L105: RIC Core Training, Level1

Kidney Anatomy & Physiology

Content
GENERAL ANATOMY
KIDNEY FUNCTION
THE NEPHRON
URINE FORMATION
GLOMERULAR FILTRATION
CLEARANCE

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L105 RIC Core Training: Kidney Anatomy & Physiology

Guiding Questions
What constitutes the Urinary System ?
How much blood flows through the kidneys in 24 hours ?
What are the excretory functions of the kidney ?
What are secretory functions of the kidney ?
What are the two major components of the Nephron ?
In what part of the kidney is the urine formed ?
What is the meaning of GFR ?
How is Estimated GFR and Creatinine Clearance measured ?

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L105 RIC Core Training: Kidney Anatomy & Physiology

The Urinary System

The kidneys are principal organs of the urinary system
Organs of Urinary System
The Kidneys, functions,
coverings,
Size, weight
Location
Blood Supply
Urine production & flow
Adrenal Glands

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L105 RIC Core Training: Kidney Anatomy & Physiology

Kidney Anatomy

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L105 RIC Core Training: Kidney Anatomy & Physiology

How many ml of blood flows through the

kidney in one minute ?

What percent of total cardiac output

(blood pumped by the heart) does this
volume represent ?

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L105 RIC Core Training: Kidney Anatomy & Physiology

Anatomy of the Kidney

Approximately 1,200 ml of blood or 25 % of
Cardiac Output flows through the kidney in one minute
Cortex

Fibrous capsule

Renal artery
and vein

Deep inside the cortex and

the medulla regions are long
hairpin-like structures called
nephrons, these are the
functional urine producing
unit of the kidney

Pelvis
Pyramid (medulla)
Ureter

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L105 RIC Core Training: Kidney Anatomy & Physiology

Kidney Function
Function is both excretory and secretory

Impaired renal function has adverse effects on:

blood chemistry
blood pressure
fluid balance
nutrient intake
general state of health.

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L105 RIC Core Training: Kidney Anatomy & Physiology

Kidneys Excretory Functions

Needed to maintain Homeostasis in the body
The excretion product of the kidney is urine
Remove excess fluid

Regulate acid/base balance

Remove waste products

Regulate electrolyte levels

Urea & Creatinine

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L105 RIC Core Training: Kidney Anatomy & Physiology

Kidneys Secretory function

Hormonal function of the kidneys
Secretion of three different hormones
Renin: regulate blood pressure

EPO: regulate red blood cell production

Vitamin D: regulate calcium uptake

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The Nephron is the urine producing part

of the kidney. What are the approximate
number of Nephrons in each kidney ?

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L105 RIC Core Training: Kidney Anatomy & Physiology

The Nephron
The urine producing part of the kidney
Distal tubule

Proximal tubule

There are one million Nephrons in each kidney

Bowmans
capsule
Peritubular
capillaries

Collecting duct

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Loop
of Henle

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Efferent arteriole
(narrow)
The efferent arteriole, which
is narrower than the afferent
arteriole, creating a
hydrostatic pressure in
glomerulus

Glomerulus

Afferent arteriole
(wider)

L105 RIC Core Training: Kidney Anatomy & Physiology

The Nephron

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Urine Formation
In the Nephron, divided into a three step processes
Glomerular filtration

Tubular reabsorption

Tubular secretion

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How many liter of primary urine

(glomerular filtrate) does the kidneys
produce each day ?

What percent of this volume

constitute the final urine ?

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L105 RIC Core Training: Kidney Anatomy & Physiology

Glomerular Filtration
Primary urine is formed
Step 1

Glomerular filtration (unspecific) :

filtration of the blood when a large
amount of primary urine is formed,
containing water and low molecular
weight substances (resembles plasma
without proteins)
Approximately 180 liter of glomerular
filtrate is produced every 24 hours

Filtration is taking place due to the hydrostatic pressure in the glomerulus

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Tubular Reabsorption
Most of primary urine (99%) is reabsorbed
Step 2

Tubular reabsorption:
most substances needed by the body that
were filtered into the primary urine (99%)
are selectively reabsorbed to the blood

Creatinine, which a waste product from muscle catabolism,

is not reabsorbed at all
Glucose, amino acids, vitamins and bicarbonate (substances that are needed in
the body) are normally completely reabsorbed into the blood
Electrolytes are absorbed in varying amounts to regulate the electrolyte balance in
order to maintain homeostasis

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Tubular Secretion
Active transport from blood to urine
Step 3

Tubular secretion:
some specific substances, often of high
molecular weight, are selectively
transported from the blood to the urine

Hydrogen ions (H+, acid) are secreted from blood

into the tubuli and in the very same process
bicarbonate is regenerated (maintenance of acid-base balance)
The final composition of the urine is determined by hormones;
anti-diuretic hormone (ADH) and aldosteron.

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A constant GFR is maintained

through autoregulation but this
process will only go so far.
At what mean arterial pressure is
autoregulation impaired ?

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Glomerular Filtration Rate (GFR)

Volume of plasma cleared of a given substance per minute
Best estimate of renal function

120 ml/min
1,200 ml/min

1,080 ml/min

A constant GFR is maintained through a process called autoregulation

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Autoregulation
Selective vasoconstriction or dilatation to maintain organ blood
flow at a constant rate, despite changes in perfusion pressure
Ability to maintain renal perfusion pressure through autoregulation is
limited; only until MAP reaches approximately 60 - 80 mmHg.

MAP is dependent on a number of important systemic factors

Blood Volume (dehydration, hemorrhage)
Blood flow; reduced Cardiac output (congestive heart failure, infarct)
Albumin level in blood (disease of liver and starvation) affects intravascular volume
Hypotension from severe vasodilatation (anaphylactic shock, sepsis)

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L105 RIC Core Training: Kidney Anatomy & Physiology

What is Creatinine and why is it used

to measure kidney function ?

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L105 RIC Core Training: Kidney Anatomy & Physiology

Creatinine Clearance (K) and GFR

A screening to estimate kidney function
the volume of blood from which a substance is completely cleared
by the kidneys per unit time (ml/min)

calculated based on level of creatinine in blood and urine

a commonly used laboratory test - easily performed
gives a close estimate of the actual GFR
Creatinine a breakdown product from the
muscle, is a substance freely filtered in the
glomeruli but neither absorbed nor secreted it therefore has a the clearance (ml/min) that
equals the GFR (ml/min) of the kidneys.
Well functioning kidneys have a Creatinine
Clearance of approximately 120 ml /min.
Blood measurement of Creatinine
and a 24 hour urine collection on which Creatinine is measured

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L105 RIC Core Training: Kidney Anatomy & Physiology

KEYPOINTS
Approximately 1200 ml of blood or 25 % of Cardiac Output flows
the kidneys in one minute

through

The excretory function of the kidneys is needed to maintain homeostasis in

the body, it is essential for the regulation of the water and electrolyte
(dissolved salts) balance and for the body to maintain normal acid-base
balance

The secretory function or the hormonal function of the kidneys includes

the secretion of three different hormones; Renin, Erythropoietin & Vit.D

The Nephron is the urine producing part of the kidney, there are about
one million in each kidney

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L105 RIC Core Training: Kidney Anatomy & Physiology

KEYPOINTS
The formation of urine in the kidney is divided in three different steps
Approximately 180 liter of glomerular filtrate is produced every 24 hours,
as much as 99% is reabsorbed

GFR is the volume of plasma cleared by the kidneys of a given substance

per minute

Autoregulation is the ability of an organ to maintain a constant blood flow

despite changes in perfusion pressure

Creatinine is freely filtered by glomeruli, it has a clearance that equals GFR

Well functioning kidneys have a Creatinine clearance and therefore GFR of
approximately 120 ml / min

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L105 RIC Core Training: Kidney Anatomy & Physiology

Adapted in part from Gambro Basics

Further references and reading:
http://www.uhmc.sunysb.edu
RENAL BLOOD FLOW-GLOMERULAR FILTRATION
RATEGeorge N. Coritsidis, MD
http://en.wikipedia.org/wiki/Glomerular_filtration_rate
http://www.labtestsonline.org/understanding/analytes/gfr/sample.
html