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1. Urine formation starts the blood in the renal vein. The blood enters glomeruli via the efferent arteriole. Blood in the glomeruli is under high pressure, therefore, plasma are filtered into the glomerular capsule (Cesie, Evers & Lisa 93). The fluid is called filtrate. When it moves through the glomerular tubes, it is referred to as tubular tubes. It moves through proximal convoluted tubule, descending loop of Henle, ascending loop of Henle, distal convoluted tubule and collecting duct (Cesie, Evers & Lisa 88). Ones in the collecting duct, it is referred to as urine. From the collecting duct, urine moves through renal pelvis, ureter, urinary bladder, urethra and finally out of the body.

2. Diseases like Kwashiorkor are caused by malnutrition. Malnutrition has a significant effect on the filtration rate on the glomeruli (Cesie, Evers & Lisa 78). The disease is caused by lack of enough proteins in the human body. Diseases like these increases the glomerular filtration rates (GFR) of the kidney. The plasma proteins in the body of kwashiorkor patients lead to the reduction of the pressure, that is, oncotic pressure (Cesie, Evers & Lisa 87). This pressure is not able to retain the fluid hence increasing the glomerular filtration rates.  The following equation shows how to calculate the GFR. The equation also explains further the effect of kwashiorkor on GFR (Cesie, Evers & Lisa 88).

GFR = age * Weight in kg * 0.85 if female / 72 * Cr                                                   

3. Sympathetic nervous system overrides the renal autoregulation. The nerves innervate afferent arteriole leading to the contraction of the smooth muscles (Cesie, Evers & Lisa 106). The events sequence is as follows; ECF volume loss (caused by diarrhea, hemorrhage, or dehydration) leads to pressure drop in the mean arterial pressure (MAP). The decreased MAP activates the baroreceptors of the arteries leading to the activation of the sympathetic nervous system, constriction of the afferent arteriole and lowering the glomerular filtration rate (GFR). 

4 Angiotensin-conversing enzyme (ACE) inhibitor has an effect of blocking or hindering the angiotensin I into angiotensin II. Angiotensin I has the following effects:  it causes vasoconstriction, which may lead to an increase in blood pressure or hypertension (Cesie, Evers & Lisa 142). Afferent arteriole constriction may always lead to increased glomerular perfusion pressure. It also stimulates the adrenal cortex leading to the release of the hormone aldosterone. This hormone causes potassium excretion and retention of sodium and chloride ions. Sodium is known to be water-holding molecules hence, water retention also occurs (Cesie, Evers & Lisa 77). This leads to an increase in the blood volume therefore an in crease in the blood pressure. Angiotensin II also stimulates posterior pituitary gland that, in effect, releases hormone vasopressin (Antidiuretic Hormone (ADH)). ADH acts on the kidneys leading to an increase in water retention (Cesie, Evers & Lisa 79). The above effects of angiotensin II show that it generally lowers the water concentration in the kidney tubules. The effect of this is excretion of small quantities of concentrated urine. Therefore, ACE inhibitors have an effect of lowering urine output.

5. Anemia is a common disease especially with people with kidney diseases. Healthy kidneys are responsible for the production of hormone erythropoietin (EPO) which has an effect of stimulating the bone marrow that produces the required and proper number of red blood cells. The red blood cells carry oxygen to the body’s vital organs (Cesie, Evers & Lisa 86). Renal failure or kidney failure renders kidney diseased. Such kidney does not make enough EPO. Therefore, the bone marrow makes fewer than normal red cells leading to anemia. Such patient should take iron rich foods such as green vegetables and liver or red meat. Renal failure in a person leads to leads to difficulties in the management of phosphorus. Their large sizes make them unsuitable to go through the thin membranes of the dialyzer. It therefore, stays in circulation, that is, it is not absorbed into the blood (Cesie, Evers & Lisa 67). The phosphorus searches for calcium to bind with. Calcium is pulled from the bones for binding with the phosphorus. The calcium in the bones is therefore depleted making the bones brittle and can easily fracture. This disease is called osteoporosis. The two diseases should be properly managed by dialysis. Such a patient should take food with more phosphorus binders like calcium and aluminum.

6. Potato chips are a reducing sugar, which is hydrolyzed into glucose. It increases the solute concentration of the blood encouraging more absorption of water from the kidney tubules. The effect of this is an increase in blood pressure. High blood pressure leads to inactivation of the pituitary glands and no or little Antidiuretic Hormone is produced (Cesie, Evers & Lisa 59). Absorption of water into blood vessels leaves the tubule fluid more concentrated and little in volume. Hence, Emma will produce less concentrated urine. Another hormone involved is Insulin. High amount of sugar level in the body stimulates the secretion of insulin. It stimulates the liver cells to convert the excess glucose into glycogen, which is stored in the liver cells.

7.Problem 1. pH7.63 –Alkalosis

Cause -Respiratory

PCO2 19mm Hg-Acidosis

Cause- metabolic

HCO319.5mEq/L-Alkalosis

Cause-respiratory

Problem 2.

pH 7.5-alklosis

Compensated

 PCO2 24mm Hg- Acidosis

Not compensated

 HCO323.0mEq/L- Alkalosis

Compensated

Possible cause of imbalance

To respond to the acidosis, more bicarbonate is reabsorbed from the tubular fluid of the kidney by the tubular cells (White 24). 

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