The renal system

2010 ◽  
Author(s):  
Eleanor Hollywood ◽  
Paul Costello
Keyword(s):  
Best Practice ◽  
Clinical Skills ◽  
Young Person ◽  
The Body ◽  
Waste Products ◽  
Medial Side ◽  
System P ◽  
Renal Fascia ◽  
Renal System ◽  
Urine Testing

The focus of this chapter is the renal system and the clinical skills that are associated with renal dysfunction. By the end of this chapter you will be knowledgeable in relation to these skills and your new knowledge will be underpinned by up-to-date evidence-based best practice. It is anticipated that you will be able to do the following once you have read and studied this chapter: ● Understand urine sampling techniques and urine testing methods and their significance in clinical practice. ● Understand the various procedures and investigations that the infant, child, or young person may have to endure for renal system evaluation. The urinary system is important in maintaining the correct water and electrolyte concentrations in the body. Waste products and excess water and ions are eliminated from the body in the urine. The kidneys are situated on either side of the vertebral column in the abdomen. The ureter, renal blood vessels, nerves, and lymphatics enter the kidney at a cleft on the medial side called the hilum. The adrenal gland lies on top of the kidney. The outside of each kidney is lined by: ● The renal capsule—a layer of collagen fibres. ● The adipose capsule—a layer of fat. ● The renal fascia—a layer of dense connective tissue. These three layers of tissue protect and support the kidney. The inside of each kidney contains an outer area (the cortex) and an inner area (the medulla). The cortex is lighter in colour compared to the dark reddish-brown medulla. The medulla contains cone-shaped areas of tissue called the medullary pyramids, which point towards the hilum. The cortex extends in between the medullary pyramids forming the renal columns. Urine forms at the tip of the pyramids (papillae) and drains into the minor calyx, then into a larger major calyx. Two or three major calyces join together to form the renal pelvis, a funnel-shaped chamber that leads into the ureter. Nephrons are the functional units of the kidney, the structures where urine is formed.

scholarly journals Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients

Toxins ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 289
Author(s):  
Adamasco Cupisti ◽  
Piergiorgio Bolasco ◽  
Claudia D’Alessandro ◽  
Domenico Giannese ◽  
Alice Sabatino ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Residual Renal Function ◽  
The Body ◽  
Uremic Toxins ◽  
End Stage Kidney Disease ◽  
Waste Products ◽  
Hemodialysis Treatment ◽  
Life Saving ◽  
Kidney Replacement Therapy ◽  
End Stage

The retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment.

scholarly journals Nutrition for Travel: From Jet lag To Catering

2019 ◽  
Vol 29 (2) ◽  
pp. 228-235 ◽  
Author(s):  
Shona L. Halson ◽  
Louise M. Burke ◽  
Jeni Pearce
Keyword(s):  
High Performance ◽  
Best Practice ◽  
Light Exposure ◽  
International Travel ◽  
The Body ◽  
Personal Hygiene ◽  
Jet Lag ◽  
Group Management ◽  
Food Needs ◽  
Eating Practices

Domestic and international travel represents a regular challenge to high-performance track-and-field athletes, particularly when associated with the pressure of competition or the need to support specialized training (e.g., altitude or heat adaptation). Jet lag is a challenge for transmeridian travelers, while fatigue and alterations to gastrointestinal comfort are associated with many types of long-haul travel. Planning food and fluid intake that is appropriate to the travel itinerary may help to reduce problems. Resynchronization of the body clock is achieved principally through manipulation of zeitgebers, such as light exposure; more investigation of the effects of melatonin, caffeine, and the timing/composition of meals will allow clearer guidelines for their contribution to be prepared. At the destination, the athlete, the team management, and catering providers each play a role in achieving eating practices that support optimal performance and success in achieving the goals of the trip. Although the athlete is ultimately responsible for his or her nutrition plan, best practice by all parties will include pretrip consideration of risks around the quality, quantity, availability, and hygiene standards of the local food supply and the organization of strategies to deal with general travel nutrition challenges as well as issues that are specific to the area or the special needs of the group. Management of buffet-style eating, destination-appropriate protocols around food/water and personal hygiene, and arrangement of special food needs including access to appropriate nutritional support between the traditional “3 meals a day” schedule should be part of the checklist.

scholarly journals Intercorrências Clínicas em Hemodiálise Ambulatorial: Intervenções do Enfermeiro

2021 ◽  
Vol 24 (5-esp.) ◽  
pp. 611-618
Author(s):  
Vânia Aparecida dos Santos ◽  
Haroldo Ferreira Araújo ◽  
Marcio Luiz Dos Santos
Keyword(s):  
Kidney Disease ◽  
Kidney Diseases ◽  
The Body ◽  
Waste Products ◽  
Clinical Complications ◽  
Renal Replacement Therapies ◽  
Urinary Infections ◽  
Toxic Agents ◽  
Volume Of Fluids ◽  
Do So

Os rins têm função vital, pois são responsáveis pela eliminação de toxinas, regulação do volume de líquidos e pela filtragem do sangue (filtram, por minuto, em média 20% do volume sanguíneo bombeado pelo coração). Dessa forma, a função renal é avaliada com base na filtração glomerular (FG) e sua redução é observada na doença renal crônica (DRC), quando ocorre a perda das funções reguladora, excretora e endócrina dos rins. Desequilíbrios esses que podem ser de consequência vascular, por comorbidade secundária, por doença renal secundária a drogas ou agentes tóxicos, infecções urinárias de repetição, doença de próstata, doenças policísticas renal, entre outras. Nas terapias renais substitutivas, a diálise é empregada para remover líquidos e produtos residuais urêmicos do organismo, quando o corpo não consegue mais fazê-lo. Tendo em vista que o procedimento hemodialítico tem complicações potenciais, considera-se vital  que o enfermeiro deva estar apto para intervir em tais intercorrências, portanto, ficando evidente a importância deste estudo. Objetiva-se, portanto, descrever as intervenções do enfermeiro em intercorrências clínicas durante a hemodiálise ambulatorial, bem como descrever as principais intercorrências durante as sessões de hemodiálise ambulatorial e se há protocolos específicos de intervenções do enfermeiro em intercorrências com o paciente dialítico. Trata-se de uma pesquisa de revisão integrativa da literatura, pois esta metodologia de revisão tem por propósito realizar uma dada síntese rigorosa de todas as pesquisas encontradas relacionadas a uma questão específica.   Palavras-chave: Enfermagem. Hemodiálise. Intercorrências   Abstract The kidneys have a vital function, as they are responsible for eliminating toxins, regulating the volume of fluids and filtering the blood (they filter, on average, 20% of the blood volume pumped by the heart per minute). Thus, renal function is assessed based on glomerular filtration (FG) and its reduction is seen in chronic kidney disease (CKD), when the loss of the kidneys regulatory, excretory and endocrine functions occurs. These imbalances can be of vascular consequence, secondary comorbidity, kidney disease secondary to drugs or toxic agents, recurrent urinary infections, prostate disease, polycystic kidney diseases, among others. In renal replacement therapies, dialysis is used to remove uremic fluids and waste products from the body when the body is unable to do so. Bearing in mind that the hemodialysis procedure has potential complications, it is considered nodal that the nurse must be able to intervene in such complications, therefore, the importance of this study is evident. Therefore, the objective is to describe the nurse's interventions in clinical complications during the outpatient hemodialysis, as well as to describe the main complications during the outpatient hemodialysis sessions and if there are specific protocols for the nurse interventions in complications with dialysis patients. It is an integrative literature review research, since this review methodology aims to perform a given rigorous synthesis of all the studies found related to a specific issue.   Keywords: Nursing. Hemodialysis. Complications

Abstract 533: Lymph is a Vehicle for Extracellular Vesicles in Mice

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Andreea Milasan ◽  
Nicolas Tessandier ◽  
Sisareuth Tan ◽  
Alain Brisson ◽  
Eric Boilard ◽  
...  
Keyword(s):  
Extracellular Vesicles ◽  
Biological Fluids ◽  
Lymphatic Vessels ◽  
The Body ◽  
Artery Wall ◽  
Waste Products ◽  
Peripheral Tissues ◽  
Cellular Debris ◽  
Long Time ◽  
Almost All

Introduction: Although for a long time considered as simple cellular debris, extracellular vesicles (EVs) are now known to be involved in many pathophysiological processes such as thrombosis, autoimmune diseases and inflammation. Due to their diversity and presence in different tissues, EVs are considered important biomarkers and thus, their precise detection in various biological fluids is important to better understand all their different functional activities. The lymphatic system works in close collaboration with the cardiovascular system to preserve fluid balance throughout the body. Lymphatic vessels are present in almost all vascularized tissues, including the brain and the artery wall, and their role in these organ-related pathologies are under intense investigations. Hypothesis: Since lymphatic vessels are often perceived as "sewers", due to their role in removing interstitial fluid and waste products from peripheral tissues such as the artery wall, we herein want to qualitatively and quantitatively assess the presence of EVs in circulating lymph. Methods and Results: Using several approaches such as a Zetasizer Nano S, electron microscopy and flow cytometry analysis, we have detected and characterized EVs in lymph of healthy animals, and found that these EVs are inclusively derived from red blood cells, platelets and lymphatic endothelial cells. Analysis of lymph from atherosclerotic mice (Ldlr -/- ) confirmed the idea that EVs number and origin varies according to the pathological setting. Conclusion: Herein, we show for the first time that EVs are present in lymph and that their level and origin vary in atherosclerosis. Our work will be setting the stage to a better understanding of the mechanism underlying EV accumulation in peripheral tissues during inflammation, and to better control related diseases.

scholarly journals The Role of Extracellular Vesicles in Cutaneous Remodeling and Hair Follicle Dynamics

2019 ◽  
Vol 20 (11) ◽  
pp. 2758 ◽  
Author(s):  
Elisa Carrasco ◽  
Gonzalo Soto-Heredero ◽  
María Mittelbrunn
Keyword(s):  
Hair Follicle ◽  
Extracellular Vesicles ◽  
Cell Function ◽  
Hair Follicles ◽  
The Body ◽  
Epithelial Stem Cells ◽  
Therapeutic Approaches ◽  
Waste Products ◽  
Efficient Treatment

Extracellular vesicles (EVs), including exosomes, microvesicles, and apoptotic bodies, are cell-derived membranous structures that were originally catalogued as a way of releasing cellular waste products. Since the discovery of their function in intercellular communication as carriers of proteins, lipids, and DNA and RNA molecules, numerous therapeutic approaches have focused on the use of EVs, in part because of their minimized risk compared to cell-based therapies. The skin is the organ with the largest surface in the body. Besides the importance of its body barrier function, much attention has been paid to the skin in regenerative medicine because of its cosmetic aspect, which is closely related to disorders affecting pigmentation and the presence or absence of hair follicles. The use of exosomes in therapeutic approaches for cutaneous wound healing has been reported and is briefly reviewed here. However, less attention has been paid to emerging interest in the potential capacity of EVs as modulators of hair follicle dynamics. Hair follicles are skin appendices that mainly comprise an epidermal and a mesenchymal component, with the former including a major reservoir of epithelial stem cells but also melanocytes and other cell types. Hair follicles continuously cycle, undergoing consecutive phases of resting, growing, and regression. Many biomolecules carried by EVs have been involved in the control of the hair follicle cycle and stem cell function. Thus, investigating the role of either naturally produced or therapeutically delivered EVs as signaling vehicles potentially involved in skin homeostasis and hair cycling may be an important step in the attempt to design future strategies towards the efficient treatment of several skin disorders.

scholarly journals “Evaluation of a best practice approach to assess undergraduate clinical skills in Paediatrics”

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fabiola Stollar ◽  
Bernard Cerutti ◽  
Susanne Aujesky ◽  
Mathieu Nendaz ◽  
Annick Galetto-Lacour
Keyword(s):  
Best Practice ◽  
Clinical Skills ◽  
Practice Approach

MRI Analysis of Anteroposterior Stability in the Normal Human Knee

2009 ◽  
Author(s):  
Sally Arno ◽  
Rachel Forman ◽  
Philip Glassner ◽  
Ravinder Regatte ◽  
Peter S. Walker
Keyword(s):  
Shear Force ◽  
Medial Meniscus ◽  
Sagittal Plane ◽  
The Body ◽  
Lateral Side ◽  
Human Knee ◽  
Medial Side ◽  
Normal Human ◽  
Femoral Rollback ◽  
High Range

During activities the knee experiences compressive forces caused by the weight of the body and muscle forces. However, there is also an anterior shear force pushing the femur forwards on the tibia. It is likely to be important to the feeling of stability that the shear force is resisted so as to limit the anterior femoral displacement. The dished bearing surface of the medial tibial compartment in combination with the medial meniscus may well perform this function. In contrast, the lateral tibial surface is convex in the sagittal plane and the meniscus is too mobile to offer any anteroposterior (AP) restraint. Therefore, we hypothesize that if an anterior or posterior force is applied to the femur relative to the tibia, AP stability is provided by the medial side, while the lateral side allows for femoral rollback to facilitate a high range of flexion. At any flexion angle, rotational laxity will occur about a point on the medial side.

Care of the child/young person and family in the community

2010 ◽  
Keyword(s):  
Sick Child ◽  
Family System ◽  
Community Setting ◽  
Young Person ◽  
Long Term Conditions ◽  
System P ◽  
Diverse Communities ◽  
Sick Children ◽  
At Home

Effects of being a sick child or young person at home 76Managing long-term conditions in the community setting 78Communication with professionals 80Working with technology-dependent children at home 82Working with diverse communities 84NHS walk-in centres 86As a result of the development of policy in the 1950s with regard to the care of sick children, professionals caring for children are generally of the mindset that acutely ill children are best cared for at home, and that any health problems a child encounters are likely to have an effect on the whole family system....

scholarly journals Metabolic Acidosis Alters Expression of Slc22 Transporters in Mouse Kidney

2020 ◽  
Vol 45 (2) ◽  
pp. 263-274
Author(s):  
Janine Gottier Nwafor ◽  
Marta Nowik ◽  
Naohiko Anzai ◽  
Hitoshi Endou ◽  
Carsten A. Wagner
Keyword(s):  
Metabolic Acidosis ◽  
Mrna Level ◽  
The Body ◽  
Large Set ◽  
Protein Abundance ◽  
Waste Products ◽  
Anion Transporters ◽  
Solute Carrier ◽  
The Impact ◽  
Oxonic Acid

Introduction: The kidneys play a central role in eliminating metabolic waste products and drugs through transporter-mediated excretion along the proximal tubule. This task is mostly achieved through a variety of transporters from the solute carrier family 22 (SLC22) family of organic cation and anion transporters. Metabolic acidosis modulates metabolic and renal functions and also affects the clearance of metabolites and drugs from the body. We had previously shown that induction of metabolic acidosis in mice alters a large set of transcripts, among them also many transporters including transporters from the Slc22 family. Objective: Here we further investigated the impact of acidosis on Slc22 family members. Methods: Metabolic acidosis was induced for 2 or 7 days with NH4Cl, some animals also received the uricase inhibitor oxonic acid for comparison. Expression of transporters was studied by qPCR and immunoblotting. Results: NH4Cl induced no significant changes in plasma or urine uric acid levels but caused downregulation of Slc22a1 (Oct1), Slc22a6 (Oat1), Slc22a19 (Oat5), and ­Slc22a12 (Urat1) at mRNA level. In contrast, Slc22a4 mRNA (Octn1) was upregulated. On protein level, NH4Cl increased Octn1 (after 7 days) and Urat1 (after 2 days) abundance and decreased Oat1 (after 2 days) and Urat1 (after 7 days). Oxonic acid had no impact on protein abundance of any of the transporters tested. Conclusion: In summary, metabolic acidosis alters expression of several transporters involved in renal excretion of metabolic waste products and drugs. This may have implications for drug kinetics and clearance of waste metabolites.

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