Bio217 F2014 Unit 8 Bio217: Pathophysiology Class Notes Kidneys (2) Professor Linda Falkow ◦ Retroperitoneal ◦ Renal capsule Unit VIII: Urinary (Renal) System Disorders ◦ Adipose capsule and ◦ Renal fascia Reproductive System Disorders ◦ Hilum Ureters (2) Urinary Bladder (1) Chapter 28: Structure & Function of Renal & Urologic Systems Urethra (1) Chapter 29: Alterations of Renal & Urinary Tract Function Chapter 31: Structure and Function of Reproductive Systems Chapter 32: Alterations of the Reproductive Systems Structures of Urinary System • 1.2 million nephrons per kidney • Functional unit of the kidney • Cortex – Cortical nephrons • Medulla – Juxtamedullary nephrons • Pyramids • Parts of nephron • Calyces – Renal corpuscle (=_______________________________) – Minor and major – Renal tubules • Proximal tubule (pct) • Renal pelvis • Loop of Henle Structures of the Kidney • Distal tubule (dct)Nephron • Glomerular filtration membrane –Blood passes through the three layers and forms the filtrate Nephron Nephron 1 Bio217 F2014 Unit 8 • Juxtaglomerular apparatus – Juxtaglomerular cells ( renin) – Macula densa (sense changes in Na+) – Renin-angiotensin pathway: ___________ • Decr. blood vol. or decr. Na+ incr. renin Angiotensin I Angiotensin II aldosterone (incr. reabsorption of Na+ and H2O) Nephron Juxtaglomerular Apparatus • Urinary Bladder – Detrusor muscle – Trigone – Micturition reflex • Urethra – Internal and external sphincters – 3 to 4 cm in females – 18 to 20 cm in males Structures of Urinary System Urinary Bladder and Urethra • Receive 1000 to 1200 mL of blood/min. • Neural regulation • Glomerular filtration rate (GFR) • Hormones • Autoregulation –Renin-angiotensin system –Tubuloglomerular feedback –Aldosterone –ADH (_____________________________) Renal Blood Flow Renal Blood Flow 2 Bio217 F2014 Unit 8 • Filters plasma • Reabsorbs and secretes – Tubular reabsorption and secretion • Forms a filtrate of protein-free fluid • Regulates filtrate to maintain fluid volume, electrolytes, and pH Renal Blood Flow Nephron Function • Countercurrent exchange system • Glomerular filtration – Contributes to production of concentrated urine –Net filtration pressure • Glomerular capillary oncotic/hydrostatic pressure • Bowman capsule oncotic/hydrostatic pressure –Filtration rate • ____________ Concentration and Nephron Function Dilution of Urine • Aldosterone • Urinary tract obstruction • Antidiuretic hormone (ADH) – • Atrial natriuretic peptide (ANP) interference with flow of urine at any site along urinary tract – produced by RA, when RA press. – Obstruction can be caused by anatomic or increases, inhibits secretion of renin functional defect • Diuretics • Obstructive uropathy – changes in – __________urine flow (by disrupting Na+ urinary system due to obstructions reabsorption and decr. ECF vol. (anatomic) Concentration and Urinary Tract Obstruction Dilution of Urine 3 Bio217 F2014 Unit 8 • UTI - inflammation of urinary epithelium caused by bacteria • Acute cystitis • Interstitial cystitis • Acute and chronic pyelonephritis Urinary Tract Infection (UTI) Urinary Tract Obstruction Acute cystitis • Interstitial cystitis ◦ Cystitis is an inflammation of the u.b. – Nonbacterial infectious cystitis ◦ E. coli most common cause – Manifestations • Most common in women 20 to 30 years old ◦ Manifestations • Bladder fullness, frequency, small urine vol., Frequency, dysuria, urgency, and lower abdominal chronic pelvic pain and/or suprapubic pain • Immunocompromised (undergoing chemo or radiation therapy) ◦ Treatment – Treatment Antimicrobial therapy, increased fluid intake, • No single treatment effective, symptom relief avoidance of bladder irritants, and urinary analgesics Urinary Tract Infection (UTI) Urinary Tract Infection (UTI) • Pyelonephritis – Acute pyelonephritis • Acute infection of the renal pelvis & interstitium – Vesicoureteral reflux (urine reflux up ureter into kidney), E. coli, Proteus, Pseudomonas – Chronic pyelonephritis • Persistent or recurring episodes of acute pyelonephritis that leads to scarring • Risk of chronic pyelonephritis increases in individuals w/ Normal size- scarring on Shrunken size - scarring renal infections and some type of obstructive upper surface pathologic condition Chronic Pyelonephritis Urinary Tract Infection (UTI) 4 Bio217 F2014 Unit 8 • Mechanisms of injury • Glomerulonephritis – Immune response - deposition of antigen- – Inflammation of the glomeruli (typically after a antibody complexes in glomerular capillaries strep infection) • Immunologic abnormalities (most common) • Drugs or toxins – Formation of antibodies against the • Vascular disorders glomerular basement membrane • Systemic diseases break down cells incr. permeablility • Viral causes – Most common cause of end-stage renal failure Glomerulonephritis Glomerular Disorders • Acute poststreptococcal glomerulonephritis • Rapidly progressing glomerulonephritis (RPGN) – Antiglomerular basement membrane disease (Goodpasture syndrome) – rare • Chronic glomerulonephritis Glomerulonephritis Kidneys are small and have granular external surface Glomerulonephritis • Uremia Chronic renal failure (CRF) = accumulation of N-wastes and metabolic • toxins in plasma -progressive, irreversible loss of renal function that affects nearly all organ systems – Symptoms: confusion, GI complaints, • Stages fluid in lungs, infection –Chronic renal insufficiency (GFR 20-35% of normal) – Describes clinical manifestations of CRF –Chronic renal failure (GFR 20-25% of normal) (chronic renal failure) –End-stage renal failure (GFR <20% of normal) Chronic Renal Failure 5 Bio217 F2014 Unit 8 • CRF due to: – Glomerulonephritis – Chronic infections (pyelonephritis or TB) – Congential (polycystic disease) – Vascular (HT or nephrosclerosis) – Obstructions (renal calculi) – Diabetic neuropathy Chronic Renal Failure • Alterations seen in following systems: Imbalances in following factors: – Musculoskeletal • Proteinuria and uremia – Cardiovascular and pulmonary • Creatinine and urea clearance – Hematologic • Fluid and electrolyte balance – – Sodium and water balance Immune – Phosphate and calcium balance – Neurologic – Potassium balance – Acid-base balance Chronic Renal Failure Chronic Renal Failure • 1. Which is an abnormal substance of urine? – A. Urea C. NaCl –Gastrointestinal – B. glucose D. Creatinine • Alteration in protein, carbohydrate, and lipid metabolism • 2. The presence of albumin in urine would indicate damage to: – A. Glomeruli C. pyramids –Endocrine and reproduction – B. Collecting ducts D. None of the above –Integumentary • 3. GFR is regulated by – A. ANS C. Renin-angiotensin system – B. ANF D. All of the above Chronic Renal Failure Concept Check 6 Bio217 F2014 Unit 8 • 4. An increase in permeability of the dct and cd Matching: is due to: • ___ 6. acute cystitis a. Infection of renal pelvis & – A. Decrease in ADH production interstitium – B. Increase in ADH • ___ 7. uremia b. Inflam. that is most common – C. Decrease in blood plasma osmolality cause of end-stage renal – D. Increase in water content in blood failure • ___ 8. glomerulonephritis c. Renal failure w/ elevated blood urea and creatinine • 5. UTIs occur: • ___ 9. pyelonephritis d. U.b. inflam. ranging from – A. Only in the kidneys hyperemic mucosa to – B. Anywhere but the kidneys necrosis of u.b. wall – C. Anywhere in the urinary system Development of the Reproductive System Structure and Function of the • Dependent on sex hormones Reproductive Systems – Males—testosterone – Females—estrogen, FSH, and LH Chapter 31 & Alterations of the Reproductive Systems Chapter 32 Female Reproductive System Internal Genitalia • External genitalia (vulva) • Vagina – Mons pubis • Uterus – Labia majora – Cervix – Labia minora • Fallopian tubes – Clitoris • Ovaries – Vestibule 7 Bio217 F2014 Unit 8 Uterine Position Internal Genitalia Ovary Follicle Development Female Sex Hormones Menstrual Cycle • Estrogens • Menarche – Estradiol (E2)- 95% produced by ovaries • Menopause • - remainder by adrenal gland & placenta (pregnancy) • Phases – Estrone – Menstruation (menses) – Estriol – Follicular/proliferative phase • Progesterone – from____________ – Luteal/secretory phase • Androgens – small amt. from____________ – Ischemic/menstrual phase ____________ 8 Bio217 F2014 Unit 8 Menstrual Cycle Menstrual Cycle • Ovarian cycle • Uterine phases • Vaginal response • Body temperature change – BBT (basal body temp.) biphasic – Follicular phase = ~98oF – Luteal phase ~ 0.4 -1.0 oF.elevation Male Reproductive System Male Reproductive System • External genitalia – Testes • Produce gametes and sex hormones – Epididymis • Vas deferens – Scrotum – Penis • Glans and prepuce Male Reproductive System Spermatogenesis • Internal genitalia • Spermatogonia – Ducts • Primary spermatocytes • Vas deferens and ejaculatory duct – Accessary Glands • Secondary spermatocytes • Seminal vesicles • Spermatids • Prostate gland • Bulbourethral glands • Sertoli cells (Sustentacular cells) 9 Bio217 F2014 Unit 8 Disorders of the Female Reproductive Male Sex Hormones System • Androgens • Hormonal and menstrual alterations – Primary androgen—testosterone – Primary dysmenorrhea (___________ menstruation) • Painful menstruation associated with prostaglandin – Produced mainly in (_____________of) release in ovulatory cycles Leydig cells of testes – Secondary dysmenorrhea – Testosterone • Painful menstruation related to pelvic pathology • Sexual differentiation (endometrioisis, PID, fibroids) • Urogenital system dev. – Pathophysiology • Nervous and skeletal