Body Fluids, Kidneys &

Renal Physiology
 Body Fluids
Total Body Water (TBW) = 0.6 x body weight (kg)
Intracellular = 0.4 x body weight
Extracellular = 0.2 x body weight
plasma = 1/3 extracellular
interstitial = 2/3 extracellular

75 kg
TBW =45 litres
intra = 30 litres (⅔ of TBW)
extra = 15 litres (⅓ of TBW)
plasma = ~5 litres
interstitial = ~10 litres
Normal Daily Water Loss:
1. Insensible:
– Skin 0.4 L
– Respiratory tract 0.4 L
2. Sweat
– Normal temp 0.1 L
– Hot Temp 1.4 L
3. Feces 0.1 L
4. Urine 1.4 L

Normal Water Intake Balances Normal Water Loss

 Physiology of Fluid
• Concentration & Osmotic Forces
– Concentration expressed as molarity
• Amount relative to molecular weight
– i.e glucose MW=180g/mol
– 1 g of glucose in 1 L of water = 1g/L / 180 g/mol = 0.056mol/L
– Osmotic Forces determined by the number of
solute particles
• Glucose – one solute particle
• NaCl – two solute particles
• Osmolarity = concentration x # particles/molecule
– i.e 150 mmol/L solution glucose = 150 mOsm
– 150 mmol/L solution NaCl = 300 mOsm

– Also expressed as osmolality

» Number of particles per kg of solvent (mOsm/kg H20)
• Plasma
– Major ionic components are Na+, Cl-, HCO3-
– Plasma osmolality
2x [Na+]plasma ≈ 290 mOsm/Kg H20

0.9% NaCl solution = Iso-osmotic

Any solution < 290 mOsm = hypo-osmotic
Any solution > 290 mOsm = hyper-osmotic
• Tonicity
– Tendency of a solution to cause cells to swell or shrink
– Very important because water moves into and out of
cells under osmotic pressure and is not actively
transported by pumps

– Isotonic – no effect on cell volume - 0.9% NaCl

– Hypotonic – cause cell to swell <0.9% NaCl
– Hypertonic – cause cell to shrink >0.9% NaCl
• Under normal circumstances
– Extracellular Fluid (ECF) and Intracellular
Fluid (ICF) are at osmotic equilibrium

– Changes in osmotic forces lead to a new

osmotic equilibrium within ~1 minute
Changes in ICF and ECF as fluids are
added or removed
1. If iso-osmotic fluid added there is no
change in ICF, only an increase in ECF
volume since there is no osmotic effect
2. If hypo- or hyper-osmotic fluid added
then ICF and ECF redistribute to get a
new osmotic equilibrium
 • For example, add 10L of water (hypo-osmotic)
to the body

Total body
ICF (L) ECF (L)
volume (L)
Initial 40 26 14
After osmotic
50 32 18
equilibrium
 • For example, add 2L of 4.5% NaCl solution
(hyper-osmotic) to the body

Total body
ICF (L) ECF (L)
volume (L)
Initial 40 26 14
After osmotic
42 22 20
equilibrium
• Therefore,
1. hyposmotic solution will be distributed into
the intracellular and extracellular space
2. hypersmotic solution will remove solution
from intracellular and bring it to extracellular
space
 The Kidney
1. Regulation of water & ion balance
2. Removal of waste from blood & excretion
in urine
3. Hormone/enzymes production:
a) 1,25 dihydroxyvitamin D
b) Renin – an enzyme important for
Angiotensin II production – blood pressure,
Na+ regulation
The outer layer
is the renal cortex;
and it contains the
sites of filtration
and the convoluted The functional unit in
tubules. the kidney

The inner part of

is the renal medulla;
this is the location of
the longer loops of
Henle, and the drainage
of the collecting ducts
into the renal pelvis
and ureter.
 Proximal tubule

Bowman’s capsule
Bowman’s space

Blood flow
Blood flow

The intersection of the macula densa in the distal tubule

with the afferent and efferent arterioles forms the
juxtaglomerular apparatus, which secretes renin
into blood in the afferent arteriole.
artery Afferent
arteriole Glomerular
capillary Efferent
arteriole

Bowman’s Peritubular
space capillary

vein
tubule
 Steps in urine formation

1. Filtration 2
2. Secretion
3
3. Reabsorption
4. Excretion (urine)

4
 Basic Renal Processing
• General strategy
– Everything but cells and protein gets filtered
into Bowman’s space (called glomerular
filtrate)
– Flitrate has the same substances at same
concentrations as plasma
– Further along tubule, substances are added
(secretion) or removed (reabsorption)
Amount excreted =
amount filtered + amount secreted – amount
reabsorbed
 1. Filtered and secreted;
not reabsorbed

3. Filtered and
completely reabsorbed

2. Filtered, some
reabsorbed, some
excreted
• For each substance in plasma
there is some combination of filtration,
reabsorption and secretion

• For many substances (eg, Na+, Ca++,

water) these processes are under
physiological control
Glomerular Filtration
Capillary Fenestra allow movement
from plasma to Bowman’s space
 Glomerular Filtration
• A bulk flow process

PGC
πGC

PBs πBS
• Glomerular Filtration Pressure

GFP= ((PGC-PBS)-(πGC- πBS))

Bowman’s Space
Usually 0
GFP=(60-15)-(29)
= 16 mmHg

Positive pressure indicates filtration

• Glomerular Filtration Rate (GFR)
– How much is filtered per unit of time
– Function of:
1. Filtration pressure
2. Membrane permeability

• 70 kg person
– GFR = 180 L/day (125 mL/min)
• Recall if plasma volume = 4-5 L, kidneys filter
entire plasma volume ~36-45 times per day!
Role of hydrostatic pressure in controlling GFP

1. PBC – primarily a function of the tubules & ureters;

movement of fluid through the system keeps PBC
low
2. PGC – a function of blood volume in glomerular
capillary
– Afferent and efferent arterioles may be regulated
independently
– Function of arteriole resistance
– Constriction of afferent ↓flow into glomerular capillary
therefore ↓ PGC
– Constriction of efferent ↓ flow out of glomerular capillary
therefore ↑ PGC
– Opposites for dilation