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OUTLINE
WATER AND ELECTROLYTE REGULATION
I.
Effects of sodium reabsorption
II.
Blood pressure regulation
III.
Potassium regulation
IV.
Factors maintaining the tonicity of the medullary interstitium
V.
Plasma osmolarity regulation
MICTURITION REFLEX
I.
Micturition contraction
II.
Control of brain in micturition
URINALYSIS
I.
Macroscopic examination
II. Microscopic examination
Addl info from Berne and Levy in Times New Roman (bold)
RESPONSES TO CHANGES IN BP
Short term: Baroreceptor reflexes (detect changes in the amount
of blood in the body passing through the specific area)
Intermediate:
o Renin
Secreted when there is low BP and detected by the granular
cells (which also secretes renin)
Needed in the conversion of angiotensinogen which comes
from the liver to become Angiotensin I Angiotensin II in
the lungs in the presence angiotensin converting enzyme
which is the ACE (Fig 1)
Renin-angtiotensin is an intermediate compensatory
mechanism for changes in blood pressure
Regulator of Na+ and K+ balance
o Macula Densa cells will detect the amount of fluid and sodium
chloride flowing through the juxtamedullary apparatus
What will be the main effect of angiotensin II?
o It is a vasoconstrictor agent and thus changes total peripheral
resistance increase blood pressure
o Stimulates the release of aldosterone and antidiuretic hormone
(ADH) long term response to changes in blood pressure
(Figure 2)
Figure 2. Effects of Angiotensin II
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B. VASA RECTA
Peritubular capillaries that go down with the loop of Henle in the
medullary area, supplying blood and nutrients to the renal
medulla. Also highly-permeable to solute and water via AQP1
and works at the same time to move excess solute and water
out
Figure 4 . Potassium handling
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MICTURITION REFLEX
Also known as urination, voiding or peeing.
Micturition center is in the the rostral pons, specifically the
Barringtons Center
It is the process of disposing urine from the urinary bladder via
the urethra
Full bladder felt at 200-300 mL Trips mechanoreceptors that
are eventually triggered by the pressure, resulting in discharge
Normally under voluntary control but may occur involuntarily
especially in infants, elderly and those with neurologic injuries
Involves coordination of the central, autonomic and somatic
nervous systems
I. MICTURITION CONTRACTION
Product of stretch reflex from the sensory stretch receptors found
in the bladder wall
Receptors in the posterior urethra also have an influence in the
production of contractions
Signals from stretch receptors sacral segments of the spinal
cord via pelvic nerves back to the bladder via parasympathetic
nerve fibers
C. UREA
product of protein metabolism
is really filtrable, 50% of urea will be reabsorbed in the PCT; 50%
in the tubular lumen
the distal tubule, cortical collecting ducts and the outer medullary
collecting ducts are IMPERMEABLE to urea; thus no urea is
reabsorbed in these segments
ADHinc urea permeability of the inner medullary collecting
ducts into the insterstitial fluid contributes to urea recycling
Urea secretion varies with urine flow rate (UFR)
o High water reabsorption (low UFR) greater urea
reabsorption and dec urea excretion
o Low water reabsorption (high UFR) less urea reabsorption
and inc urea excretion
B. RESPONSE TO INTAKE
water intake dec plasma osmolarity inhibits osmoreceptors
dec secretion of ADH dec water permeability of late distal
tubule and collecting duct dec water reabsorption DEC urine
osmolarity and INC urine volume INC plasma osmolarity
toward normal
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VOLUNTARY URINATION
o Pressure in the bladder contracts abdominal muscles
o Pressure in the bladder increases; extra urine enters bladder
neck and posterior urethra
o Walls of the bladder and posterior urethra stretch
o Stretch receptors stimulated
Group 5 | Ballero, Baluyot, Bamba, Baas
I.
URINALYSIS
MACROSCOPIC EXAMINATION
A.PHYSICAL CHARACTERISTICS
Volume : 600-2000 ml /day (She explicitly said she would go with
500-2000 ml/day)
o Oliguria : decrease in the normal volume of urine
o Polyuria : increased in normal urine volume
Color : colorless black
o Pale yellow, straw, light yellow, dark yellow, amber
o If your taking medicines, there will be changes in the urinehighly colored
Appearance refers to clarity of the urine
o Freshly voided urine is clear
o Cloudiness due to amorphous phosphates and carbonates
o Turbidity may be due to the presence also of: WBC, RBC,
Epithelial Cells, Bacteria
Specific gravity: determines how dilute or concentrated the urine
o Density of a substance compared with a similar volume of
distilled water at a similar temperature
o Can be determined using dipstick or urinometer
o Normal Value = 1.010 to 1.025 (higher value = more
concentrated)
Odor: faintly aromatic usually due to the breakdown of urea
B.CHEMICAL ANALYSIS
Urine chemical dipstick analysis - narrow plastic strip with squares of
different color attached to it. Strip is dipped into the sample and the
color changes will take place and be interpreted accordingly (think
pH paper)
pH: 4.5-8
o Acidic Urine: due to high meat or high protein and cranberry
juice (Uric acid will precipitate in acidic urine)
o Alkaline Urine: Vegetarian diets (Phosphates will precipitate in
alkaline urine)
Protein in the urine is most indicative of renal problem (signifies
that high molecular weight substances have passed through the
glomerular filtration barrier; more sensitive to albumin than other
globulins). Higher than trace amounts of protein is usually
indicative of disease.
o N.V.: 10 mg/dl or 100 mgs /24 hours
o Microalbuminuria: proteinuria that cannot be detected by
reagent strips (Significant if 30-300 mgs/24 hrs.)
o Orthostatic Proteinuria:
Caused by High fever, Exposure to cold, Strenuous exercise,
Dehydration, Acute phase of severe illness
Blood in the Urine:
o Hematuria: RBC in urine
Causes: Renal calculi (renal stones), glomerulonephritis,
pyelonephritis, tumors, trauma, exposure to toxic chemicals,
strenuous exercise
Glucose: indicates that filtered load of glucose exceeds the
maximal tubular capacity for glucose. In diabetes mellitus, urine
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