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Chronic Kidney Disease Overview

Normal Kidneys and Their Function The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower middle of the back. Each kidney weighs about pound and contains approximately one million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like structure attached to the glomerulus. The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube like structure called the urethra.

The main function of the kidneys is to remove waste products and excess water from the blood. The kidneys process about 200 liters of blood every day and produce about two liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood. As the first step in filtration, blood is delivered into the glomeruli by microscopic leaky blood vessels called capillaries. Here, blood is filtered of waste products and fluid while red blood cells, proteins, and large molecules are retained in the capillaries. In addition to wastes, some useful substances are also filtered out. The filtrate collects in a sac called Bowman's capsule. The tubules are the next step in the filtration process. The tubules are lined with highly functional cells which process the filtrate, reabsorbing water and chemicals useful to the body while secreting some additional waste products into the tubule. The kidneys also produce certain hormones that have important functions in the body, including the following: Active form of vitamin D (calcitriol or 1,25 dihydroxy-vitamin D), which regulates absorption of calcium and phosphorus from foods, promoting formation of strong bone.

Erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells. Renin, which regulates blood volume and blood pressure.

The anatomy and physiology of the human kidney, evolved over millennia, enable this organ to excrete waste, regulate homeostatic processes and produce important hormones.

One of the most complex, beautifully engineered organs of the human body, the kidneys perform several essential tasks including the excretion of waste products, the maintenance of homeostatic balance in the body and the release of important hormones. To achieve this, human kidneys have a highly developed, superbly refined anatomy and physiology.

Location and Basic Structure of the Kidneys


The kidneys are located near the vertebral column at the small of the back; the left kidney lying a little higher than the right. Each is identical in structure and function. They are bean-shaped, about 10 cm long and 6.5 cm wide. Each kidney comprises an outer cortex and an inner medulla. The kidney is supplied with oxygenated blood via the renal artery and drained of deoxygenated blood by the renal vein. In addition, urine produced by the kidney as part of its excretory function, drains out via narrow tubules and the ureter, in turn connected to the bladder.

The Nephron
The main functional unit of the kidney is the nephron. There are approximately one million nephrons per kidney. The role of nephrons is to make urine by:
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Filtering blood of small molecules and ions such as water, salt, glucose and other solutes including urea. Large macromolecules like proteins are untouched. Recycling the required quantities of useful solutes which then re-enter the bloodstream. (A process called reabsorption) Allowing surplus or waste molecules/ions to flow from the tubules/ureter as urine.

Filtration and Reabsorbtion in the Kidneys


During progress through the nephron, some solutes like sodium chloride, potassium and glucose are reabsorbed, along with water, back into the bloodstream. This maintains a correct balance of these chemicals within the blood, assisting blood pressure regulation, for example. The filtration and reabsorbtion of glucose within the kidneys also helps to maintain correct levels of vital blood sugars. When this regulation breaks down very serious health consequences can follow.

Urea and uric acid are nitrogen containing waste products from metabolic processes in the body. These substances are potentially toxic and are partially excreted by the kidneys to maintain good health. Interestingly, of the filtrate which enters each nephron from the blood, only about 1% actually leaves the body as urine because of the various reabsorbtion mechanisms driven by osmosis, diffusion, and active transport.

Tubular Secretion in the Kidneys


Another, less familiar, mechanism for urine production in the kidneys is tubular secretion. Specialised cells move solutes directly from the blood into the tubular fluid. For example, hydrogen and potassium ions are secreted directly into the tubular fluid. This process is coupled or balanced by the re-uptake of sodium ions back into the blood. Tubular secretion of hydrogen ions, augmented by control of bicarbonate levels, is important in maintaining correct blood pH. When the blood is too acidic (acidosis) more hydrogen ions are secreted. If the blood becomes too alkaline (alkalosis), hydrogen secretion is reduced. In maintaining blood pH within normal limits (about 7.357.45) the kidney can produce urine with pH as low as that of acid rain or as alkaline as baking soda!

The Kidney as an Endocrine Gland


In addition to its excretory and homeostatic roles, the kidneys also release two important hormones into the blood. These are:
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Erythropoietin which acts on bone marrow to increase the production of red blood cells Calcitriol which promotes the absorption of calcium from food in the intestine and acts directly on bones to shift calcium into the bloodstream.

Finally the kidney produces the enzyme renin, an important regulator of blood pressure.

Read more at Suite101: The Human Kidney Structure and Function: The Anatomy and Physiology of the Kidneys | Suite101.com http://www.suite101.com/content/the-human-kidney-structure-and-functiona75153#ixzz1Txk2YHu0 http://www.emedicinehealth.com/chronic_kidney_disease/article_em.htm http://en.wikipedia.org/wiki/Kidney http://www.scribd.com/doc/11516012/Chronic-Kidney-Disease

DEVELOPMENTAL STAGE

FREUD
y Genital stage: post pubertygenital (puberty - adulthood) Physical focus: genitals Psychological theme: maturity and creation and enhancement of life. So this is not just about creating new life (reproduction) but also about intellectual and artistic creativity. The task is to learn how to add something constructive to life and society. Adult character: The genital character is not fixed at an earlier stage. This is the person who has worked it all out. This person is psychologically well-adjusted and balanced. According to Freud to achieve this state you need to have a balance of both love and work.

ERIKSON Middle Adulthood: 35 to 55 or 65

Ego Development Outcome: Generativity vs. Self absorption or Stagnation Basic Strengths: Production and Care Now work is most crucial. Erikson observed that middle-age is when we tend to be occupied with creative and meaningful work and with issues surrounding our family. Also, middle adulthood is when we can expect to "be in charge," the role we've longer envied. The significant task is to perpetuate culture and transmit values of the culture through the family (taming the kids) and working to establish a stable environment. Strength comes through care of others and production of something that contributes to the betterment of society, which Erikson calls generativity, so when we're in this stage we often fear inactivity and meaninglessness. As our children leave home, or our relationships or goals change, we may be faced with major life changesthe mid-life crisisand struggle with finding new meanings and purposes. If we don't get through this stage successfully, we can become self-absorbed and stagnate. Significant relationships are within the workplace, the community and the family.
Robert J. Havighurst

(Ages 4060)
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Assisting teenage children to become responsible and happy adults. * Achieving adult social and civic responsibility. * Reaching and maintaining satisfactory performance in ones occupational career. * Developing adult leisure time activities. * Relating oneself to ones

spouse as a person. * To accept and adjust to the physiological changes of middle age. * Adjusting to aging parents. PIAGET

The Formal Operational Stage


The Formal Operational stage [ 3 ] is the final stage in Piaget's theory. It begins at approximately 11 to 12 years of age, and continues throughout adulthood, although Piaget does point out that some people may never reach this stage of cognitive development. The formal operational stage is characterized by the ability to formulate hypotheses and systematically test them to arrive at an answer to a problem. The individual in the formal stage is also able to think abstractly and to understand the form or structure of a mathematical problem. Another characteristic of the individual is their ability to reason contrary to fact. That is, if they are given a statement and asked to use it as the basis of an argument they are capable of accomplishing the task. For example, they can deal with the statement "what would happen if snow were black".