Ch 18 urinary Flashcards
what are the seven functions of the urinary system
removes metabolic wastes
removes hormones from the body
removes drugs and other foreign material from the body
regulates water, electrolyte, and acid-base balance
secretes erythropoietin
activates vitamin D
regulates blood pressure through the renin-angiotensin-aldosterone system
what is the path of the urinary system
kidneys to ureters to urinary bladder to urethra
functional units of the kidneys
nephrons
how many nephrons does each kidney have?
over a million
what are the two parts of the renal corpuscles
glomerulus and Bowman capsule
what are the four parts of the renal tubules
proximal convoluted tubule, Loop of Henle, distal convoluted tubules and collecting duct
how does urine form
through filtration and reabsorption
where does filtration take place
in the renal corpuscles
what happens during filtration
large volumes of fluid passes from glomerular capillaries into the tubule or Bowman capsule
what are the types of fluids that are filtered
wastes, nutrients, electrolytes, and other dissolved substances
what remains in the blood during filtration
cells and proteins
what does reabsorption control
pH and electrolytes
what is reabsorbed
essential nutrients, water and electrolytes
reabsorption takes place in what
the peritubular capillaries
what are the three transport mechanisms for reabsorption
active transport, co-transport and osmosis of water
where is the most water reabsorbed
proximal convoluted tubules
what maintains homeostasis during reabsorption
nutrients and electrolytes
where is glucose reabsorbed
proximal convoluted tubules
what hormones are involved in reabsorption
antidiuretic hormone, aldosterone and atrial natriuretic hormone
Antidiuretic hormone is secreted by what
the posterior pituitary
where does reabsorption of water take place in the antidiuretic hormone
in distal convoluted tubules and collecting ducts
aldosterone is secreted by what
the adrenal cortex
during aldosterone, sodium is reabsorbed in exchange for
potassium or hydrogen
where is atrial natriuretic hormone come from
the heart
what does the atrial natriuretic hormone reduce
sodium and fluid reabsorption
how does blood flow through the kidney
renal artery to interlobar artery to arcuate artery to interlobular artery to afferent arteriole to glomerular capillaries to efferent arteriole to peritubular capillaries to interlobular vein to arcuate vein to interlobular vein to renal vein
what are the three autoregulation and hormone control pressure in the glomerular capillaries
vasoconstriction of afferent arteriole, dilation of afferent arteriole, and vasoconstriction of the efferent arteriole
what does vasoconstriction of the afferent arteriole do
decreases the glomerular pressure which decreases filtrate
what does dilation of afferent arteriole do
increases pressure of the glomerulus which increases filtrate
what does vasoconstriction of the efferent arteriole do
increases pressure in glomerulus which increases filtrate
what are the three controls of the arteriolar constriction
autoregulation, sympathetic nervous system and renin
what is autoregulation
local adjustment in diameter of arterioles
autoregulation maintains what
normal filtration rate
autoregulation is made in response to what changes
in blood flow in the kidneys
what does the sympathetic nervous system do
increases vasoconstriction in both arterioles
what is renin secreted by
juxtaglomerular cells
when is renin secreted
when blood flow to afferent arteriole is reduced
what is closely related to kidney function
blood pressure
what stimulates aldosterone secretion
angiotensin
angiotensin does what
increases reabsorption of sodium and water to increase blood volume and pressure
loss of voluntary control of the bladder
incontinence
involuntary urination by child age older than four years
enuresis
what is related to enuresis
developmental delay, sleep pattern, or psychosocial aspect
what are the four types of incontinence
overflow incontinence, incontinence, enuresis, and stress incontinence
stress incontinence is more common in who
women
stress incontinence has to do with what four things
coughing, lifting, laughing and multiple pregnancies
stress incontinence does what
increases intra-abdominal pressure and forces urine through the sphincter
overflow incontinence has to do with what three things
older adults, incompetent bladder sphincter, and spinal cord injuries or brain damage
why do older adults have overflow incontinence problems
weakened detrusor muscle may prevent complete emptying the bladder
interference with what two things controls the bladder (think spinal cord and brain)
CNS and ANS
neurogenic bladder may be what
spastic or flaccid
what does retention mean
inability to empty the bladder
retention may be accompanied by what
overflow incontinence
retention may follow what
anesthesia
spinal cord injury blocks what during retention
micturition reflux
lots of protein, blood, bacteria and pus has what appearance of urine
cloudy
hematuria, excessive bilirubin, or highly concentrated urine has what appearance
dark color
infection or result from certain dietary components or medication does what to urine
unpleasant or unusual odor
what is the pH of urine
between 4.5 and 8
what is the normal specific gravity of urine
1.010 to 1.050
what is the normal appearance of urine
straw colored with mild odor
what does hematuria mean
blood in the urine
what does small amounts of blood in the urine mean
infection, inflammation, or tumors in urinary tract
what does large amounts of blood in the urine mean
increases glomerular permeability or hemorrhage
what does proteinuria or albuminuria mean
elevated protein in the urine
what does bacteriuria mean
bacteria in the urine
what does bacteria in the urine indicate
infection in the urinary tract
what do urinary casts indicate
inflammation of the kidney tubules
what does specific gravity indicate
ability of tubules to concentrate urine
dilute urine with normal hydration
low specific gravity
concentrated urine with normal hydration
high specific gravity
what type of specific gravity is related to renal failure
high
what are found when diabetes mellitus is not well controlled
glucose and ketones
what does elevated serum urea and serum creatinine levels indicate
failure to excrete nitrogen wastes from protein metabolism
what does elevated serum urea and serum creatinine levels are caused by
decreased GFR
what does metabolic acidosis indicate
decreased GFR
what does metabolic acidosis decrease
serum pH and serum bicarbonate
metabolic acidosis has to do with what
failure of tubules to control acid-base balance
anemia indicates what
decreased erythropoietin secretion and or bone marrow depression due to accumulated wastes
low hemoglobin levels has to do with what
anemia
electrolytes depend on what
related fluid balance
used for diagnosis of post-streptococcal glomerulonephritis
antistreptolysin O or antistreptokinase titers
elevated renin levels indicate what
kidney as a cause of hypertension
what are the blood test that can be run on urine
creatinine and BUN levels metabolic acidosis anemia electrolytes antibody level elevated renin levels
culture and sensitivity studies on the urine specimens help do what
select appropriate drug treatments
used to visualize structures and possible abnormalities, flow patterns, and filtration rates
radiologic test
visualizes lower urinary tract and may be used to perform biopsy or remove kidney stones
cystoscopy
what are the tests used for clearance
creatinine or insulin
used to acquire tissue specimens
biopsy
used to remove excess sodium ions and water from the body
diuretic drugs
increased excretion of water through the kidneys
reduces fluid volume in tissues and blood
several different mechanisms to increase urine volume
often administered in the morning
diuretic drugs
what are the diseases that require a prescription for a diuretic drug
renal disease, hypertension, edema, congestive heart failure, liver disease, pulmonary edema
what are the two forms of dialysis
hemodialysis
peritoneal dialysis
provides filtration and reabsorption sustains life during kidney failure used to treat patients with acute kidney failure for patients in end-stage renal failure between transplants
dialysis
in hospital, dialysis center, or home with special equipment and training
patients blood moves from an implanted shunt or catheter in an artery to machines
hemodialysis
exchange of wastes, fluids, and electrolytes
semipermeable membrane between blood and dialysis fluid
after exchange is completed, blood returned to patients vein
hemodialysis
during dialysis what remains in the blood
blood cells and proteins
what are possible complications with hemodialysis
shunt may become infected
blood clots may form
blood vessels may become sclerosed
increased risk of infection with hepatitis B and C and HIV
how often is hemodialysis required
three times a week
How long does a treatment of hemodialysis take
three to four hours
done at dialysis unit or home
may be done at night
semipermeable membrane is the peritoneal
catheter with entry and exit points is implanted in the peritoneal cavity
peritoneal dialysis
dialysate is drained from the peritoneal cavity via what
gravity
what are the major complications of peritoneal dialysis
infection resulting in peritonitis
which takes longer hemodialysis or peritoneal dialysis
peritoneal dialysis
peritoneal dialysis requires what
loose clothing to accommodate the bag of fluid
what has to do with both types of dialysis
prophylactic antibiotics
any additional problem occurring in patient such as infection may alter dialysis requirements
caution is required with many drugs because toxic level buildup can occur
what type or urinary infection is the most common
UTI
what has to do with lower urinary tract infections
cystitis
urethritis
what has to do with upper urinary tract infections
pyelonephritis
what is an excellent growth medium
urine
what is the common causative agent of urinary tract infections
E coli
what other species are associated with UTIs
Klebsiella Proteus Enterobacter Citrobacter Serratia Pseudomonas Enterococcus Coagulase-negative Staphylococcus Chlamydia Mycoplasma
Why is UTIs more common in women
shortness of urethra
proximity to anus
