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Lecture 5 : Urinary organs and genital system and nutrition
How to make urine
capillary
Glomerulus
Convoluted tubule
Kidney
Adrenal
Cross section
of left kidney
superior segmental artery
Front upper artery
Small calyx
calices renales majores
Back artery
Front under artery
Pelvis renalis
Meddula
Renal sinus
Columnae renales
Cortex
Interlober artery
Under artery
Arcuate artery
medullary ray
fibrous capsule
Urine tube
Inulin
Sodium
thiosulfate
Density in renal
blood flow
Clearance
The glomerulus is
freely passed, and it is
excreted in urine as it is
Glucose, Amino acid
Renal tubule
Glucose
Amino acid
Completely it chiefly
secretes and it xcretes
from the proximal
convoluted tubule
Creatinine
Clearance is
About 100ml/min
Secretion from distal
convoluted tubule and
set tube chiefly
It is filtered by the
glomerulus, and if it is
Tm or less, almost
100% is reabsorbed in
the convoluted tubule.
A certain material
shows whether only
plasma ml how
many was purified
in one
minute
It is filtered by the
glomerulus,and part is
reabsorbed in the
convoluted tubule
P=Density of
Plasma
(PAH) p-aminohippuric acid
(PSP) phenolsulfonphthalein
V=Amount of urine
a minute
Glucose, Amino acid, Vitamin (proximate)
U=Density of urine
Proximate Henle DIstant
C = UV/P
Urea, creatinine, uric acid,
beta 2-microglobulin ,
phosphoric acid
Clearance（C)
min
min
Amount of plasma
min
Amount of
Density of
per minute
urine
urine
Density of plasma
Amount of glomerulus filtration
min
Aboutn min ml/ min
Tm secretes Tm in re-absorption and PAH in the glucose
Clearance, transport maximum, amount of renal blood flow, amount of glomerulus filtration
Because the urinary output is about 1ml/minute, it is near U/P though the clearance of a
certain material shows whether the plasma of ml how many was purified in one
minute. FF (filtration fraction) is a ratio of C of C/inulin of PAH. (about 20%)
Yasuo KAGAWA et al. “Core, molecular biology
of human body” MARUZEN, 1997, p.286
Juxtaglomerular apparatus
Closeup of
glomerulus
It touches the
arteriole that goes
in and out to the
glomerulus and
there is a
juxtaglomerular
apparatus, and the
renin is secreted
according to the
electrolyte and the
blood pressure,
and it controls the
blood pressure
Afferent
arterioles
Granule
cell
Extraglomerular
mesangial cell
Macula densa cell
Efferent arteriole
Mesangial cell and
Substrate
Glomerular epithelial cell
Glomerular endothelial cell
Glomerular basement
membrane
Bawman's capsule
epithelial cell
Proximal tubule cell
Monitoring of nutrient intake
Water
Electrolyte
Glucose Amino acid
Metabolism /energy
It is a urea and an
electrolyte every day
until stabilizing. If 2-3
times and the
management every week
afterwards are difficult,
the electrolyte of urine
and other body
fluids is measured
The chart of the body
fluid equilibrium and
the loss from urine
and fistula are
recorded
Serum zinc(If it is
long-term TPN, even
copper and the
selenium are
acceptable. )
The capillary blood sugar
in urine every six hours
is measured in the ward
Trace
element
Vitamin
Serum zinc (If it is
long-term TPN,
copper and the
selenium also)
Serum and urine
inside density
and measurement
every week
one-twice
Nourishment in vein and the monitor
It is once every 1-2
weeks as for folic
acid and vitamin B12.
If the patient's
consumption
promotes it, vitamin C
and B1 also
Safety region of fluid infusion in kidney function normal person
ｙ (L/a day）
GFR = １００L/a day
Urine Dilution most 50mOsm/kg ・H2O
Urine Concentration most 1,000mOsm/kg ・H2O
10
520
C y = 50 - x
Transfusion Haca
D y=
900
1,000 - x
Safety region of fluid infusion
5
B xy = 1,360
0
A xy = 17
500
Density of osmotic pressure in fluid infusion
x
1,000
(mOsm/kg ・H2O)
Safety level of fluid infusion in senior citizen
ｙ (L/a day）
GFR = ５０L/a day
Urine Dilution most 200mOsm/kg ・H2O
Urine Concentration most 700mOsm/kg ・H2O
10
Transfusion Haca
580
C′y = 200 - x
5
780
D′y =
700 - x
B′xy = 680
0
A′xy = 17
500
1,000
Density of osmotic pressure in fluid infusion
x
(mOsm/kg ・H2O)
Rate of microalbuminuria (Number of 100 / a year)
If the blood sugar level is controlled with meal and
the number of haemoglobins A1c is decreased, a
diabetic syndrome can be prevented occurring.
However, 13,000 people a year introduce the
dialysis now, and 260,000 total people keep
dialyzing it by health benefits of 700,000 yen a
person every month
Level of blood sugar control and kidney disease appearance of disease rate (DCCT research)
Kidney function classification by creatinine
clearance (Ccr)
Kidney healthy
Ccr 91ml/min or more
Kidney function slight decrease
Ccr 71～90ml/min or more
Middle kidney function degree decrease
High degree of kidney function decrease
Renal failure period
Uremia period
Ccr 51～70ml/min or more
Ccr 31～50ml/min or more
Ccr 11～30ml/min
or more
Ccr 10ml/min or more －Before dialyzing
Though passage to the chronic renal failure is classified based on ideas of Seldin at four
terms (the first stage (Nou preliminary decrease), the second stage (kidney function
trouble period), the third stage (renal failure period), and the fourth stage (uremia
period)), the place where it means a slight deterioration of renal function classifies the
first stage and the second stage more in detail with a kidney function slight decrease, a
middle degree decrease, and an advanced decrease because it is large in actual clinical
Blood dialysis = kidney machine
270,000 dialysis patients, Dialysis cost of 600,000 yen a month,
Patient sudden increase
Stream of
dialyzing fluid
Oralalcorl
Vitamin E
Fluorine
Acrylic block
union
Stream of blood
Polysulfone
Treatment of renal failure
Acute kidney disease
recovery
Low
protein diet
Chronic renal disease
recovery
Chronic renal failure
Blood dialysis
CAPD
Dialysis
food
Kidney transplant
What is
the blood dialysis treatment?
Bloo
d
Kidney
machine
1.
Remove the waste matter in blood
2.
Remove Extra moisture
3.
Adjust The density of the electrolyte
4.
Correct blood pH
(eg. Na,K,Ca)
Principle of blood dialysis
1. Diffusion phenomenon
Blood
◎
◎
◎
◎
◎ ◎
Dialyzing fluid
×
×
×
×
Dialysis membrane
Blood
◎
◎
×
Dialyzing fluid
◎
×
◎
×
◎
◎
×
Waste matter : Urea, Creatinine
Electrolyte : K(remove),Ca・Heavy carbonic acid (absorb)
Blood dialysis system
Water
-treating
unit
Dialysis liquid supply device
Thick dialysis
liquid
Arm
Bed-side
Monitor
Dialyzer
Blood Pump
Heparin injection machine
Point of alimentary therapy (blood dialysis)
Protein
1.0～1.2g/kg/a day(Dialysis ３ times a week)
1.0g/kg/a day(Dialysis ２ times a week)
Intake of good quality amino acid
・Food with a lot of essential amino acids
・Food with high score of amino acid and protein score
Energy
35～40kcal/kg/a day
fluency
Use of lipid
Yasuo KAGAWA. “Easy nourishment study”
KAGAWA Nutrition publishing, 2006, p.144
Point of alimentary therapy(blood dialysis)
Na
Within7～8g with Salt (within 120～137mEq)
At the edema and the high blood pressure complication:
Within 5g. (85mEq or less)
Intake of water
Keeping from water
A weight increase during a day is within 0.7－1.0kg
Point of alimentary therapy(blood dialysis)
K
Within 2g/a day (within 50mEq/a day)
It doesn't take it too much. The vegetables,
especially the root vegetable
throw away the boiled soup
When there is a high potassium blood syndromeIt strongly limits it
P
Within 1000mg/a day (within 32mEq/a day)
It doesn't take it too much.
The polyphosphoric acid such as the processed foods is avoided
When there is a high phosphorus blood syndromeIt limits it
Point of alimentary therapy(blood dialysis)
Ca
More than 600mg/a day (more then 15mEq/a day)
Be careful not to be lack of Ca
Vitamin
B group: It supplements because it is lost by the dialysis
because of the water solubility
C group: Normal range
A: Accumulation
D: VD replenishes revitalization type VD because
it becomes a revitalization type by the kidney
Balance of synthesis and excretion of uric acid
Synthetic amount / day
(700mg)
Normal
Into sweat and feces
(200mg)
Uric acid pool
(1200mg)
Into Urine
(500mg)
Yasuo KAGAWA. “Easy nourishment study”
KAGAWA Nutrition publishing, 2006, p.135-6
High uric acid
blood syndrome
Repetition of attacks
of gout
There is a chalkstone
Attacks of gout and
coexisting illness
are none
Non gouty attack,
But have a
complication
Within 7-8mg/dL
Within 7-9mg/dL
8mg/dL and more
Lifestyle
guidance
Drug therapy
Drug therapy
9mg/dL or more
Lifestyle
guidance
Drug therapy
Fundamental ADL (activity of daily living)=
Decrease in activity operation in daily life and the nursing
• Meal：Swallowing difficulty,Carved meal→PEG
Walking：Articulatio genus pain →Wheelchair→Bedridden
Cloth：Operation decrease of finger, Cloth for nursing
Bathing： Lost earlist→Bathing support system
Excretion：Especially, woman's QOL and pride are ruined
Incontinence： Pelvis exercise → Wearing deaper
Constipation： Food fiber, water→Purgative →
Enema clyster
Urinary retation： Needle prick to the bladder in the emergency
• The urethral catheterization and the enema clyster are
law revision to make it do in case of no nursing master
They are three stages of the character decision, and,
moreover, social differences
Meiosis
First step
Inherited decision
of sex chromosome
Second step
First sex determination
by SRY antigen
Testicle
Undifferentiation
gonad
Ovary
Third step
2nd
sex determination
by sex hormone
Androgen
Estrogen
male
female
(1st polar body)(2nd polar body)
maturity
Immature
ovum
ovum
X-Y Antigen
Maturity semen
Sex determinating gene SRY=Sex-determining Region of Chromosome Y makes the indifferent
gonad a testicle, changes the brain to the man by the androgen shower, and makes the vesicular
gland, the prostate, and the penis. Making the brain a nature becomes trouble and a gender
identity disorder. It is a woman if there is no SRY
Yasuo KAGAWA et at al. “Core, molecular
biology of human body” MARUZEN, 1997, p.186
Male genitalia and hormone
Testicle : Secretion of sperm formation
and male hormone
Glans
Pubis
Penis
Urethra
(24cm)
The dilation of the prostate is
diagnosed by the rectal
examination and the
supersonic wave.
Deferent
canal
Bladder
The bladder is looked after with
the bladder mirror
Amount of semen
Biochemistry of male function
Number of semen
Prostate
Seminal vesicle
(prostaglandin)
Anus
1.
2.
3.
4.
XY chromosome (Sex choromosome)
Pituitary hormone (FSH, LH)
Androgen (C19 Steroid)
Others (LHRH, Prostaglandin)
Cunt and character hormone
Ovary
UrethraUrinary
(4cm) bladder
Ovum formation
Womb
Follicle hormone
Pubis
Embryo's
secretion
Clitoris
Progestin
secretion
growth
Labia majora
Labia minor
The make an internal
examination and the vaginal
retractor speculum of the
examination on the make an
internal examination stand.
The virgin is a rectal
examination.
The bladder is a bladder mirror.
Biochemistry of female function
Vagina
Anus
1.
2.
3.
4.
5.
6.
XX chromosome (Sex choromosome)
Pituitary hormone (FSH, LH, PRL)
Estrogen (C18 Steroid)
Progesterone (C21 Steroid)
Placental hormone (HCG, other)
Others (LHRL etc)
progesterone
hypothalamus
Yasuo KAGAWA et at al. “Core, molecular
hypophyseal portal
biology of human body” MARUZEN, 1997, p.190 anterior pituitary
gland
Menstrual cycle
and female
hormone
Inhibin
oxytocin
milk ejection
growth
luteinizing
hormone
Mammary
growth
ovarian follicle
ovarian follicle
Is mature
Placenta
chorionic gonadotropin
corpus luteum
egg
Intimal development
progesterone
corpus luteum degeneration
Functional
layer
menstruating follicular phase
LH serge
ovulation
estradiol
luteal phase
Corpora lutea
degeneration
Progesterone
(from corpus luteum )
progesterone
Basal lamina
estradiol
Vagina mucosa
Placenta
lactogen
endometria
Glycogen synthesis
Vagina self purification
The functional
layer of the
endometrium
is lost by the
yellow body
degeneration if
the ovulation
happens by the
LH serge (rapid
decrease of the
yellow body
making
hormone), and
there is no
conception
release
posterior pituitary
gland
prolactin
follicle-stimulating
hormone
Hypothalamus
↓
Pituitary body
Fertilization and
Nuclear fusion period
arrival floor
Hydatidiform A female
pronucleus
mole
A male
pronucleus
A man pronucleus
that is divided
to 2 pieces
A male
pronucleus
A female
pronucleus
Sperm tail
The ovum fertilized in the
oviduct gets off in the
endometrium while doing the
cleavage and is an arrival floor
Mulberry real embryo
Blastulation
Semen
Yolk
Fertilization
Ovulation
Transparent body First polar body
Yolk
Perivitelline space
Implantation
Endometrium that
acted progestin
Yasuo KAGAWA et at al. “Core, molecular
biology of human body” MARUZEN, 1997, p.192