Renal Physiology V & VI

Ritchie B. Rebong, MD
Other Functions of the kidney
Erythropoiesis
• Erythropoietin
– 90 % of erythropoietin is formed in the kidneys
– Remainder formed mainly in the liver
– It is not known exactly where in the kidneys are
formed
– The site of EPO production within the kidney is in
the interstitial cells of the renal cortex near the
base of the proximal tubule cells.( Brenner
Vitamin D
RAAS
Renin is synthesized and stored in
an inactive form
called prorenin in the
juxtaglomerular cells (JG cells)
of the kidneys.

Arterial pressure falls in the

Kidneys

prorenin molecules
in the JG cells to split and release
Renin
 Filling of Urinary Bladder
•URETERS
•Regular peristaltic contractions
occurring one to five times per
minute move the urine from the
renal pelvis to the bladder

•The ureters pass obliquely

through the bladder wall

•the oblique passage tends to

keep the ureters closed except
during peristaltic waves,
preventing reflux of urine from
the bladder.
 Urinary Bladder Emptying
• smooth muscle of the bladder, like that of the ureters,
is arranged in spiral, longitudinal, and circular bundles
• detrusor muscle
– Contraction is mainly responsible for emptying the
bladder during urination (micturition).
• internal urethral sphincter
– Muscle bundles pass on either side of the urethra
• External urethral sphincter
– sphincter of skeletal muscle; the sphincter of the
membranous urethra;located further along the urethra
• Micturition
– fundamentally a spinal reflex facilitated and
inhibited by higher brain centers and subject to
voluntary facilitation and inhibition
• Urine enters the bladder

The first urge to void is felt at a bladder volume of about 150 mL

marked sense of fullness at about 400 mL

During micturition:
• the perineal muscles and external urethral sphincter are relaxed
• the detrusor muscle contracts
• and urine passes out through the urethra
Micturition
• The bands of smooth muscle on either side of
the urethra play no role in micturition, and
their main function in males is believed to be
the prevention of reflux of semen into the
bladder during ejaculation.
 Voluntary Urination
• Mechanism remains unsettled
initial events is relaxation of the muscles of the pelvic floor

may cause a sufficient downward tug on the detrusor muscle to
initiate its contraction

perineal muscles and external sphincter can be contracted
voluntarily, preventing urine from passing down the urethra
or interrupting the flow once urination has begun
• After urination, the female urethra empties by
gravity.
• Urine remaining in the urethra of the male is
expelled by several contractions of the
bulbocavernosus muscle.
 Reflex control
• stretch receptors in the bladder wall initiate a
reflex contraction
• afferent limb of the voiding reflex
– Fibers in the pelvic nerves
• efferent limb
– parasympathetic fibers to the bladder
– Also travel in the pelvic nerves
• The reflex is integrated in the sacral portion of
the spinal cord
• the volume of urine in the bladder that normally
initiates a reflex contraction is about 300 to 400
mL
• The bladder can be made to contract by voluntary
facilitation of the spinal voiding reflex.
• Voluntary contraction of the abdominal muscles
aids the expulsion of urine by increasing the
intra-abdominal pressure
• Voiding can be initiated without straining even
when the bladder is nearly empty
 Edema
• refers to the presence of excess fluid in the
body tissues
• edema occurs mainly in the extracellular fluid
compartment, but it can involve intracellular
fluid as well.
 Intracellular Edema
• 2 conditions prone to cause intracellular
• swelling:
• (1) depression of the metabolic systems of the
tissues
• (2) lack of adequate nutrition to the cells.
cell membrane ionic pumps become depressed

sodium ions that normally leak into the interior of
the cell can no longer be pumped out of the
cells

excess sodium ions inside the cells cause osmosis
of water into the cells
• Sometimes this can increase intracellular volume of a tissue area—even of an
entire ischemic leg, for example—to two to three times normal.
 Extracellular Edema
• 2 general causes
– (1)abnormal leakage of fluid from the plasma to
the interstitialspaces across the capillaries
– (2) failure ofthe lymphatics to return fluid from
the interstitium back into the blood.
• The most common clinical cause of interstitial
fluid accumulation is excessive capillary fluid
filtration.
Lymphatic blockage causes edema
• plasma proteins that leak into the interstitium
have no other way to be removed.
• The rise in protein concentration raises the
colloid osmotic pressure of the interstitial fluid
– Draws even more fluid out of the capillaries.
Causes of extracellular edema
 Edema caused by heart failure.
Heart fails to pump blood normally from the
veins into the arteries

 venous pressure and capillary pressure,
 increased capillary filtration
• In addition, the arterial pressure tends to fall, causing
decreased excretion of salt and water by the kidneys

•  blood volume and further raises capillary hydrostatic
pressure to cause still more edema
 Edema caused by heart failure.
• Diminished blood flow to the kidneys stimulates

secretion of renin

Angiotensin II and increased secretion of aldosterone

both additional salt and water retention by the kidneys
Edema caused by decreased kidney
excretion of salt and water
• Kidney diseases that compromise urinary
excretion of salt and water, large amounts of
sodium chloride and water are added to the
extracellular fluid.
• The main effects
– (1) widespread increases in interstitial fluid
volume (extracellular edema)
– (2) hypertension because of the increase in blood
volume
Edema caused by decreased plasma
proteins
• Fall in the plasma colloid osmotic pressure
• e.g. nephrotic syndrome
– Loss of protein in the urine
• e.g. Liver cirrhosis
– Decrease production of plasma protein
 Edema fluid in the potential spaces is
called effusion.
• Potential Spaces
– abdominal cavity
– Pleural cavity
– Pericardial cavity
– Joint spaces