FUNCTIONS OF THE URINARY SYSTEM

a. Excretion - kidneys are the major excretory organs of the body. They remove waste products from the
blood that are mostly toxic. Other products include metabolic by-products of cells and substances.
b. Regulation of blood volume and pressure - the kidneys are a major role in the control of the
extracellular fluid volume in the body by the means of urine.
c. Regulations of the concentration of the solutes in blood - the kidneys help in regulating the
concentration of major molecules and ions such as sodium, potassium and calcium.
d. Regulation of extracellular fluid pH - the kidneys excrete variable amounts of hydrogen to regulate pH.
e. Regulation of RBC synthesis - kidneys secrete a hormone called erythropoietin that regulates the
synthesis of RBC in the red bone marrow.
f. Regulation of Vitamin D synthesis - kidneys control blood levels of calcium by regulation the synthesis
of vitamin D.

KIDNEY ANATOMY AND HISTOLOGY

- Typical kidney size is 10-12 cm long and 3 cm thick; size of a bar soap
- Bean-shaped organs

Renal hilum or hilus - indention of the kidney where the ureter emerges from the kidney along with the
blood and lymphatic vessels and the nerves.

LAYERS OF TISSUE
a. Renal Capsule - smooth, transparent sheet of dense irregular connective tissue. This serves as the
kidneys barrier against any trauma and helps maintain its shape.

b. Adipose Capsule - mainly a mass of fatty tissue. This also protects the kidney and holds it firmly within
the abdominal cavity.

c. Renal Fascia - thin layer of dense irregular connective tissue that anchors the kidney to other structures
inside the abdominal cavity and to the abdominal wall.

REGIONS

1. Renal Cortex - light red area; smooth textured area.

It is divided into an outer cortical zone and an inner juxtamedullary zone.
Renal Columns - portions that extend between renal pyramids.
Renal Lobe - consists of a renal pyramid and ½ of each adjacent renal column,
2. Renal Medulla - darker reddish-brown inner region.
This consists of cone-shaped renal pyramids. The base of each pyramid faces the renal cortex
and its apex that is called renal papilla points toward the renal hilum. A funnel-shaped structure
called calyx surrounds the tip of each renal pyramid. The calyces from all the renal pyramids join to
form a larger funnel called the renal pelvis that narrows to form a small tube called the ureter that
exits the kidney and connects to the urinary bladder.

The functional unit of a kidney is a nephron, each consists of a renal corpuscle, proximal
convoluted tubule, loop of Henle and a distal convoluted tubule.
 A Renal corpuscle consists of the Bowman capsule which consists of the enlarged end of the nephron
which is indented that forms a double-walled chamber. The inner layer of the Bowman capsule consists of
specialized cells called podocytes while the outer layer consists of squamous epithelial cells. Also found
inside the renal corpuscle is the glomerulus that is a tuft of capilliaries that lies within the indention of the
Bowman capsule.

ARTERIES AND VEINS

Renal Arteries branch off the abdominal aorta and enter the kidneys. The interlobar arteries pass between
the renal pyramids and give rise to the arcurate arteries which arch between the cortex and the medulla.
Afferent arterioles arise from the branches of the interlobular arteries and xctend to the globular capilliaries.
Efferent arterioles extend from the glomular capilliaries to the peritubular capilliaries which surround the
proximal convoluted and distal convoluted loops of Henle.
Vasa Recta are specialized portions of the peritubular capillaries.
Juxtaglomuerular Apparatus is formed where the distal convoluted tubule comes in contact with the afferent
arteriole next to the Bownman capsule.

URINE PRODUCTION
The primary function of the kidney is regulation of body fluid composition. The kidney is the organ that
sorts the substances from the blood for either removal in the urine or return to the blood. Substances that are
waste products, toxins, and excess materials are permanently removed from the body, whereas other
substances need to be preserved to maintain homeostasis. The structural components that perform this sorting
are the nephrons, the functional units of the kidney.
Urine is a produced by filtration, tubular reabsorption, and tubular secretion.

FILTRATION
The first step of urine production, 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 then into the renal
tubule.

● Filtration Membrane
- permits filtration of water and small solutes but prevents filtration of most plasma proteins, blood
cells, and platelets
- Substances filtered from the blood cross three filtration barriers
- glomerular endothelial cell:
- quite leaky because they have large fenestrations
- permits all solutes in blood plasma to exit glomerular capillaries
- prevents filtration of blood cells and platelets
- Located among the glomerular capillaries and in the cleft between afferent and efferent
arterioles are mesangial cells
- Basal lamina
- a layer of acellular material between the endothelium and the podocytes
- consists of minute collagen fibers and proteoglycans in a glycoprotein matrix
 - Pedicles
- wrap around glomerular capillaries
- The spaces between pedicels are the filtration slits.
- A thin membrane, the slit membrane, extends across each filtration slit
- it permits the passage of molecules having a diameter smaller than 0.006–0.007 micrometer,
including water, glucose, vitamins, amino acids, very small plasma proteins, ammonia, urea,
and ions.

● Net Filtration Pressure

- Glomerular filtration depends on three main pressures. One pressure promotes filtration and two
pressures oppose filtration

1. Glomerular blood hydrostatic pressure (GBHP)

- blood pressure in glomerular capillaries
- It promotes filtration by forcing water and solutes in blood plasma through the filtration
membrane
2. Capsular hydrostatic pressure (CHP)
- hydrostatic pressure exerted against the filtration membrane by fluid already in the capsular
space and renal tubule
- CHP opposes filtration and represents a “back pressure”
3. Blood colloid osmotic pressure (BCOP),
- which is due to the presence of proteins such as albumin, globulins, and fibrinogen in blood
plasma, also opposes filtration.

● Glomerular Filtration Rate

- The amount of filtrate formed in all the renal corpuscles of both kidneys each minute is the
glomerular filtration rate (GFR).
- Homeostasis of body fluids requires that the kidneys maintain a relatively constant GFR.
- 125 mL/min in males and 105 mL/min in females
- The mechanisms that regulate glomerular filtration rate operate in two main ways: (1) by
adjusting blood flow into and out of the glomerulus and (2) by altering the glomerular capillary
surface area available for filtration
- Three mechanisms control GFR: renal autoregulation, neural regulation, and hormonal
regulation.
Renal Autoregulation of GFR:
- consists of two mechanisms: myogenic mechanism and tubuloglomerular feedback.

Myogenic mechanism:

- occurs when stretching triggers contraction of smooth muscle cells in the walls of afferent
arterioles.
- The myogenic mechanism normalizes renal blood flow and GFR within seconds after a change
in blood pressure.

Tubuloglomerular feedback:

- so named because part of the renal tubules—the macula densa—provides feedback to the
glomerulus
- Tubuloglomerular feedback operates more slowly than the myogenic mechanism.
Neural Regulation of GFR

- Like most blood vessels of the body, those of the kidneys are supplied by sympathetic ANS
fibers that release norepinephrine
- Norepinephrine causes vasoconstriction through the activation of alpha-1 receptors
- Lowering of renal blood flow has two consequences:
It reduces urine output, which helps conserve blood volume.
It permits greater blood flow to other body tissues.

Hormonal Regulation of GFR

- Two hormones contribute to regulation of GFR

- Angiotensin II reduces GFR: a very potent vasoconstrictor that narrows both afferent and efferent
arterioles and reduces renal blood flow, thereby decreasing GFR.
- atrial natriuretic peptide (ANP) increases GFR: Stretching of the atria, as occurs when blood volume
increases, stimulates secretion of ANP. By causing relaxation of the glomerular mesangial cells, ANP
increases the capillary surface area available for filtration. Glomerular filtration rate rises as the surface
area increases.

TUBULAR REABSORPTION

- The return of water and solutes in the filtrate to the blood.

- Nearly all (99%) of the water and solutes are rapidly returned to the blood via the renal tubules, and
because of this, toxins are quickly removed from the blood.
- These processes, such as simple and facilitated diffusion, active transport, symport, and osmosis, all
result in tubular reabsorption
- As the solutes in the renal tubule are reabsorbed, water follows the solutes by the process of osmosis
- The small volume of the filtrate that forms urine contains urea, uric acid, creatinine, K+, and other
substances

Reabsorption in the Proximal Convoluted Tubule

- The majority of reabsorption occurs in the proximal convoluted tubule.

- Reabsorption of most solutes from the proximal convoluted tubule is linked to a steep Na+
concentration gradient between the filtrate and the cytoplasm of the tubule cells.
- A basal surface, which forms the outer wall of the tubule; and lateral surfaces, which are bound to the
surfaces of other cells of the tubule.
- Active transport of Na+ across the basal membrane of the tubule epithelial cells from the cytoplasm into
the interstitial fluid creates a low concentration of Na+ inside the cells
- At the basal membrane, the sodium-potassium pump moves Na+ out of the cell and K+ into the cell
- Because the concentration of Na+ in the lumen of the proximal convoluted tubule is high, a large
concentration gradient is present from the lumen of the tubule to the cytoplasm of the tubule cells
- Carrier proteins that transport amino acids, glucose, and other solutes are located within the apical
membrane, which separates the lumen of the proximal convoluted tubule from the cytoplasm of
epithelial cells
- Carrier proteins binds specifically to one of those substances to be transported and to Na+
- The concentration gradient for Na+ provides the energy that moves both the Na+ and the other
molecules or ions from the lumen into the tubule cell.
- Once the symported molecules are inside the cell, they cross the basal membrane of the cell by
facilitated diffusion or symport.
- Some solutes also diffuse from the lumen of the proximal convoluted tubule into the interstitial fluid by
moving between the cells.
- As other solutes are transported out of the lumen, through the proximal convoluted tubule cells, and
into the interstitial fluid, water follows by osmosis.
- The reabsorption of water causes the concentration of solutes that remain in the lumen to increase
- Reabsorption of solutes and water in the proximal convoluted tubule is extensive
- As solute molecules are transported from the tubule to the interstitial fluid, water moves by osmosis in
the same direction.
- By the time the filtrate has reached the end of the proximal convoluted tubule, its volume has been
reduced by approximately 65%.

Reabsorption in the Loop of Henle

- As the filtrate from the proximal convoluted tubule moves toward the loop of Henle, the wall of the
tubule undergoes a histological change
- As the loop of Henle descends into the medulla of the kidney, the wall transforms from simple cuboidal
epithelial tissue to simple squamous epithelial tissue in the thin segment.
- Thus, the thin segment of the descending limb of the loop of Henle is highly permeable to water.
- It is moderately permeable to urea, Na+, and many other ions.
- Because the thin segment of the descending limb is so permeable to water and somewhat permeable
to solutes, water leaves this portion of the tubule by osmosis and some solutes move into this portion of
the loop of Henle.
- By the time the filtrate has reached the end of the thin segment of the descending limb, the volume of
the filtrate has been reduced by another 15%, and the concentration of the filtrate is equal to the high
concentration of the interstitial fluid
- The thin segment of the ascending limb of the loop of Henle is permeable to solutes but impermeable to
water
- The ascending limb of the loop of Henle is surrounded by interstitial fluid, which becomes less
concentrated toward the cortex.
- As the filtrate flows through the thin segment of the limb, solutes diffuse into the interstitial fluid, making
the filtrate less concentrated.
- As we follow the filtrate through the loop of Henle, we see that it becomes very concentrated toward the
bend of the loop of Henle, but the concentration of the filtrate is reduced by the time the fluid reaches
the distal convoluted tubule.

Reabsorption in the Distal Convoluted Tubule and Collecting Duct

- The reabsorption of these solutes is generally under hormonal control and depends on the current
conditions of the body.
- The distal convoluted tubule and the collecting duct are not always permeable to water.
- Hormone regulation can change the permeability of the distal convoluted tubule and the collecting duct.
- Reabsorption of water is via osmosis across the wall of the distal convoluted tubule and the collecting
duct when the hormone ADH is present.
- ADH causes the tubule wall to become more permeable to water.
 - When ADH is absent, the distal convoluted tubule and collecting duct are not permeable to water and
water stays in the filtrate.

Changes in the Concentration of Urea and Other Solutes in the Nephron

- One of the nephron’s major functions is to remove wastes from the body
- urea, a protein breakdown product, enters the glomerular filtrate at the same concentration as in the
plasma.
- Because renal tubules are not as permeable to urea as they are to water, urea tends to stay inside the
tubules.
- These substances are toxic if they build up in the body, so their accumulation in the filtrate and
elimination in urine help maintain homeostasis.

TUBULAR SECRETION

- the movement of nonfiltered substances from the blood into the filtrate.
- As with tubular reabsorption, tubular secretion can be either active or passive.

URINE CONCENTRATION MECHANISM

- The vasa recta, the loop of Henle, and the distribution of urea are responsible for the concentration
gradient in the medulla. The concentration gradient is necessary for the production of concentrated
urine.
- Production of urine:
- In the proximal convoluted tubule, Na+ and other substances are removed by active transport. Water
follows passively, filtrate volume is reduced 65%, and the filtrate concentration is 300 mOsm/L.
- In the descending limb of the loop of Henle, water exits passively and solute enters. The filtrate volume
is reduced 15%, and the osmolality of the filtrate concentration is 1200 mOsm/kg.
- In the ascending limb of the loop of Henle, Na+, Cl− , and K+ are actively transported out of the
filtrate, but water remains because this segment of the renal tubule is impermeable to water. The
osmolality of the filtrate concentration is 100 mOsm/kg.

REGULATION OF URINE CONCENTRATION AND VOLUME

Urine
- Can be dilute or very concentrated
➢ - Can be produced in large or small amounts

Filtrate reabsorption in the proximal convoluted tubules and the descending limbs of loops of Henle:
- obligatory and remains relatively constant

Filtrate reabsorption in the distal convoluted tubules and collecting ducts:

- tightly regulated and can change dramatically depending on body’s exposure to varying conditions
 · When homeostasis requires elimination of large volume of dilute urine, the dilute filtrate pass through
the distal convoluted tubules and collecting ducts.
· If water must be conserved to maintain homeostasis, water is reabsorbed from the filtrate as it passes
through the distal convoluted tubules and collecting ducts → very concentrated urine

Mechanisms that maintain the kidney’s extracellular fluid and keep the urine concentration and volume within
narrow limits:
1. Autoregulation and the sympathetic nervous system
2. Hormonal Mechanisms
Two major hormones involved in regulating urine concentration and volume:
o Renin-angiotensin-aldosterone hormone mechanism
§ Sensitive to changes in blood pressure
o Antidiuretic hormone (ADH) hormone mechanism
§ Sensitive to changes in blood osmolality

Renin-Angiotensin-Aldosterone Hormone Mechanism

Renin – enzyme secreted by the juxtaglomerular cells of the juxtaglomerular apparatus.
· Macula densa cells signals juxtaglomerular cells to secrete renin when Na+ concentration of the filtrate
drops → Juxtaglomerular cells detect reduced stretch of the afferent arteriole → drop in afferent arteriole
pressure → secrete renin àrenin enters the blood → converts to angiotensinogen (plasma protein produced
by the liver) → angiotensin I → Angiotensin-converting enzyme (ACE) produced by the capillaries of organs
to convert angiotensin I to angiotensin II

Angiotensin II
- vasoconstricting hormone, which increases peripheral resistance causing blood pressure to increase.
- Rapidly broken down (effects lasts only for a short time)
- Increases rate of aldosterone secretion, sensation of thirst, salt appetite, and ADH secretion.
· Rate of renin secretion decreases if blood pressure in the afferent arteriole increases, or if the Na+
concentration of the filtrate increases as it passes by the macula densa of the juxtaglomerular apparatuses
· Large decrease in the concentration of Na+ in the interstitial fluid acts directly on the aldosterone-
secreting cells of the adrenal cortex to increase the rate of aldosterone secretion. Angiotensin II is much
more important than the blood level of Na+ for regulating aldosterone secretion

Aldosterone
- Steroid hormone secreted by the cortical cells of the adrenal glands
- Passes through the blood from adrenals glands to the cells in the distal convoluted tubules and the
collecting ducts
- Diffuse through plasma membranes and bind to receptor molecules within cells
- Aldosterone + receptor molecule = increased synthesis of the transport proteins that increase the
transport of Na+ across the basal and apical membranes of the tubule cells → rate of Na+ reabsorption
increases
- Reduced secretion of aldosterone decreases the rate of Na+ reabsorption → The concentration of Na+
in the distal convoluted tubules and the collecting ducts remains high → concentration of filtrate has a
greater-than-normal concentration of solutes → water’s capacity to move by osmosis from the distal
convoluted tubules and collecting ducts is diminished → urine volume increases, and the urine has a greater
concentration of Na+
- Increase in blood K+ levels act directly on the adrenal cortex to stimulate aldosterone secretion, and
vice versa.

Antidiuretic Hormone Mechanism

Vasopressin - absence of ADH makes distal convoluted tubules and collecting ducts remain relatively
impermeable to water

ADH
- Secreted from the posterior pituitary
- Produced by the neurons of the supraoptic nucleus of the hypothalamus
Osmoreceptor cells
o Cells in the supraoptic nucleus
o Very sensitive to even slight changes in the osmolality of the interstitial fluid
· If the osmolality of the blood and interstitial fluid increases, osmoreceptor cells stimulate ADH-secreting
neurons → action potentials are then propagating along the axons of the ADH-secreting neurons to the
posterior pituitary gland → axon release ADH from their ends
· Reduced osmolality of the interstitial fluid within the supraoptic nucleus inhibits ADH secretion from the
posterior pituitary gland

Little ADH secretion → 19% of the filtrate that is normally reabsorbed in the distal convoluted tubules and
collecting ducts becomes part of urine.

Insufficient ADH secretion: Diabetes insipidus

- Diabetes; production of large volume of urine
- Insipidus; urine is clear, tasteless, and dilute
- 10-20 L of urine per day → dehydration and ion imbalances
Diabates mellitus
- Production of large volume of urine that contains high concentration of glucose

Baroreceptors
- Monitor blood pressure in the atria of the heart, large veins, carotid sinuses, and aortic arch
- Influence ADH secretion when blood pressure changes by more than 5-10%
- Reduced stretch of the blood vessel – decrease in blood pressure → causes the baroreceptor to send
lower frequency of action potentials to the hypothalamus along afferent pathways (pathway terminate in the
supraoptic nucleus of the hypothalamus) → hypothalamus secretes more ADH

· ADH secretion is also stimulated by elevated blood osmolality

· ADH secretion → increased water reabsorption by the distal convoluted tubule when blood osmolality
increases or when blood pressure declines → Water reabsorption lowers blood osmolality & increases blood
volume, which elevates blood pressure
· ADH secretion declines → blood osmolality decreases or when blood pressure goes up → causes the
kidneys to reabsorb less water and to produce a larger volume of dilute urine → greater loss of water in the
urine → raises blood osmolality and lowers blood pressure
· ADH secretion occurs in response to small changes in osmolality, whereas a substantial change in
blood pressure is required to alter ADH secretion. Thus, ADH is more important in blood osmolality than it
is in regulating blood pressure.

Production of Concentrated Urine

Filtrate passes through the loops of Henle → Filtrate enters the distal convoluted tubules → Near the ends of
the distal convoluted tubules and in the collecting ducts, the walls of the tubules become very permeable to
water, ADH is present → filtrate passes through the collecting ducts → water diffuses from the lumens of the
distal convoluted tubule and collecting duct into the more concentrated interstitial fluid
· ADH increases the permeability of the apical membranes of the distal convoluted tubules and collecting
ducts to water by binding to membrane-bound receptors → activates a G protein mechanism that increase
cAMP synthesis inside these cells
· cAMP (Cyclic AMP)
o promotes the insertion of aquaporins into the apical membrane
· Aquaporins
o Water channel proteins that increase apical membrane’s permeability to water
o Different forms of Aquaporins:
§ Aquaporin-3 and Aquaporin-4
· Basal membrane in the cells of the distal convoluted tubules and collecting
ducts
· Sensitive to ADH
· Provide channels for water to exit from the collecting duct cells into the
interstitial fluid
§ Aquaporin-2
· Regulate water movement into the cells
· In cells that have not been exposed to ADH, the Auqaporin-2 are found in
the vesicles in the cytoplasm.

· In response to ADH, the increased cAMP initiates the incorporation of the membranes of vesicles
containing aquaporin-2 channels into the apical membrane.
· ADH is present → water moves by osmosis out of the distal convoluted tubules and collecting ducts
· ADH is absent → water remains in the distal convoluted tubules and collecting ducts to become urine
· Abnormal aquaporin-2 genes: excessive urine production because these genes code for abnormal
aquaporin-2 molecules that do not function normally. Thus, the number of functional aquaporins decreases,
and water remains in the renal tubule.
 · Filtrate flows into the distal convoluted tubules and collecting ducts → pass through the kidney medulla
with high concentration of solutes → If ADH is present, water moves by osmosis from the distal convoluted
tubules and the collecting ducts into the interstitial fluid
· By the time the filtrate has reached the end of the collecting ducts, another 19% of the filtrate has been
reabsorbed. Thus, 1% of the filtrate remains as urine, and 99% of the filtrate has been reabsorbed. The
osmolality of the filtrate at the ends of the collecting ducts is approximately 1200 mOsm/kg
· Waste products, such as creatinine and urea, and excess ions, such as K+, H+, phosphate, and
sulfate, are at a much higher concentration in urine than in the original filtrate because water has been
removed from the filtrate.
· The processes of reabsorption and secretion are selective so that, in the end, beneficial substances
are retained in the body and toxic substances are eliminated.

Production of Dilute Urine

· ADH is not present: the distal convoluted tubules and collecting ducts are less permeable to water →
dampens water reabsorption

· Concentration of urine produced: less than 1200 mOsm/kg and the volume is increased
· Volume of more dilute urine can be much larger than 1% of the filtrate formed each day.
· If no ADH is secreted, the osmolality of the urine may be close to the osmolality of the filtrate in the
distal convoluted tubule, and the volume of urine may approach 20–30 L/day, which is the same volume as
10–15 2-liter soda bottles per day

· Healthy person – kidneys produce dilute urine, the concentration of waste products in the urine is large
enough to maintain homeostasis.

· Beneficial substances are retained, and both toxic substances and excess water are eliminated

Other Hormones
ANH (atrial natriuretic hormone)
- Produced by right atrial cardiac muscle cells when they are stretched more than normal
· Increased stretch of the right atrium: occurs when blood volume is higher than usual
- ANH decreases blood volume through inhibition of Na+ reabsorption in the kidney tubules
- Also inhibits ADH secretion from the posterior pituitary gland
- Increased ANH secretion → increase volume of urine produced → lower blood pressure and blood
pressure
- Dilates arteries and veins → reduces peripheral resistance and lowers blood pressure
- Thus, venous return and blood volume decrease in the right atrium

PLASMA CLEARANCE AND TUBULAR MAXIMUM

GFR
● Measured to determine plasma clearance when kidney function is declining
Plasma clearance
● Calculated value representing the volume of plasma that is cleared of a specific substance each minute
Example: If the clearance value is 100 mL/min for a substance, the substance is completely removed
from 100 mL of plasma each minute

● Can be used to estimate GFR if the appropriate substance is monitored

Characteristics of such substance:
○ It must pass through the filtration membrane of the renal corpuscle as freely as water or other
small molecules
○ Must not be reabsorbed
○ Must not be secreted into the renal tube
○ Must not be either metabolized or produced in the kidneys
Inulin - non physiological polysaccharide that has these characteristics

● As filtrate forms, it has the same concentration of inulin as plasma; however, as the filtrate flows
through the renal tubule, all the inulin remains in the tubule lumen to enter the urine. As a
consequence, all the volume of plasma that becomes filtrate is cleared of inulin, and the plasma
clearance for inulin is equal to the rate of glomerular filtrate formation
● GFR reduced : kidney fails
● GFR indicate degree of kidney damage

● Clearance value of urea and creatinine can also be used clinically

○ Advantage of using these substances: they are naturally occurring metabolites, so foreign
substances do not have to be injected.
○ High plasma concentration and a lower-than-normal clearance value for urea and creatinine :
reduced GFR and kidney failure
○ Creatinine clearance: used to monitor the progress of GFR changes in people experiencing
kidney failure
○ Plasma clearance can also be used to calculate renal plasma flow
■ Substances with the following characteristics can be used:
● The substance must pass through the filtration membrane of the renal corpuscle
● It must be secreted into the renal tubule at a sufficient rate that very little of it
remains in the blood as the blood leaves the kidney
Para-aminohippuric acid (PAH) meets these requirements
● All the PAH is either filtered or secreted into the renal tubule as the blood flows through the
kidney
● Clearance circulation of the PAH: a good estimate of the volume of plasma flowing through the
kidney each minute
● If the hematocrit is known, the total volume of blood flowing through the kidney each minute can
be calculated easily

● Plasma clearance can be used to determine how drugs or other substances are excreted by the
kidney
● High plasma clearance than the inulin clearance suggests that the substance is secreted by the
tubule into the filtrate.
Tubular load
● Total amount that passes through the filtration membrane into the renal tubule each minute
● Glucose is almost completely reabsorbed from the tubule by active transport
 ● Tubule’s capacity to actively transport glucose across the epithelium is limited
● Excess glucose remains in the urine if the tubular load is greater than the tubule’s capacity to reabsorb
it

Tubular maximum
● The maximum rate at which as substance can be actively reabsorbed.
● Determined by the number of active transport carrier proteins and the rate at which they are able to
transport molecules of the substance
● Example: people who have diabetes mellitus, the tubular load for glucose can exceed the tubular
maximum by a substantial amount, thus allowing glucose to appear in the urine
● Urine volume is also greater than normal because the glucose molecules in the filtrate increase the
osmolality of the filtrate in the tubule and reduce the effectiveness of water reabsorption by osmosis.

URINE MOVEMENT

Urine is formed when the blood reaches the malpighian corpuscle that is composed of the Bowman's capsule
and glomerulus. Here most of the blood plasma is filtered out into the Bowman's capsule. Glomerular filtrate
is taken down the proximal convoluted tubule (PCT). Most of the water, glucose and amino acids are
reabsorbed here. Active as well as passive reabsorption occurs here. The resulting fluid passes down the loop
of Henle . Electrolytes like Na+ and K+ are reabsorbed here. All the absorbed materials enter the peritubular
capillaries.
The fluid then passes on to the distal convoluted tubule (DCT). Tubular secretion takes place here. This fluid
then passes on to the collecting duct where the tissues reabsorb some urea from it. A lot of water gets
reabsorbed along collecting duct and urine becomes concentrated.
Several such collecting ducts meet to pour their fluids - now known as urine - into the Papillary duct, also
known as duct of Bellini .Papillary ducts open at the apex of renal pyramid where urine gets collected in minor
calyx, later in major calyx. Calyces open in pelvis , located inside hilum of kidney.Pelvis gives rise to duct like
outlet called ureter which travels out of kidney through hilum. The ureter of each side meets the urinary
bladder and pours urine into it.
When the bladder is full, the stretch receptors come to work and send the signal to brain and we feel the urge
to micturate. The outlet that travels from bladder is called urethra . There are sphincters to control opening of
urethral opening to void urine outside the body.
EFFECTS OF AGING ON THE KIDNEYS

Changes in the kidneys that occur with age:

● Amount of kidney tissue decreases.

● Number of filtering units (nephrons) decreases. Nephrons filter waste material from the blood.
● Blood vessels supplying the kidneys can become hardened. This causes the kidneys to filter blood more
slowly.
Changes in the bladder:

● The bladder wall changes. The elastic tissue becomes tough and the bladder becomes less stretchy. The
bladder cannot hold as much urine as before.
● The bladder muscles weaken.
● The urethra can become blocked. In women, this can be due to weakened muscles that cause the bladder
or vagina to fall out of position (prolapse). In men, the urethra can become blocked by an enlarged prostate
gland.
Aging increases the risk of kidney and bladder problems such as:

● Bladder control issues, such as leakage or urinary incontinence (not being able to hold your urine), or
urinary retention (not being able to completely empty your bladder)
● Bladder and other urinary tract infections (UTIs)
● Chronic kidney disease