Anatomy and Physiology Location of the Kidneys

The two kidneys are located to the rear of the abdominal cavity on either side of the spine. They normally weigh about 5 ounces each, but receive about 20% of the blood flow coming from the heart. The urine produced by each kidney drains through a separate ureter into the urinary bladder, located in the pelvic region. The bladder is emptied in turn by a single urethra, which exits the body. The right kidney is lower than the left due to displacement by the liver.

Basic Functions The kidneys are essential for homeostasis (maintaining a constant internal environment) of the body's extracellular fluids. Their basic functions include: 1. Regulation of extracellular fluid volume. The kidneys work to ensure an adequate quantity of plasma to keep blood flowing to vital organs. 2. Regulation of osmolarity. The kidneys help keep extracellular fluid from becoming too dilute or concentrated with respect to the solutes carried in the fluid. 3. Regulation of ion concentrations. The kidneys are responsible for maintaining relatively constant levels of key ions including sodium, potassium and calcium. 4. Regulation of pH. The kidneys prevent blood plasma from becoming too acidic or basic by regulating ions. 5. Excretion of wastes and toxins. The kidneys filter out a variety of water-soluble waste products and environmental toxins into the urine for excretion. 6. Production of hormones. The kidneys produce erthryopoietin, which stimulates red blood cell synthesis, and renin, which helps control salt and water balance and blood pressure. They are also involved in regulating plasma calcium and glucose levels.

Renal Blood Supply The kidneys receive their blood supply from the renal arteries which branch to the left and right from the abdominal aorta. This blood supply to the kidney is equal to 21%of cardiac output and 99% of this cardiac output returns to the general body circulation via the renal vein. The remaining1% undergoes further processing in the nephron resulting in urine.

The kidneys receive their blood supply from the renal arteries which branch to the left and right from the abdominal aorta. This blood supply to the kidney is equal to 21%of cardiac output and 99% of this cardiac output returns to the general body circulation via the renal vein. The remaining1% undergoes further processing in the nephron resulting in urine.

The Nephron The function unit of the kidney is the nephron and each nephron contains two components: 1. Glomerulus and Bowmans capsule (Renal Corpuscle) 2. Tubular Component The Glomerulus and Bowmans capsule allows blood to be filtered. This is followed by the proximal convoluted tubule which can absorb the bulk of the filtrate. The next segment is the Loop of Henley which is divided into the Descending and Ascending Limb. The remainder of the nephron consists of a Distal Convoluted which drains into the Collecting Ducts.

The kidneys perform the essential function of removing the waste products from regulating the water fluid levels.

Introduction Acute Kidney Injury is characterized by rapid decline in glomerular filtration rate over hours to days. Clinical features include clubbing, retention of nitrogenous waste products, oliguria (urine output <410 ml/day) contributing to extracellular fluid overload, electrolytes and acid base abnormalities. Acute Kidney Injury is usually asymptomatic and diagnosed when biochemical monitoring of hospitalized patient reveals a new increase in blood urea and serum creatinine concentration, post injury might not be sufficient sensitive to detect clinically significant irreversible damage that may ultimately contribute to chronic kidney disease. Dehydration which is pre renal caused the AKI of our patient. Hypercalcemia is common in elderly patient due to reduce thirst and diminished access to fluids. Hypernatremia increased osmolality of the ECF generating on osmotic gradient between the ECF and ICF an efflux of extracellular water and cellular shrinkage. Symptom of hypernatremia include fever, flushed skin, restlessness, irritability, edema, decreased urine output with dry mouth, hypernatremia should be corrected slowly to avoid cerebral edema, placing the calculated free water deficit over 48 hour NA corrected by no more than 10 mm/day water totally should be corrected by mouth /NGT D5 water or or saline.

Patient is a 98 y/o female with a chief complaint of general body weakness of 3 days duration associated with loss of appetite. She was a known hypertensive and was previously admitted due to E. coli infection. Generalized body weakness in the elderly can be infectious/non-infectious in origin. Due to a previous history of E. coli infection, patient has given an impression of urogenital sepsis. Laboratory results show hypernatremia, elevated creatinine and decreased globulin. Hypernatremia is secondary to dehydration which is common in the elderly due to poor intake and poor regulatory mechanism. Urinalysis was done and showed many bacteria indicating a possible UTI. Patient was considered to have acute kidney injury secondary to UTI and dehydration.