AUBF | RENAL FUNCTION TRISHA LORAINNE R.

VILLOCENO

RENAL PHYSIOLOGY 2. Proximal convoluted tubule (PCT) – part

 Nephron of renal tubule; majority of reabsorption
 Basic structural and functional unit of happens here
kidney 3. Loop of Henle (LH) – part of renal tubule
 1 to 1.5 million nephrons per kidney subdivided into two, descending and
 Consists of Glomerulus and Renal Tubules ascending loop of henle. Each loop has
Two Types of Nephron thick and thin limb
4. Distal convoluted tubule (DCT) – part of
 Cortical (85%)
renal tubule; majority of sodium
o Remove waste products and
reabsorption happens here
reabsorption of nutrients
5. Collecting duct (CD) or Collecting tubule
o Situated at the cortex of kidney
–part of renal tubule; also reabsorbs
 Juxtamedullary
sodium which is acted by Aldosterone
o Concentration of urine
(hormone) and potassium will be secreted
o Has longer loop of henle compared to
-also permeable to water in the presence
cortical
of Antidiuretic hormone (Vasopressin)
6. Calyx
7. Renal Pelvis

Note:
o PCT, LH, DCT, and CD alter urine
concentration
o Ascending loop of henle (thick) is highly
permeable to water and salt

RENAL FUNCTIONS
a. Renal Blood Flow c. Tubular
b. Glomerular Reabsorption
Filtration d. Tubular Secretion
MNEMONICS: Renal Blood Flow FiReS
 Functions of nephron that control ability of
kidney to clear waste, maintain body water,
and electrolyte balance.

RENAL FUNCTION: RENAL BLOOD

FLOW
 Order of Blood Flow:
1. Renal Artery (blood in) - 25% of cardiac
output will enter this artery
Order of Uring Formation 2. Afferent Arteriole
1. Glomerulus – more permeable to water 3. Glomerulus
and salt 4. Efferent Arteriole
5. Peritubular Capillaries – surrounds the
proximal and distal convoluted tubules
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6. Vasa Recta – located adjacent to ascending
and descending loop of henle
7. Renal Vein (blood out)
 Major exchange of water and salts take place
between blood and medullary interstitium  Shield of Negativity:
that maintain osmotic gradient in medulla for
renal concentration.
 Renal Blood Flow: 1200 mL/min
 Renal Plasma Flow: 600 to 700 mL/min
RENAL FUNCTION: GLOMERULAR
FILTRATION  Hydrostatic Pressure
 Glomerulus:
 Coil of approx. 8 capillary lobes (capillary
tuft)
 Glomerular Filtration Barrier – walls of
glomerulus
 Within the Bowman’s capsule
 Resembles a sieve
 Non-selective filter of plasma substance
with MW of 70,000  Autoregulatory
 Factors Affect Actual Filtration:
 Cellular structure of capillary walls and
Bowman’s capsule
 Hydrostatic and oncotic pressure
 Feedback mechanisms of RAAS
Cellular Structure of Capillary walls and
Bowman’s Capsule
 Plasma filtrate must pass through three
glomerular filtration barrier cellular
Note:
layers:
o Capillary wall membrane
-Endothelial cells contain pores
refered as ‘Fenestrated’
-Pores increase capillary permeability
but do not allow the passage of large
molecules and blood cells (like
molecules with >70,000 daltons)
o Basement membrane/basal lamina
-Has further restrictions as large
molecules pass through here
TRISHA LORAINNE R. VILLOCENO
o Visceral Epithelium of bowman’s
capsule
-Podocytes (at the inner layer of
Bowman’s capsule)
o Because of presence of sialic acid
o Repels molecule w/ positive charge
(ex. Albumin, that is associated with
renal diseases)
Glomerular Pressure
o Result from smaller size of efferent
arteriole and glomerular capillaries
o Enchance filtration
o Necessary to overcome opposition of
pressure from fluid w/in Bowman’s
capsule and oncotic pressure of
unfiltered plasma proteins in
glomerular capillaries
Mechanism w/in
Juxtaglomerula Apparatus
o Maintain glomerular blood pressure
(by increasing or decreasing size of
afferent and efferent arteriole) at
constant rate regardless of
fluctuation in systemic blood pressure
o Responsible in sensing high blood
pressure
o If there is low blood pressure, Afferent
arteriole is dilated and Efferent arteriole is
constricted
o If there is high blood pressure, Afferent
arteriole is constricted and Efferent
arteriole is dilated
o Purpose: To maintain glomerular filtration
rate
AUBF | RENAL FUNCTION
Renin-Angiotensin-Aldosterone System
 Regulates blood flow to and w/in
glomerulus
 Respond to changes in blood pressure and
plasma sodium content monitored by
juxtaglomerular apparatus (Macula Densa
and Juxtaglomerular cells)
Example:
If there is low blood pressure and low
plasma sodium, there will be secretion of
Renin. Renin will react with Angiotensinogen
to peoduce Angiotensin I and will go to the
lungs (alveoli) and converted to Angiotensin
II by Angiotensin converting enzyme (ACE).
Angiotensin II will have different effects
like:
 Vasoconstriction of EA or dilation of
AE
 Proximal convulated tubule
reabsorption of sodium and water
 Distal convulated tubule reabsorption
of sodium by Aldosterone (Adrenal
cortex)
 Collecting duct/tubule reabsorption
of water by ADH (Hypothalamus)
Note:
o Renin: produced by juxtaglomerular cells
o Angiotensin I: inert hormone
o Angiotensin II: active hormone
o As fluid leaves glomerulus, filtrate is
shown to have SG of 1.010 and confirms
that it is an ultrafiltrate of plasms. This is
useful in the baseline for evaluating renal
mechanisms involved in converting
plasma ultrafiltrate into final urinary
product.
RENAL FUNCTION: TUBULAR
REABSORPTION
 First function affected in renal disease
 Major site (65%) of reabsorption of plasma
substances [because the body cannot lose 120
ml every minute]
TRISHA LORAINNE R. VILLOCENO
A. Reabsorption Mechanisms
Active Transport
 Substances to be reabsorbed must
combine with carrier proteins contained
in membranes of renal tubular epithelial
cells
 Electrochemical energy: created with this
interaction
 It transfers substances across the
cell membrane and back to
bloodstream
 Substances and Location
 Glucose, AA and Salts - PCT
 Chloride – Ascending loop of Henle
 Sodium – PCT and DCT
Passive Transport
 Movement of molecules across membrane
as result of differences in concentration
or electrical potential on opposite sides of
membrane
 Gradient: Physical differences
 Substances and Location
 Water – PCT, Descending Loop of
Henle, collecting duct
 Urea – PCT, Ascending Loop of Henle
 Active Transport & Passive Transport are
influenced by concentration of substance
being transported
 Maximal Reabsorptive capacity –
exceeded when plasma cincentration
achieved abnormally high level
 Renal Threshold – plasma concentration
at which active transport stops
o Renal Threshold for glucose: 160 to
180 mg/dL
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B. Tubular Concentration
 Begins in descending and ascending loop of
Henle where filtrate is exposed to high
osmotic gradient of renal medulla
 Water: Removed by osmosis, in
descending LH
 Sodium and Chloride: reabsorbed in
ascending LH
 Countercurrent Mechanism: selective
reabsorption process that maintain
osmotic gradient of medulla
C. Collecting Duct Concentration
 Final concentration begins in Distal
Convoluted tubule and continue in
collecting duct
 Antidiuretic Hormone (ADH/Vasopressin)
o Regulates water reabsorption in DCT
and CD
o Diabetes Insipidus = ADH Deficiency
(nephrogenic/neurogenic)
o SIADH = ADH Excess (urine
concentration)
>Increased body hydration = decreased ADH =
Increase urine volume (large volume diluted urine)
>Decreased body hydration (dehydrated) =
increased ADH = Decrease urine volume (low
volume concentrated urine)
 Aldosterone
o Regulate sodium reabsorption
RENAL FUNCTION: TUBULAR
SECRETION
 Involves passage of substances from blood
in peritubular capillaries to tubular filtrate
 Proximal convoluted tubule: Major site for
removal of nonfiltered substances
 2 Major Functions:
 Regulate acid-base balance in body
through secretion of H ions (in form of
NH4+ and H2PO4)
TRISHA LORAINNE R. VILLOCENO
 Eliminate waste product not filtered by
glomerulus
Acid Base Balance
 Blood: pH 7.4, to maintain its pH, it must
buffer and eliminate excess acid
 Bicarbonate HCO3: Where blood depend
on its buffering capacity. This are readily
filtered by glomerulus and must be
returened to blood to maintain pH
 Hydrogen Ion excretion in urine:
a. Secreted H ions combine w/ filtered
phosphate ion instead of Bicarbonate
ion and excreted rather than
reabsorbed.
b. Ammonia is produced in PCT by
breakdown of amino acid glutamine.
Ammonia reacts with H to form
ammonium ion then it is excreted in
urine
 Renal Tubular Acidosis
 Aka Metabolic Acidosis
 Inability to produce an acid urine
 Hydrogen ions are not excreted in urine
 pH of urine: alkaline
RENAL FUNCTION TESTS
A. Creatinine Clearance
 Standard test used to evaluate glomerular
filtration
 Most common
 Lower preference limit: approx 95 mL/min
male; 85 mL/min in female
 Formula: U ÷ P x V x 1.73/A
 U = urine creatinine (mg/dL)
 P = plasma creatinine (mg/dL)
 V = urine volume (mL/min)
 1.73 = mean body surface area (m2)
 A = surface area
Example: Given the ff data, calculate the creatinine
clearance
o Serum creatinine = 1.2 mg/dL
o Urine creatinine = 100 mg/dL
AUBF | RENAL FUNCTION TRISHA LORAINNE R. VILLOCENO

o Urine volume = 1.4 L/day

o Body surface area = 1.80 m2
Solution:
=100 mg/dL ÷ 1.2 mg/dL x 1.4L/day x 1000
mL/L x 1 day/1400 min x (1.73 m2 ÷1.8 m2)
=78 mL/min (decrease)

B. Osmolality and Specific gravity

 Used to evaluate tubular reabsorption
C. PAH and PSP
 Used to evaluate tubular secretion and
renal blood flow
 Not routinely done