Renal physiology

BY Yibeltal Y.(MSc)
HO and
Dietetics students
Objectives
At the end of this lesson you are expected to:
List functions of the renal system

Discuss the components of renal system

Explain the functional structures of the nephron

Discuss blood flow through the kidney

Explain the urine formation processes

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Overview
• The kidneys represent the primary organs of
homeostasis in the regulation of both volume &
composition of body fluids & the excretion of
metabolic waste products in urine
• The kidneys are large, bean-shaped organs which lie
on the dorsal side of the visceral cavity
• They are protected by a tough fibrous coat called the
renal capsule
• Adipose (fatty) tissue surrounds the renal capsule &
cushions the kidney
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 Components of renal system
The renal system composed of

• Kidneys: formation of urine

• Ureters: transport urine from

the kidneys to the bladder

• Urinary bladder: provides a

temporary storage reservoir
for urine

• Urethra: transports urine

from the bladder out of the
body

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 Kidneys
• Bean-shaped, retroperitoneal,
located in the abdominal
cavity at the lumbar region
• The right kidney is crowded
by the liver & lies slightly
lower than the left
• Renal hilus: inlet/out let of
ureters, arteries, veins,
lymphatics and nerves
• At the top of each kidney there
is adrenal gland (suprarenal
gland)

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 Kidneys…
• On a longitudinal section of
kidney there are 2 distinct
regions, cortex & medulla
• The outer cortex surrounds
darker triangular structures
called pyramids which form
the medulla
• The inner part of the kidneys,
the renal pelvis collects the
urine from the calyces draining
it into the ureter

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 Nephron
 The basic functional unit of the kidneys
 Each kidney is made up of approximately 1 million
nephrons, consisting:
 Renal corpuscle
• Glomerulus
• Bowman’s capsule
 Renal tubules
• Proximal convoluted tubule
• Loop of Henle
• Distal convoluted tubule
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Nephron…

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 Types of Nephrons
Cortical nephrons Juxtamedullary nephrons
• 85% of nephrons, • Few in number, are located
located in the cortex in the medullary region
• Have short loop of • Have long loops of Henle
Henle that deep the medulla,
have extensive thin
• Supplied with segments
peritubular
capillaries • Supplied with vasa recta
• Involved in the • Involved in the production
formation of diluted of concentrated urine
urine
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Types of Nephrons …

Corticla nephrons

Juxtamedullary nephron

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Functions of the Urinary System
1. Filtration of the blood
• Occurs in the glomerulus of the kidney
nephron
• Contributes to homeostasis by removing toxins
or waste
2. Reabsorption of vital nutrients, ions & water
• Occurs in most parts of the kidney nephron
• Contributes to homeostasis by conserving
important materials
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Functions of the Urinary System…
3. Secretion of excess materials
• Assists filtration in removing material from the
blood
• Contributes to homeostasis by preventing build-
up of certain materials in the body (drugs,
waste, etc)
4. Activation of Vitamin D
• Active Vitamin D (D3) assists homeostasis by
important for calcium absorption
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Functions of the Urinary System…
5. Release of Erythropoietin (EPO) by the kidney
• EPO stimulates new RBC production.
• New RBC’s assist homeostasis by insuring
adequate Oxygen & Carbon dioxide transport.
6. Release of Renin by the kidney
• Renin stimulates the formation of a powerful
vasoconstrictor called Angiotensin II
• Angiotensin II assists homeostasis by causing
vasoconstriction which increases blood pressure
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Functions of the Urinary System…
7. Release of Prostaglandins
• Prostaglandins dilate kidney blood vessels
• Dilated blood vessels contribute to homeostasis
by maintaining blood flow in the kidneys
8. Secretion of H+1 & reabsorption of HCO3-1
• Eliminates excess hydrogen ions & conserves
buffer material such as bicarbonate.
• Contributes to homeostasis by controlling
acid/base conditions in body fluids
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Kidney Structures

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Kidney Structures…
 Capsule
• The outer membrane that encloses, supports and protects
the kidney
 Cortex
• The outer layer of the kidney that contains most of the
nephron, main site for filtration, reabsorption & secretion
 Medulla
• Inner core of the kidney that contains the pyramids,
columns, papillae, calyces, pelvis and parts of the nephron
not located in the cortex

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 Kidney Structures…
 Renal Pyramids
• Triangular shaped units in the medulla that house the
loops of Henle and collecting ducts of the nephron.
• Site for the counter-current system that concentrates salt
and conserves water and urea.
Renal Column
• A passageway located between the renal pyramids found
in the medulla and used as a space for blood vessels
 Nephron
• The physiological unit of the kidney used for filtration of
blood and reabsorption and secretion of materials
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Kidney Structures…
 Renal Papilla
• tip of the renal pyramid that releases urine into a calyx
 Calyx
• A collecting sac surrounding the renal papilla that
transports urine from the papilla to the renal pelvis
 Renal Pelvis
• Collects urine from all of the calyces in the kidney
 Ureter
• Transports urine from the renal pelvis to the bladder

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Blood supply to kidneys
• The kidneys receive approximately 20% of the
cardiac output (about 4 ml/min/g) one of the
highest blood flow values

• The profile of the vascular blood pressure in the

renal circulation is characteristic, with a high
capillary pressure:
• that reflects the need to support the filtering capacity of
the kidneys

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 Blood supply to kidneys…
• Renal Artery
• Transports oxygenated
blood from the heart and
aorta to the kidney for
filtration
• Renal Vein
• Transports filtered and
deoxygenated blood
from the kidney to the
posterior vena cava and
then the heart
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 Blood supply to kidneys…
Renal blood flow/RBF
• The amount of blood flow to kidney per minute
• Arterial flow into and venous flow out of the
kidneys follow similar paths

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Blood supply to kidneys…

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Capillary Beds of the Nephron
• Every nephron has two
capillary beds
• Glomerulus
• Peritubular
capillaries or Vasa
recta
• Each glomerulus is:
• Fed by an afferent
arteriole
• Drained by an
efferent arteriole
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Characteristics of the RBF
1. RBF = 1200 ml/min, or 20% of
the CO. 94% to the cortex
2. Two capillary beds: glomerulus
and peritubular capillaries
3. High hydrostatic pressure in
glomerular capillary (about 60
mmHg) & low hydrostatic
pressure in peritubular
capillaries (about 13 mmHg)
4. It is unique that glomerular
capillaries are found b/n 2
arterioles

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Nerve supply to the kidneys
• Kidneys receive sympathetic nerve supply from the last
thoracic & upper 2 lumbar segments of the spinal cord
which relay in the paravertibral and mesentric ganglia
• Sympathetic stimulation results in
Constriction of arteries & arterioles →↓RBF (α-AR effect)
 ↑Na reabsorption in renal tubules (α-AR effect)
 ↑Renin secretion by JG-cells (β-AR effect)
Dilation of efferent arterioles (β-AR effect)

• Parasympathetic supply from vagus nerve

• function is not clear so far
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 Process of urine formation
- The mechanism by which
nephrons clear the plasma of
unwanted substances is:
1. Filters the plasma through
the fenestrated glomerular
membrane into renal tubules.
2. Reabsorption of needed
substances , as the filtrate flows
through the tubules.
3. Secretion of unwanted
substances into the renal
tubules.
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 Process of urine formation…

GFR  125 ml/min, 180L/day, about 1% is

excreted
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 Process of urine formation…

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 Glomerulus and Bowman’s
capsule

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Glomerular Filtration
• Filtration of fluid through the glomerular capillaries.
• The kidneys filter the body’s entire plasma volume
60 times each day. The filtrate contains:
• all plasma components (except protein); water,
nutrients, and essential ions to become urine
(Plasma proteins are not filtered and are used to
maintain oncotic pressure of the blood)
• Glomerulus is more efficient than other capillary
beds because:
Its filtration membrane is significantly more permeable
Glomerular blood pressure is higher ;it has a higher net
filtration pressure

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 Glomerular filtration…
• Mechanism: bulk flow
• Direction of movement :
- from glomerular capillaries to capsule space
• Driving force:
- Pressure gradient (net filtration pressure, NFP)
• Types of pressure:
• Favoring Force: Capillary Blood Pressure (BP)
• Opposing Force: Blood colloid osmotic pressure(COP),
and Capsule Pressure (CP)

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 Filtration Membrane

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 Glomerular membrane
– Made up of 3 layers
1. Endothelial layer
2. Basement membrane
3. Epithelial cell (podocytes)
– Thickness: 1 µm
– Fenestrated, highly
permeable
– Allows the passage of all
components of plasma
except plasma proteins and
blood cells

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 Glomerular Filtration Rate (GFR)
• The amount of fluid filtered per minute in all nephrons of
both kidneys. [GFR = 125 ml/min, or 180 L/day].
• Filtration fraction (FF): the fraction of RPF (renal plasma
flow) that becomes glomerular filtrate
RBF = 1200 ml/min RPF = 55% of RBF, 650 ml/min
FF = GFR/RPF, 125/650 = 19%
• Filtration pressure (FP): the net pressure forcing fluid to be
filtered through the glomerular membrane. Determined by
1. Glomerular capillary pressure (60 mm Hg)
2. Glomerular capillary colloid osmotic pressure (32mm Hg)
3. Capsular hydrostatic pressure (18 mm Hg)

FP = GCP – (GCCOP + CHP) = 60 – (32 + 18) = 10 mm Hg

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 Glomerular Filtration Pressure

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Factors affecting GFR
1. Filtration pressure
2. Permeability of the glomerular capillary membrane
3. Diameter of afferent arterioles: dilation ↑ GFR
- Caffeine & diuretics dilate AA & ↑ GFR.
- Sympathetic stimulation constricts AA and ↓ GFR.
4. Diameter of efferent arterioles: dilation ↓ GFR
↓RBF→↓GFR →↑Renin →↑Ang-II →EA constriction → ↑GFR
5. Concentration of plasma proteins:
↑Proteins → ↑PCOM →↓GFR
6. Renal blood flow: ↑RBF → ↑GFR
7. Arterial blood pressure: ↑ABP (limits) → ↑GFR

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 Diameter of AA vs. GFR

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 The Juxtaglomerular apparatus
• Initial portion of the DT passes in the angle between the
AA & EA
• Epithelial cells that come in contact with the arterioles are
being modified & become secretory & collectively called
macula densa
– secret PG - E1 & E2, vasodilator action on AA & EA
• The smooth muscles of AA & EA at the contact site become
thickened and granulated called JG cells
– responsible for the secretion of renin & erythropoietin
• The whole complex of macula densa and JG cells or
granular cells is called JG-complex
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 Juxtaglomerular Apparatus (JGA)

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 GFR regulation : Adjusting blood flow

• GFR is regulated by three mechanisms

1. Renal Autoregulation

2. Neural regulation

3. Hormonal regulation

• All three mechanism adjust;

Renal blood pressure & resulting blood

flow
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Autoregulation of GFR
When the GFR is increased:
– tubular fluid will pass with minimum
reabsorption of the required substances.
When the GFR is decreased:
– tubular fluid will pass with maximum
reabsorption of unwanted substances.
Therefore, the glomerular filtrate must flow into the
tubular system at an appropriate rate to:
- allow unwanted substances to pass into the
urine
- reabsorb nutritionally important substances
• GFR shows only little change with a broad change in
ABP b/n 80 – 220 mm Hg
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Autoregulation of GFR …
There are two autoregulation mechanisms of GFR
1. Afferent arteriole vasodilator feedback mechanism
↓GFR →Tubular fluid flows slowly →↑Na+, Cl- reabsorption
→Detected by the macula densa, secret PG-E1 & E2 →Dilation
of AA → ↑GFR
2. Efferent arteriole vasoconstrictor Feedback
mechanism
↓GFR →Tubular fluid flows slowly →↑Na+, Cl- reabsorption
→Detected by the macula densa, secret PG-E1 & E2
→Stimulate JG-cells to secret renin → ↑Ang-II →
vasoconstriction of EA → ↑GFR

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Neural regulation of GFR
• Sympathetic nerve fibers innervate afferent and
efferent arteriole

 Sympathetic stimulation is low but can increase

during hemorrhage and exercise

 Sympathetic stimulation constricts AA and ↓GFR

• Vasoconstriction occurs as a result which

 Conserves blood volume (hemorrhage) and

 Permits greater blood flow to other body parts

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Hormonal regulation of GFR
 Several hormones contribute to GFR regulation
1. Angiotensin II
• produced by renin (released by JG-cells) is a potent
vasoconstrictor. ↓ GFR.
2. ANP
• released by atria when stretched, ↑ GFR by increasing
capillary surface area available for filtration.
3. NO: a potent vasodilator, ↑ GFR
4. Endothelin: a potent vasoconstrictor, ↓ GFR
5. Prostaglandin E2
• a potent vasodilator on AA, ↑ GFR

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Regulation of renin-angiotensin system

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Renin Release
Renal Tubular Reabsorption
and Secretion
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Tubular reabsorption & secretions
 Proximal convoluted tubule (PCT)
- Composed of cuboidal cells with numerous microvilli and
mitochondria. [15 mm long & 55 µm in diameter].
- Reabsorbs water and solutes from filtrate and secretes
substances into it.
 Loop of Henle
– a hairpin-shaped loop of the renal tubule (U-shaped tubules),
lie b/n PCT and DCT , has descending & ascending limbs
with 2 segments: thin & thick segments
 Distal convoluted tubule (DCT)
– Cuboidal cells without microvilli that function more in
secretion than reabsorption. 5 mm long, 35 µm in diameter.
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Tubular reabsorption & secretions…
11/10/2022 54
Function of proximal tubules
1. Reabsorption of nutrients
2. Reabsorption of Na+ (70-75%)
3. Almost total reabsorption of K+
• Fluid in the Loop of Henle is free of K+
• K+ is secreted in the DT
4. Passive reabsorption of Cl-, HCO3-
• Obligatory reabsorption of H2O (70-75%) along with Na,
K, Cl, HCO3 independent of ADH
5. Reabsorption of urea
6. Secretion of H+, NH4, creatinin sulphate and drug
metabolites
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 Function of proximal tubules…

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 Glucose reabsorption in the
PCT
 Glucose is reabsorbed along with Na+ in the
early portion of the proximal tubule
Glucose is typical of substances removed from
the urine by secondary active transport
Essentially all of the glucose is reabsorbed, and no
more than a few milligrams appear in the urine per
24 hours

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Na+ reabsorption in the PCT
• Paracellular transport of • Trans-cellular transport
Na+ involves: of Na+ involves:
– Passage of Na+ through – Antiport carriers
the tight junction b/n cells Na-H ATPase, Na-K
– Passive diffusion of Na+ ATPase
through Na-channels – Symport carriers
Na-Glu, Na-aa, Na-HCO3-

Transcellular Pathway
- Active/carrier
Lumen
Cells Plasma mediated
Paracellular Transport
- Passive transport
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 Na+ reabsorption in the PCT…

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Tubular transport maximum (Tm)
• The maximum amount of substance (mg) transported
(reabsorbed/secreted) by tubules per minutes.
• TmG (Tmax of glucose =350 mg/min)
– the maximum amount of glucose in mg that can
be reabsorbed by the renal tubules per minute
• it means glucose that is filtered in the
glomerulus is reabsorbed.
• Determination of TmG is used as a renal function test
– b/c it measures the reabsorptive power of the
kidneys.

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Tubular transport maximum (Tm)…

• Renal threshold for glucose is 180 mg/dl

– When BGC > 180 mg/dl, small amount start to be

appeared in urine

– When the TLoad of glucose is 400 mg/min, the

amount excreted in urine is 400-350=50 mg/min.

• Tm for creatinin is 16 mg/min

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Tubular load (TLoad) of substances
• The rate of a particular substance filtered through
the glomeruli into the tubules per minute
• It equals GFR times the concentration of the
substance in the filtrate.
TLoad of a subs (freely filtered) = Conc. In the filtrate X GFR

• TLoad of Glucose = 100 mg/dl X 125 ml/min = 125 mg/min

• TLoad of Na+ = 142 meq/1000 ml X 125 ml/min=18 meq/min
• TLoad of Cl- = 13 meq/min
• TLoad of Urea = 33 mg/min
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Tubular reabsorption & secretion (cont’d)
 Loop of Henle
Descending limb
• passive reabsorption of H2O
Ascending limb
• active reabsorption of NaCl
• impermeable to H2O
 Distal tubules (diluting segment)
• active reabsorption of NaCl
• impermeable to H2O & urea
• late DT is permeable is to H2O
ADH dependently
 Collecting ducts
• reabsorption of Na, Ca and H2O hormone
dependently
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Function of Loop of Henle
Create & maintain osmotic gradient in the renal
medullary interstitium

It involves in the formation of concentrated urine up

to 1200 Mosm/l

It acts as a counter-current multiplier system which

creates

 osmotic gradient in the renal medullary

interstitium as well as in the tubule

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Function of Loop of Henle…
 A counter-current system
is any system where there are two currents flowing
parallel, opposite and adjacent to each other
 Counter-current multiplier
operates actively to create an osmotic or chemical
gradient in the renal interstitial space by the Loop
of Henle and vasa recta
 Counter-current exchanger
operates passively to maintain an osmotic or
chemical gradient
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Countercurrent system
The U-shaped loop forms
the counter-current system,
which means fluid passes
in opposite direction
through 2 loops, Loop of
Henle and vasa recta
It has also a counter-
current multiplier function,
b/c it acts to increase
(multiply) the osmolality of
fluid in the loop of Henle as
well as in the medullary
interstitium.

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 Counter-current multiplier system…

 Osmolality of tubular fluid

& interstitial fluid increases
progressively as we go deep
into the renal medulla from
the cortex.
 Formation of multiple
stratification of osmolality
by the flow of fluid in
opposite directions in the
LH and in VR.

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Countercurrent Mechanism…
 Descending limb of Loop of Henle
• Permeable to water, but impermeable to Na+, K+,
Cl-, urea
• Water flows out down the osmotic gradient
• Osmolality of tubular fluid increases progressively
up to 1200 mosm/L
 Thick segment of the ascending limb of Loop of
Henle
• Impermeable to water & urea, but active
reabsorption of electrolytes (Na+, Cl- and K+)
• The osmolaltiy of tubular fluid is progressively
decreases up to 150 mosm/l
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 Contin…….

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 Countercurrent system
Function of vasa recta as a
counter current exchanger
maintains hyper-
osmolarity
of medullary interstitium
through:
a. Uptake of NaCl & urea
& removal of water from
the descending limb
b. Removal of NaCl & urea
& uptake of water in the
ascending limb
c. Slaggish flow of blood in
it
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 Hyperosmotic Gradient in the Renal Medulla
Interstitium
 Causes of hyperosmolality in the medullary
interstitium
1. Counter-current arrangement of the ascending &
descending limb of the LH
2. Both passive & active reabsorption of Na, Cl & K in
the ascending limb of LH
3. Active reabsorption of Na+ and passive
reabsorption of urea from CD
Importance of medullary hyperosmolarity
• It is essential for the formation of concentrated
urine
• This is b/c it leads to passive reabsorption of water
from the CD (ADH)
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Formation of concentrated and diluted
urine
Importance:
1. When there is excess water in the body and body
fluid osmolarity is reduced:
 the kidney can excrete urine with an osmolarity as
low as 50 mOsm/liter,
 a concentration that is only about 1/6 the osmolarity
of normal extracellular fluid
2. when there is a deficient of water and extracellular
fluids osmolarity is high: 74
The basic requirements for formation of
concentrated or diluted urine
1. Controlled secretion of antidiuretic hormone (ADH)
• which regulates the permeability of the distal
tubules and collecting ducts to water
2. High osmolarity of the renal medullary interstitial
fluid
• which provides the osmotic gradient necessary for
water reabsorption to occur in the presence of high
level of ADH
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 Water reabsorption
Facultative (selective) Obligatory water reabsorption
water reabsorption
• Using sodium & other
• Occurs mostly in solutes.
collecting ducts • Water follows solute to the
• Through the water interstitial fluid
poles (channel) (transcellular and
• Regulated by the paracellular pathway).
ADH • Largely influenced by
sodium reabsorption

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The Role of ADH
• There is a high osmolarity of the renal medullary interstitial
fluid, which provides the osmotic gradient necessary for
water reabsorption to occur.
• Reabsorption of water in the DT & CT is determined by the
hormone ADH.
• Osmoreceptors in the hypothalamus detect the low levels of
water (high osmolarity), so the hypothalamus sends an
impulse to the pituitary gland which releases ADH into the
bloodstream.
• ADH makes the wall of the DT and CT more permeable to
water.
• Therefore, when ADH is present more water is reabsorbed
and high amount of electrolytes are excreted.
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 Formation of Water Pores:
Mechanism of Vasopressin Action

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 Mechanism of formation of concentrated urine
When there is a shortage of H2O in
the body

↓ECF volume, ↑Osmolality

Stimulates osmoreceptors in the
HT

↑ADH secretion
ADH
↑ H2O reabsorption in the DT & CD

↑Excrition of solutes

Concentrated (1200 mosm/l), in

small volume of urine is produced

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 Mechanism of formation of diluted urine
When there is excess H2O in
the body

↑ECF vlume, ↓Osmolality

↑Aldosterone secretion
↓ADH secretion

↑NaCl reabsorption in the

DT & CD

↑H2O excretion
Diluted urine (50-100
mosm/l)
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The Effects of ADH on the distal collecting duct and
Collecting Ducts

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 Water handling of the renal tubules

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Tubular reabsorption of H2O and electrolyte

1. Reabsorption of H2O in the DT and CD is

dependent on the presence of ADH

2. Reabsorption of Na+ in the DT and CD is

dependent on aldosterone

3. Reabsorption of Ca2+ in the DT and CD is

dependent on the presence of PTH and
calcitriol
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 Regulation of [Na+] and osmolality

↑[Na+] and ↑Osmolality ↓[Na+] or ↓Osmolality &

↑[K+]
Stimulates osmoreceptors
in
the SON of HT
Stimulates adrenal cortex

↑ADH secretion ↑Aldosterone secretion

↑H2O reabsorption in the ↑Na+ reabsorption

DT and CD ↑K+ excretion in DT and CD

↓[Na+] and ↓Osmolality ↑[Na+] &↑Osmolality ↓[K+]

back to normal back to normal
 Diuretics
• Drugs that increase the urine output. Of 3 classes
1. Drugs increasing solute excretion
a. Na+ reabsorption inhibitors
Mercurials, thiazides, frusemide
b. Na-H pump inhibitors: acetazolamide, NH4Cl
c. Osmotic diuretics: mannitol, dextran, glucose
2. Drugs increasing GFR
- cardiac glycosides, plasma expanders , xanthenes
derivatives
3. Drug inhibiting release of ADH
- water, ethanol alcohol
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Normal urine & blood values
• Urine pH ~ 6.0
• Blood pH = 7.4
• Blood [HCO3-] = 24 mM
• Blood PCO2 = 40 mmHg
• Plasma osmolality = 300 mOsm/kg water
• Urine osmolality = 600 mOsm/kg water
– depends upon hydration status
– note that this can vary between 50-1200 depending
on water intake etc.
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 Urinary Bladder…

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 Urethra
• Muscular tube that drains urine from the bladder &
moves urine out of the body
• Sphincters keep the urethra closed when urine is not
being passed
 Internal sphincter
– involuntary sphincter at the bladder-urethra junction
 External sphincter
– voluntary sphincter surrounding the urethra as it passes
through the urogenital diaphragm
• Levator ani muscle
– voluntary urethral sphincter

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 Urethra …
• The female urethra is tightly bound to the anterior
vaginal wall.
– Its external opening lies anterior to the vaginal opening
and posterior to the clitoris
• The male urethra has three named regions
 Prostatic urethra
– runs within the prostate gland
 Membranous urethra
– runs through the urogenital diaphragm
 Spongy (penile) urethra
– passes through the penis and opens via the external
urethral orifice

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 Micturition reflex
1. Stimulation of stretch receptors
by large volume of urine (200-
400 ml)
2. Sensory impulse transmitted to
the spinal cord through PNS
3. Motor impulse stimulates
smooth muscle lining bladder &
4. Relax internal urethral sphincter
(IUS)
5. Stretch receptors also send
impulse to higher centers
(Pons, HT and cerebral cortex)
6. Motor impulse from higher
centers promote readiness to
urinate
7. Identify places for urination
8. 11/10/2022
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 Regulation of acid-base balance
• Normal blood pH: 7.35 – 7.45
- pH < 7.35 is called acidosis, >7.45 is called
alkalosis
- Acidosis & alkalosis disturb the function of cells,
hormones,
enzymes
• The body has 5 pH regulatory mechanisms that
control the normal range:
1. The chemical buffer system: has 3 components
– Bicarbonate system: H2CO3 & NaHCO3
– Phosphate buffer system: NaH2PO4/Na2HPO4
– Hb & protein buffer system that can trap H+ or
11/10/2022OH- 93
 Regulation of acid-base balance…
2. The respiratory buffer system:
– Regulates pH by controlling PCO2
3. The renal buffer system:
– Regulates pH by controlling the concentration
of HCO3- and H+
– The kidneys regulate the concentration of H in
the blood by excreting a variable amount of H
in the urine.
– They also conserve blood bicarbonate ions
(HCO3), an important buffer of H.
– Both activities help regulate blood pH.

11/10/2022 94
 THANK YOU !

• GOD BLESS
THE RENAL
PATIENTS !!!

11/10/2022 95