...to function. Once in chronic renal failure, damage to kidneys is progressive and irreversible. The nephrons are damaged, can't function and don't recover. Surviving nephrons then hypertrophy and increase their rate of filtration, reabsorption, and secretion. Compensatory excretion continues as GFR decreases. This leads to retention of water, waste products, oliguria, and even hypertension because the kidneys cannot excrete. Also due to ESRD, BUN, creatinine, are high, GFR decreases, resulting anemia, metabolic acidosis. Hypertension: progressive damage to major organs like the kidneys, brain or heart, lead to hypertension. The kidneys, through the renin-angiotensin system help control blood pressure, by releasing angiotensin II a vasoconstrictor, and aldosterone, which leads to sodium and water retention. Impairment in this system affects blood pressure. Also changes in blood vessels cause hypertension, if their force of contractility is increased due to blockage or structural changes. Diabetes mellitus: it is known as type 2 diabetes mellitus, and is as a result of relative insulin deficiency. The pancreas produces either normal or excessive amounts of insulin but the body s unable to use it effectively, so glucose levels remain elevated, thus know as insulin resistance. Also, failure of the pancreas to produce enough insulin to overcome this insulin resistance precipitates clinical type 2 diabetes in predisposed individuals. One of the complications of diabetes is hypertension...
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...Hypertension and the Renin-Angiotensin-Aldosterone System Renin-Angiotensin-Aldosterone System The renin-angiotensin-aldosterone system, otherwise known as RAAS is a complex hormone system that regulates blood pressure and fluid balance in the human body. When blood volume is low, juxtaglomerular cells in the kidneys activate prorenin, which secretes renin directly into the blood stream circulation. Subsequently, a drop in blood volume additionally releases angiotensinogen from liver, in which renin converts into angiotensin I. Angiotensin I is then converted to angiotensin II through the enzyme angiotensin converting enzyme (ACE) found in the lung. Angiotensin II is a potent biological compound that causes blood vessels to constrict, resulting in an increase in blood pressure. Additionally, angiotensin II also stimulates the secretion of the hormone aldosterone from the adrenal cortex. Furthermore, thirst or antidiuretic hormone can effectively stimulates the pituitary gland, which could release corticotropin-releasing hormone stimulating the adrenal cortex and thereby releasing aldosterone. Aldosterone contributes to the RAAS system by causing the tubules of the kidneys to increase the reabsorption of sodium and water back into the blood stream. Thus, an increase in the reabsorption of water, increases the volume of fluid in the body, which increases the blood pressure. Once the blood volume and blood pressure stabilizes, these collective effects triggers a negative feedback...
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...Jimmy, a five year old boy, was admitted into the hospital by his pediatrician. He is small for his age at 3ft. tall and weighs 37lbs. He has no known health issues. Jimmy walked into the hospital looking fatigued, his skin was pale, and when we pinched the skin it stayed pinched. His eyes were sunken. Jimmy had caught a stomach virus; he had been vomiting and had diarrhea so severe that he lost 5lbs in just four days. Jimmy was severely dehydrated. Dehydration is a condition that occurs when a person loses more fluid than they take in. It is a loss of water content and electrolytes (sodium, potassium, calcium and bicarbonate) that are needed for normal body functioning. There are three types of dehydration; mild, moderate and severe. Severe dehydration is a loss of 10%-15% of body fluids. At this point, dehydration becomes a medical emergency. Jimmy was severely dehydrated and immediate steps were taken to rehydrate him. He was given intravenous fluids to restore his water and electrolytes that he had lost. What was happening in Jimmy’s body is that the osmolarity of his blood is higher than that of his tissues. This naturally causes water to be drawn from the cells and into the blood, since water follows a higher solute. (Where salt goes water follows.) The movement of water into the blood causes increases in blood volume, which increases blood pressure. Giving the blood enough pressure to pass though the glomerulus, the glomerulus is a capillary tuft surrounded by...
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...Brittany Pilcher Unit 4 Test Short Answer Questions Explain the role of the Renin-angiotensin mechanism in its control of blood pressure through the kidneys. The Renin-Angiotensin-Aldosterone Mechanism: influences blood pressure and blood volume, with its ability to regulate aldosterone, thus meaning it can regulate water and sodium reabsorption by the kidneys. The juxtaglomerular complexes in the kidneys are cells that get excited due to decreasing in blood volume and or blood pressure. The juxtaglomerular cells accommodate by releasing renin into the blood. The renin blocks of part of the angiotensinogen in the plasma proteins, this initiates the formation of angiotensin II, which in turn releases aldosterone by stimulating specific...
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...Assignment #9 - Renal Physiology 1. Describe, in detail, the effects that the following altered states would have on blood pressure and plasma osmolarity (if any). Be sure to include a step-by-step description of underlying processes occurring. Note that plasma osmolarity is a measure of the concentration of solutes in the blood and is most profoundly affected by plasma sodium concentrations. (8 points) a) Increased aldosterone secretion (hyperaldosteronism) Increased aldosterone secretion causes increased sodium reabsorption from the tubules. Since sodium has a high osmotic pressure, water will “follow” the sodium back into the blood stream, and blood pressure will increase. Even though sodium is moving into the blood stream, plasma osmolarity will not change because the water moves into the blood stream as well, keeping the overall sodium concentration the same. b) Decreased aldosterone secretion (hypoaldosteronism) Decreased aldosterone secretion results in less sodium being reabsorbed, and therefore less water being reabsorbed, resulting in decreased blood volume and decreased blood pressure. Osmolarity will remain the same. c) Increased ADH secretion (syndrome of inappropriate ADH (SIADH) When ADH binds to receptors on the outer membrane cells of the distal and collecting tubules, it activates cAMP as a second messenger, which, in turn, causes water channels in the inner membrane cells to open. The water can then freely flow through the tubule membrane cells and...
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...ideal weight. Persons who are overweight have a higher risk of developing hypertension. Due to the fact that K.H. has been placed on a salt restricted diet, it is safe to assume that he was consuming high amounts of sodium in his diet prior, which is a primary risk factor of hypertension. K.H.âs has a systolic pressure is 135 and the diastolic pressure is 96. This is stage 1 hypertension. The rationale for treating the patient with an ACE inhibitor is that Angiotensin II needs to be controlled because that is what ultimately is narrowing the blood vessels and causing the blood pressure to increase. An ACE inhibitor slows the production of Angiotensin II. The mechanism of action includes the modification of the production of Angiotensin II. This is a vasoconstrictor. Vasoconstriction is what leads to the elevation of B/P. Angiotensin II is made from angiotensin I through the means of the angiotensin converting enzyme. ACE inhibitors impede the activity of the enzyme ACE and this leads to the decrease in production of angiotensin II. Consequently, you have vasodilation and blood pressure is...
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...|Action |Starting Dose |Target dose |Indications, Contraindications, Averse Effects | | |ACE Inhibitors |Block RAAS system, decrease |Lisinopril: 2.5-5 mg qd |Lisinopril: 20-40 mg qd |Initiate at low doses | |Lisinopril |symptoms and mortality |Enalapril: 2.5-5 mg bid |Enalapril: 10-20 mg bid |May cause angioedema, hyperkalemia, increased creatinine, symptomatic | |Enalapril |Block conversion of Angiotensin I |Captopril: 6.25-12.5 mg tid |Captopril: 50 mg tid |hypotension, cough (tickle in throat) | |Captopril |to angiotensin II | | |Takes days, weeks to months to see improvement | | |Afterload reduction | | | | |Hydralazine |Pure vasodilator |10-25 mg q6-8 hrs |75 mg q6 hrs or 100 mg q8 hrs |May cause tachycardia | | |Afterload reduction | | |Used for intolerance of ACE inhibitors, for additional BP control, or | | ...
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...prescribed a diuretic to eliminate the fluid that what giving her shortness of breath, edema and weight gain but if not taken correctly or at all this would explain why M.G. is still having these manifestations. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. * Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg po bid Pioglitazone (Actos) 45 mg po every morning Furosemide (Lasix) 40mg/day po Potassium Chloride 20meq/day po 2. Which of these medications may have contributed to M.G.’s heart failure? Explain. . 3. How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), work to reduce heart failure? (Select all that apply.) ACE inhibitors: a. prevent the conversion of angiotensin I to angiotensin II. b. cause systemic vasodilation. c. promote the excretion of sodium and water in the renal tubules. d. reduce preload and afterload. e. increase cardiac...
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...an adequate understanding of what a "fluid" restriction diet entails. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. * Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg po bid Pioglitazone (Actos) 45 mg po every morning Furosemide (Lasix) 40mg/day po Potassium Chloride 20meq/day po 2. Which of these medications may have contributed to M.G.’s heart failure? Explain. a. Pioglitazone: Side effects:Severe weight gain and water retention (edema) are both known to contribute to heart probelms. . 3. How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), work to reduce heart failure? (Select all that apply.) ACE inhibitors: a. prevent the conversion of angiotensin I to angiotensin II. b. cause systemic vasodilation. c. promote the excretion of sodium and water in the renal tubules. d. reduce...
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...Health problems do not affect all women and men the same way, women and men are both subjected to different risk depending on their current health situation. Focusing on ethnicity, age, health care coverage and household income; health issues can arise and affect women and men. First, we must understand that having the poorest health does make it easier but, it is a beginning towards identifying the societal, enriching and policy-related factors that influence the health of women and men. Additionally, that benefiting from targeted instructive interventions, policies, and programmatic resources can be an asset towards this disease. For this reason, research has found that women do have higher blood pressure when compared to men. There are roughly 3.3 million women age 18 and older in New York City: 42 percent are between 25 and 44 years old, 44 percent have a household income less than $25,000, and 28 percent do not have a high school degree. As a reflection, the diversity is not on one culture alone, however there is Hispanic, Black or Asians all a part of the comparison under women and they too come with different lifestyles (The Endocrine Society, 2013). Lifestyle modifications Women are less likely to have their blood pressure controlled than men with lifestyle interventions alone, maybe because women are not as much successful in losing weight. Weight decrease is of great importance for blood pressure management in women, that’s why there is elevated popularity...
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...The liver starts by producing angiotensinogen and the kidney responds by secreting renin which react by creating Angiotensin I. when Angiotensin I reaches the lungs they release ACE or Angiotensin converting enzyme when ACE and angiotensin I react they create Angiotensin II, which works on the level of the kidneys and adrenal glands. When Angiotensin II reacts with the adrenal glands they secrete Aldosterone which regulates BP by increasing the reabsorption of Na which increase fluid volume thus increasing BP. Secondly Aldosterone decreases K+ via urine. When Angiotensin II reacts on the kidneys it cause vasoconstriction on the arterioles which also increases BP. Renal Clearance is Cx = UxV/Px = volume of plasma from which the substance is completely cleared per unit time. Cx = clearance of X (mL/min); Ux = urine concentration of X (eg, mg/mL); Px = plasma concentration of X (eg, mg/mL); V = urine ow rate...
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...Kidney’s balance the amount of fluid in the body, detect waste in the blood, and know when to release the vitamins, minerals, and hormones you need to stay alive. There are multiple hormones that affect the function of the kidneys. Renin-Angiotensin System is activated when there is a loss of blood volume or drop in blood pressure ("You & Your Hormones", 2017). Renin is formed by the juxtaglomerular apparatus cells and released at this time. Renin is responsible for converting angiotensinogen into angiotensin I. Angiotensin I is converted into angiotensin II in the presence of the angiotensin-converting enzyme. Angiotensin II is an efficient and potent vasoconstrictor. Along with renin, aldosterone is part of the renin-angiotensin system. Aldosterone causes the tubules of the kidneys to retain sodium, chloride, and water. This reduces urine output and forms concentrated urine (Bledsoe, Porter, Cherry 306). The antidiuretic hormone, ADH, is another hormone that regulates kidney function. ADH regulates the permeability of the distal convoluted tubule and the collecting duct. A lack of ADH results in production of a large volume of dilute urine due to the distal convoluted tubule being less permeable to water. Inversely, if ADH is...
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...epithelium * Exocrine glands – secrete their product onto the outer surface or into a cavity (have a duct) * Endocrine glands are ductless and secrete their product internally to be transported by the bloodstream * The pancreas has both endocrine and exocrine functions Endocrine Glands The endocrine system consists of glands and tissues that secrete hormones. Endocrine Glands: * Are ductless; they secrete their hormones directly into tissue fluid * From there the hormones diffuse into the blood stream for distribution throughout the body Hormones: * Are chemical signals that affect the behavior of other glands or tissues. * Hormones influence the metabolism of cells, the growth and development of body parts, and homeostasis. Hormones can be categorized into peptide hormones and steroid hormones: * Peptide hormones: (non-lipid soluble) * Include proteins, glycoproteins, and modified amino acids. (non-lipid soluble) * The peptide hormones can not enter the cell * Peptide hormones bind to a receptor protein in the plasma membrane and activate a "second messenger" system. * Second messenger sets in motion an enzyme cascade that leads to a cellular response * The second messenger causes the cellular changes for which the hormone is credited. (the peptide hormone stays outside the cell and directs activities within) * Common second messengers found in many body cells...
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...despite normal filling of the heart. Usually causes include hypertension, cardiomyopathy, and coronary heart disease. In heart failure, the increase in the resistance against which the heart pumps (afterload) further depresses cardiac output. A reduced renal blood flow induces renin secretion and increased plasma aldosterone and angiotensin concentrations. Water and sodium retention increases blood volume causing central venous pressure to increase. These changes overall first help to maintain cardiac output however in the long term they eventually cause morbidity and mortality (BOOK). Treatment of heart failure begins with angiotensin converting enzyme (ACE) inhibitor and as severity increases a diuretic is added which supports the excretion of sodium and water (book). In very severe heart failure, the addition of β-blocker further decreases mortality in patients on ACE inhibitors and diuretics. Valsartan/ Sacubitril is a combination drug approved for use in heart failure. It has a brand name of Entresto and is also previously known as LCZ696....
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...functions are maintained by the sympathetic nervous system (part of the automatic nervous system) and the kidneys. The way the sympathetic nervous system increases blood pressure is by releasing epinephrine and norepinephrine, which makes the heart pump faster as well as dilating (for areas in need of blood supply) or constructing (for areas that do not need much blood supply) various arterioles. The sympathetic nervous system also stimulates the kidney to keep more salt and water in the body, increasing the blood volume and the blood pressure. As for the kidneys, it maintains homeostasis based on the blood pressure via the renin-angiotensin-aldosterone system, a chain of reactions that help maintain blood pressure levels. When the blood pressure gets too high, the kidney eliminates salt and water, which decreases blood volume. When the blood pressure gets too low, the kidney keeps the salt and water in the body, increasing blood volume. When increasing blood pressure, the kidneys secrete renin, an enzyme designed to produce the hormones that controls the blood pressure. Upon release, renin splits a large protein called angiotensinogen, into various parts. One of the parts, angiotensin I, is further split by an angiotensin-converting enzyme (ACE) into angiotensin II. Angiotensin II is a hormone that increases blood pressure by constricting the arterioles via the sympathetic division and the release of the hormones, aldosterone from the adrenal gland and antidiuretic hormone (vasopressin)...
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