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WEEK 1:RENAL PHYSIOLOGY AND FUNCTION OF THE KIDNEY 01/11/2018

LEARNING OBJECTIVES:
 Discuss the function of Kidney, nephron and excretory system
 Trace the blood flow through the nephron and state the physiologic functions that occur.
 Discuss the process of glomerular ultra filtration, Renin-angiotensin-aldosterone system.
 Explain the function of antidiuretic hormone in the concentration of urine.
 Explain the laboratory procedures used to evaluate glomerular filtration,tubular reabsorption and secretion
and renal blood flow.
Kidney:
 Contains 1 to 1.5 million functional units called Nephrons.
o Two types of nephrons
o 1. Cortical nephrons= 85% of nephrons, removal of waste products and reabsorption of nutrients
in blood
o 2. Juxtamedullary nephrons= ability to concentrate urine
 Reddish, kidney bean-shaped organs, typical size of adult kidney is 10-12cm, 5-7cm wide and 3cm thick.
Functions of kidney
1. Regulation of blood ionic composition. Regulate several ions sodium, potassium, calcium, chloride,
phosphate ions.
2. Regulate blood pH. Excrete variable amount of Hydrogen ions (H+) in urine and conserve bicarbonate
ions (HCO3-).
3. Regulation of blood volume. by conserving or eliminating water in the urine
4. Regulation of blood pressure. by the activation of Renin-angiotensin-aldosterone pathway.
5. Maintenance of blood osmolarity. Kidney maintains a relatively constant blood osmolarity close to 300
milliosmoles per liter (mOsm/L)
6. Production of Hormones. Kidney produce 2 hormones: 1.) Calcitriol= active form of vitamin D, regulate
calcium homeostatis. 2.) Erythropoietin= stimulates the production of RBC.
7. Regulation of blood glucose level.
8. Excretion of wastes and foreign substances Pathway of urine drainage

1. collecting duct
2. papillary
RENAL BLOOD FLOW: duct 3-4. minor calyx
 The human kidneys receive approximately 25% of the and major calyx
5. renal pelvis
blood pumped through the heart at all times
1. Blood enters the capillaries of the nephron through 6. Ureter
afferent arteriole.
2. Flows through the glomerulus and into the
Efferent arteriole. 7. Urinary Bladder
3. Before returning the renal vein, the blood from the
efferent arteriole enters the peritubular capillaries
and vasa recta
4. Flows slowly through the cortex and medulla of the kidney.
5. Peritubular capillaries immediately reabsorb of essential substances from the fluid in proximal
convoluted tubule.
6. In the distal convoluted tubule wherein the final adjustment of urine compositions.
7. The vasa recta, which located along with the ascending and descending loop of henle is the major
exchange of water and salts take place between the blood and the medullary interstitium (osmotic
gradient)
8. Ends in the collecting duct.
9. Total renal blood flow= 1200mL/min.
10. Total renal plasma flow= 600-700 mL/min.
To produce urine, nephrons and collecting ducts perform three basic processes
GLOMERULAR FILTRATION:
 The water and most solutes in blood plasma move across the wall of glomerular capillaries, where they
are filtered and move into the glomerular capsule and to renal tubule.
 Glomerulus consist of approximately 6-8 coils of capillary lobes, the walls which referred as glomerular
filtration barrier.
 The daily volume of glomerular filtrate in adults is 150 liters in females and 180 in males.
WEEK 1:RENAL PHYSIOLOGY AND FUNCTION OF THE KIDNEY 01/11/2018

 More than 99% of the glomerular filtrate returns to the bloodstream via tubular reabsorption, so only 1-2
liter is excreted as urine.
Glomerulus serves as a nonselective filter of plasma substances 0.07-0.1um diameter. This size permits all
solutes in blood plasma to exit glomerular capillaries but prevents filtration of blood cells and platelets.

Figure 1: factors affecting the glomerular filtration in renal corpuscle

Plasma filtrate must pass through three glomerular filtration:


1. Capillary wall membrane
2. Basement membrane (Basal lamina)
3. Visceral epithelium of bowman’s capsule.

 The capillary wall contains pores and fenestrated which increased the capillary permeability from 0.07-0.1um
diameter, the blood plasma and small size protein can exit the glomerulus but not the Blood cells and
platelets.
 In basement membrane (basal lamina): further restriction of large molecules occurs as the filtrate passes
through in the thin membrane filtration slits called Podocytes.
o It repels the positive charge molecule pass through the layer barrier. And it permits the passage of
molecules having a diameter smaller than 0.006-0.007um i.e., (water, glucose, vitamins, amino
acids, plasma protein, ammonia, urea and ions. THE BARRIER CALLED “SHIELD OF
NEGATIVITY”.
o While the albumin does not pass through easily since the albumin is positive charge and the
diameter of albumin is 0.007um slightly too big to get through

 In the glomerular pressure, the presence of hydrostatic pressure resulting from the smaller size of the
efferent arterioles and the glomerular capillaries enhance the filtration which maintained by the
“JUXTAGLOMERULA APPARATUS”.
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM.

 The RAAS regulates the flow of blood to and within the glomerulus. The system changes in blood
pressure and plasma sodium content that are monitored by juxtaglomerular apparatus.
Sequence of pathway:
1. The juxtaglomerular cells secrete enzyme Renin into the blood.
2. The renin will bind to angiotensinogen (10AA), which synthesized by hepatocytes and form into product
angiotensin I.
3. The angiotensin I cliff of two more amino-acid , the angiotensin-converting enzyme (ACE) which
converts the angiotensin I to Angiotensin II (active form)
Result:
A. It decreases the glomerular filtration rate by causing the vasoconstriction of the afferent arterioles.
WEEK 1:RENAL PHYSIOLOGY AND FUNCTION OF THE KIDNEY 01/11/2018

B. Enhance the reabsorption of (Na, Cl and water in the proximal convoluted tubule by stimulating the
activity of electrolyte antiporters.
C. Stimulates adrenal cortex to release aldosterone to reabsorb more sodium and chloride and secrete more
potassium.
D. Release ADH, which regulates the water reabsorption by increasing the permeability of cells in collecting
ducts.

TUBULAR REABSORPTION:

 Body cannot lose 120 ml of water-containing essential substances


every minute.
 The plasma ultrafiltrate enters the proximal convoluted tubule,
the nephrons, through cellular transport mechanisms, begin
reabsorbing these essential substances and water.
 Active transport: the substance to be reabsorbed must combine
with a carrier protein contained in the membranes of the renal
tubular cells.
 Passive transport: movement of molecules across a membrane
as a result of differences in their concentration or electrical
potential on opposite sides of the membrane called Gradient.
 the renal threshold for glucose is 160-180mg/dL.
“Glucose appearing in the urine of a person with normal blood glucose level is the result of tubular damage and
not diabetes mellitus. A non-fasting patient with high glucose intake would not have a norm0al blood glucose”
RENAL CONCENTRATION:

 Begins in the descending and ascending loops of henle.


 Filtrate is exposed to the high osmotic gradient of the renal medulla.
 Water is removed by osmosis in descending loop of henle.
 Sodium and chloride are reabsorbed in ascending loop.
 Excessive reabsorption of water as the filtrate passes through the highly concentrated medulla.
 Reabsorption process called “Countercurrent mechanism” which serves to maintain the osmotic
gradient of medulla.
 Maintenance of osmotic gradient is essential for the final concentration of the filtrate when it reaches the
collecting duct.
 Reabsorption of sodium continues in the distal convoluted tubule.
COLLECTING DUCT CONCENTRATION:

 Concentration of the filtrate through the reabsorption of water begins in the distal convoluted tubule and
ends in collecting duct.
 ADH, hormones that regulates the permeability of water to the walls of tubules.
WEEK 1:RENAL PHYSIOLOGY AND FUNCTION OF THE KIDNEY 01/11/2018

TUBULAR SECRETION:

 Tubular secretions serves two major functions:


 Eliminating waste products not filtered by the glomerulus
 Regulation of acid-base balance in body through secretion of hydrogen ions.
 Foreign substances ie. Medication cannot be filtered by glomerulus due to bound to plasma proteins.
o They develop strong affinity for the tubular cells and dissociate from their carrier proteins
 The major site for removal of these nonfiltered substances is PROXIMAL CONVOLUTED TUBULES.

ACID-BASE BALANCE:
 Normal blood pH 7.35-7.45
 The secretion of hydrogen ions (H+) by the renal tubular cells into the filtrate prevents the filtered
bicarbonate from being excreted in urine.
 This process almost 100% reabsorption of filtered bicarbonate and occurs primarily in the Proximal
convoluted tubules.
 In the proximal convoluted tubules, ammonia is produced from the breakdown of the amino acid
glutamine.
 Ammonia reacts with the H+ to form ammonium ion (NH4+).
o Resulting ammonium ions is excreted in urine.
 Distal convoluted tubule and Collecting duct also produce ammonium ions
 Any distruption leads to metabolic acidosis or renal tubular acidosis, inability to produce an acid urine.