Lecture 5 : Urinary organs and genital system and nutrition

How to make urine

Kidney

capillary

Glomerulus

Convoluted tubule

AdrenalCross section of left kidney

Urine tube

superior segmental artery

calices renales majores

Cortex

Arcuate artery

Small calyx

Meddula

Interlober artery

fibrous capsule

Renal sinus

Pelvis renalis

Back artery

Front under artery

Columnae renales

Under artery

Front upper artery

medullary ray 　

Clearance（ C)

C =　 UV/P

U=Density of urine

V=Amount of urine a minute

P=Density of Plasma

A certain material shows whether only plasma ml how many was purified in one minute

Yasuo KAGAWA et al. “Core, molecular biology of human body” MARUZEN, 1997, p.286

It is filtere

d b

y th

e

glo

me

rulu

s,an

d p

art is

reab

so

rbe

d in

the

co

nv

olu

ted

tub

ule

It is filtere

d b

y th

e

glo

me

rulu

s, an

d if it is

Tm

or les

s, a

lmo

st

10

0% is

rea

bso

rbed

in

the c

on

volu

ted tu

bu

le.

Sec

retio

n fro

m d

ista

l

co

nv

olu

ted

tub

ule a

nd

se

t tub

e ch

iefly

Co

mp

letely

it ch

iefly

se

crete

s an

d it x

cre

tes

from

the

pro

xim

al

co

nv

olu

ted

tub

ule

Th

e g

lom

eru

lus

is

freely

pas

se

d, a

nd

it is

ex

crete

d in

urin

e as

it is

Pro

xim

ate H

en

le D

Ista

nt

Clearance, transport maximum, amount of renal blood flow, amount of glomerulus filtrationBecause the urinary output is about 1ml/minute, it is near U/P though the clearance of a cer

tain 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%)

Glu

co

se, A

min

o ac

id, V

itam

in (p

rox

ima

te)

Ren

al tu

bu

le

Inu

lin

So

diu

m

thio

su

lfate

(PA

H) p

-am

ino

hip

pu

ric a

cid

(PS

P) p

he

no

lsu

lfon

ph

tha

lein

Creatinine

Clearance is

About 100ml/min

Clearance

Glucose, Amino acid

Glucose

Amino acid

min

min Amount of plasma Amount of glomerulus filtration

Density of

urine

Density of plasma

Amount of

per minute

urine

minmin

Aboutn min ml/ min

Tm secretes Tm in re-absorption and PAH in the glucose

Den

sity in ren

al

blo

od

flow

Urea, creatin

ine, u

ric acid,

beta 2-m

icrog

lob

ulin

,

ph

osp

ho

ric acid

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

Bawman's capsule epithelial cell

Efferent arteriole

Afferent arterioles

Mesangial cell and Substrate

Proximal tubule cell

Glomerular epithelial cell

Glomerular basement

membrane

Glomerular endothelial cell

Juxtaglomerular apparatus

Granule

cell

Macula densa cell

Extraglomerular

mesangial cell

Water VitaminAmino acid

/energyElectrolyte

Monitoring of nutrient intake

Nourishment in vein and the monitor

GlucoseMetabolism

Trace element

Serum zinc(If it is

long-term TPN, even

copper and the

selenium are

acceptable. )

The chart of the body

fluid equilibrium and

the loss from urine

and fistula are

recorded

The capillary blood sugar

in urine every six hours

is measured in the ward

Serum and urine

inside density

and measurement

every week

one-twice

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

Serum zinc (If it is

long-term TPN,

copper and the

selenium also)

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

Safety region of fluid infusion in kidney function normal person

GFR = １００ L/a dayUrine Dilution most 　 50mOsm/kg ・ H2OUrine Concentration most 　 1,000mOsm/kg ・ H2O

C y = 52050 - x

D y = 9001,000 - x

Safety region of fluid infusion

B 　 xy = 1,360

A 　 xy = 17

ｙ (L/a day ）

10

5

0500 1,000

x

(mOsm/kg ・ H2O)Density of osmotic pressure in fluid infusion

Tran

sfusio

n H

aca

Safety level of fluid infusion in senior citizen

GFR = ５０ L/a dayUrine Dilution most 　 200mOsm/kg ・ H2OUrine Concentration most 　 700mOsm/kg ・ H2O

Tran

sfusio

n H

aca

ｙ (L/a day ）

10

5

0 500 1,000

Density of osmotic pressure in fluid infusion (mOsm/kg ・ H2O)

x

C′y = 580200 - x

D′y = 780700 - x

B′xy = 680

A′xy = 17

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)

Rat

e o

f m

icro

alb

um

inu

ria

(Nu

mb

er o

f 10

0 /

a y

ear)

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 　 Ccr 51 ～ 70ml/min or more

High degree of kidney function decrease 　　 Ccr 31 ～ 50ml/min or more

Renal failure period 　　　　　　　 Ccr 11 ～ 30ml/min or more

Uremia period 　 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 troub

le 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 t

he second stage more in detail with a kidney function slight decrease, a middle degree d

ecrease, 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

Vitamin E

Stream of blood

Stream of dialyzing fluid Oralalcorl

Polysulfone

Fluorine

Acrylic block

union

Treatment of renal failureTreatment of renal failure

Acute kidney disease

Chronic renal disease

Chronic renal failure

Blood dialysis

CAPDKidney transplant

recovery

recovery

Diabetic syndrome

Low

protein diet

Dialysis food

What is What is the blood dialysis treatment?the blood dialysis treatment?

Kidney machine

Blood

1.　 Remove the waste matter in blood

2.　 Remove Extra moisture

3. 　 Adjust The density of the electrolyte (eg. Na,K,Ca)

4.　 Correct blood pH

Principle of blood dialysisPrinciple of blood dialysis

1. Diffusion phenomenon

Waste matter : Urea, Creatinine

Electrolyte : K(remove),Ca ・ Heavy carbonic acid (absorb)

Blood Dialyzing fluid

Blood Dialyzing fluid

◎ ◎◎

◎◎ ◎

× ×× ×

◎ ◎ ◎ ◎ ◎ ◎× × × ×

Dialysis membrane

Blood dialysis systemBlood dialysis system

Water-treating unit

Dialysis liquid supply deviceBed-side Monitor Dialyzer

Th

ick d

ialysis

liqu

id

Blood Pump

Heparin injection machine

Arm

Point of alimentary therapy (blood dialysis)Point of alimentary therapy (blood dialysis)

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

ProteinProtein

・ Food with a lot of essential amino acids

・ Food with high score of amino acid and protein score

EnergyEnergy

35～ 40kcal/kg/a day　 fluency

Use of lipidYasuo KAGAWA. “Easy nourishment study” KAGAWA Nutrition publishing, 2006, p.144

NaNaWithin7～ 8g with Salt (within 120～ 137mEq)

At the edema and the high blood pressure complication: Within 5g. (85mEq or　 less)

Intake of waterIntake of waterKeeping from water

A weight increase during a day is within 0.7 － 1.0kg

Point of alimentary therapy(blood dialysis)Point of alimentary therapy(blood dialysis)

K 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 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)Point of alimentary therapy(blood dialysis)

Ca Ca More than 600mg/a day (more then 15mEq/a day)

Be careful not to be lack of Ca

VitaminVitaminB group: It supplements because it is lost by the dialysis

because of the water solubilityC group: Normal range

A: Accumulation

D: VD replenishes revitalization type VD because it becomes a revitalization type by the kidney

Point of alimentary therapy(blood dialysis)Point of alimentary therapy(blood dialysis)

Balance of synthesis and excretion of uric acid

Into sweat and feces(200mg)

Into Urine(500mg)

Uric acid pool(1200mg)

NormalSynthetic amount / day(700mg)

Yasuo KAGAWA. “Easy nourishment study” KAGAWA Nutrition publishing, 2006, p.135-6

High uric acid blood syndrome

Drug therapy Drug therapy Drug therapy

Attacks of gout and coexisting illness

are none

Lifestyleguidance

Lifestyleguidance

Repetition of attacks of gout

There is a chalkstone

Non gouty attack,But have a

complication

Within 7-8mg/dL Within 7-9mg/dL

8mg/dL and more 9mg/dL or more

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 systemExcretion ： 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

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

Estrogen

Androgen

First step Second step Third step

Ovary

Testicle

Meiosis

Undifferentiation gonad

Immature ovum

maturity ovum

Maturity semen

Inherited decision of sex chromosome

X-Y Antigen

Yasuo KAGAWA et at al. “Core, molecular biology of human body” MARUZEN, 1997, p.186

First sex determination by SRY antigen

2nd sex determinationby sex hormone

(1st polar body)(2nd polar body)

male

female

Male genitalia and hormoneThe dilation of the prostate is diagnosed by the rectal examination and the supersonic wave.

The bladder is looked after with the bladder mirror

Glans

Urethra(24cm)

Penis

Anus

PubisDeferent

canal Bladder

Testicle : Secretion of sperm formation and male hormone

Amount of semen

Number of semen

Seminal vesicle(prostaglandin)

Prostate

Biochemistry of male function

1. XY 　 chromosome (Sex choromosome)2. Pituitary hormone (FSH, LH)3. Androgen (C19 Steroid)4. Others (LHRH, Prostaglandin)

Cunt and character hormone

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.

Anus

Vagina

Labia majora

Labia minor

Clitoris

Ovary

Ovum formationFollicle hormone

secretionProgestin secretion

Urethra(4cm)

Pubis

Urinary bladder

WombEmbryo's

growth

1. XX 　 chromosome (Sex choromosome)2. Pituitary hormone (FSH, LH, PRL)3. Estrogen (C18 Steroid)4. Progesterone (C21 Steroid)5. Placental hormone (HCG, other)6. Others (LHRL etc)

Biochemistry of female function

Menstrual cycle and female hormone

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

LH sergeCorpora lutea degeneration

Hypothalamus↓

Pituitary body

Inhibin

Placenta

Yasuo KAGAWA et at al. “Core, molecular biology of human body” MARUZEN, 1997, p.190 anterior pituitary

gland posterior pituitary

gland

prolactin

ovarian follicle ovarian follicleIs mature

luteinizing hormone

follicle-stimulating hormone

progesterone

progesterone

Progesterone(from corpus luteum ) p

rog

es

tero

ne

es

tra

dio

l

Basal lamina

Functionallayer

menstruating follicular phase ovulation luteal phase

estradiol

Placentalactogen

corpus luteum

growth

hypothalamus

Pro

ges

teron

e

chorionic gonadotropin

Va

gin

a m

uc

os

a

hypophyseal portal

milk ejection oxytocin

release

Mammary

growth

Glyco

gen

synth

esis

Vag

ina self p

urificatio

n

end

om

etria

corpus luteum degeneration

Intimal development

day

s

lutein

ization

egg

Fertilization and

arrival floor

The ovum fertilized in the oviduct gets off in the endometrium while doing the cleavage and is an arrival floor

Transparent body

Ovulation

Implantation

Hydatidiform mole

Perivitelline space

Endometrium that acted progestin

Nuclear fusion period

BlastulationA man pronucleus that is divided

to 2 pieces

Fertilization

A female pronucleus

A female pronucleus

A male pronucleus

A male pronucleus

Sperm tail Mulberry real embryo

Yasuo KAGAWA et at al. “Core, molecular biology of human body” MARUZEN, 1997, p.192

SemenYolk

Yolk

First polar body