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Lecture 18

NURS 364 Lecture Notes - Lecture 18: Distal Convoluted Tubule, Peritubular Capillaries, Renal Artery


Department
Nursing
Course Code
NURS 364
Professor
Deborah Van Kuiken
Lecture
18

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Review of Structure and Function of the Renal and Urologic Systems
Nursing 364: Pathophysiology
Structure of the Kidneys
Cortex
Medullary Pyramids
Calyces
Minor and major
Renal pelvis
Lobe
Functions of the Urinary System
Primary functions of the renal system:
Filter water & ions
Maintenance of pH
HCO3- retention & H+ elimination
Elimination of metabolic by products
Renin-angiotensin system
Maintenance of BP and blood volume
Erythropoietin
Production of RBCs
Activation of Vitamin D
Nephron
Functional unit of the kidney (1.2 million nephrons/kidney)
Cortical nephrons (85% of nephrons)
Juxtamedullary nephrons (15% are juxtamedullary nephrons)
Nephron consist of:
Bowman’s capsule
Glomerulus
Tubular components
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Proximal tubule
Loop of Henle
Distal tubule
Collecting duct
Glomerulus
Tubular Components
Proximal convoluted tubule--- enhances reabsorption
Drains Bowman’s Capsule
“Filtrate”
Loop of Henle--- reabsorbs shit
Distal convoluted tubule--- secretes acid
Collecting tubule
Renal Blood Flow
Receive 1000 to 1200 mL of blood per minute
Glomerular filtration rate (GFR)
Blood Vessels
Renal arteries
Interlobar arteries
Arcuate arteries
Glomerular capillaries
Peritubular capillaries
Vasa recta
Renal veins
Renal Blood Flow
Neural regulation
In afferent and efferent arterioles
Sympathetic; no parasympathetic nerves
Celiac ganglion and splanchnic nerve
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Hormones
Renin-angiotensin system
Depends upon the amount of pressure on the juxtaglomerular cells that sit
alongside the glomerulus
Decreased pressure leads to increased renin secretion
Aldosterone
Renal Blood Flow
Effect of renal blood flow on GFR
increased renal blood flow  reduce tendency of glomerular COP to resist filtration
through glomerulus  increased GFR
Effect of sympathetic stimulation on GFR
Sympathetic stimulation  preferential afferent arteriolar constriction  decrease renal
blood flow & decrease hydrostatic pressure glomerular pressure  decreased GFR
Effect of arterial BP on GFR
Decreased BP  automatic afferent arteriolar constriction  decrease renal blood flow 
decreased GFR  less water loss  increase blood volume  systemic BP
Renal Processes
Filtration
Movement of protein free plasma across the glomerular membrane (hydrostatic
pressure)
Tubular reabsorption
Movement of fluid/solutes from tubular lumen to the peritubular capillaries
Tubular secretion
Transfer of substances from the peritubular capillaries to the tubular lumen
Excretion
Elimination of fluids/substances in the final urine
Nephron Function
Filters plasma
Forms a filtrate (protein-free plasma)
Filtrate formed in Bowman’s capsule via:
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