1. Copyright © 2008 Thomson Delmar Learning CHAPTER 16 Renal Failure and Its Effects on the Cardiopulmonary System

2. Copyright © 2008 Thomson Delmar Learning THE KIDNEYS

3. Copyright © 2008 Thomson Delmar Learning Urinary System Organs Fig. 16-1. Organs of the urinary system. Urine is formed by the kidney and flows through the ureters to the bladder, where it is eliminated via the urethra.

4. Copyright © 2008 Thomson Delmar Learning Cross-Section of the Kidney Fig. 16-2. Cross-section of the kidney.

5. Copyright © 2008 Thomson Delmar Learning THE NEPHRONS

6. Copyright © 2008 Thomson Delmar Learning The Nephron Fig. 16-3. The nephron.

7. Copyright © 2008 Thomson Delmar Learning BLOOD VESSELS OF THE KIDNEYS

8. Copyright © 2008 Thomson Delmar Learning Blood Vessels of the Kidneys Fig. 16-4. Blood vessels of the kidney.

9. Copyright © 2008 Thomson Delmar Learning Urine Formation Glomerular Filtration Tubular Reabsorption Tubular Secretion

10. Copyright © 2008 Thomson Delmar Learning Forces of Glomerular Filtration Table 16-1

11. Copyright © 2008 Thomson Delmar Learning Urine Concentration and Volume Countercurrent mechanism Selective permeability

12. Copyright © 2008 Thomson Delmar Learning Antidiuretic Hormone (ADH) Fig. 16-5. Pathway by which antidiuretic hormone (ADH) is controlled. When the baroreceptors in the left atrium sense an increased pressure (increased plasma volume), they send neural impulses to the hypothalamus, causing the production of ADH to decrease. In contrast, a decreased pressure (decreased plasma volume) causes the production of ADH to increase.

13. Copyright © 2008 Thomson Delmar Learning Regulation of Electrolyte Concentration Kidneys play a major role in a normal cellular environment by regulating the concentration of various ions. Important ions regulated: –Sodium –Potassium –Calcium, Magnesium, and Phosphate

14. Copyright © 2008 Thomson Delmar Learning Role of Kidneys in Acid-Base Balance All the renal tubules are capable of secreting hydrogen ions Rate of secretion is directly proportional to hydrogen ion concentration in the blood

15. Copyright © 2008 Thomson Delmar Learning Role of Kidneys in Acid-Base Balance Thus, when the extracellular fluids become too acidic, the kidneys excrete hydrogen ions into the urine

16. Copyright © 2008 Thomson Delmar Learning Role of Kidneys in Acid-Base Balance In contrast, when the extracellular fluids become too alkaline, the kidneys excrete basic substances into the urine –Primarily sodium bicarbonate

17. Copyright © 2008 Thomson Delmar Learning Role of Kidneys in Acid-Base Balance Fig. 16-6. The effect of extracellular fluid pH on urine pH.

18. Copyright © 2008 Thomson Delmar Learning Blood Volume Adult has normal blood volume of about 5 L It rarely increases or decreases more than a few hundred milliliters Two major mechanisms responsible for this constancy of the blood volume are the: –Capillary fluid shift system –Renal system

19. Copyright © 2008 Thomson Delmar Learning Renal Failure (Common Causes of Renal Disorders) Congenital disorders Infections Obstructive disorders Inflammation and immune responses Neoplasm

20. Copyright © 2008 Thomson Delmar Learning Table 16-2 Factors that Obstruct Urinary Flow

21. Copyright © 2008 Thomson Delmar Learning Classification of Renal Disorders Prerenal conditions Renal conditions Postrenal conditions

22. Copyright © 2008 Thomson Delmar Learning Table 16-3 Prerenal Abnormalities

23. Copyright © 2008 Thomson Delmar Learning Renal Abnormalities Table 16-4

24. Copyright © 2008 Thomson Delmar Learning Table 16-5 Renal Abnormalities

25. Copyright © 2008 Thomson Delmar Learning Mechanical Ventilation as a Cause of Renal Failure Positive pressure ventilation decreases urinary output Negative pressure ventilation increases urinary output

26. Copyright © 2008 Thomson Delmar Learning Cardiopulmonary Disorders Caused by Renal Failure Hypertension and edema Metabolic acidosis Electrolyte abnormalities –Chloride abnormalities –Potassium abnormalities

27. Copyright © 2008 Thomson Delmar Learning Cardiopulmonary Disorders Caused by Renal Failure Anemia Bleeding Cardiovascular problems