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Abdu||rahman A|shahran|
1ar|q A|-Cta|b|
Abdu|ma||k A|mufarr|h
Abdu|az|z A|-hamad
Ahmed A|marzuq|
Nasser A|-moosa
Abdu|kahman A|-shar|dah

Yafa Al-shamlan
Sara Al-anazy
Lama Mokhlis
Tmader alaofi
Hayfa alabdulkareem
Dalal fatani
Jomanah alshammari
Shehanah alomair
Alaa Al-anazi
Ghaida Al-suqir
Manar aljebreen
Rand Al-hwil
Afnan Al-hargan

1eam |eaders
Mohammed As|r|
Nour A|-khawa[a
Renal Bl ood fl ow and Renal
Cl earance
Renal Blood flow:
1he kldney recelves exLremely hlgh blood flow compared wlLh oLher organs, Lo supply
Lhe kldneys wlLh enough plasma for Lhe hlgh raLes of glomerular fllLraLlon.
ln average adulL 88l =1.1L/mln = 22 of Cardlac ouLpuL
AP (para-amlnohlppurlc acld) an organlc acld used for measuremenL of 88l.
ln one renal clrculaLlon/mln AP ls almosL compleLely removed(90) from Lhe plasma
& excreLed ln urlne.
AP clearance = volume of plasma cleared from
AP/mln = 8l/mln
8l= Lhe amounL of a AP excreLed per unlL t|me
1heoreLlcally, lf a subsLance ls
compleLely cleared from Lhe
plasma, Lhe clearance raLe of LhaL
subsLance ls equal Lo Lhe LoLal
renal plasma flow
Calculation of renal blood flow:
1o ca|cu|ate the k8I we have to fo||ow a number of steps:
1- Ca|cu|ate the rena| p|asma f|ow by f|nd|ng the c|earance of An
x V)]
= 383ml/mln = effecLlve renal plasma flow (L8l)

2- 8ut because on|y 90 of An |n arter|a| b|ood |s removed by
the k|dney we have to ca|cu|ate the Actua| rena| p|asma
f|ow (AkI)
A8l= L8l/exLracLlon raLlo = 585/0.9= 650ml/min

3- Now we have to Ca|cu|ate the rena| b|ood
f|ow (k8I)
k8I= kI](1-hematocr|t)
= 6S0](1-0.4S)=1182 m|]m|n
k8I = kena| artery pressure - kena| ve|n pressure

1ota| kena| vascu|ar pressure

**An |s used to measure the k8I
**CLkA1ININL |s used to measure the GIk
1- C
Clearance of AP
2- u
urlne AP concenLraLlon= 3.83mg/ml
3- v= urlne flow raLe, lL can be measured by 24hrs collecLlng urlne.
Supposlng = 1440 ml/24 hrs 1440-24-60= 1ml/mln
= arLerlal plasma AP concenLraLlon
LxLracLlon raLlo=(
-8enal venous
(0.01-0.001)/0.01)= 0.9
PemaLocrlL= 1he hemaLocrlL (ls Lhe volume percenLage () of red blood cells ln
blood. lL ls normally abouL 43 for men and 40 for women

Auto regulation:

! It's a Ieedback mechan|sm to keep k8I and GIk re|at|ve|y constant desp|te marked
changes |n A8
! kange of auto regu|at|on |s between 7S-160 mmng A8
! If the A8 became |ower than 60, GIk decreases tremendous|y |ead|ng to k|dney
! When |t exceeds 160 mmng, damage to k|dney w||| occur

Auto regulation of GFR:
Auto regulation largely occurs by the regulation of renal vascular resistance

Changes d|ameters of afferent, efferent arter|o|e, and g|omeru|ar cap|||ar|es.
Drop pressure resu|ts |n d||at|on of afferent arter|o|e, d||at|on of g|omeru|ar cap|||ar|es
and constr|ct|on of efferent arter|o|e.
k|ses |n pressure resu|ts |n constr|ct|on of afferent arter|o|e
In severe cases of |ncreased A8 efferent d||atat|on w||| occur a|ong w|th afferent

Three processes controlling GFR:
1. Myogen|c auto regu|at|on
2. normona| regu|at|on (tubu|og|omeru|ar & ren|n-ang|otens|n)
3. Autonom|c regu|at|on (extr|ns|c)
4. N|tr|c Cx|de (NC):
o Causes arteriolar vasodilation
o Elevated NO may result in hyperfiltration of early Diabetes Mellitus
o Reduced NO after salt intake may lead to hypertension

1. Myogenic auto regulation:

1he ab|||ty of b|ood vesse|s to res|st Stretch|ng
nydrostat|c ressure stretch|ng Vesse|s wa|| ref|ex contract|on

2. Hormonal Regulation:

I. 1ubu|og|omeru|ar feedback
II. ken|n-ang|otens|n A|dosterone
III. Cther normones

3. Autonomic Regulation of GFR:

-In norma| cond|t|on Sympathet|c NS has ||tt|e |nf|uence on GIk
- 8 (hemorrhage) sympathet|c Vasoconstr|ct|on of rena| artery k8I
vasoconstr|ct|on of afferent GIk
I. 1ubu|og|omeru|ar feedback:

GIk s|ow f|ow Nac| reabsorpt|on to the c|rcu|at|on due to hypotens|on Nac| at
macu|a densa |ead|ng to:
1. ren|n ang|otens|n II efferent vasoconstr|ct|on GIk
2. Afferent d||at|on GIk

1o perform Lhe funcLlon of auLo regulaLlon, Lhe kldneys have a feedback mechanlsm LhaL llnks changes ln sodlum chlorlde
concenLraLlon aL Lhe macula densa wlLh Lhe conLrol of renal arLerlolar reslsLance. 1he Lubuloglomerular feedback mechanlsm has 2
componenLs LhaL acL LogeLher Lo conLrol Cl8: 1sL an afferenL arLerlolar feedback mechanlsm and 2nd an efferenL arLerlolar
feedback mechanlsm. 1hese feed back mechanlsms depend on speclal anaLomlcal arrangemenLs of Lhe [uxLaglomerular complex.
1he [uxLaglomerular complex conslsLs of macula densa cells ln Lhe lnlLlal porLlon of Lhe dlsLal Lubule and [uxLaglomerular cells ln Lhe
walls of Lhe afferenL and efferenL arLerloles. 1he macula densa cells sense changes ln volume dellvery Lo Lhe dlsLal Lubule by way of
slgnals LhaL are noL compleLely undersLood. LxperlmenLal sLudles suggesL LhaL decreased Cl8 may slow Lhe flow raLe ln Lhe loop of
henle causlng an lncrease ln reabsorpLlon of sodlum and chlorlde lons ln Lhe ascendlng loop of henle and Lhereby reduclng
concenLraLlon of sodlum and chlorlde concenLraLlon ln Lurn lnlLlaLes a slgnal from Lhe macula densa LhaL has 2 effecLs: (1) lL
decreases reslsLance of Lhe afferenL arLerlole, whlch ralses glomerular hydrosLaLlc pressure and helps Lo reLurn Cl8 Loward normal
and (2) lL lncreases renln release from Lhe [uxLaglomerular cells of Lhe afferenL and efferenL arLerloles, whlch are ma[or sLorage
slLes for renln. 8enln released from Lhese cells Lhen funcLlons as an enzyme Lo lncrease Lhe formaLlon of Angll. llnally, Lhe Angll
consLrlcLs Lhe efferenL arLerloles, Lhereby lncreaslng glomerular hydrosLaLlc pressure and reLurnlng Cl8 Loward normal

II. ken|n-ang|otens|n A|dosterone:
ken|n |s re|eased |nto p|asma due to:
! |ow LCI Na or |ow LCV
! sympathet|c (due to hypotens|on)
! afferent pressure (hypotens|on)

ken|n acts on ang|otens|nogen Ang|otens|n I
Ang|otens|n convert|ng enzyme (ACL): Ang|otens|n I ang|otens|n II
Ang|otens|n II act on adrena| cortex a|dosterone secret|on Na reabsorpt|on |n d|sta|
& co||ect|ng duct of nephron
n and k secret|on |n exchange for Na

III. Cther normona| kegu|ator of GIk:
1. Adrena||ne, noradrena||ne afferent vasoconstr|ct|on GIk
2. Ang|otens|n II Vasoconstr|ct|on of efferent GIk
3. rostag|and|ns, bradyk|n|n afferent vasod||ator GIk

Renal Clearance:

" 1he Vo|ume of |asma that |s comp|ete|y c|eared of any substance by the k|dneys per m|nute
|s ca||ed the c|earance of that part|cu|ar
" C|earance equat|on

! Cs = ([U]s x V)][]s = m|]m|n

" kena| c|earance for d|fferent substances var|ous between 0-600m|]m|n

1. Ne|ther reabsorbed nor secreted (e.g. Inu||n)
! A|| the substance w||| go |nto ur|ne. Whatever |s f||tered |s excreted
2. A|| |s reabsorbed but |s not secreted (e.g. G|ucose)
! 1h|s substance w||| not be found |n ur|ne
3. art|a||y reabsorbed and |s not secreted (e.g. urea)
! art of th|s substance w||| be excreted to the ur|ne and the rest
(about S0)
w||| be
! 1he on|y waste product wh|ch |s reabsorbed |s urea
4. Not reabsorbed but |t |s secreted (e.g. creat|n|ne)
! More concentrated |n ur|ne that |t |s |n f||trate

Cs=clearance raLe of any subsLance
us=urlne concenLraLlon of LhaL subsLance
s=plasma concenLraLlon of LhaL subsLance
v= urlne flow raLe per mlnuLe
Inulin clearance & GFR:

" 120 m|]m|n
As |nu||n |s free|y f||tered not secreted or
Inu||n c|earance = GIk

Creatinine clearance &GFR:
# Creat|n|ne |s an endogenous substance used rout|ne|y
to measure GIk
# Comp|ete|y f||tered, but secreted |n sma|| quant|ty
# Inverse re|at|onsh|p between GIk & p|asma creat|n|ne
# Ior examp|e: when the GIk |ncrease the p|asma
creat|n|ne |s decreased and v|es versa.

Inulin clearance vs. clearance of other
# Cx = |nu||n c|earance (GIk) Substance x |s f||tered but not absorbed or secreted=GIk

# Cy < |nu||n c|earance (GIk) Substance y |s f||tered and part|a||y absorbed < GIk

# Cz > |nu||n c|earance (GIk) Substance z |s f||tered and secreted >GIk

Glucose & urea clearance:
kena| c|earance of g|ucose=zero

I||tered, comp|ete|y absorbed, no g|ucose |n ur|ne
[U]g x V = zero
Urea c|earance = 60 m|]m|n, urea f||tered, part|a||y reabsorbed


ln average concenLraLlon of dlfferenL
subsLances aL dlfferenL polnLs ln Lhe Lubular
sysLem relaLlve Lo Lhe concenLraLlon of each
subsLance ln Lhe glomerular fllLraLe. A value 1.0
lndlcaLes LhaL concenLraLlon of Lhe subsLance ln
Lhe Lubular fluld ls Lhe same as Lhe concenLraLlon
of LhaL subsLance ln Lhe glomerular fllLraLe.
values below 1.0 lndlcaLe LhaL Lhe subsLance ls
reabsorbed more avldly Lhan waLer, whereas
values above 1.0 lndlcaLe LhaL Lhe subsLance ls
reabsorbed Lo a lesser exLenL LhaL waLer.

lL demonsLraLes Lhe concenLraLlon of dlfferenL
subsLances aL dlfferenL levels, e.g. Clucose ls
absenL ln Lhe urlne= 0.

Indicate wither in of the following factors would (A) increase (B) decrease
the GFR:

__1.Tubuloglomerular feedback response to decreased salt delivery to the
distal tubule
__2.Affernt arteriole vasoconctriction
__3.A dramatic fall in arterial pressure following sever hemorrhage (<80 mmHg)
__4.A fall in plasma protien concentration resulting from loss of these proteins from
a large burned surface of skin
__5.Contraction of podocyte
__6.Contraction of mesangial cells
__7.A rise in bowman's capsule pressure resulting from ureteral obstruction by
kidney stone
__8.Myogenic response of an afferent arteriole stretched as a result of an increased
driving blood pressure
__9.Increase in sympathatic actvity to the afferent arterioles.

the answers: