- extend toward the cortexChanges names
Arcuate arteries- base of pyramids Changes names
Interlobular arteries- afferent arterioles that branch into the glomerulus where blood is filtered
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
10 BLOOD VESSELS (continued)
Efferent arterioles
Peritubular capillaries (vasa recta) Interlobular vein Arcuate vein Interlobar vein renal vein
Blood flows into
But I am not going to test you on this stuff
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Macroscopic KidneysA Capsule amp hilus
B Renal sinus
1 renal pelvis
2 major calyces
3 minor calyces
C Renal medulla
1 renal pyramids
a papilla
2 Renal column
D Renal cortex
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
B Gross Anatomy- URETER
1 28 cm long
2 Allows urine to travel from kidney to urinary bladder
3 3 layers of tissuendash Mucous liningndash Smooth muscle middlendash DWF outer layer
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
C URINARY BLADDER
1 behind symphysis pubis
2 mostly smooth muscle aka detrusor muscle lined with transitional epithelium
3 3 openings 2 from ureters and one into the urethra
4 Has valve to prevent backflow into kidney
5 Functionsndash urine reservoirndash aided by urethra expels urine from body
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Male Urethra Female Urethra
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Gross Anatomy- URETHRA1 3 cm in females 20 cm in males
2 Male urethra (URINE) passes through prostate gland where it is joined by 2 ejacuatory ducts (SEMEN) then travels through penis and ends at the urinary meatus at the tip of the penis
3 In females completely separate from vagina
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
4 Micturition- urination1 Voluntary relaxation of
external sphincter muscle of bladder
2 Detrusor muscle contracts
3 Parasympathetic nerve control
4 Incontinence
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Microscopic Structure of the NEPHRON
bull Filtering unit of kidney
bull Process blood plasma
bull Form urine
bull 125 million per kidney
bull Looks like a funnel with a
long winding stem
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
NEPHRONComponents
1 renal corpuscle
2 PCT
3 loop of Henle
4 DCT
5 Collecting tubule amp duct
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
The Nephronbull The nephron is the
functional unit of the kidney responsible for the actual purification and filtration of the blood
bull About one million nephrons are in the cortex of each kidney
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
The NEPHRON
RENAL CORPUSCLE- in the cortex
1 Bowmanrsquos capsulebull Cup-shaped mouth of
nephron
2 Glomerulusbull capillaries in BCbull Pores (fenestrations)bull Basement membrane
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
The Glomerulus
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Microscopic Structure of the NEPHRON
PROXIMAL TUBULE- in cortexndash Closest to BC
(ldquoproximalrdquo)ndash Aka PCT (proximal
convoluted tubule)ndash Brush border
(microvilli) face lumen- increase surface area
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
The NEPHRON
LOOP OF HENLE (LOH)bull Renal tubule beyond the PCT
ndash Descending limb (thin)
ndash Sharp turn
ndash Ascending limb (thick)
ndash Dips into medulla
cortex
medulla
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
THE NEPHRON
DISTAL TUBULEbull Aka DCT (distal
convoluted tubule)bull Beyond LOH (ldquodistalrdquo)bull Juxtaglomerular
apparatus
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
THE NEPHRONCOLLECTING DUCT
ndash Straight tubule joined by distal tubules of several nephrons
ndash Fuse to form papillary ducts which deliver urine to the calyces
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Overview of KIDNEY FUNCTION
1 FILTRATIONndash Occurs in glomerulusndash Dependent on
Glomerular Filtration Rate (GFR)
ndash Filter water and solutes from blood into renal tubule
bull Glucosebull Amino acidsbull Nitrogen wastes
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
KIDNEY FUNCTION-Filtration
bull FILTRATIONndash Whatrsquos left in the
bloodbull Blood cellsbull Most plasma proteins
ndash What causes itbull Pressure gradient
(high to low)bull Related to blood
pressure
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Filtration
GFR is directly dependent on blood pressurea If GFR (BP) is too high filtrate flows too fast and substances are NOT reabsorbed urine flow increases water is lost blood volume drops blood pressure drops
b If GFR (BP) is too low filtrate flows too slow and substancesare retained too much urine flow decreases water is preserved blood volume increases blood pressure increases
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Overview of KIDNEY FUNCTION
2 REABSORPTIONndash Occurs in mostly in
PCT and little in LOH DCT CD
ndash Put good things in the renal tubule back into the blood (peritubular capillaries)
bull Waterbull Electrolytesbull Nutrients
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Healthy kidneys
reabsorbbull Glucose (if nothellip)bull Amino acidsbull Sodiumbull Water
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash Substances that are NOT reabsorbed fully
bull Things that lack carriersbull Things that are not lipid solublebull Things that are too largebull Examples urea creatinine uric acid
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Overview of KIDNEY FUNCTION
bull REABSORPTIONndash ADH causes the
distal and collecting tubules to become more permeable to water
ndash This allows hypertonic urine to be formed
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Overview of KIDNEY FUNCTION
bull SECRETIONndash PCT mostlyndash Reabsorption in reversendash Movement of small molecules out of the
peritubular blood and into the tubule for excretionbull Including K H urea ammoniabull Dispose certain drugsbull Helps control blood pH
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Review Questions
bull Do you know the names of the structures
bull What is GFR What regulates it
bull Why is reabsorption important
bull Where is the only place glucose is reabsorbed
bull Where does ADH act What does it do
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Making Urinebull Choose your water solution (Normal or Dehydrated)bull Fill the cup 23 of the way with that solutionbull Add frac12 dropper of Urea + vitaminsbull Add frac12 dropper of acidbull Check pH with pH paperbull If you desire pimp your urine with 1 dropper of the following
ConditionSubstance
Diabetes Urinary Tract Infect
Kidney Failure
Glucose + - +
Blood - + +
Protein - - +
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Answer the following questions on a piece of paper and turn it in
1 Did you drink the urine2 What type did you make3 How did it taste4 Did it taste like you expected5 If you did not drink it why not
(please provide at least three reasons)
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
URINE COMPOSITION
bull Water- 95bull Other substances- 5
ndash Nitrogen wastesndash Electrolytesndash Toxinsndash Pigmentsndash Hormonesndash Abnormal stuff like blood glucose casts
calculi
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
URINE COMPOSITION
bull Characteristicsndash Colorndash Compoundsndash Slight odorndash 46-80 pH (fresh is acidic)ndash 1001- 1035 specific gravity
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull FLUIDndash Water accounts for 50-60 total weight (why less in obese
people)bull 37 of this is ECFbull 63 of this is ICF
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
FLUID ELECTROLYTE and ACID-BASE BALANCE
bull Mechanisms to maintain fluid balancendash Volumes of ICP ECF
plasma and total volume of water relatively constant
ndash Adjust output (urine volume) to intake
ndash Adjust fluid intake (liquids we drink water in food we eat water formed by catabolism)
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Anatomy of Micturition amp Incontinence bull Detrusor muscle with an External and Internal sphincterbull Normal capacity 300-600ccbull First urge to void 150-300ccbull CNS control
ndash Pons - facilitatesndash Cerebral cortex - inhibits
bull Harmonal effects - estrogen
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Bladder Pressure-Volume Relationship Or how to hold it
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Treatment Options
bull Reduce amount and timing of fluid intakebull Avoid bladder stimulants (caffeine)bull Use diuretics judiciously (not before bed)bull Reduce physical barriers to toilet (use
bedside commode)
1
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Pessaries
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Predisposing conditions to UTI
bull Femalebull Short urethra proximity to
anus termination beneath labia
bull Sexual activitybull Pregnancy
ndash 2-3 have UTI in preg 20-30 with asx bacteriuria
bull decreased ureteral peristalsis temp incomp ofvesicoureteral valves
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Urethritis
bull 1048707 Acute dysuria frequency
bull 1048707 Often need to suspect sexually
bull transmitted pathogens esp if sx more than 2 days no hematuria no suprapubic
bull pain new sexual partner cervicitis
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Cystitis
bull Sx frequency dysuria urgency suprapubic pain
bull Cloudy malodorous urine (nonspec)
bull Leukocyte esterase positive = pyuria
bull Nitrite positive (but not always)
bull WBC (2-5 with sx) and bacteria on urine microscopy
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Nephrolithiasis kidney stones
bull Supersat of urine by stone forming constituents
bull Freq stone types Calcium (most common) struvite oxalate uric acid
bull Risk factors metabolic disturbances previous UTI gout genetic
bull Incidence = 2-3bull Hematuria (rarely dangerous
by itself)bull Dangerous combo =
obstruction + infection
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Addisonrsquos Disease
Addisons disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases the hormone aldosterone
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Cystocele
bull mildmdashgrade 1mdashwhen the bladder droops only a short way into the vagina
bull severemdashgrade 2mdashthe bladder sinks far enough to reach the opening of the vagina
bull advancedmdashgrade 3mdashcystocele occurs when the bladder bulges out through the opening of the vagina
the wall between a womanrsquos bladder and her vagina weakens and allows the bladder to droop into the vagina
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
Nocturnal enuresis
bull Hormonal problems
bull Bladder problems
bull Genetics
bull Sleep problems
bull Medical conditions
bull Psychological problems
