The kidneys are organs that serve several essential regulatory roles in most animals, including vertebrates and

some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acidbase balance, and regulation of blood pressure (via maintaining salt and water balance). They serve the body as a natural filter of the blood, and remove wastes which are diverted to the urinary bladder. In producing urine, the kidneys excrete wastes such as urea and ammonium, and they are also responsible for the reabsorption of water, glucose, and amino acids. The kidneys also produce hormones including calcitriol, erythropoietin, and the enzyme renin. Located at the rear of the abdominal cavity in the retroperitoneum, the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter, itself a paired structure that empties into the urinary bladder. Renal physiology is the study of kidney function, while nephrology is the medical specialty concerned with kidney diseases. Diseases of the kidney are diverse, but individuals with kidney disease frequently display characteristic clinical features. Common clinical conditions involving the kidney include the nephritic and nephrotic syndromes, renal cysts, acute kidney injury, chronic kidney disease, urinary tract infection, nephrolithiasis, and urinary tract obstruction.[1] Various cancers of the kidney exist; the most common adult renal cancer is renal cell carcinoma. Cancers, cysts, and some other renal conditions can be managed with removal of the kidney, or nephrectomy. When renal function, measured by glomerular filtration rate, is persistently poor, dialysis and kidney transplantation may be treatment options. Although they are not severely harmful, kidney stones can be a pain and a nuisance. The removal of kidney stones includes sound wave treatment to break up the stones into smaller pieces, which are then passed through the urinary tract. One common symptom of kidney stones is a sharp pain in the medial/lateral segments of the lower back. Functions Main article: Renal physiology The kidney participates in whole-body homeostasis, regulating acid-base balance, electrolyte concentrations, extracellular fluid volume, and regulation of blood pressure. The kidney accomplishes these homeostatic functions both independently and in concert with other organs, particularly those of the endocrine system. Various endocrine hormones coordinate these endocrine functions; these include renin, angiotensin II, aldosterone, antidiuretic hormone, and atrial natriuretic peptide, among others.

Kidneys

Many of the kidney's functions are accomplished by relatively simple mechanisms of filtration, reabsorption, and secretion, which take place in the nephron. Filtration, which takes place at the renal corpuscle, is the process by which cells and large proteins are filtered from the blood to make an ultrafiltrate that eventually becomes urine. The kidney generates 180 liters of filtrate a day, while reabsorbing a large percentage, allowing for the generation of only approximately 2 liters of urine. Reabsorption is the transport of molecules from this ultrafiltrate and into the blood. Secretion is the reverse process, in which molecules are transported in the opposite direction, from the blood into the urine. [edit] Excretion of wastes The kidneys excrete a variety of waste products produced by metabolism. These include the nitrogenous wastes called "urea", from protein catabolism, as well as uric acid, from nucleic acid metabolism. Formation of urine is also the function of the kidney.

Structure

1. Renal pyramid 2. Interlobular artery 3. Renal artery 4. Renal vein 5. Renal hilum 6. Renal pelvis 7. Ureter 8. Minor calyx 9. Renal capsule 10. Inferior renal capsule 11. Superior renal capsule 12. Interlobular vein 13. Nephron 14. Minor calyx 15. Major calyx 16. Renal papilla 17. Renal column The kidney has a bean-shaped structure; each kidney has a convex and concave surface. The concave surface, the renal hilum, is the point at which the renal artery enters the organ, and the renal vein and ureter leave. The kidney is surrounded by tough fibrous tissue, the renal capsule, which is itself surrounded

by perinephric fat, renal fascia (of Gerota) and paranephric fat. The anterior (front) border of these tissues is the peritoneum, while the posterior (rear) border is the transversalis fascia. The superior border of the right kidney is adjacent to the liver; and the spleen, for the left kidney. Therefore, both move down on inhalation. The kidney is approximately 1114 cm in length, 6 cm wide and 4 cm thick. The substance, or parenchyma, of the kidney is divided into two major structures: superficial is the renal cortex and deep is the renal medulla. Grossly, these structures take the shape of 8 to 18 cone-shaped renal lobes, each containing renal cortex surrounding a portion of medulla called a renal pyramid (of Malpighi). [5] Between the renal pyramids are projections of cortex called renal columns (of Bertin). Nephrons, the urine-producing functional structures of the kidney, span the cortex and medulla. The initial filtering portion of a nephron is the renal corpuscle, located in the cortex, which is followed by a renal tubule that passes from the cortex deep into the medullary pyramids. Part of the renal cortex, a medullary ray is a collection of renal tubules that drain into a single collecting duct. The tip, or papilla, of each pyramid empties urine into a minor calyx; minor calyces empty into major calyces, and major calyces empty into the renal pelvis, which becomes the ureter

What causes diabetic nephropathy? The kidneys have many tiny blood vessels that filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn't able to do its job as well. Later it may stop working completely. This is called kidney failure. For reasons doctors don't yet understand, only some people who have diabetes get kidney damage. Out of 100 people with diabetes, as many as 40 will get kidney damage.1 Certain things make you more likely to get diabetic nephropathy. If you also have high blood pressure or high cholesterol, or if you smoke, your risk is higher. Also, Native Americans, African Americans, and Hispanics (especially Mexican Americans) have a higher risk.2

What are the symptoms? There are no symptoms in the early stages. So its important to have regular urine tests to find kidney damage early. Sometimes early kidney damage can be reversed. The first sign of kidney damage is a small amount of protein in the urine, which is found by a simple urine test. As damage to the kidneys gets worse, your blood pressure rises. Your cholesterol and triglyceride levels rise too. As your kidneys are less able to do their job, you may notice swelling in your body, at first in your feet and legs. How is diabetic nephropathy diagnosed? The problem is diagnosed using simple tests that check for a protein called albumin in the urine. Urine does not usually contain protein. But in the early stages of kidney damage-before you have any symptoms-some protein may be found in your urine, because your kidneys aren't able to filter it out the way they should. Finding kidney damage early can keep it from getting worse. So its important for people with diabetes to have regular testing.

If you have type 1 diabetes, get a urine test every year after you have had diabetes for 5 years. If your child has diabetes, yearly testing should begin when your child is 10 years old and has had diabetes for 5 years. If you have type 2 diabetes, start yearly testing at the time you are diagnosed with diabetes.

How is it treated? The main treatment is medicine to lower your blood pressure and prevent or slow the damage to your kidneys. These medicines include:

Angiotensin-converting enzyme inhibitors, also called ACE inhibitors. Angiotensin II receptor blockers, also called ARBs.

You may need to take more than one medicine, especially if you also have high blood pressure.

The human heart is a muscular organ that provides a continuous blood circulation through the cardiac cycle and is one of the most vital organs in the human body.[1] The heart is divided into four main chambers: the two upper chambers are called the left and right Atrium and two lower chambers are called the right and left Ventricle.There is a thick wall of muscle separating the right side and the left side of the heart called the septum. Normally with each beat the right ventricle pumps the same amount of blood into the lungs that the left ventricle pumps out into the body. Physicians commonly refer to the right atrium and right ventricle together as the right heart and to the left atrium and ventricle as the left heart.[2] The electric energy that stimulates the heart occurs in the sinoatrial node, which produces a definite potential and then discharges, sending an impulse across the atria. In the atria the electrical signal moves from cell to cell[3] while in the ventricles the signal is carried by specialized tissue called the Purkinje fibers[4] which then transmit the electric charge to the myocardium.

At 21 days after conception, the human heart begins beating at 70 to 80 beats per minute and accelerates linearly for the first month of beating. The human embryonic heart begins beating at around 21 days after conception, or five weeks after the last normal menstrual period (LMP). The first day of the LMP is normally used to date the start of the gestation (pregnancy). The human heart begins beating at a rate near the mothers, about 75-80 beats per minute (BPM). The embryonic heart rate (EHR) then accelerates by approximately 100 BPM during the first month to peak at 165-185 BPM during the early 7th week afer conception, (early 9th week after the LMP). This acceleration is approximately 3.3 BPM per day, or about 10 BPM every three days, which is an increase of 100 BPM in the first month.[5][6][7] After 9.1 weeks after the LMP, it decelerates to about 152 BPM (+/-25 BPM) during the 15th week post LMP. After the 15th week, the deceleration slows to an average rate of about 145 (+/-25 BPM) BPM, at term. The regression formula, which describes this acceleration before the embryo reaches 25 mm in crownrump length, or 9.2 LMP weeks, is: the Age in days = EHR(0.3)+6. There is no difference in female and male heart rates before birth.[8] The human heart and its disorders (cardiopathies) are studied primarily by cardiology.

Structure

Heart

anterior view, coronal section.

The blood supply of the heart is provided by the coronary circulation. Coronary arteries labeled in red text and other landmarks in blue text. The human heart has a mass of between 250 and 350 grams and is about the size of a fist.[9] It is enclosed in a double-walled protective sac called the pericardium.[10]The double membrane of pericardium consist of the pericardial fluid which nourishes

the heart and prevents shocks. The superficial part of this sac is called the fibrous pericardium. The fibrous pericardial sac is itself lined with the outer layer of the serous pericardium (known as the parietal pericardium). This composite (fibrous-parietal-pericardial) sac protects the heart, anchors its surrounding structures, and prevents overfilling of the heart with blood. The inner layer also provides a smooth lubricated sliding surface within which the heart organ can move in response to its own contractions and to movement of adjacent structures such as the diaphragm and lungs. The outer wall of the human heart is composed of three layers. The outer layer is called the epicardium, or visceral pericardium since it is also the inner wall of the (serous) pericardium. The middle layer of the heart is called the myocardium and is composed of muscle which contracts. The inner layer is called the endocardium and is in contact with the blood that the heart pumps. Also, it merges with the inner lining (endothelium) of blood vessels and covers heart valves.[11] The human heart has four chambers, two superior atria and two inferior ventricles. The atria are the receiving chambers and the ventricles are the discharging chambers. The pathways of blood through the human heart is part of the pulmonary and systemic circuits. These pathways include the tricuspid valve, the mitral valve, the aortic valve, and the pulmonary valve.[12] The mitral and tricuspid valves are classified as the atrioventricular (AV) valves. This is because they are found between the atria and ventricles. The aortic and pulmonary semi-lunar valves separate the left and right ventricle from the pulmonary artery and the aorta respectively. These valves are attached to the chordae tendinae (literally the heartstrings), which anchors the valves to the papilla muscles of the heart. The interatrioventricular septum separates the left atrium and ventricle from the right atrium and ventricle, dividing the heart into two functionally separate and anatomically distinct units. [edit] Functioning

Blood flow diagram of the human heart. Blue components indicate deoxygenated blood pathways and red components indicate oxygenated pathways. Blood flows through the heart in one direction, from the atria to the ventricles, and out of the great arteries, or the aorta for example. Blood is prevented from flowing backwards by the tricuspid, bicuspid, aortic, and pulmonary valves. The heart acts as a double pump. The function of the right side of the heart (see right heart) is to collect de-oxygenated blood, in the right atrium, from the body (via superior and inferior vena cavae) and pump it, via the right ventricle, into the lungs (pulmonary circulation) so that carbon dioxide can be dropped off and oxygen picked up (gas exchange). This happens through the passive process of diffusion. The left side (see left heart) collects oxygenated blood from the lungs into the left atrium. From the left atrium the blood moves to the left ventricle which pumps it out to the body (via the aorta). On both sides, the lower ventricles are thicker and stronger than the upper atria. The muscle wall surrounding the left ventricle is thicker than the wall surrounding the right ventricle due to the higher force needed to pump the blood through the systemic circulation. Atria facilitate circulation primarily by allowing uninterrupted venous flow to the heart, preventing the inertia of interrupted venous flow that would otherwise occur at each ventricular systole.[13] Starting in the right atrium, the blood flows through the tricuspid valve to the right ventricle. Here, it is pumped out of the pulmonary semilunar valve and travels through the pulmonary artery to the lungs. From there, blood flows back through the pulmonary vein to the left atrium. It then travels through the mitral valve to the left ventricle, from where it is pumped through the aortic semilunar valve to the aorta and to the rest of the body. The (relatively) deoxygenated blood finally

returns to the heart through the inferior vena cava and superior vena cava, and enters the right atrium where the process began. [edit] Lifestyle and heart health Obesity, high blood pressure, and high cholesterol can increase the risk of developing heart disease. However, half the number of heart attacks occur in people with normal cholesterol levels. Heart disease is a major cause of death. It is generally accepted that factors such as exercise, diet, and overall well-being, including both emotional and physiological components, affect heart health in humans.