Dr. SIRAJ Excretory System The excretory system's job is to bring the wastes out of your body.

If the wastes are not carried out, then the excretory system could get some diseases. The skin, intestines, kidneys, liver, lungs, and sweat glands are the main organs in the excretory system. The skin excretes water and salt from the body, the lungs excrete carbon dioxide from the burning glucose, the liver and gall bladder excrete bilirubin, and the kidneys excrete urea. Plasmacarries cell wastes to body organs that get rid of the wastes. "Removing Wastes From The Blood" Kidneysare the most important organs in this system Kidneys are about the size of your fist. Blood with cell wastes goes into your kidneys through arteries. On the inside of your kidneys the blood flows through small blood vessels until it reaches the capillaries. Wastes from blood goes through thin walls in a capillary into very little tubes. The tubes take away some salts, nitrogen wastes, and extra water from the blood. Your kidneys clean all of your blood forty times a day. The wastes form a liquid called urine. Excretion is the removal of toxic (nitrogenous) waste products of metabolism from the body. The waste end products of catabolism contain carbon, hydrogen, oxygen and nitrogen. Carbon atoms are eliminated in carbon dioxide, hydrogen in water (H2O), and oxygen in carbon dioxide and water. Nitrogen, which is a highly toxic end product of protein metabolism, is found in large quantities and needs to be excreted as soon as it is formed. The kidneys (also liver) carry out detoxification, altering toxic substances into forms that are not poisonous to the body. osmoregulation The process of maintenance of osmotic and ionic concentration of body fluids is called osmoregulation. Osmoregulation and excretion are intimately related; these processes together maintain homeostasis (i.e. staying the same), and are performed by the same set of organs The term 'excretion' is correctly applied only to substances which must cross the cell membrane to leave the body. This does not include expulsion of undigested food material (egestion) since the food passes down the digestive tract without ever passing through a cell membrane.[ Nitrogen is a major constituent of amino acids and proteins The excess of amino acid is catabolized either for release of energy or is used for the synthesis of glycogen and fat. When proteins, amino acids or nucleic acids are catabolized, 3-nitrogen-containing

predominant excretory end-products are formed ammonia, urea and uric acid. Human Excretory System A) Morphology :The two kidneys are compact, red brown oval or bean shaped structures located on the dorsal wall of the abdominal cavity The right kidney is slightly lower (half an inch)than the left and about four inches in length and weighs about four ounces. External Anatomy External Anatomy 1. Average kidney 10 to 12 cm in length. 2. Bean shaped with a notch, hilus, in the concave portion 3. Blood vessels, nerves, and ureter enter and leave through hilus 4. Hilus is entrance to renal sinus. 5. Kidney is surrounded by the capsule. Over the capsule is the renal fascia, a layer of connective tissue which anchors kidney to abdominal wall and surrounding structures KIDNEY Internal Anatomy Internal Anatomy of the Kidney. Outer portion is cortex. Inner middle portion is called medulla. Inner portion is the renal pelvis. Cortex contains glomerulus, Bowman's capsule, proximal and distal convoluted tubules of many of the nephrons. Within the medulla you can see renal pyramids and renal columns. The renal pyramids are striated and cone-shaped. They vary in number between 5 and 12. The Kidney has THREE Regions; the Inner part called the RENAL MEDULLA; the Outer part called the RENAL CORTEX and the RENAL PELVIS, a Funnel Shaped Structure in the Center of the Kidney. Sagittal Section of a Kidney The vertical section of a kidney shows that it consists of two regions, the outer dark region called the cortex, and the inner, lighter colored zona medulla. There is a collecting space called the pelvis where the ureter leaves the kidney; 6 to 15 cones or pyramids of kidney tissue project into this space. A tube, the ureter, conveys urine from each kidney into the urinary bladder, which opens into the urethra In females, the urethra opens in front of the vagina. In males, the urethra passes through the penis and transports both urine and semen. Each Kidney is a Bean-Shaped organ, about the size of a Fist The base is directed to the cortex. The apex projects toward the renal pelvis, where it forms the papilla. The papilla has numbers of openings like a sieve. Urine flows through them into the major and minor calyces. The calyces open into the renal pelvis. The renal pelvis is the upper expanded end of the ureter. Kidney stones (renal Calculi) may form in the pelvis of the kidneys. Internal anatomy of the Kidney - microscopic 1. There are about 1 million specialized tubules called nephrons

2. Upper end is a sac called the Bowman's capsule 3. An afferent blood vessel, extending from the renal artery, enters the sac. A knot of about 50 separate capillaries form the glomerulus. 4. Every blood vessel comes in contact with the capsule wall 5. Nephron becomes tubular and convoluted. Urine enters the proximal convoluted tubule, descending limb of loop of Henle, Loop of Henle, ascending limb of loop of Henle, distal convoluted tubule, and collecting tubule. Capsule and convoluted tubules are in cortex (juxtamedullary nephrons). Loop of Henle is in medulla. (Except in cortical nephrons 6. Collecting tubule is joined with others, which open into the pelvis from pyramid 7. The efferent blood vessel leaves glomerulus and branches to form capillaries that surround the tubules. Eventually they lead back to the renal vein and to the heart. It also shows a large number of tiny tubules (nephrons), many capillaries and connective tissue The Renal Cortex contains the NEPHRONS, THE BASIC FUNCTIONAL UNIT OF THE KIDNEYS. . EACH NEPHRON IS A SMALL INDEPENDENT FILTERING UNIT. IN EACH KIDNEY THERE ARE ABOUT 1 MILLION NEPHRONS. The glomerulus is surrounded by a cup-shaped structure called Bowman The glomerulus is surrounded by a cup-shaped structure called Bowmans capsule. The Bowmans capsule and the glomerulus together are called the Malpighian body. The glomerulus is a small knot of blood vessels formed by a capillary network from the renal artery (afferent vessel). The smaller efferent vessels take the blood away from the glomerulus and enter the capillary network around the tubule of the nephron. The capillaries unite to form the venules to form the renal vein which joins the inferior vena cava. Each Bowman Each Bowmans capsule leads into a renal (kidney) tubule.(NEPHRON). Bowman's capsule filters everything, except for the blood cells and plasma protein, out of the blood into the proximal (close) tubule. The filtration is also aided by the specialised permeable epithelium on the walls of the Bowman's capsule Now that all the potentially dangerous substances from the blood have been removed, the useful substances are ready to be reabsorbed back into the blood stream. The main substances that are re-absorbed in the proximal convoluted tubule are glucose, water and salt. From the proximal tubule the filtrate, now containing urea, sodium and chloride ions and water, moves into the loop of Henle Loop of Henle The loop of Henle is a U - shaped loop that extends from the cortex to the medulla of the kidney. The effect of this loop is to concentrate salts in the medulla. After the loop of Henle the filtrate passes through the distal (far) tubule. It then continues on to the collecting duct where water is reabsorbed.

The water is reabsorbed by diffusion because of the higher salt concentration on the outside in the medulla of the kidney. The filtrate which now consist mainly of urea and other harmful substances, as well as a varying amount of water depending on the need for it in the body, is excreted via the urethra. Physiology of the Kidney - Glomerular Filtration 1. Goal of urine production is homeostasis by regulating volume and composition of blood There are 3 noteworthy organic waste products A. Urea - Most abundant organic waste. Product of breakdown of amino acids and the resulting NH2 (amino). Otherwise produce ammonia - very toxic. B. Creatinine - Generated by skeletal muscle breakdown. Creatinine phosphate is an energy compound which has a role in muscle contraction. C. Uric acid - Results from recycling of nitrogenous bases from RNA molecules 1. As the renal artery branches into smaller vessels, the result is increasing pressure hydrostatic pressure. 2. Blood in capillaries in body is about 25 mm Hg. In the glomerulus is 60 - 70 mm Hg. 3. As a result fluid is forced from capillaries into capsule at a rate of 125 ml per minute. 180 L in 24 hours, which is about 48 gallons. However, only 1.0 to 1.5 liters of fluid per day is formed as urine. 4. Fluid is forced across the endothelial-capsular membrane. Contains water and dissolved components and is called filtrate. 5. Filtrate consists of all the materials present in blood except for formed elements (blood cells). 6. Filtrate contains water, glucose, some amino acids, Na+, Cl-, HCO3-, K+, urea, uric acid, and creatinine. 7. Plasma proteins and other cellular elements of blood should not normally pass. Physiology --Tubular reabsorption 1. Blood in efferent blood vessel is highly concentrated due to loss of water and presence of blood proteins. 2. Proximal convoluted tubule -80 % of reabsorption of water and other solute occurs at proximal tubules. Water absorption is due to osmotic pressure - a passive process. 90% of water is reabsorbed. 3. 99 % of glucose, amino acids, and other organic substance are returned by facilitated diffusion and cotransport. 4. Urea is removed from blood by passive transport - diffusion. Some is reabsorbed; however, it remains concentrated in urine. (40% is reabsorbed). 5. Ions such as Na+, K+, Cl-, HCO3- are actively pumped back by ion pumps. Ion absorption is influenced by hormones (later). 90% of bicarbonate (HCO3-) is reabsorbed. It is important in blood pH stabilization. 6. Descending limb - Passive reabsorption of water. 7. Ascending limb - Reabsorption of Na+, Cl-, and urea. 8. Distal Convoluted Tubule - Na+, influenced by aldosterone; Cl-, HCO3-, and urea. Facultative water reabsorpiton under influence of ADH.

9. Collecting Tubule - Na+, influence of aldosterone; Cl-, urea.Faculatative water reabsorption under influence of ADH. Physiology - Tubular secretion. 1. Tubular secretion adds materials to the filtrate from the blood. Includes H+, K+, ammonia, creatinine. 2. Functions to rid body of certain materials, and helps control blood pH. 3. Secretory activities occur primarily at distal convoluted tubules, especially K+. 4. K+ and H+ are of special interest. K+ is mostly secreted at DCT, with some at collecting tubules. H+ is secreted at PCT, DCT, and collecting tubules. 5. K+ ions are exchanged for Na+ ions which are reabsorbed 6. H+ secretion is also associated with Na+ reabsorption. Sodium linked coutertransport. 7. Hydrogen ions generated by dissociation of carbonic acid (H2CO3) are secreted out. Bicarbonate (HCO3-) are reabsorbed. This helps prevent changes in blood pH. 8. As concentrations in blood increase, more will be secreted. Hydrogen ion secretion acidifies tubular fluid while elevating pH of blood. H+ secretion accelerates when pH of blood falls, as in lactic acidosis, after muscle activity. 9. Process is also hormone regulated. Nephron Structure of a uriniferous tubule (Nephron) The nephron is the basic excretory unit of the kidney; there are over a million in each kidney. Each nephron consists of a glomerulus, Bowman The nephron is the basic excretory unit of the kidney; there are over a million in each kidney. Each nephron consists of a glomerulus, Bowmans capsule and associated renal tubules. Factors Affecting Urination 1. Amount and concentration of urine are affected by ingestion of water or salt. 2. Drinking large amounts of water results in dilute urine. Ingesting large amounts of salts results in more concentrated urine. 3. The events brining about these reactions involve both nervous and endocrine systems. 4. Intake of fluid or salt affects osmotic pressure. Concentration of solutes is measured as osmolarity or total solutes in moles per liter. Milliosmoles are noted as mOsm/L. An increase in the osmolarity represents a decrease in the osmotic pressure. 5. Antidiuretic hormone (ADH) is produced in the hypothalamus. Also known as vasopressin. It is stored and released in the posterior pituitary gland. 6.Osmoreceptor cells in the hypothalamus monitor the osmolarity of the blood. 7. When blood osmolarity in blood rises above 300 mOsm/L, release of ADH is stimulated. Water loss due to exercise, sweating, or diarrhea are examples. 8. ADH reaches kidney, particularly the distal convoluted tubules and collecting ducts. 9. ADH increases permeability of tubules to water. This increases water reabsorption and concentrates the urine.

10. Reduction of osmolarity in turn reduces effects on osmoreceptors and decreases ADH secretion. This is negative feedback. 11. Additional intake of water is necessary to bring osmolarity down to 300 mosm/L 12. Large intake of water has effect of reducing ADH secretion. This reduces reabsorption of water and increases urination. Increased urination is called diuresis. That is why it is called antidiuretic hormone. 13. Alcohol disturbs water balance by inhibiting the release of ADH, causing excess loss of water. 14. Normally this feedback loop contributes to homeostasis 15. Another hormone that helps regulate the kidneys is aldosterone. 16. It is secreted in the cortex of the adrenal glands. High concentrations of aldosterone causes sodium to be retained in greater amounts, and potassium is excreted in greater amounts When blood pressure or volume drops, Aldosterone is secreted and bp and blood volume are restored. A deficiency of aldosterone causes potassium to be retained and excessive sodium lost and with it equivalent amounts of water. Body fluid decreases. iii) Micturition When the bladder is full (about 600 cm3), waves of contraction pass down the bladder resulting in an urge to urinate. Nerve impulses relax the sphincter muscle at the mouth of bladder, and allow the urine to escape through the urethra. This expulsion of urine from the urinary bladder is called micturition When urine is expelled, the sphincter muscles contract, the muscles of bladder relax and the urine is collected again in the bladder. In babies (two years old and younger) the contraction of the bladder and relaxation of the sphincter muscles are under reflex control only. But later (after two years of age) the reaction is usually under voluntary control. Formation of Urine The formation of urine involves three processes: 1. ultrafiltration, 2. reabsorption 3. secretion. FILTRATION About 1600 liters of blood passes through the human kidney daily. The amount of plasma in the human body is only about three liters. Thus every drop of plasma in the blood passes through the kidneys, where its contents are monitored, checked and altered, about 560 times in a day About 180 liters of filtrate passes through the nephron in a day, at the rate of about 125 ml per minute. Most of it is reabsorbed, so that only about one liter of urine is produced and excreted from the body daily. Regulation of kidney function (Hormonal control) The amount of salts, water and production of urine depends upon kidney functions like filtration, reabsorption, and secretion.

These are regulated by certain hormones from the pituitary and adrenal gland. 1 .Antidiuretic Hormone (ADH): 2Aldosterone: 3 .Angiotensin: --stretch receptor cells in the juxtaglomerular apparatus of the kidney initiate nerve impulses and produce a proteolytic enzyme called renin. This enzyme causes the release of angiotensin I and II (one and two). Skin and Lungs as Accessory Excretory Organs In addition to the urinary system, the skin, lungs and liver of vertebrates are accessory excretory organs. Human skin possesses glands for secreting two fluids on its surface, namely sweat from the sweat glands and sebum from sebaceous glands. Sweat is a watery fluid containing in solution primarily contains sodium-chloride, lactic acid, urea, amino acids and glucose. It helps in excreting mainly water and sodium chloride, and a small amount of urea and lactic acid. Sebum is a wax-like secretion which helps to excrete some lipids such as waxes, sterols, other hydrocarbons and fatty acids on the skin. Lungs: Lungs which are the main respiratory organs of vertebrates, help to eliminate the entire volume of carbon dioxide produced in the body, as well as some moisture, during expiration. The lungs maintain the blood-gas homeostasis through elimination of carbon dioxide. When lungs fail to eliminate enough carbon dioxide, the kidneys attempt to compensate. They change some of the carbon dioxide into sodium bicarbonate, which becomes part of the blood buffer system. diseases and disorders of the excretory system include: Nephritis-----an inflammation of the glomeruli Nephrosis ---affects the glomeruli urinary tract infections (UTIs )----are caused by Gram negative bacteria such as E. coli. . kidney stones . If there is an obstruction of the urethra, catheterization may be needed, but as a general rule, catheterization in cases of UTI is contraindicated because it can actually introduce pathogens and make the infection worse. Women tend to acquire more urethral and bladder infections than men, perhaps because the opening of the urethra is closer to the anus. The way a woman cleans the area after relieving herself can influence her chances of contracting a UTI and/or vaginal infection. When parents are toilet-training toddlers, the common mistake is to wipe young girls from back to front. The toddlers get used to this feeling, and when they start to wipe themselves, they also go from back to front. This technique wipes bacteria from the anal area towards or into the ends of the vagina

and urethra. The urinary system is a very important excretory system of the body. It consists of: two kidneys which form and excrete urine; two ureters which convey the urine from the kidneys to the urinary bladder; a urinary bladder where urine collects and is temporarily stored; and, a urethra through which urine is discharged from the urinary bladder to the exterior of the body Most diseases of the kidneys and other parts of the urinary system are related to an imbalance of simple filtration in the kidneys About 100-150 liters of dilute filtrate are formed each day by the two kidneys. Of these 1-1.5 liters are excreted as urine. With the exception of blood cells, platelets and blood proteins, all other blood constituents must pass through the kidneys The process of filtration is disrupted and weakened by poor performance of the digestive system, and the liver in particular. Gallstones in the liver and gallbladder reduce the amount of bile necessary to digest food properly. Much of the undigested food begins to ferment and putrefy leaving toxic waste matter in the blood and lymph. Under normal circumstances, the body knows how to deal with acidic waste material that has been deposited in the connective tissue It releases an alkaline product, sodium bicarbonate NaHCO3, into the blood that is able to retrieve and neutralize the acidic toxins and eliminate them through the excretory organs. This emergency system, however, begins to fail when toxins are deposited faster than can be retrieved and eliminated. Consequently, the connective tissue may become as thick as jelly; nutrients, water and oxygen can no longer pass freely and the cells of the organs begin to suffer malnutrition, dehydration and oxygen deficiency. As the blood vessel walls become increasingly congested, fewer proteins are able to escape the blood stream. This leads to blood thickening, making it more and more difficult for the kidneys to filter it. At the same time, the basement membranes of the blood vessels supplying the kidneys also become congested. As this process of hardening of the blood vessels progresses further, blood pressure starts to rise and overall kidney performance drops. Ever-increasing amounts of metabolic waste excreted by kidney cells, normally eliminated via venous blood vessels and lymphatic ducts, are held back and, thereby, increase thickness of the cell membranes. Through all of this, the kidneys become overburdened and can no longer maintain normal fluid and electrolyte balance. In addition, there may be precipitation of urinary components that form into crystals and stones of various types and sizes. Uric acid stones, for example, are formed when uric acid concentration in the urine exceeds the level of 2-4 mg %.

Uric acid is a by-product of the breakdown of protein in the liver. Stones formed from excessive uric acid can lead to urinary obstruction, kidney infection and, eventually, kidney failure. As kidney cells become increasingly deprived of vital nutrients, including oxygen, malignant tumors may develop. In addition, uric acid crystals that are not eliminated by the kidneys can settle in the joints and cause rheumatism, gout and water retention. The most observable and common symptoms of kidney problems are abnormal changes in the volume, frequency and coloration of the urine. These are usually accompanied by swelling of the face and ankles, and pain in the upper back. If the disease has progressed further, there may be blurred vision, tiredness, falling off in performance, and nausea The following symptoms may also indicate malfunctioning of the kidneys: high blood pressure, low blood pressure, pain moving from the upper to lower abdomen, dark brown urine, pain in the back just above the waist, excessive thirst, increase in urination, especially in night time, less than 500ml urine per day, feeling of fullness in the bladder and pain passing urine, drier and browner skin pigment, ankles puffy at night, eyes puffy in morning, bruising and hemorrhage. Kidner Stones Imbedded in Kidney Bladder Stones Kidney stones What are kidney stones? Kidney stones can form anywhere within the urinary tract, within the kidney, within the ureter (the tube draining urine from the kidney), or in the bladder. Kidney stones may be many sizes and shapes. They may be tiny microsopic crystals to stones as large as potatoes. What are kidney stones made of? Calcium is present in nearly all stones (80%) usually as calcium oxalate or less often as calcium phosphate Struvite stones form in the presence of urinary infection and are made of a mixture of calcium, ammonia and phosphate (struvite). A staghorn calculus is very large struvite stone and takes the shape of the kidney itself. What are kidney stones made of? Uric acid stones form from the substance which causes gout

Cystine stones are very rare and occur in an inherited condition called cystinuria Who gets kidney stones? How do kidney stones form? Every stone that develops is the result of a combination of factors The chemicals that form stones are normally dissolved in the urine, however if they become concentrated in the urine crystals begin to form How do kidney stones form? A stone is a hard mass formed from crystals which grow in size and stick tightly to the inner surfaces of the kidney. Stones are more likely to form if the urine is concentrated (small volume), or if there is infection in the urine. How do kidney stones form? Some people may form kidney stones because there is increased amount of a stone forming substance in the urine. Occasionally a stone forms because there are cysts or scars in the kidney What problems are caused by kidney stones? The most common first symptom of a kidney stone is severe pain, this often occurs as the stone starts to move from the kidney to the ureter or bladder. The pain often comes in spasms known as colic. It starts in the back and can move into the groin. There may be blood in the urine and you may feel sick. If a stone is present there is an increased chance of infection. Large stones like staghorns may affect kidney function even before any symptoms occur. Serious complications arise if the stone completely blocks the flow of urine from the kidney, which then stops working. How are kidney stones treated? The aims of treatment are to improve symptoms, deal with any complications, remove stones which don't pass spontaneously and prevent further stones forming. Immediate treatment of kidney stones Pain control is the most important part of treatment and strong painkillers are sometimes needed. You may need medication to prevent sickness or intravenous fluids. Most small stones (<5mm) will pass on their own. It is very helpful to keep any stones that are passed for analysis. Some stones between 5-9mm will pass but larger stones need special treatment. All the treatments for removing kidney stones need to be done in a specialist centre. Most kidney stones can be seen on an X-ray of the lower end of the abdomen. Some stones however don't show up on X-ray and need a special dye scan called an IVP (intravenous pyelogram) showing up the kidneys, ureter and bladder. CT scans can also show kidney stones. These tests involve X-rays and are best avoided if you are pregnant. Some kidney stones show up on an ultrasound scan. Treatment to remove a kidney stone ESWL (extra-corporeal shockwave lithotripsy

Nephrolithotomy Bladder stones are removed using a cystoscope, a special instrument which is passed through the urethra into the bladder. Advice Key Points HAEMATURIA What is haematuria? Haematuria means the appearance of blood in the urine. Causes of haematuria Causes of haematuria Causes of haematuria Haematuria can originate from the kidney itself due to inflammation in the kidney, eg glomerulonephritis affecting the filtering units (glomeruli). When this is the cause of haematuria there are often other signs of kidney disease such as protein in the urine (proteinuria) high blood pressure abnormal blood tests of kidney function Kidney cysts, tumours or kidney stones can also cause haematuria This is an elderly man who complains of gross painless haematuria. Exam the retrograde pyelogram Chronic Voiding Difficulty Nephrotic Syndrome What is nephrotic syndrome? It is the name given to a condition when large amounts of protein leak out into the urine In nephrotic syndrome the leak is large enough so that the levels of protein in the blood fall. What trouble does it cause? The most obvious symptom is usually swelling of the ankles and legs. Extra fluid may also accumulate in the abdomen and around the face, especially overnight. In children and young adults the ankles may be less affected and the abdomen and face more affected. Urine tests and blood samples are required to prove that nephrotic syndrome is the cause. Other problems can occur in nephrotic syndrome : Infections Patients are unusually susceptible to some infections. CholesterolIn people who have nephrotic syndrome for a long time, cholesterol is often very high. This may increase the risk of narrowing of the arteries unless it is treated. Blood clottingBlood is more likely to clot in the veins, which may cause thrombosis in the leg veins and occasionally elsewhere. Some of these may require extra treatments to prevent them SYMPTONS The nephrotic syndrome is characterized by massive proteinuria, which leads to hypoproteinemia/hypoalbunemia, hyperlipidemia with elevated cholesterols, triglicerides and other lipids, and edema. He received steroid treatment for ten years, suffering many relapses. NEPHROTIC SYNDROME

HYDRONEPHROSIS Definition : Unilateral hydronephrosis occurs when a single kidney becomes distended or swollen due to a backup of urine. When both kidneys are involved, the condition is called bilateral hydronephrosis. Causes, incidence, and risk factors Hydronephrosis is a condition that occurs with a disease and is not a disease itself. Treatment and prognosis for unilateral hydronephrosis depend on the associated disorder. Conditions that are often associated with unilateral hydronephrosis include the following Acute unilateral obstructive uropathy Chronic unilateral obstructive uropathy Vesicoureteric reflux (backflow of urine from bladder to kidney) Nephrolithiasis (kidney stones) Idiopathic hydronephrosis of pregnancy Unilateral hydronephrosis occurs in approximately 1 in 100 people. Symptoms Flank pain Abdominal mass Nausea and vomiting Urinary tract infection Fever Dysuria Increased urinary frequency Increased urinary urgency Note: Sometimes unilateral hydronephrosis does not have symptoms. Treatment infections. A ureteral stent (which allows the ureter to drain) or nephrostomy tube (which allows the kidney to drain through the back, bypassing the ureter) will provide temporary relief of the obstruction If signs and symptoms of an infection are present, antibiotics and prompt relief of urinary obstruction is mandatory. Patients who have only one kidney, who have immunecompromising disorders such as diabetes or HIV, or who have received a transplant should be treated promptly. If hydronephrosis is chronic, preventive antibiotics may be prescribed to decrease the risk of urinary tract Hydronephrosis. Note distended pelvis. The thin translucent pelvis suggests that this hydronephrosis is of acute, recent origin Hydronephrosis (Staghorn calculus). In contrast to previous illustration, the pelvic mucosa is more opaque and thickened, suggesting chronic obstruction and possible infection . The dilatation involved only one kidney indicating the obstruction is unilateral (e.g., calculus, ureteral stricture, or unilateral obstruction of ureteric orifice). Acute Renal Failure Definition : Acute renal failure is sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes. ("Acute" means sudden, "renal" refers to the

kidneys.) There are numerous potential causes of damage to the kidneys. Decreased blood flow -- this may occur when there is extremely low blood pressure caused by trauma, complicated surgery, septic shock, hemorrhage, or burns; associated dehydration; or other severe or complicated illnesses acute arterial occlusion of the kidney and renal artery stenosis). Over-exposure to metals, solvents, radiographic contrast materials, certain antibiotics alcohol abuse, a crush injury, tissue death of muscles from any cause, seizures, and other disorders. Direct injury to the kidney Infections such as acute pyelonephritis or septicemia Urinary tract obstruction, such as a narrowing of the urinary tract (stricture), tumors, kidney stones, nephrocalcinosis or enlarged prostate with subsequent acute bilateral obstructive uropathy Symptoms decreased urine output decreased urine volume (oliguria) no urine output (anuria) urination, excessive at night (can occur in some types of renal failure) ankle, feet, and leg swelling generalized swelling, fluid retention decrease in sensation, especially the hands or feet changes in mental status or mood agitation drowsiness, lethargy delirium or confusion coma fluctuating mood difficulty paying attention (attention deficit) hallucinations slow, sluggish, movements seizures hand tremor nausea, vomiting may persist for days morning sickness vomiting blood prolonged bleeding, bruising easily stools, bloody nosebleed growth, slow (child 0-5 years) flank pain fatigue ear noise/buzzing

breath odor breast development in males blood pressure, high Lab values may change suddenly (within a few days to 2 weeks): Urinalysis may be abnormal. Serum creatinine may increase by 2 mg/dL or more over a 2-week period. Creatinine clearance may be decreased. BUN may increase suddenly. Serum potassium levels may be increased Arterial blood gas and blood chemistries may show metabolic acidosis Kidney or abdominal ultrasound is usually the best test, but abdominal X-ray, abdominal CT scan or abdominal MRI may also reveal the cause of acute renal failure. Kidney size is usually normal or slightly large Treatment The goal of treatment is to identify and treat any reversible causes of the kidney failure (e.g., use of kidney-toxic medications, obstructive uropathy, volume depletion). Hospitalization is required for treatment and monitoring Your fluid intake may be severely restricted to an amount equal to the volume of urine you produce. You may be given specific dietary modifications to reduce build-up of toxins normally handled by the kidneys, including a diet plan high in carbohydrates and low in protein, salt, and potassium. Antibiotics may be used to treat or prevent infection. Diuretics may be used to remove fluid from the kidney. Dialysis may be used to remove excess waste and fluids This often makes the person feel better and may make the kidney failure easier to control. Dialysis may not be necessary for all people, but is frequently lifesaving, particularly if serum potassium is dangerously high. Common symptoms that require the use of dialysis include decreased mental status, pericarditis, increased potassium levels, total lack of urine production, fluid overload, and uncontrolled accumulation of nitrogen waste products (serum creatinine > 10 mg/dl and BUN > 120 mg/dl). Chronic renal failure (CRF) is defined as a permanent reduction in glomerular filtration rate (GFR) sufficient to produce detectable alterations in well-being and organ function. This usually occurs at GFR below 25 ml/min. Uremia (Azotemia) is a term applied to the manifestations of organ dysfunction Azotemia, the accumulation of nitrogenous waste products, chiefly urea, in the blood is the hall mark of renal failure. It is a clinical syndrome resulting from retention of certain substances which are normally

excreted into the urine and thus accumulate causing toxicity. CAUSES OF CHRONIC RENAL FAILURE Any disorder that permanently destroys nephrons can result in chronic renal failure. Most Common Causes of CRF are Diabetic nephropathy Hypertensive nephrosclerosis Glomerulonephritis Interstitial nephritis Polycystic kidney disease Clinical Manifestations (changes in bodily functions) Electrolyte Imbalances Metabolic Changes Cardiovascular Changes Hematologic Changes Respiratory Changes Musculoskeletal Changes Endocrine Changes Clinical Manifestations (changes in bodily functions ) Psychosocial Changes Immunologic Changes Reproductive Changes Medication Metabolism Changes Neurologic Changes Gastrointestinal Changes Integumentary Changes The clinical manifestations of chronic renal failure, with its retention of nitrogenous waste products; changes in fluid, electrolyte, and acid-base balances; and loss of normal kidney functions, are present throughout the body. No organ system is spared. Electrolyte Imbalances: IN CRF----electrolyte balances may be upset by impaired excretion and utilization. The salt-wasting properties of some kidneys, in addition to vomiting and diarrhea, may cause hyponatremia (low sodium). Late in the disease the problem becomes hypernatremia (high sodium). This problem often contributes to hypertension, fluid overload, and congestive heart failure. Cardiovascular Changes Hypertension Hypertension Congestive Heart Failure and Left Ventricular Hypertrophy Arrhythmias Atherosclerosis Pericarditis Gastrointestinal Changes

Respiratory Changes Hematologic Changes Anemia Iron, folate depletion Bleeding Tendencies Integumentary Changes Dry, itchy skin Color changes in skin Increased bruising, petechiae, purpura Dry, thin, brittle hair Brittle, thin nails Musculoskeletal Changes Osteoporosis Osteosclerosis Osteomalacia Osteitis fibrosis Reproductive Changes Decreased libido Infertility in females Menstrual irregularities - particularly amenorrhea Testicular atrophy in men Reduced sperm motility or oligospermia Immunologic Changes Increased susceptibility to infection due to depressed humoral antibody formation Decreased chemotactic function of leukocytes Supression of delayed hypersensitivity Neurologic Changes Peripheral neuropathy- causes many symptoms such as Burning feet Restless leg syndrome Gait changes Central Nervous System Forgetfulness Inability to concentrate Impaired reasoning and judgment Increased irritability Twitching Seizures Decreased hearing Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level walking

walking EXCRETORY SYSTEM EXCRETORY SYSTEM urinary_system urinary_system kidney kidney Animated kidneys Animated kidneys modkidneystructure modkidneystructure modfilreabsecr modfilreabsecr nephron nephron kidney kidney Kidney Cross Section modfilreabsecr modfilreabsecr filtration filtration excretory excretory Excretory System Excretory System DISEASES & DISORDERS of EXCRETORY SYSTEM DISEASES & DISORDERS of EXCRETORY SYSTEM urin_sys KIDNEY KIDNEY The most common first symptom of a kidney stone is severe pain, this often occurs as the stone starts to move from the kidney to the ureter or bladder. KIDNEY

KIDNEY schisto_children schisto_children What is the most likely diagnosis? Answer Transitional cell carcinoma. The retrograde pyelogram shows transitional cell carcinoma involving right upper pole calices and infundibulum stricture with marginal irregularity of pre-sacral right ureter nephroticpic nephroticpic Severe swelling of the ankles in nephrotic syndrome after receiving the remedy. nephrotic-syndrome nephrotic-syndrome hydronephrosis hydronephrosis hydronephrosis hydronephrosis kidney_hydro kidney_hydro Anorexia, Nausea, Vomiting Anorexia, Nausea, Vomiting Constipation Pulmonary Edema Pleuritis Uremic Lung Acidosis . sneeze sneeze THANK YOU THANK YOU Excretory System Dr Sirajuddin Lakshmi "Removing Wastes From The Blood" osmoregulation Human Excretory System External Anatomy External Anatomy KIDNEY Internal Anatomy Internal Anatomy of the Kidney. Sagittal Section of a Kidney Each Kidney is a Bean-Shaped organ, about the size of a Fist Internal anatomy of the Kidney - microscopic Loop of Henle Physiology of the Kidney - Glomerular Filtration

Physiology --Tubular reabsorption Physiology - Tubular secretion. Nephron Structure of a uriniferous tubule (Nephron) Factors Affecting Urination iii) Micturition Formation of Urine FILTRATION Regulation of kidney function (Hormonal control) Skin and Lungs as Accessory Excretory Organs Lungs: diseases and disorders of the excretory system include: Most diseases of the kidneys and other parts of the urinary system are related to an imbalance of simple filtration in the kidneys Kidner Stones Imbedded in Kidney Bladder Stones Kidney stones What are kidney stones? What are kidney stones made of? What are kidney stones made of? Who gets kidney stones? How do kidney stones form? How do kidney stones form? How do kidney stones form? What problems are caused by kidney stones? How are kidney stones treated? Immediate treatment of kidney stones Treatment to remove a kidney stone Advice Key Points HAEMATURIA What is haematuria? Causes of haematuria Causes of haematuria Causes of haematuria This is an elderly man who complains of gross painless haematuria. Exam the retrograde pyelogram Chronic Voiding Difficulty Nephrotic Syndrome What trouble does it cause?

SYMPTONS He received steroid treatment for ten years, suffering many relapses. NEPHROTIC SYNDROME HYDRONEPHROSIS Causes, incidence, and risk factors Conditions that are often associated with unilateral hydronephrosis include the following Symptoms Treatment

Acute Renal Failure Symptoms

Lab values may change suddenly (within a few days to 2 weeks): Treatment Chronic renal failure (CRF) CAUSES OF CHRONIC RENAL FAILURE Clinical Manifestations (changes in bodily functions) Clinical Manifestations (changes in bodily functions ) Electrolyte Imbalances: IN CRF----Cardiovascular Changes Gastrointestinal Changes Respiratory Changes Hematologic Changes Integumentary Changes Musculoskeletal Changes Reproductive Changes Immunologic Changes Neurologic Changes Design Template Slide Titles _PID_HLINKS

Version http://library.thinkquest.org/J002312/Excertoryvocab.htm http://library.thinkquest.org/J002312/Excertoryvocab.htm http://library.thinkquest.org/J002312/Excertoryvocab.htm http://library.thinkquest.org/J002312/Excertoryvocab.htm http://library.thinkquest.org/J002312/Excertoryvocab.htm http://library.thinkquest.org/J002312/Excertoryvocab.htm http://www.westsidevolleyball.com/gunther/kidney.jpg http://www.westsidevolleyball.com/gunther/kidney.jpg http://www.westsidevolleyball.com/gunther/nephron.jpg http://www.westsidevolleyball.com/gunther/nephron.jpg http://www.mef.hr/Patologija/ch_7/c7_shock_kidney.jpg http://www.mef.hr/Patologija/ch_7/c7_shock_kidney.jpg http://www.westsidevolleyball.com/gunther/kidney.jpg http://www.westsidevolleyball.com/gunther/kidney.jpg http://www.angelo.edu/faculty/rwilke/anat-images/intro/images/kidney_jpg.jpg http://www.angelo.edu/faculty/rwilke/anat-images/intro/images/kidney_jpg.jpg http://www.westsidevolleyball.com/gunther/nephron.jpg http://www.westsidevolleyball.com/gunther/nephron.jpg http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/ProteinuriaLong.html http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/ProteinuriaLong.html http://www.nlm.nih.gov/medlineplus/ency/article/000474.htm http://www.nlm.nih.gov/medlineplus/ency/article/000474.htm http://www.nlm.nih.gov/medlineplus/ency/article/000509.htm http://www.nlm.nih.gov/medlineplus/ency/article/000509.htm http://www.nlm.nih.gov/medlineplus/ency/article/000498.htm http://www.nlm.nih.gov/medlineplus/ency/article/000498.htm http://www.nlm.nih.gov/medlineplus/ency/article/000459.htm http://www.nlm.nih.gov/medlineplus/ency/article/000459.htm http://www.nlm.nih.gov/medlineplus/ency/article/000458.htm http://www.nlm.nih.gov/medlineplus/ency/article/000458.htm http://www.nlm.nih.gov/medlineplus/ency/article/003113.htm http://www.nlm.nih.gov/medlineplus/ency/article/003113.htm http://www.nlm.nih.gov/medlineplus/ency/article/003274.htm http://www.nlm.nih.gov/medlineplus/ency/article/003274.htm http://www.pathology.vcu.edu/education/renal/images/dc-12.jpg http://www.pathology.vcu.edu/education/renal/images/dc-12.jpg http://www.pathology.vcu.edu/education/renal/images/dc-13.jpg http://www.pathology.vcu.edu/education/renal/images/dc-13.jpg http://www.nlm.nih.gov/medlineplus/ency/article/002350.htm http://www.nlm.nih.gov/medlineplus/ency/article/002350.htm http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm http://www.nlm.nih.gov/medlineplus/ency/article/000668.htm http://www.nlm.nih.gov/medlineplus/ency/article/000668.htm http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm

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http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm http://www.nlm.nih.gov/medlineplus/ency/article/000740.htm http://www.nlm.nih.gov/medlineplus/ency/article/000740.htm http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm http://www.nlm.nih.gov/medlineplus/ency/article/003192.htm http://www.nlm.nih.gov/medlineplus/ency/article/003192.htm http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm http://www.nlm.nih.gov/medlineplus/ency/article/003119.htm http://www.nlm.nih.gov/medlineplus/ency/article/003119.htm http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm http://www.nlm.nih.gov/medlineplus/ency/article/003235.htm http://www.nlm.nih.gov/medlineplus/ency/article/003235.htm http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm http://www.nlm.nih.gov/medlineplus/ency/article/003021.htm http://www.nlm.nih.gov/medlineplus/ency/article/003021.htm http://www.nlm.nih.gov/medlineplus/ency/article/003113.htm http://www.nlm.nih.gov/medlineplus/ency/article/003113.htm http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm http://www.nlm.nih.gov/medlineplus/ency/article/003043.htm http://www.nlm.nih.gov/medlineplus/ency/article/003043.htm http://www.nlm.nih.gov/medlineplus/ency/article/003058.htm http://www.nlm.nih.gov/medlineplus/ency/article/003058.htm http://www.nlm.nih.gov/medlineplus/ency/article/003165.htm http://www.nlm.nih.gov/medlineplus/ency/article/003165.htm http://www.nlm.nih.gov/medlineplus/ency/article/003082.htm http://www.nlm.nih.gov/medlineplus/ency/article/003082.htm http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm http://www.nlm.nih.gov/medlineplus/ency/article/003475.htm

http://www.nlm.nih.gov/medlineplus/ency/article/003475.htm http://www.nlm.nih.gov/medlineplus/ency/article/003611.htm http://www.nlm.nih.gov/medlineplus/ency/article/003611.htm http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm http://www.nlm.nih.gov/medlineplus/ency/article/003484.htm http://www.nlm.nih.gov/medlineplus/ency/article/003484.htm http://www.nlm.nih.gov/medlineplus/ency/article/003468.htm http://www.nlm.nih.gov/medlineplus/ency/article/003468.htm http://www.nlm.nih.gov/medlineplus/ency/article/000335.htm http://www.nlm.nih.gov/medlineplus/ency/article/000335.htm http://www.nlm.nih.gov/medlineplus/ency/article/003777.htm http://www.nlm.nih.gov/medlineplus/ency/article/003777.htm http://www.nlm.nih.gov/medlineplus/ency/article/003815.htm http://www.nlm.nih.gov/medlineplus/ency/article/003815.htm http://www.nlm.nih.gov/medlineplus/ency/article/003789.htm http://www.nlm.nih.gov/medlineplus/ency/article/003789.htm http://www.nlm.nih.gov/medlineplus/ency/article/003796.htm http://www.nlm.nih.gov/medlineplus/ency/article/003796.htm http://www.nlm.nih.gov/medlineplus/ency/article/000507.htm http://www.nlm.nih.gov/medlineplus/ency/article/000507.htm http://www.nlm.nih.gov/medlineplus/ency/article/002469.htm http://www.nlm.nih.gov/medlineplus/ency/article/002469.htm http://www.nlm.nih.gov/medlineplus/ency/article/002467.htm http://www.nlm.nih.gov/medlineplus/ency/article/002467.htm http://www.nlm.nih.gov/medlineplus/ency/article/003421.htm http://www.nlm.nih.gov/medlineplus/ency/article/003421.htm http://www.nlm.nih.gov/medlineplus/ency/article/003484.htm http://www.nlm.nih.gov/medlineplus/ency/article/003484.htm http://www.nlm.nih.gov/medlineplus/ency/article/000182.htm http://www.nlm.nih.gov/medlineplus/ency/article/000182.htm http://www.nlm.nih.gov/medlineplus/ency/article/003475.htm http://www.nlm.nih.gov/medlineplus/ency/article/003475.htm http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm Root Entry Root Entry Pictures Pictures Current User Current User SummaryInformation SummaryInformation ntidh121 ntidh121 ntidh121

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