Kideny

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  • The Kidney
    • structure
      • simple
        • cortex, helieum and the nephron
      • the nephron
        • is the functional unit of the kidney
        • renal corpuscle = bowman's capsule and golmerus
          • role = filtration
        • renal tubules= PCT and loop of henel
          • role = reabsorbtion
        • collecting duct
      • PCT
        • 80% reabsorbed
        • reabsorption of nacl ect and regulation of PH
        • na
          • antiporters
            • transported with K into cell from blood
            • transported with H+ into tubule
        • Glucose
          • symporters
            • with NA
              • has a max rate as transporters can be saturated
    • GFR
      • amount of filtrate filtered across golmerus to BC per min
        • normal = 125ml/min
      • factors effecting
        • filtration barrier - made up of podcytes
        • volumes and pressure
          • if vas resistance increases in the aff arterioles = less Bf into golmerus = decrease GFR
          • if Vas res increases in eff arterioles = more RBF in glomerus and higher pressure in golmerus = higher GFR
      • methods for estimation
        • creatine
        • measure filtration of a substance
          • must be freely filtered
          • not secreted ect by the kidney
          • present a stable concentrations in plasma
          • inert
      • control
        • autoregulation
          • myogenic= osmatic changes
          • tubulargolmera feedback
            • GFR increases- detected , paracrine, aff arteriole constricts and decreases GFR
            • sympathetic nerves inv in stress responses
        • nervous - sympathetic and noradrenaline
        • hormonal - agngeotenisn
    • control of osmolarity
      • as filtrate moves down loop of henel = more concentrated as water is removed
        • counter current system
        • solutes punped out in asending limb - hypoosmotic
      • if the collecting duct = permeable to water the urine becomes more concentrated as water moves out
      • ADH controls osmolarity of collecting duct
      • thrist mechanicm
        • dry mouth, increase in osmolarity, decrease in bv and BP
          • stimulates thirst center in hypothalamus
    • regulating blood composition
      • ADH
        • osmoreceptors detect an increase in osmolarity
        • stimulates ADH relase form posterior pituitary gland
        • travels in blood to kidney = increase number of water channels open
          • decrease osmolarity
      • PH
        • H+ buffer system = co2+H2o - H+ +hco3-
          • increase in co2 = shidt to right
        • renal mechanism
          • nephrone secretes H+ into lumen - combines with Hco3 making Co2 and water
            • Co2 diffuses back into cell - + water back to H+ and hco3
              • H+ secreted again and hco3 = reabsobed with NA
                • H+ = extreted with Nh4
      • Blood volume
        • RAAS
          • dehydration of na+ deficency stimulates
            • rennin released and cleaves angeotensinogen into angeotensin 1
              • travels to lungs where ACE converts it to agngeotensin 2
                • vasoconstriction increasing BP or
                  • stimulates relase of aldosterone which increases NA retension = increasing water reabsorption increasing BV
      • Sympathetic nerves innervate afferent and efferent arterioles as well as cells of the nephron. ? Sympathetic activity is increased as part of the efferent arm of the baroreceptor reflex
    • ? Erythropoietin ? Production stimulated by decrease in PO2 ? Produced in interstitial cells in the kidney ? Stimulates erythrocyte production through differentiation of CFU-E into proerythroblast. ? Calcitriol ? Active form of vitamin D ? Produced by hydrolysis from stored forms released from the liver ? Essential in maintenance of calcium uptake from the GI tract.
    • Bladder
      • Filling
        • 2 uters - wave of peristalsis =pushes urine down
        • parasympathetic = inactive
        • sympathetic = active and keep relax
        • Pudendal nerve fibres from sacral segments maintain closure of the external sphincter- active 
      • Micturition:
        • Parasympathetic nerves are now active, ? they release acetylcholine and the bladder contracts ? they relax the outflow tract
        • ?Sympathetic nerves are now inactive ?Pudendal nerve fibres are less active and the external sphincter open

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