Renal

 Kidneys are capable of generating

vitamin D in the body. This is
primarily done by the skin on
exposure to sunlight. Should the skin

Anatomy and fail, however, the duty falls to the liver,

should the liver fail the kidney takes
over.

Physiology
Analysis of Urine and other Body Fluids
Mr. Charles Villaceran

URINARY SYSTEM OR EXCRETORY THE KIDNEYS AND THE PROCESS OF

SYSTEM URINE FORMATION
 Kidneys Anatomy of the Kidneys
o Where the urine is formed
 Ureters  Bean – shaped paired organs
o Carry the urine to the bladder  Adult male
o 150g each
 Urinary Bladder
o Stores the urine  Adult female
o 135g each
 Urethra
o Delivers the urine for excretion  Renal Cortex
outside the body o Outer portion of kidney
o Reabsorption/filtration
KIDNEY  Renal Medulla
 Each kidney contains approximately 1 to o Innermost part
1.5 million functional units called o Regulate concentration of
nephrons. urine
 Most human beings are born with 2  Renal Pelvis
kidneys. However, if one of the kidneys o Gives way to renal calyces
is taken out, the body only loses 25% of  Renal Artery Renal Vein
kidney function. o Responsible for getting the
 Due to hypertrophy, the remaining blood from kidneys
kidney continues to sustain the body.
THE KIDNEYS AND THE PROCESS OF
 For children born with renal agenesis
URINE FORMATION
(i.e. one kidney), the lone kidney grows
till it has the combined weight of two.  Nephrons
 Aplasia o Functional units of kidney
o the other kidney is premature or o 1 to 1.5 million in each kidney
not yet developed, in other terms o PARTS:
you have only one functioning  Glomerulus or Renal Corpuscle
kidney.  Proximal Convoluted Tubule
 Hypoplasia or PCT
o your other kidney is not the  Descending Loop of Henle
same size as the other  Ascending Loop of Henle

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  Distal Convoluted Tubule or
DCT
 Collecting duct or CD
 Cortical Nephrons
o Seen in the cortex alone
o For tubular reabsorption and
secretion
o Make up 85% of nephrons
 Juxtamedullary Nephrons
o Loops of Henle extend into the
Medulla for concentration of the
urine
THREE MAJOR PROCESSES:
 Glomerular filtration
 Tubular reabsorption
 Tubular secretion
 Glomerular Filtration
o Filters the blood
 Proximal convoluted tubule reabsorbs
some solutes then secretes the rest
 Descending loop of Henle is water
permeable absorbs water
 Ascending loop of Henle is water
impermeable absorbs salts, chloride,
magnesium, calcium and potassium,
excrete urea, doesn’t absorb water.
 Distal convoluted tubule body
 The difference between Proximal
convoluted tubule and distal convoluted
tubule is that distal convoluted tubule
secretes potassium while proximal
convoluted tubule still tries to absorb
potassium.
 Collecting ducts is the site for tubular
secretion and for the meantime the
major reabsorption of your water and
sodium
 When there is water there is sodium
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RENAL FUNCTION
 Renal Blood Flow
o Urine formation is dependent on
renal blood flow
 Glomerular Filtration
o Process of filtering blood to form
and ultrafiltrate
 Tubular Reabsorption
o Returning of filtered substances
back to the blood
 Tubular Secretion
o Passage of non-filtered
substances to the blood for
excretion
RENAL BLOOD FLOW
 Waste products of metabolism are
moved from the circulatory system to
the urine and excreted from the body
via the kidney
 Without the proper blood volume and
pressure, urine cannot be formed
 Take Note of the DIRECT
RELATIONSHIP between Kidney’s
Functional Ability and Its Blood
Supply
 25% of Cardiac Output
 Blood Flows in the Kidney thru:
 Afferent Arterioles
Glomerular Filtration
o Carries blood to the glomerulus
 Efferent Arterioles
o Carries blood from the
glomerulus
o Has a smaller size to maintain
glomerular pressure
 Peritubular Capillaries
o The capillaries that are
responsible for reabsorption,
and are attached to the
proximal convoluted tubule.
o Surround the PCT and DCT
 Vasa recta
o Located adjacent to the loops
of Henle in the juxtamedullary
nephrons
 Glomerular Filtration
o Process of filtering blood to
form an ultrafiltrate
 Tubular Reabsorption
o Returning of filtered
substances back to the blood
 Tubular Secretion
o Passage of non-filtered
substances to the blood for
excretion
SLIDE TO REMEMBER!!!
 Total Renal Blood Flow
o 1,200 mL/min
 Total Renal Plasma Flow
o 500-700 mL/min
RENAL FUNCTIONS
 Happens in the glomerulus
 Coil of 8 capillary lobes
 Located within Bowman’s Capsule
(renal capsule and glomerulus)
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 Non-selective filter/sieve of plasma
substances with molecular weight of
<70,000
 Albuminuria is bad that means your
filters are damage
 Factors Affecting Filtration Process
o Cellular structure of the
glomerulus
o Hydrostatic and oncotic
pressures
o Feedback mechanisms of the
renin angiotensin aldosterone
system
o Filtration rate
 is 120mL/minute (or ⅕ of
renal plasma flow) as a
result of the glomerular
mechanism
Glomerular Pressure
1. Glomerular capillary pressure, the
blood pressure within the glomerulus
moves fluid from the blood into
bowman’s capsule
2. Capsular pressure, the pressure inside
bowman’s capsule moves fluid from the
capsule into the blood
3. Colloid osmotic pressure, produced by
the concentration of blood proteins,
moves fluid from bowman’s capsule
into blood by osmosis
4. Filtration pressure is equal to the
glomerular capillary pressure minus the
capsular and colloid

 Autoregulatory Mechanism:
Juxtaglomerular Apparatus
o Decrease in Blood Pressure >
DILATION of the afferent
arterioles
o Increase in Blood Pressure >
 Podocytes
CONSTRICTION of the afferent
o finger like processes inside
arterioles
glomerulus
o The purpose of your podocyte is RENAL FUNCTIONS
to repel large particles (i.e.
proteins)  Renin-Angiotensin-Aldosterone-
System (RAAS)
 Shield of negativity
o Controls the regulation of blood
o Term describing the impediment
flow to and within the glomerulus
produced by negatively charged
o JUXTAGLOMERULAR
components (e.g. proteoglycans)
of the glomerular filtration barrier APPARATUS
o Present of both sides of and
throughout the filtration barrier
o Effectively limit the filtration of
negatively charged substance from
the blood (e.g., albumin) into the
urinary spaces

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 Blood Pressure Varies Depending on:
o Body position
o Breathing  Glomerular Filtration
o Food and drink o The Glomerular Ultrafiltrate:
o Medications  Same composition as blood
o Physical conditions but is free of plasma protein,
o Stress any protein-bound
o Time of day substances and cells
 Conditions that causes low blood  Specific Gravity: 1.010
pressure  This proves that urine is
o Pregnancy chemically an
o Heart and heart valve conditions Ultrafiltrate of Plasma
o Hormone-related diseases Tubular Reabsorption
(endocrine disorders)
o Dehydration  Substances removed from the filtrate
o Severe infection are returned to the blood
o Severe allergic reaction  Reabsorption Mechanisms
(anaphylaxis) o Active Transport
o Lack of nutrients in diet  A carrier protein in the
membrane of the renal
tubular cells is involved
 Products:
 Glucose, amino acids,
salts – PCT
 Chloride – ascending
loop of Henle

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  Sodium – DCT
o Passive Transport
 Movement of molecules
across a membrane as a
result in the difference in
their concentration gradients
 Products:
 Water- all parts of the
nephron except
ascending loop of Henle
 Urea- PCT and
ascending loop of Henle
 Sodium- ascending loop
of Henle
 Urine Concentration
o Tubular Concentration
o Collecting Duct Concentration
MAJOR SITE OF REABSORPTION
 Proximal Convoluted Tubule (PCT)
o Accounts for 65%
o With brush border of microvilli
which provides a large surface
area for reabsorption and
secretion
 Renal Threshold
o Plasma concentration at which
active transport stops
o GLUCOSE RENAL
THRESHOLD
 160-180 mg/dl
 Fluid leaving the proximal convoluted
tubule has the same concentration as the
ultrafiltrate (specific gravity: 1.010)
 ⅔ of reabsorbed sodium is
accompanied by passive reabsorption of
the same amount of WATER
 Urine Concentration
o Begins in the descending and
ascending loops of Henle
o Filtrate is exposed to the high
osmotic (salt) gradient of the
medulla
o Counter Current Mechanism
 Selective reabsorption
 Water is removed via
osmosis in descending
loop of Henle
 Na and Cl are reabsorbed
in the ascending loop of
Henle
 Filtrate leaving ascending loop is
diluted
 Final concentration begins in the late
distal convoluted tubule and continues
in the collecting ducts
 Reabsorption of water and sodium in
the distal convoluted tubule and
collecting ducts is controlled by
hormones
Previously “Antidiuretic Hormone (ADH)”
RENAL FUNCTIONS
 Aldosterone
o Responds to the body’s need for
SODIUM
o Produced and released from the
adrenal cortex
o Promotes sodium reabsorption
in the DCT and Potassium
Secretion
 Antidiuretic Hormone/ADH or
Vasopressin
o Responds to body’s state of
hydration
o Produced in the hypothalamus
and released by posterior
pituitary gland
o Makes the walls of the DCT and
CD permeable to water
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Tubular Secretion
 Passage of substances from the blood
to the filtrate for excretion
 Serves 2 major functions
o Elimination of waste products not
filtered by the glomerulus
o Regulation of the acid-base
balance thru secretion of hydrogen
ions
 H+ secreted in exchange for
bicarbonate ions in the PCT
 Secreted H+ combines with a
filtered phosphate ion and is
excreted
 Secreted H+ combines with
ammonia produced by distal
convoluted tubule to form
ammonium ion which is then
excreted

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  <0.5 mL/kg/hr in children
 <400mL/day in adults
 Seen in dehydration as a
result of excessive water loss
from vomiting, diarrhea,
perspiration or severe burns
o Anuria- cessation of urine flow
 May result from any serious
damage to the kidneys
 Or from a decrease in blood

Physical flow to the kidney

Examination
o Nocturia
 Increase in nocturnal
excretion of urine

of Urine
o Polyuria- increase in daily urine
volume
 2.5-3 mL/kg/day in children
Analysis of Urine and other Body Fluids  >2/5L/day in adults
Mr. Charles Villaceran  Often associated with
diabetes mellitus and
PHYSICAL/MACROSCOPIC insipidus
EXAMINATION  May be artificially induced
 Volume by diuretics, caffeine or
 Color alcohol (suppress the
 Clarity secretion of ADH)
 Specific Gravity
 Odor
URINE VOLUME
 Affected by
o Fluid intake
o Fluid loss from non-renal sources
 Outside kidney
o Variations in ADH
o Necessity to excrete increased
amounts of dissolved solids such as
glucose or salts
 Normal Duty Output
o 600 to 2000 mL (average of 1200-
1500mL)
 Variations
o Oliguria- decrease in urine
output
 <1mL/kg/hr in infants

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 Normal urine has a wide range of
color: mainly determined by its
concentration
o Pale yellow
 Dilute urine
o Dark yellow
 Concentrated urine
 Examine the specimen under a good
light source, looking down through the
container against a white background
 Normal urine color: pale yellow,
yellow, dark yellow and amber
 Urine Pigments:
o Urochrome
 Cause the yellow color of
urine
 Named by thudichum in
1864
o Uroerythrin
 A pink pigment most
evident in refrigerated
specimens as a result of
amorphous urates
precipitation
o Urobilin
 Oxidation product of
urobilinogen and imparts and
orange brown color to urine
that is not fresh
URINE COLOR
 Abnormal Urine Color
o Dark Yellow/Amber/Orange
 Bilirubin
 Produces a yellow foam
when specimen is shaken
vs white foam in
increased protein
concentration
 Urobilin
 When urobilinogen is
photo-oxidized (no
yellow foam when
shaken) vs photo-
oxidation of bilirubin
which imparts a yellow
green color
 Medications
 Phenazopyridine
(pyridium) or azo -
gantrish compounds -
also causes yellow foam
when shaken which can
be mistaken for bilirubin
o Red/Pink/Brown
 Red Blood Cells
 Produce red and cloudy
urine
 Imparts red color
(usual) to brown color
depending on the amount
of blood, urine pH and
length of contact
 Rbc’s remaining in
acidic urine for several
hours produce brown
urine (due to oxidation
of hemoglobin to
methemoglobin)
 Hemoglobin and
Myoglobin
 Produced red and clear
urine
 Porphyrins
 Causes port-wine color
and results from the
oxidation of
porphobilinogen
 Non-pathologic causes:
 Menstrual
contamination
 Ingestion of highly
pigmented foods
o Beets: red color in
alkaline urine
o Blackberries: red
color in acidic
urine
 Medications
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  Rifampin,  Oxidation product of the
phenolphthalein, colorless pigment
phenindione, melanogen
phenothiazines  Medications
 Levodopa, methyldopa,
phenol derivatives,
metronidazole (flagyl)
o Blue/Green
 Bacterial infection:
 green color
 Urinary tract infection by
pseudomonas spp
 Intestinal tract infections
resulting in increased urinary
indication
 Clorets: a breath
deodorizer which imparts a
green color
 Medications: may cause blue
urine
 Methocarbamol (robaxin),
methylene blue,
amitriptyline (elavil), azure
A (diagnex blue test)
CLARITY

 Refers to the transparency/turbidity of

a urine specimen
 Determined by visually examining the
urine container while holding it in front
of a light source
 Normal clarity: usually clear
(particularly if midstream clean-catch
specimen)

o Brown/Black
 Homogentisic Acid
 Metabolite of
phenylalanine
 Imparts black color to
alkaline urine in
alkaptonuria
 Melanine

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  Maple syrup urine disease (MSUD)
o Maple Syrup
 Methionine malabsorption
o cabbage, hops
 Phenylketonuria
o Mousy
 Trimethylaminuria
o Rotting Fish
 Tyrosinemia
 Nonpathological Turbidity o Rancid
o Squamous epithelial cells and
 Lack or odor
mucus (particularly in women)
o Acute Tubular Necrosis
o Bacterial growth in improperly
preserved specimens
o White cloudiness: precipitation of
amorphous phosphates and
carbonates SPECIFIC GRAVITY AND OSMOLALITY
o Pink brick dust: precipitation of
amorphous urates due to presence  Used to measure the concentrating and
of uroerythrin diluting ability of the kidney in its
o Semen effort to maintain homeostasis in the
o Fecal contamination body
o Radiographic contrast media  Tubular reabsorption:
o First function to diminish renal
o Talcum powder
disease
o Vaginal creams
 Normal urine specific gravity
 Pathologic Turbidity
o Random:
o RBC’s, WBC’s bacteria or yeast
 1.003 to 1.035
cells
o 24 hour:
o Bacteria causes uniform turbidity
 1.015 to 1.025
that cannot be cleared by filtration
 Specific gravity < 1.003
o Abnormal amounts of squamous
o probably not urine
epithelial cells
o probably water
o Abnormal crystals
o Lymph fluid  Specific gravity > 1.035
o radiographic contrast media
o Lipids
 Variations:
ODOR o Isosthenuria
 Fixed gravity of 1.010
 Normal
 Seen in end-stage renal
o faint, aromatic odor
disease
 Bacterial overgrowth o Hyposthenuria
o ammoniacal, fetid odor  Consistent specific
 Amino disorders gravity <1.010
 Isovaleric acid and glutaric acidemia o Hypersthernuria
o Sweaty Feet  Specific gravity >1.010
 Measurements can be made through

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 o Urinometer (hydrometer)
 Large volume of urine
o Refractometer
o HOD (harmonic oscillation
densitometry
o Reagent strips
REFRACTOMETER
URINOMETER
 Directly measure specific gravity at
room temperature
 Minimum volume of urine:
o 15mL
 A correction of 0.001 should be made
for each 30C above (+) or below (-) the
calibration temperature (about 200C)
OSMOLALITY
Corrections Needed for Glucose and Protein
 Subtract 0.003 for every 1g/dl of
protein
 Subtract 0.004 for every 1g/dl of
glucose
 Example:
o Specimen containing 2 grams of
protein and 3 grams of glucose has
a specific gravity of 1.030
 1.030 - 0.006 (protein) = 1.024 - 0.012
(glucose)
 = 1.012 corrected specific gravity
 Principle:
o measures the refractive index
which is a comparison of the
velocity of light in air with the
velocity of light in a solution
o Refractive index of a solution is
related to the content of dissolved
solid present
o Calibrated between 150 to 380
o Advantages:
 Uses small volume of urine
 Temperature correction not
necessary
 Indicates the number of particles of
solute per unit of solution
 Normal adult with normal fluid
intake:
o 500 - 850 mOsm/kg water
 Method:
o freezing point depression
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 A solution containing 1 osmol or 1000
mOsm/kg water depresses the freezing
point 1.86 celsius below the freezing
point of water

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