Renal Function and Micturition
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Renal Function and Micturition Presented by Kelly L. Sparks, RN, BSN, CWOCN, CFCN Capital Nursing Education Made possible by a grant from Shield HealthCare
Transcript of Renal Function and Micturition
Renal Function and Micturition
Presented by Kelly L. Sparks, RN, BSN, CWOCN, CFCNCapital Nursing Education
Made possible by a grant from
Shield HealthCare
OBJECTIVES
Review the anatomy of the kidney and bladder
Define glomerular filtration rate and list the major factors affecting it
Outline tubular handling of Na+, water, glucose, and K+
Define autoregulation in the kidneys
Understand Micturition
1PROVIDER APPROVED BY THE CALIFORNIA BOARD OF REGISTERED NURSING/Provider Number 16028, approved for 1
CE contact hour/Provider: Kathleen J. Ellis
Renal Function
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Urinary System Filter blood
Eliminate liquid waste (urea)
Keep chemicals in balance
Create urine
Expel urine
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Kidney
Bladder
Ureters
K.Sparks
Kidneys Remove waste products and
drugs from the body
Balance the body's fluids
Release hormones to regulate
blood pressure
Control production of red
blood cells
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Fibrous capsule
Renal pyramid in renal medulla
Minor calyx
Major calyx
Renal Cortex
Renal Medulla
Renal sinus
Renal artery
Renal Vein
Renal pelvis
Ureter
Fat in renal sinus
K.Sparks
Superficial and Midcortical
Loop of Henle-short or long
One Million Per Kidney
Products include urine, renin,
erythropoietin and calcitriol
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salturea
water
urea
water
salt
urea
salt
water
urea
water
water
water
water
water
urea
ureasalt
saltsaltsalt
Vasa Recta
Afferent
Efferent
K.Sparks
NephronThe Working Part Of The Kidney
90-100% Stage 1 Kidney damage with normal kidney function
89-60% Stage 2 Kidney damage with mild loss of kidney function
59-45% Stage 3aMild to moderate loss of kidney function
44-30% Stage 3bModerate to severe loss of kidney function
29-15% Stage 4 Severe loss of kidney function
< 15% Stage 5 Kidney failure
GFR-Glomerular Filtration Rate
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Adrenal Glands Top of kidneys
Right is shape of pyramid
Left is semilunar shape
and a bit larger
Produce hormones vital to health
Cortisol-for stress
Aldosterone- helps control BP
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Adrenal Glands
K.Sparks
Adrenal Cortex Zona Fasciculata-Cortisol
• Negative feedback loop in hypothalamus and pituitary gland Zona Glomerulosa-Aldosterone
• Regulates BP, electrolytes and blood pH Zona Reticularis-DHEA and Androgenic Steroids
• Weak Male Hormones Adrenal Medulla-Adrenaline (epinephrine) and
Noradrenaline (norepinephrine) Increasing heart rate Increasing heart contractions Increasing blood flow to muscles and brain Relaxing airway smooth muscles Assisting with glucose metabolism Vasoconstriction
Adrenal Glands Functions
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Capsule
Blood VesselsMedulla
Cortex
Regulation of Hypertension or Hypovolemia
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Regulation of Hypotension or Hypovolemia
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Renin release Angiotensin from Liver Converted by renin becomes
Angiotensin I Angiotensin converting enzyme
(ACE) to Angiotensin II Binds to cause
vasoconstriction Aldosterone increases NA
absorption which increases volume
(-)
(-)
AngiotensinProduced in the liver
Angiotensin IConverted by angiotensin converting enzyme(ACE) on vascular endothelium
Site of action of ACE inhibitors
Angiotensin IISite of action of ARBsBinds angiotensin receptors
Increased Blood volume
Increased Blood pressure
Low afferent arteriole pressure
Decreased NaCl delivery to macula densa
Hypertension or Hypovolemia
Renal hypoperfusion Activation of aortic/carotid baroreceptors
Increased sympathetic tone
Converted by Renin
Renin releaseFrom juxtaglomerular cells of
nephrons
VasoconstrictionIncreased sympathetic NS activity
Aldosterone release (from adrenal cortex)Increased Na absorption (in proximal tubule)
Endothelial dysfunctionProthrombotic effects (increases PAI-1)
AutoregulationTo minimize changes in Renal blood flow and Glomerular filtration rate at different blood pressure values.
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Renal Blood Flow
13K.Sparks
K.Sparks
Renal Artery
Interlobular Arterioles
Arcuate arteries
Afferent Arteriole
Glomerular capillaries
Efferent Arteriole
Peritubular Capillaries
Vesa RectaArcuate vein
Renal vein
Autoregulation of the Renal Blood Flow (RBF) and Glomerular Filtration Rate (GFR)
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The major function of autoregulation in the kidneys, is to maintain a relatively constant GFR and to allow very precise control of the renal excretion of water and solutes.
K.Sparks
CO = 5 L/Min
RBF = 20% of CO
1000 ml/min
1000 ml
120 ml/min
Autoregulation Due to changes in the resistance of the afferent arterioles
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MAP
GFR
RBF RBFMAP
GFR
K.Sparks
Mechanisms of RBF (GFR) Autoregulation Myogenic and Tubuloglomerular Feedback
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RBF (GFR) Autoregulation
Myogenic
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MAP
RBF
RBF
GFR
Ca**
K.Sparks
RBF (GFR) Autoregulation
Tubuloglomerular Feedback
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Afferent Arteriole
Distal Convoluted Tubule Efferent Arteriole
Juxtaglomerular Apparatus
Afferent Arteriole
Efferent Arteriole
Macula Densa Cells
Juxtaglomerular Cells
DCT
Distal Convoluted Tubule
K.Sparks
Afferent Arteriolar Feedback Mechanism
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MAP RBF
GFR
Na
Cl
Na
Cl
Na
Cl
Na
Cl
NaCl
Afferent Arteriole
K.Sparks
MAPRBF
GFR
NaClNaClNaClNaCl
NaClAscending loop of Henle
Afferent Arteriole
Vasodilation
Afferent Arteriolar Feedback Mechanism
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K.Sparks
Efferent Arteriolar Feedback Mechanism
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MAP RBF
GFR
NaClNaClNaClNaCl
Juxtaglomerular Cells
ANGII
Afferent ArterioleEfferent Arteriole
PGC Renin
K.Sparks
MAP RBF
GFR
ClNaClNaCl
Macula Densa Cells
NaCl
Vasoconstriction
Afferent arteriole
Efferent Arteriolar Feedback Mechanism
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K.Sparks
00
80
Autoregulatory Range
RBF
GFR
120
1000
RBF
mm
/min
GFR m
m/m
in
MAP mmHg
180
Renal Function Curve
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Micturition
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K.Sparks
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Kidney
KidneyUreters
Ureters
bladder
bladder
Detrusor muscle
Internalsphincter
Urogenital diaphragm
urethra
urethrapenis
External sphincter
FemaleMale
prostate
Anatomical Review of Urinary Tract
Kidney
KidneyUreters
Ureters
bladder
bladder
Detrusor muscle
Internalsphincter
Urogenital diaphragm
urethra
urethra
penis
External sphincter
FemaleMale
prostate
K.Sparks
Anatomical Review of Urinary Tract
Nicotinic Receptor
M3 Receptor
B3 Receptor
Alpha 1 Receptor prostate
Muscarinic (M3) - top of bladder
Beta Adrenergic (B3) - in bladder
Alpha 1 internal - sphincter
Nicotinic external - sphincter area
K.Sparks
Receptors
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Nicotinic Receptor
M3 Receptor
B3 Receptor
Alpha 1 Receptor
Brain
Mid brain, Pons, Medulla
Brain stem
Pons
Thoracic
sacral
Cervical
Lumbar
prostate
K.Sparks
Central Nervous System is in control
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Nicotinic Receptor
M3 Receptor
B3 Receptor
Alpha 1 Receptor
Brain stem
Cervical
PonsMid brain, Pons, Medulla
Brain
Thoracic
sacral
Lumbar
Pudendal Nerve(Somatic)
Hypogastric Nerve
(Sympathetic)
Pelvic Nerve(Parasympathetic) ACH
ACH
NAganglion
prostate
K.Sparks
Central Nervous System is in control
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M3
B3
1
Nicotinicprostate
Pons Micturition Center
Thoracic
Sacral
urine
Slow ImpulsesThrough Sensory Pelvic Nerve
Brain
K.Sparks
Empty Bladder
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M3
B3
1
Nicotinic
Pons Micturition Center
Thoracic
Sacral
urine
Slow ImpulsesThrough Sensory Pelvic Nerve
Hypogastric
Brain
K.Sparks
Empty Bladder
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M3
B3
1
Nicotinic
Pons Micturition Center
Thoracic
Sacral
urine
Slow ImpulsesThrough Sensory Pelvic Nerve
Hypogastric
Brain
K.Sparks
Empty Bladder
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1
M3
B3
1
Nicotinic
Pons Micturition Center
Thoracic
Sacral
urine
Slow ImpulsesThrough Sensory Pelvic Nerve
Hypogastric
Brain
K.Sparks
Empty Bladder
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M3
B3
1
Nicotinic
Pons Micturition Center
Thoracic
Sacral
urine
Slow ImpulsesThrough Sensory Pelvic Nerve
Hypogastric
Brain
K.Sparks
Empty Bladder
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M3
B3
1
Nicotinic
Pons Micturition Center
Thoracic
Sacral
urine
Slow ImpulsesThrough Sensory Pelvic Nerve
Hypogastric
Brain
Pelvic efferent
K.Sparks
Empty Bladder
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M3
B3
1
Nicotinic
Pons Micturition Center
Thoracic
Sacral
urine
Slow ImpulsesThrough Sensory Pelvic Nerve
Hypogastric
Brain
Pelvic efferent
Pudendal
K.Sparks
Empty Bladder
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M3
B3
1
Nicotinic
M3
B31
Nicotinic
Pons Micturition Center
Thoracic
Sacral
Brain
Increased firing of afferent pelvic nerve
K.Sparks
Full Bladder
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M3
B3
1
Nicotinic
M3
B31
Nicotinic
Pons Micturition Center
Thoracic
Sacral
Brain
Increased firing of afferent pelvic nerve
K.Sparks
Full Bladder
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M3
B3
1
Nicotinic
M3
B31
Nicotinic
Pons Micturition Center
Thoracic
Sacral
Brain
Increased firing of afferent pelvic nerve
Hypogastric
K.Sparks
Full Bladder
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M3
B3
1
Nicotinic
M3
B31
Nicotinic
Pons Micturition Center
Thoracic
Sacral
Brain
Increased firing of afferent pelvic nerve
Hypogastric
K.Sparks
Full Bladder
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M3
B3
1
Nicotinic
M3
B31
Nicotinic
Pons Micturition Center
Thoracic
Sacral
Brain
Increased firing of afferent pelvic nerve
Hypogastric
pudendal
K.Sparks
Full Bladder
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Sacral
Pelvic
Pelvic
K.Sparks
Voiding Reflex
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John Hopkins Medicine article https://www.hopkinsmedicine.org/health/conditions-and-diseases/adrenal-glands
https://www.sciencedirect.com/topics/medicine-and-dentistry/blood-pressure-regulation
https://www.youtube.com/watch?v=JwaeWXhklio
https://medlineplus.gov/lab-tests/glomerular-filtration-rate-gfr-test/
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=glomerular_filtration_rate
https://www.kidney.org/atoz/content/gfr
Department of Cell and Molecular Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Submitted 17 May 2006; accepted in final form 14 September 2006
Physiology, Renal Authors Ifeanyichukwu Ogobuiro; Faiz Tuma. Last Update: July 26, 2021. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
References
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