• Renal system

• Dr. Surekha Kamath

• MMMC, Manipal
Renal System

14.1a
 Kidneys
• Situated in the posterior part of abdomen.
• Each weighs about 150 gm.
• At the hilus-ureters, renal arteries, renal veins,
nerves and lymph vessels either enter or leave the
kidney.
• Total blood flow of about 1200 ml/min.
 Functions of the kidney
1. Homeostasis
• Regulation of ECF osmolarity and volume
(electrolyte & water balance)

2. Long term regulation of blood pressure

3. Excretion of metabolic waste products

• Urea, Uric acid & Creatinine
• Also excretes foreign substances (pesticides,
chemicals)
4. Acid-base balance
• Regulates the pH of body fluids

5. Endocrine functions
• 1. Erythropoietin
• Erythropoiesis
• 2. Renin
• Blood pressure regulation
• 3. Active form of Vitamin D 3 (calcitriol )
• Calcium absorption from GIT
 Kidneys

Renal Cortex Renal

Pyramid
Renal Medulla
Hilum
Renal Pelvis
Renal Artery

Minor Renal Vein

calyx

Major Ureter
calyx

pyramids → minor calyx→ major calyx→ pelvis→ ureter

• Nephrons
• Structural and functional unit of kidneys
• 1 million nephrons in each kidney

• Two main parts of nephrons are

a. renal corpuscle
b. renal tubules
Parts of Nephron Glomerulus
The renal corpuscle in turn is made up of + Bowmans
a. tuft of capillaries capsule =
Renal
(glomerulus) Corpuscule
b. Bowman’s capsule
• Renal tubules are
composed of
• c. Proximal convoluted
tubule (PCT)
• d. Loop of Henle (LH)
• e. Distal convoluted
tubule (DCT)
• f. Collecting duct (CD).
 Bowman’s capsule
Distal convoluted
tubule Glomerulus

Connecting tube Proximal convoluted

tubule

NEPHRON

Thick ascending limb of

the Loop of Henle
Descending limb of
Thin ascending limb of the Loop of Henle
the Loop of Henle

Bowman’s capsule +
Collecting Duct the glomerulus =
Renal Corpuscle
 Types of
nephrons

• Cortical nephrons • Juxtamedullary

nephrons
• Comprises 85% of total
nephrons • Comprises 15% of total
nephrons
• Glomeruli in the • Glomeruli in the
outer portion of juxtamedullary
renal cortex region of the cortex
• Short loops of Henle • Longer loop of Henle
 Juxtaglomerular Apparatus (JGA)
• Is a specialized region of a nephron
• Afferent arteriole & DCT comes into direct
contact with each other
 Lacis cells
Efferent capillaries
Arteriole

Macula densa
Distal
tubule
Afferent
Arteriole
Components
Juxtaglomerular cells
1. Juxtaglomerular cells - afferent arteriole
2. Macula densa - DCT
3. Lacis cells
 1. Juxtaglomerular cells (afferent arteriole)
• Secretes Renin
• Stimuli for release of renin
• Sympathetic nerve stimulation
• ↓Renal perfusion pressure

Afferent
arteriole
• Renin helps in the formation of Angiotensin II
Action of Ang II is to maintain BP
 2. Macula densa
• Initial part of DCT
• Senses NaCl concn in
distal tubule

• NaCl concn in distal

tubule
• Afferent arteriole
constrict
• ↓GFR
 Lacis cells

• Has contractile power

• Alters GFR
RENAL CIRCULATION
Blood Flow in the Kidneys
Special features of renal circulation
1. Very high blood flow compared to other
organs
• Kidneys receives 1.2-1.3L of blood per
min.
• 25% of cardiac output

2. Uneven distribution of blood flow

• Cortical blood flow is more than medulla
3. High pressure system
• Renal artery is a direct branch of
abdominal aorta
4. Vasa recta
Longest
capillaries
present in the
body.
5. Autoregulation
 Autoregulation
• RBF remains constant when Mean arterial
blood pressure is between 90- 220mm Hg
 Questions
1. List functions of kidney
2. Define nephron. Draw and label its parts.
3. Define nephron. Name the types of nephron.
4. List 2 differences between cortical and
juxtamedullary nephrons
5. Draw and label JGA. mention its components.
List its functions.
6. List any FOUR special features of renal
circulation. Explain any TWO.
 Mechanism of urine formation
Efferent peritubular capillaries
arteriole

glomerulus 2.
1. 3.
Bowman’s capsule
 Glomerular Filtration
Barrier

Capillary endothelial cell

Basement membrane
Bowman’s capsule
epithelial cell
(podocyte)
1. Endothelium of
glomerular capillary
• Fenestrated
2. Basement membrane
• Glycoprotein negatively
charged
• Barrier to protein
filtration
3. Epithelial cell layer of
Bowmans capsule
• Podocytes that form
filtration slits
 Glomerular Filtration
• Passive process
• Ultrafiltration
• Free from proteins
and formed elements
• Rich in water and
electrolytes
 GLOMERULAR FILTRATION RATE(GFR)
• Volume of plasma filtered
from glomerulus into
bowman's capsule of all the
nephrons in both the
kidneys per minute.

• In an average adult human

the GFR is about
125ml/min.
 Factors governing the GFR
1. Permeability of the filtration membrane

2. Surface area available for filtration

3. Effective or net filtration pressure

 1.Permeability of the filtration
membrane
• 1. Size of the molecule
• Freely allow the neutral substance with
diameter upto 4nm
• 2. Charge of the substance
• Retards the passage of negatively
charged molecule
• Facilitates positively charged molecule
 2. Surface area available for filtration

• Directly proportional to GFR

• Decrease in surface area
• ↓ GFR
 3. Effective filtration Pressure
• EFP= Forces favoring filtration- Forces opposing
filtration
• Forces favoring filtration
• P GC the hydrostatic pressure in glomerular
capillaries
•  BC is the colloidal osmotic pressure (exerted by
proteins) in the Bowman’s capsule
• Forces opposing filtration
• P BC is the hydrostatic pressure in the Bowman’s
capsule
•  GC is the colloidal osmotic pressure (exerted by
the plasma proteins present) in the capillary blood
Glomerular Capillary Hydrostatic Pressure (PGC)

• Favours filtration Efferent

arteriole
• 45 mmHg
PGlom
• Renal artery is a direct
branch of Abdominal aorta

Afferent
arteriole
 Glomerular Capillary colloidal osmotic Pressure (πGlom)

Efferent
• Opposes filtration arteriole

• Due to proteins in the glomerular

capillary plasma.
πGlom

• 25 mmHg
Liver disease

Malnutrition
Afferent
arteriole
 Bowman’s Capsule Hydrostatic Pressure (PGlom)

Efferent
arteriole
• Opposes filtration
PBow
•10 mmHg

• Obstruction in renal tubules Afferent

arteriole
Bowman’s Capsule colloidal osmotic Pressure
(πBow)
• Favours filtration Efferent
arteriole

• [protein] in Bowman’s
capsule is negligible

πBow

Afferent
arteriole
 3. Effective filtration Pressure/ Net
filtration Pressure
• Driving force which favors filtration

• EFP/ NFP = Forces favoring filtration- Forces opposing

filtration
• (PGC +  BC ) – (PBC + GC)

• EFP=[(45+0)-(10+25)]

• EFP =[(45)-(35)]

• EFP = 10mmHg
 Factors influencing/affecting the GFR
1. Permeability of the filtration membrane
2. Surface area available for filtration
3. P GC the hydrostatic pressure in glomerular
capillaries (45 mmHg)
4. P BC is the hydrostatic pressure in the Bowman’s
capsule (10 mmHg)
5.  GC is the colloidal osmotic pressure (exerted
by the plasma proteins present) in the capillary
blood (25mmHg)
6.  BC is the colloidal osmotic pressure (exerted
by proteins) in the Bowman’s capsule(0mmHg)
Inulin clearance as a measure of
GFR
• Inulin, a polymer of fructose which is
injected intravenously,
–freely filtered across glomerulus
–Not reabsorbed
–Not secreted
Amount filtered = Amount excreted
 Creatinine clearance
• Creatinine clearance is used to estimate GFR
in clinical practice.
• Breakdown product of skeletal muscle
metabolism.
• Produced endogenously, an intravenous
infusion is unnecessary
• Filtered and secreted
• 140ml/min
 Questions
1. Draw a labeled diagram of filtrating membrane
or glomerular filtration barrier.
2. Define GFR. Give the normal value.
3. List four factors affecting GFR. Describe any
two.
4. Name the substance of choice for the
measurement of GFR. Give reasons for the
same.
5. Describe why inulin is used to measure GFR?
6. Describe why creatinine is used to measure
GFR?
 Mechanism of urine formation
Efferent peritubular capillaries
arteriole

glomerulus 2.
1. 3.
Bowman’s capsule
 Secretion
• Transport of substances
from the blood vessel to
the tubular lumen.
• Cells of proximal, distal
and collecting ducts
secrete Reabsortion
• H+ and K+
Secretion
 Tubular Reabsorption
• Transport of water and
solutes from the tubular
lumen to the blood vessel.
• All organic nutrients are
reabsorbed
• Water and ion Reabsortion
reabsorption is
hormonally controlled
Reabsorption by PCT Cells
 Reabsorption by PCT cells
• Glucose, amino acids and
HCO3- , K+, sodium
• Glucose and amino acids
are reabsorbed (100%) by
secondary active transport
mechanism
• 60%-70% of filtered solutes
(Na+) and water
 Glucose reabsorption
• Similar to glucose reabsorption in the intestine
• Glucose is reabsorbed (100%) along with
sodium in PCT.
• Secondary active transport.
 Glucose reabsorption
• Glucose and Na+ bind to common carrier
• Sodium moves along with electrochemical
gradient
• Sodium moves out of the cells by Na+-K+ ATPase
• Glucose is transported by glucose transporter
 Na+ Reabsorption

• PCT: 67% of filtered

sodium is reabsorbed
using glucose
• Secondary active transport
mechanism

• Collecting tubules: 3% is
regulated by aldosterone
 Na+ Reabsorption
• Collecting tubules: 3%
Na+ reabsorption is
regulated by aldosterone
• Source: Adrenal cortex
• Stimulus; ↓ Na+ in
plasma
• Action: Reabsorption of
sodium from CD
 Water Reabsorption
• 180L of fluid is filtered through glomeruli per
day.
• But average daily urine volume is only 1-1.5L.
• Regulator of water output is Vasopressin
(ADH) acting on collecting ducts.
 ADH
• Vasopressin
• Source: Secreted from posterior pituitary
• Stimulus: ↓ ECF volume/ ↑ ECF osmolarity
• Action: Increases water reabsorption from DCT
and collecting duct
• 15% of filtered water is removed
• Concentrated urine
• Obligatory water
reabsorption
• 60%-70% of water
reabsorption in PCT
• Water reabsorption is
due to osmosis i.e.
water is “following”
solutes

• Facultative water
reabsorption
• 15% water reabsorption
in the collecting ducts
• is based on need and is
regulated by ADH
 Diabetes insipidus
• Lack of ADH
• Diabetes (excessive urination)
• Insipidus (tasteless)

• Polyuria
• Polydipsia (Excessive thirst)
• Tubular load

• Amount of
solute
delivered in to
tubule per
minute.
• GFR X Conc. of
substance in
plasma.
 Tubular maximum for glucose(Tmg) /
Transport maximum

• Maximum capacity
of the nephrons to
reabsorb glucose
from the filtrate.
• TmG 325-
375mg/min
 Renal threshold
• Concentration of glucose in plasma above which
it starts appearing in urine.
• Renal threshold for glucose = 180mg/100ml.

• Glycosuria
1. Define tubular load.
2. Define tubular maximum. Give the Tm for glucose
3. Define renal threshold. Give the renal threshold for
glucose.
4. Name four substances reabsorbed by the PCT.
5. Define tubular reabsorption and secretion. Name one
substance each for the same.
6. Describe glucose reabsorption in the renal tubules
7. Describe sodium reabsorption in renal tubules.
8. Describe water reabsorption in renal tubules.
9. Describe obligatory and facultative water reabsorption.
10. Describe diabetes insipidus.
 Concentration of urine
• Countercurrent mechanism

• Hyperosmotic medullary interstitium

• Antidiuretic hormone
 Countercurrent mechanism
• A counter-current system is a
system in which the inflow
runs parallel to, counter to and
in close proximity to the
outflow for some distance.
• This flow occurs for both the
loop of Henle and the vasa
recta.
• Counter current multiplier-
LOH
• Counter current exchanger-
Vasa recta
 Hyperosmotic medullary interstitium (MI)
Factors contributing in genesis of medullary
osmotic gradient

1. Active transport of sodium, potassium

and chloride ions out of thick ascending
limb of LOH into MI.
2. Ascending limb is impermeable to
water.
3. Diffusion of large amounts of urea from
inner medullary collecting ducts in to
MI.
 Countercurrent Multiplier- Loop of Henle

1. The osmolarity is 300mOsm/L in thin descending

limb, thick ascending limb & Medullary interstium
2. Thick ascending limb pumps 100mOsm/L of Na+,
Cl- from tubular fluid into the MI. This increases
MI osmolality to 400mOsm/L.
3. Water then moves out of the descending limb and
its content equilibrates with MI
 Countercurrent Multiplier- Loop of Henle

5. Next fluid containing 300mOsm/L continuously

enters descending limb from PCT

6. Hypertonic fluid flows from descending limb of

LOH  to thick ascending limb of LOH 
hypotonic fluid flows into DCT
 Countercurrent Multiplier- Loop of Henle

The Final Medullary

Osmotic Gradient 300 300 100
450 450 250
600 600 400

Permeable to H2O 750 750 550 Impermeable

H2O 900 900 700 to H2O

1050 1050 850 Na+/ K+/ Cl-

No Na+, K+ or Cl- transport
1200 1200 1000
transport
1200 1200 1000 NaCl

7. The process keep repeating and finally develops a osmotic

gradient top to bottom of LOH (300mOsm/L to 1200 mOsm/L)
 The Vasa recta
• Counter current exchanger

• The Maintenance of
the Medullary
Osmotic Gradient
 The Vasa recta
1. Blood flow is poor
• (if it is fast-It will remove the
actively expelled solutes)
2. Blood vessels is also U shaped
• Descending limb of vasa recta
loses water and gains solutes
• Ascending limb loses solutes
and gains water
 ADH (Antidiuretic Hormone)

• Increases water permeability of DCT &

collecting duct (CD)
• Concentrated urine

• In the absence of ADH → DCT & CD is

impermeable to water
• Dilute urine
1. Describe the counter current mechanism of
kidney / Describe the mechanism of
concentration of urine.

2. Describe the role of counter current

multiplier in the formation of urine

3. Describe the role of counter current

exchanger in the formation of urine
 Micturition
• Periodic complete
emptying of urinary
bladder

• Voluntary control in
adults
• Spinal reflex
• Facilitated or inhibited by
higher centers
 Innervation
• Autonomic nerves
• Sympathetic-hypogastric
nerves
• Parasympathetic - Pelvic
nerves

• Somatic nerves
• Pudendal nerves
 Cystometrogram
• A graphic record of pressure-volume
relationship in a urinary bladder
 Cystometrogram
• Ia--First urge to void at 150ml, slight in pressure
• Ib—Flat segment, Law of Laplace P=2T/R
• Pressure in a spherical viscus is equal to twice the
wall tension divided by radius
• II--- Sudden sharp rise in pressure as micturition
reflex is triggered at about 400ml of bladder
volume
• Micturition Reflex
• Stimulus: Distension of urinary bladder
• Receptors: Stretch receptors in bladder wall
• Afferent nerve: pelvic, hypogastric and pudendal
nerves
• Centre: Sacral spinal cord , cerebral cortex
• Efferent Nerves: Pelvic and Pudendal nerves
• Effectors: Contraction of detrusor muscle,
relaxation of internal and external urethral
sphincter
• Effect: Emptying of bladder
 Structure of Skin
Hair Sebaceous Erector Receptors
follicle gland muscle
Epidermis

Dermis

Subcutaneous fat Blood capillaries

Nerve fibres
 Functions of skin
1. Protective function
Mechanical barrier
Prevents micro organisms invading the body
Protects body against infections & UV radiation
2. Regulation of body temperature
by secreting sweat
Alteration in skin blood flow
Ability to transfer heat from one part to other
 Functions of skin
3. Sense organ
Has many types of receptors
Touch, pressure, pain , temperature
4. Endocrine function
Endogenous production of Vit D3
5. Excretory function
Secretes sweat
Salt, fatty substances get excreted
1. Describe the nerve supply to the bladder.
2. Describe cystometrogram.
3. Describe the micturition reflex
4. List the functions of skin.