Urinalysis and Body Fluids

Unit 2
Renal Physiology
Objectives

Unit #2-Lecture 2

Lecture Objectives: Upon completion of this class material each student will be able to do the
following:

1. List the 4 functions of the urinary system

2. State the location of the kidneys
3. Diagram the sections of the kidney
4. List the parts of the urinary bladder for the male
5. List the parts of the urinary bladder for the female
6. Describe the differences of the urinary bladder between the male and female, include smooth muscle
and length
7. List the parts of the urethra for a man
8. List the functions of the urinary bladder
9. Evaluate the functional unit of the kidney
10. List the correct number of nephrons in each kidney
11. Analyze the normal functions of the kidney
12. Describe the functions and regulation of the renin-angiotensin-aldosterone system to include
feedback mechanisms
13. Describe the functions of ADH and the factors that influence its release
14. Describe the factors that stimulate the release of aldosterone
15. Describe how aldosterone is released
16. Compare the filtrate allowed to enter the Bowman’s Capsule with the plasma contents
17. List the molecules that are osmotically active in the kidney
18. Evaluate the function of the ascending loops of henle
19. Evaluate the function of the descending loops of henle
20. Describe the two functions of the PCT
21. Compare the salt concentration in the PCT, loops of henle, and DCT
22. Compare the functions of the collecting, connecting and convoluted portions of the DCT to include
regulation of water and release of hormones
23. List the two types of nephrons
24. Describe the two types of nephrons and how they are different from each other
25. Describe the juxtaglomerular apparatus and its importance to include feedback mechanism
26. Describe what the juxtaglomerular apparatus is composed of and describe them
27. Describe how the body would compensate for a decreased blood pressure, decreased GFR, and a
decreased Chloride reabsorption
28. Describe the filling and emptying of the bladder to include receptors and transitional epithelial cells
29. List two chemicals that lead to an increased urinary output

Reading: Chapter 3, Renal Function, Urinalysis and Body Fluids by Strasinger

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 Renal Physiology
Unit 2b

I. The Urinary System

A. Function of the Urinary System
1. Removal of waste through urine production
2. Electrolyte balance
3. Control blood volume and blood pressure
4. Production and secretion of hormones

B. Location of the Kidney

The location is retroperitoneal (behind the peritoneum and outside the peritoneal
cavity) on either side of the vertebral column. They are embedded in a small
amount of fat. The medial side of the kidney has an indentation that blood vessels
enter and exit from.

C. Sections of the Kidney

Cortex
Medulla
Pelvis
Ureter
Urinary bladder

D. Parts of the Urinary Bladder

1. Male
a. Body (fundus)
b. Neck (posterior urethra
c. Urethra (Anterior urethra)
2. Female
a. Body (fundus)
b. Neck (posterior urethra)
*The female does not contain an anterior urethra, the neck opens to the outside.
The urethra in a male is long and later becomes part of the tissue to the penis.
3. Urethra of the Male
a. Prostatic
b. Membranous
c. Cavernous

E. Functions of the Urinary Bladder

1. Hold urine

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 2. Excrete urine (micturition)

II. Kidney
The functional unit is the nephron. There are approximately 2-2.5 million nephrons
combined in both kidneys, but we only need a portion for our kidney to function. All
nephrons start in the cortex of the kidney.

A. Types of Nephrons
1. Cortical
These are short and represent approximately 85% of all nephrons. Most of
this nephron is located in the cortex, but the bottom of the loop of henle is
located in the medulla.
2. Juxtamedullary
These are long and represent approximately 15% of all nephrons. The
bowman’s capsule is in the cortex, but the entire loop of henle is in the
medulla.

B. Juxtaglomerular Apparatus
This apparatus is one component of an important feedback mechanism
(tubuloglomerular feedback mechanism) that is involved in the autoregulation of `
renal blood flow and glomerular filtration rate (GFR).

The apparatus is composed of three types of cells:

Macula Densa cells
Extraglomerular mesangial cells (EGM)
Granular cells (G)

The macula densa cells contact the EGM and the granular cells of the afferent and
efferent arterioles when they sense any type of change. The granular cells are
modified smooth muscle cells that manufacture, store and release renin. Renin is
involved in the formation of angiotensin II and ultimately in the secretion of
aldosterone.

Example
BP, GFR, Cl reabsorption
These decreases, especially Cl, are detected by the Macula Densa cells of
the Juxtaglomerular apparatus. The Macula Densa will release
prostaglandins that will stimulate the Granular Cells of the afferent and
efferent to release renin into the blood and this converts Angiotensinogen
to Angiotensin I. Angiotensin I is converted to Angiotensin II by and

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 enzyme called Angiotensin Conversion Enzyme. Angiotensin II is a very
potent vasoconstrictor, which will lead to systemic vasoconstriction. This
will increase BP, GFR and Cl reabsorption. These increases will cause
renin to stop being released by the Granular cells.

III. Functions of Angiotensin II

1. Systemic vasoconstriction
2. Increased release of norepinephrine from sympathetic nerves (also a vasoconstrictor)
3. Increased release of aldosterone
a. Aldosterone effects
1. Increase Na reabsorption
2. Increase water reabsorption
3. Increase blood volume leads to increased BP
4. Releases antidiuretic hormone (ADH)
a. Increases water reabsorption
b. Increases blood volume leading to increased BP
5. Stimulate thirst centers in brain

IV. Factors that Stimulate Release of Aldosterone

Low Na level
Low Blood volume
Low cardiac output
High K level
Stress (physical or emotional)

Factors stimulate hypothalamus to secrete glomerulotrophin in the blood stream, which

will stimulate the zona glomerulosa of adrenal cortex to secrete aldosterone that will
cause increased sodium retention in the distal convoluted tubule.

V. Production of Urine
A. Primary Urine
Urine that is filtered by the glomerulus through the glomerular filter, which has
the layers:
Endothelial cells
Basement membrane
Slit pores of podocytes
The filtrate that is allowed to enter the nephron is Na, K, Cl, Ca, water, glucose
and proteins with a molecular weight of <20,000 daltons to pass. In order for
filtration to occur two factors must be met:

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 1. Hydrostatic pressure at the end of the afferent arteriole is 45 mmHg.
The hydrostatic pressure in the bowman’s capsule is 10 mmHg. The
driving force is the difference in hydrostatic pressure.
2. The osmotic pressure of blood is 25 mmHg and the osmotic pressure
in the bowman’s capsule and interstitial fluid is 0 mmHg.
**The actual driving force of glomerular filtration is the difference between
hydrostatic pressure and osmotic pressure, this is called the Starling Hypothesis.

B. Reabsorption of urine components

The primary urine reaches the Proximal Convoluted Tubules (PCT). The
molecules may be reabsorbed either transcellular (across cells) or paracellular
(between cells). The cuboidal cells of the PCT are separated from each other by a
permeable tight junction (PTJ). The cuboidal cells contain mitochondria, so the
cell can supply ATP to actively move Na. Water is permeable to the PTJ. When
the urine leaves the PCT it is isotonic in relation to the plasma.

1. Functions of the PCT

a. Reabsorption of glucose, water, sodium, etc.
b. Secretion of Hydrogen ions, waste production, metabolism,
drugs, and toxins. These byproducts are picked up by the
peritubular capillaries and distributed to the cuboidal cells and
dumped into the urine at the PCT.

C. Descending loop of Henle

The descending loop of Henle is made up of flat squamous cells that lack
mitochondria. The function of the loop is for reabsorption of water. Once the
water has been removed from the descending loop of Henle the urine will become
more concentrated or hypertonic.

D. Ascending loop of Henle

Moving into the ascending loop of Henle. The body will reabsorb Na, K, Cl from
the ascending loop of Henle. Then we go into the distal convoluted tubule (DCT)
which is divided into three parts
Convoluted
Connecting
Collecting

E. Distal Convoluted Tubule

The convoluted part of the DCT will reabsorb Na, K and Cl from the lumen.
Then on to the connecting part of the DCT which removes Ca actively. Then we

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 move on to the collecting part of the DCT which removes Na and Cl from the
lumen back into the body. Now since we have removed all these molecules: Na,
K, Cl, Ca, etc. The urine is now more hypotonic or less concentrated and ready to
be excreted.

F. Bladder
The urine in the bladder is detected by the stretch receptors because of transitional
epithelium found in the urinary bladder and sends a signal to the sympathetic
nervous system of the spinal cord saying the bladder is full or almost full. This
signal may be overridden by the parasympathetic nervous system.

G. Chemicals that lead to increased Urinary Output

1. Caffeine
Stimulates the dilation of the afferent arterioles leading to
increased glomerular filtration rate and increased urine output
2. Ethanol
Inhibits release of ADH

VI. Glomerular Filtration Rate

The glomerulus filters approximately 20% of plasma volume. The kidney receives 1580
L/day of whole blood.
Example
What is the glomerular filtration rate?
Given: Hematocrit 45%

1580 L/day (whole blood) x 0.55 (plasma volume) =

869 L/day of plasma

869 L/day x 20% = 174 L/day

This is how much plasma the glomerulus filters
Convert this to mL/min
120.8 mL/min

VII. Antidiuretic Hormone (ADH)

Secreted by the Posterior Pituitary, also called the neurohypophysis. The function of
ADH is to increase the permeability for water in the DCT and Collecting Ducts. If the
body is well hydrated, the Posterior Pituitary will not release ADH, which causes water to
be excreted into the tubules and ducts. This allows the urine volume to increase. If the
body is dehydrated, the Posterior Pituitary will release ADH, which causes water to be

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reabsorbed into the body. This causes the urine volume to decrease. ADH is associated
with the disease state Diabetes insipidus.