ANALYSIS OF URINE AND BODY FLUIDS

RENAL ANATOMY AND PHYSIOLOGY

LEC 1 BY JORDAN JOY G. ARPILLEDA, RMT
AUGUST 23, 2022

We should have mastery on the topic because after blood, urine is the
most common analyzed specimen. This will just be a supplemental
review and I hope this will refresh your learnings in your health science.
OUTLINE
Gross Anatomy Focusing on the Renal System or
your Urinary System
Internal Macrostructure & Important to the functioning of your
Microstructure Urinary System
Renal Physiology How urine is formed
Clinical Correlates How will you also incorporate the
learnings that you have in anatomy
and physiology to the common
cases or pathologic cases that we
see in the hospital setting
THE URINARY SYSTEM
4. Endocrine Organ
Kidneys play an important role especially in body homeostasis.
1. They conserve fluids and electrolytes by disposing metabolic
wastes from the body.
● Like your lungs and your liver, the kidneys actually
retrieve essential materials and dispose of waste so
as to maintain homeostasis.
2. The kidneys also conserve water, electrolytes and other
metabolites. T
3. The kidneys are also essential in maintaining constant plasma
pH by regulating acid base balance. T
● There are two aspects of your acid base balance:
○ your metabolic aspect is governed by your
kidneys while your respiratory aspect is
governed by your lungs.
○ Kidneys actually excrete hydrogen ions
when body fluids become too acidic, or
they excrete bicarbonates when the body
fluids are also too basic, so that’s also part
of the homeostatic regulatory mechanism
of the kidney.
4. Aside from this, metabolic waste products are also discharged
from cells into the circulation, and then in the kidneys they are
removed from the blood by filtration and excretion into the
urine and also

NOTE: Kidneys are actually endocrine organs. They produce hormones

and substances.

OTHER ENDOCRINE FUNCTIONS OF THE KIDNEY

1. Erythropoietiin
● The synthesis and secretion of your glycoprotein
Figure 1. Main structures of the Urinary System hormone, Erythropoietin
● Regulates red blood cell formation
PARTS OF THE URINARY SYSTEM ● So this acts on your bone marrow and also
1. Kidneys regulates red blood cell formation in response to
● 2 bean-shaped structures decreased blood oxygen concentration.
2. Ureters ○ So that is why in patients with chronic
● 2 slender tubular structures kidney disease, you often find anemia in
● carry the urine that is formed in the Kidney to the complete blood counts of these patients
Urinary Bladder which acts now as the storage because of the deficiency of your
structure. erythropoietin.
3. Urinary Bladder ○ When you have chronic kidney disease,
● acts as the storage structure. that’s already going to your chronic renal
4. Urethra failure and if the kidneys fail they don’t
● transports your urine outside the body. produce anymore erythropoietin.
○ Thus you don’t have anymore hormone
GENERAL FUNCTIONS OF THE RENAL SYSTEM that will stimulate the production of your
red blood cells. That’s why patients
develop anemia.
● Erythropoietin is actually synthesized by the
endothelial cells of the peritubular capillaries in
the renal cortex
2. Renin
● Synthesis and secretion of your acid, Protease
Renin
● An enzyme involved in the control of your blood
Figure 2. Renal or Urinary System pressure and blood volume.
● The Renin Angiotensin System is actually
1. Excretion produced by your juxtaglomerular cells.
● Removal of metabolic wastes from body fluids 3. Hydroxylation of Vitamin D3
● This is a steroid precursor
2. Elimination ● We all know that vitamin D3 is a steroid precursor
● Discharge of wastes from body that is produced in the liver.
3. Homeostatic Regulation ● In order for it to be hormonally active, it must be
● Of volume and solute converted to your vitamin D3, your 125 vitamin D3
● Concentration of blood ● This step is regulated primarily by your parathyroid
ATRÓ 2024 | 1
AUBF: RENAL ANATOMY AND PHYSIOLOGY

hormone, which stimulates the activity of your relationships of the mentioned structures as
enzyme 1 hydroxylase and increases the production they lie just within the hilum of the kidney in a
of your active hormone. space called Renal Sinus.

KIDNEY ● The space between and around the structures is actually filled
● Bean-shaped paired reddish brown organs in the fresh state largely of loose connective tissue and at the same time a
● Situated posteriorly behind the peritoneum mixture of adipose tissue.
○ Each side of the vertebral column. And they are also
surrounded by adipose tissue PROTECTIVE LAYERS OF THE KIDNEY
● Level with the upper border of the 12th thoracic vertebra,
inferiorly with the 3rd lumbar vertebra
● Right is usually slightly inferior to the left
○ This is because of its relationship to the liver

Figure 5. Protective Layers of the Kidney

Figure 3. Kidneys
1.
GROSS ANATOMY OF THE KIDNEY
2.
Figure 4. Gross anatomy of the Kidneys
3.
GENERAL STRUCTURE OF KIDNEYS
● Each kidney approximately measures 10cm long by 6.5cm
wide that is from the concave to the convex border by 3cm
thick
● On the upper pole of each kidney you can see this actually
embedded within the renal fascia and there is a thick
protective layer of perineal adipose tissue where the
suprarenal glands lies or the adrenal gland
● The medial border (the one towards the center of the kidney)
is actually concave and contains a deep vertical fischer and
this is called the hilum.
○ This is the part in which the renal vessels and the
nerves pass and the expanded funnel shape of the
ureter originates from
○ This is also called the Renal Pelvis and this is
where the Renal Pelvis exit
There are 3 protective layers of the kidney:
Fibrous Capsule
● The kidney surface is covered by connective tissue
capsule also known as fibrous capsule
● The capsule actually consists of 2 distinct layers
1. An outer layer of fibroblast and collagen
fibers
2. Inner layers of myofibroblast
○ The myofibroblasts are very important
especially in aiding the contractility of the
kidney in resisting volume and pressure
variations especially in accompanying
variations in kidney function
○ Its specific role is still unknown but it is more of
aiding the kidneys especially on pressure
variations
● The fibrous capsule actually covers the outer surface of
the entire organ
Perinephric Fat
● This is actually a thick layer of adipose tissue that
surrounds the capsule (as you can see in the picture)
Renal Fascia
● Dense fibrous outer layer that anchors the kidney to
surrounding structures or associated structures around
the organ
CORTEX AND MEDULLA

RELATIVE PROBLEMS OF THE MAIN HILAR STRUCTURES

Location Hilar Structure
Anterior Part Renal Vein
Intermediate Part Renal Artery
Most Posterior Pelvis of the Kidneys
Part ● This is now where the pelvis exits Figure 6. Structures that consist a Kidney
● This is called the hilum.
● A section through a kidney shows these
ATRÓ 2024 | 2
AUBF: RENAL ANATOMY AND PHYSIOLOGY

● Examination with the naked eye of a cut face of a fresh

hemisected kidney reveals that its substance can be divided
into two distinct regions.
1. Cortex - outer reddish brown part
2. Medulla - much lighter colored inner part
● The colored part, especially on the cortex and on the medulla,
on a cut surface of an unfixed kidney actually reflects the
distribution of the blood in the organ.
● Approximately 90%-95% of the blood passing to the kidney
is in the cortex, that is why there is a reddish brown
appearance.
● Whereas, the medulla has a 5%-10% of the blood distribution
of blood so that's why it is much lighter and paler in color. Figure 8. Cortical Arches (?)

Figure 9. Rays of the Kidneys

Figure 7. Gross Anatomy of a Postnatal Kidney
● In the gross anatomy of a postnatal kidney , it has a very thin
fibrous capsule which is mainly composed of collagen rich
tissue with some elastic and smooth muscle fibers or also
known as Fibrous Capsule.
● The kidney can also be divided into an Internal Medulla and
an External Cortex.
NOTE: When dealing with solid organs it is usually divided into cortex
and medulla, just like thymus and so is the kidney.
RENAL MEDULLA
● Renal Medulla (meaning inside) consists of pale striated
conical renal pyramids.
● They are conical and striated because of their tubules and
their bases are peripherally located meaning they are pointed
outside.
● On the other hand, their apex or apices will converge to the
Renal Sinus
RENAL SINUS
● It is converging point of renal pyramids.
● The renal sinus also projects into Calyces that are termed as
Papillae
RENAL CORTEX
● The Renal Cortex is located below the capsule
● Meaning, it is subcapsular
○ From the word "sub'', meaning below the capsule
NOTE: When you are asked what are the components of the renal
● They arch over the bases of the pyramids and those that are
corpuscle, we have the Glomerulus plus the Bowman’s Capsule.
extending between them and towards the Renal Sinuses are
actually Urinal Columns
● The one at the cortex that is in between two Renal Pyramids
are called Renal Columns.
● The Rays will taper towards the renal capsule and are
peripheral prolongations also from the basis of your renal
pyramid (as you can see in the picture).
BLOOD SUPPLY OF THE KIDNEYS
1. Renal Artery
● The main blood supply or the main arterial supply of
your renal system is your Renal Artery
● It comes mainly from your Aorta
2. Renal Vein
● The venous drainage of your renal system is from
the Renal Vein
● It drains directly to the Inferior Vena Cava
NEPHRON
● The nephron is the basic functional unit of the kidney and is
described in sections.
1. Renal Corpuscle
● A spherical structure that is barely visible with the
naked eye
● The renal corpuscle constitutes the beginning
segment of the nephron and contains a unique
capillary network which is now called the glomerulus
● It is encapsulated by what you call the Bowman’s
capsule
● The renal corpuscle is part of the basic functional
unit of the kidney, which is now your nephron.

CORTICAL ARCHES
● In the cortex you also have peripheral regions, these are the
arches over the Renal Pyramid.
● The peripheral regions are also called your cortical arches.
● They are traversed by radial, lighter-colored medullary rays.
● They are separated by your darker tissue which is now the
convoluted part or the tubules.
Figure 10. Bowman's Capsule

ATRÓ 2024 | 3
AUBF: RENAL ANATOMY AND PHYSIOLOGY
● The kidneys are actually subdivided into two distinct regions.
1. We have the cortex, consisting of renal corpuscles
along with the convoluted tubules and straight
tubules of the nephron.
2. We also have the connecting tubules, the collecting
ducts, and an extensive vascular supply.
● As you can see in the picture, the structure labelled 1 is the
renal corpuscle.
● Beside it are the proximal convoluted tubule and the distal
convoluted tubules, and also we have here a straight tubule of
the nephron, and we have the collecting ducts. These are
situated in your cortex.
Figure 11. Capsule, Cortex and their parts
● Just to emphasize on medullary rays – if you examine a
section cut through the cortex, that is at an angle
perpendicular to the surface of the kidney so you will actually
have a series of vertical striations that appear to emanate
from the medulla
Medullary Rays
● These striations are called Medullary rays of Ferrein (or in other
books, medullary ray).
● Their name actually reflects their appearance. They have striations
that radiate from the medulla.
● Approximately, there are 400-500 medullary rays that project into
the cortex from the medulla. In summary, medullary ray is an
aggregation of straight tubules and collecting ducts.
● Each medullary ray contains straight tubules of the nephrons and
collecting ducts.
● The regions between the medullary rays - this is where renal
corpuscle, convoluted tubule of the nephrons and the connecting
tubules are all situated. This area is referred to as cortical
labyrinths because there is a mixture of renal corpuscle & tubules.
Each nephron and its connecting tubules, which connects into a
collecting duct in the medullary ray will now form the uriniferous
tubule.
Medulla
Figure 12. Medulla
There are no convoluted tubules anymore. It’s just:
● Straight tubules
● Collecting ducts
● Vasa recta- countercurrent exchange system
○ A special capillary network.
○ Unlike in the cortex, the capillary network is called
glomerulus.
The straight tubules of the nephron and the collecting ducts continue
from the cortex into the medulla. They are accompanied by a capillary
network. They run parallel with the various tubules and these vessels
represent the vascular part of countercurrent exchange system. This
regulates the concentration of urine.
Parts of the Medulla
conical structures
The tubules in the medulla because of their
arrangement and differences in their length, they
collectively form a number of conical structures
Pyramids
There are usually 8-12 pyramids but as many as 18
may be present in the human kidney.
The bases of the pyramid will now face peripherally
to the cortex.
apical portion of each pyramid
The apex faces the renal sinus. The apical portion of
Papilla each pyramid
They project into the minor calyx which is
cup-shaped
Area cribrosa top of the papilla
Minor calyces minor branches
Major calyces
.
Figure 13. Parts of the Medulla
● So there's a depression or a container that will catch the urine and
a cup-shaped structure that represents the extension of your renal
pelvis.
● The tip of the papilla is also known as your area cribrosa,
○ this is actually perforated by the openings of your collecting
ducts;
● the minor calyces are actually branches of two or three major
calyces.
○ As you can see in the picture, that in turn now are the major
divisions of your renal pelvis.
Figure 14. Renal Pyramid of Medulla
RENAL PYRAMID
Each renal pyramid is actually divided into an:
ATRÓ 2024 | 4
AUBF: RENAL ANATOMY AND PHYSIOLOGY
adjacent to your cortex
further subdivided into:
1 outer medulla inner stripe outer stripe
closer to your cortex the one near to your
medulla
2 Inner medulla
● The zonation and the stripes are actually readily recognized in
a sagittal section through the pyramids or through the renal
pyramids of a fresh specimen.
● So the stripes, the outer and the inner stripe reflect actually
the location of the distinct parts of your nephron at specific
levels within the pyramid.
● These are actually not that distinct, especially on the gross
level of the kidney. But they are actually just an arbitrary
distinct location of your nephron at the specific levels within
the pyramid
RENAL COLUMNS
Figure 15. Renal Columns
● renal columns represent the cortical tissue
● they are from the cortex
● it is contained within the medulla.
● So it is in between your medulla, the caps of your cortical
tissue that lie over the pyramids are sufficiently extensive
that they actually extend peripherally around the lateral
portion of your pyramids,
● they are found in between forming now your renal columns of
Bertin.
● So in other books it's just the renal column, and although
renal columns contain the same components as the rest of
the cortical tissue, they are regarded actually as part of the
medulla.
● The amount of cortical tissue is so extensive as you can see
that it actually spills over the side of the pyramid, it's just like a
large scoop of ice cream that extends beyond.
● actually just part of the medulla.
LOBES AND LOBULES
Figure 16. Lobes and Lobules
For the lobes and the lobules of the kidney, what is the difference?
Medullary pyramid + cortical tissue
Constitutes each medullary pyramid and the associated
cortical tissue is at its base and sides that is 1/2 of each
LOBE adjacent renal column
Therefore, the number of lobes in a kidney is actually
equivalent to the number of medullary pyramids.
Example:
if you have 8 medullary pyramids then you also have 8
lobes of the kidney.
consists of a collecting duct and all the nephrons that
it drains
LOBULE Further subdivided into lobules consisting of a:
● central medullary ray
● surrounding cortical material
● Although the center or the axis of the lobule is readily
identifiable because of the collecting duct, the boundaries of
the adjacent lobules are not obviously demarcated from one
another.
● The concept of the lobule is still retained because it actually
has a very important physiologic basis.
● The medullary ray containing the collecting duct for a group of
nephrons that drain into that duct constitutes the renal
secretory unit. This receives the urine form. It is the equivalent
of a glandular secretory unit or a lobule.
NEPHRON
The most or the basic functional unit of the kidney
● It is the fundamental structural and functional unit of the
kidney
● The kidney is actually composed of approximately 2 million
nephrons.
● Nephrons are responsible for:
○ production of the urine
○ correspond to the secretory part of other glands.
● The collecting ducts are:
○ responsible for final concentration of urine
○ analogous also to the ducts of exocrine glands.
● But unlike the typical exocrine gland in which the secretory
and the duct portions, they usually arise in a single epithelial
outgrowth.
● It’s different for your nephrons because the nephrons and
their collecting ducts arise from separate origins or separate
primordia. And, they only later become connected with each
other.
● When you say nephron, it is composed of the:
○ renal corpuscle plus the
○ tubular system.
RENAL CORPUSCLE
● When you say renal corpuscle, it is composed of:
○ glomerulus plus the Bowman’s capsule
● But if you already include the tubular system, that functional
unit is already called your nephron.
To elaborate on the general organization of the nephron and the
pathway of how your urine is formed, we have the following illustration:
Figure 17. General Organization of Nephron and its Pathway
● As what Sir has said, the nephron consists of the renal
corpuscle and tubular system.
● When you say renal corpuscle, it represents the beginning of
the nephron consisting of the glomerulus plus the double
ATRÓ 2024 | 5
AUBF: RENAL ANATOMY AND PHYSIOLOGY
layered epithelial cap which is known as the bowman’s
capsule. So the glomerulus plus the bowman’s capsule, that’s
your renal corpuscle.
BOWMAN’S CAPSULE
● The bowman’s capsule is actually the initial portion of your
nephron.
● This is where blood flows through the glomerular capillaries
and it undergoes filtration to produce your glomerular
ultrafiltrate.
GLOMERULAR CAPILLARIES
● The glomerular capillaries are supplied by your afferent
arterioles
● so that is from the systemic circulation, and are drained by
efferent arterioles which leads to your systemic circulation and
this forms, the afferent plus the efferent arterioles, a new
capillary network to supply now your kidney tubules.
VASCULAR POLE
● The side wherein the afferent and efferent arterioles penetrate
and exit from the parietal layers of your bowman’s capsule is
called your vascular pole.
● The vascular pole is here of your bowman’s capsule, while the
opposite of it is the urinary pole, where the proximal
convoluted tubule begins.
Continuing from the bowman’s capsule, the remaining parts of the
nephron are all tubular. So they are as follows:
1. From the urinary pole, the urine will go down to the proximal
convoluted tubule.
2. Then, the urine goes to the descending limb, and the
ascending limb of the loop of henle.
3. Then, to the distal convoluted tubule, then to the cortical
collecting ducts. Cortical means it is situated in the cortex.
4. And once it goes down, it becomes now the medullary
collecting duct, because it is already situated in the medulla.
5. Then, it empties into the papilla of the renal pyramid,
6. Then it goes down to the minor calyx then to the major
calyx
7. Then to the renal pelvis then to the ureters then to the
urinary bladder where it is stored until it goes out through the
urethra.
TUBULES
Again, just to emphasize the tubular segments of the nephron;
they are named according to the course that they take whether they are
convoluted or straight, also the location - if it is proximal or distal, and
lastly, your wall thickness, if it is thick or thin.
Figure 18. Tubules
So, again, so that we will be familiar with how urine flows
through the tubular system, beginning from the bowman’s capsule, the
sequential parts of the nephron consist of the following tubules:
we have Proximal Convoluted Tubule, this originates in the
1 urinary pole of the bowman’s capsule. So, it follows a very
tortuous course for convoluted course
And then, continue as the Proximal Straight Tubule which is also
2 known as your thick descending limb of the loop of Henle. And it
descends into the medulla from the cortex
Then, the Thin Descending Limb is the continuation of the
3 proximal straight tubule. Then, it makes a hairpin turn and returns
toward the cortex
From the thin descending loop of Henle, we also now have the
4 thin ascending limb since it will make a hairpin turn and it’s the
continuation of the thin descending limb
So the distal straight tubule is the continuation of the thin
5 ascending limb and is also known as the thick ascending limb of
the loop of Henle.
So, after the distal straight tubule, it ascends to the medulla and
enters the cortex and the distal straight tubule then leaves the
medullary ray and makes contact again with the vascular pole of
6
its parent renal corpuscle. So at this point, the epithelial cells of
that tubule adjacent to the afferent arteriole of the glomerulus are
modified now to form the macula densa.
So it is on the distal convoluted tubule.The distal tubule then
leaves the region of the corpuscle and becomes the distal
7
convoluted tubule. So it’s much less tortuous compared to
proximal convoluted tubule
Then from the distal convoluted tubule, it now becomes your
8
cortical collecting duct
9 then down to the medullary collecting duct
10 then down to the papilla
Figure 19. Two Types of Nephron
TWO TYPES OF NEPHRONS
Renal corpuscle located in the outer part of the
cortex
● From the word itself cortical, meaning the
renal corpuscles are located in the outer part
subcapsular of the cortex.
nephrons or ● this type of nephron has a short loop of Henle
the cortical extending only into the outer medulla as you
nephrons can see on the first part of the picture
● they are typical of the nephrons described
wherein the hairpin turn occurs in the distal
straight tubule.
Renal corpuscles are at the proximity to the base of
the renal pyramid
● make up about ⅛ of the total nephron count
so their renal corpuscles occur in the
proximity to the base of the medullary
pyramid, so that’s why they are called
juxtamedullary
juxtamedullary.
nephrons
● they have long loops of Henle and long
ascending thin segments that extend well into
the inner region of the pyramid.
● has a more physiologic significance since
they are essential to the urine concentrating
ATRÓ 2024 | 6
AUBF: RENAL ANATOMY AND PHYSIOLOGY
mechanism
Collecting Ducts:
● Cortical Collecting Ducts
● Medullary Collecting Ducts
● Papillary Ducts
● Area Cribrosa
Lastly are your collecting ducts. Again, as what I’ve said you have
the cortical collecting ducts that begin in the cortex and either
connecting tubules or ached connecting tubules of many nephrons that
proceed within the medullary rays toward the medulla. So when the
collecting tubules reach the provide additional restriction point to your
filtration of your plasma proteins, thus all layers of your Glomerular
capillary wall provide a barrier to filtration of plasma proteins.
When the collecting ducts reach the medulla, they are now referred to
as the inner medullary collecting ducts. These ducts travel to the
apex of the pyramid, where they merge into larger collecting ducts.
The collecting duct also has papillary ducts, which are small projections
that open into the minor calyx. The area of the papilla that contains the
opening of these collecting ducts is called the area cribrosa.
RENAL BLOOD FLOW
Figure 20. Renal Blood Flow
Figure 21. Renal Circulation
The renal circulation supplies the blood to the kidneys via renal
arteries. This is left and right which branch directly from the abdominal
aorta. If you trace it from the heart:
heart → ascending aorta → thoracic arch → descending aorta →
abdominal aorta → renal arteries
Despite the kidney’s relatively small size, the kidneys actually receive
approximately 20% of the cardiac output. Each renal artery branches
into segmental arteries, dividing further into interlobar arteries that
penetrate the renal capsules.
Interlobar between lobes
Lobe renal/medullary pyramid + cortical tissue
Interlobar arteries extend through the renal columns between the renal
pyramids (hence interlobar), and the interlobar arteries then supply
blood to the arcuate arteries that run through the boundary of the
cortex and medulla.
renal artery → segmental artery → interlobar artery → arcuate
artery
What vessel demarcates the boundary between the cortex and
medulla?
Arcuate vessels part of which includes the arcuate artery
Each arcuate artery supplies the several interlobular arteries that feed
into the afferent arterioles that supply the glomeruli. The glomerulus
will filter the blood through a small network (tuft) of capillaries. After
that, it will exit through the efferent arteriole wherein it will give rise to
the peritubular capillaries (cortical nephron) or the vasa recta
(juxtamedullary nephron). This is being emptied or converged into the
interlobular vein.
arcuate artery → afferent arteriole → glomerulus → efferent
arteriole → peritubular capillaries / vasa recta → interlobular vein
(cortex)
This is a special type of circulation because the usual or general rule of
every organ circulation is:
artery → capillary → veins → heart
But in renal circulation:
artery → capillary → glomerulus → efferent artery → capillary →
vein
As with the arterial distribution, the venous drainage also follows the
same pattern.
interlobular vein (cortex) → arcuate vein (cortex-medulla) →
interlobar vein (medulla) → renal vein → inferior vena cava →
heart
The renal system, especially renal blood circulation, is actually
intertwined with the heart. Patients with heart failure have a tendency to
develop kidney problems or kidney failure in the long run.
RENAL CIRCULATION
By adjusting the resistance of the afferent and efferent arterioles, the
kidneys can regulate the hydrostatic pressures in both the glomerular
and peritubular capillaries, changing the rate of glomerular filtration
and/or tubular reabsorption in response to body’s homeostatic
demands.
ATRÓ 2024 | 7
AUBF: RENAL ANATOMY AND PHYSIOLOGY
Figure 22. Glomerular Filtration Rate.
The GFR (glomerular filtration rate) is actually determined by the sum
of the hydrostatic and the colloid osmotic forces across the glomerular
membrane.
Hydrostatic pressure is the pressure exerted once blood comes from
the afferent arteriole going to the efferent arteriole.
The glomerular colloid osmotic pressure is the pressure exerted by
proteins.
This gives a net filtration pressure from the glomerular hydrostatic
pressure (+), the Bowman’s capsule hydrostatic pressure (-), and the
glomerular colloid osmotic pressure (-). This is one of the regulatory
components of the GFR aside from the glomerular filtration coefficient.
The net filtration pressure represents the sum of the hydrostatic and the
colloid osmotic forces that either favor or oppose the filtration across
the glomerular capillaries.
These forces such as hydrostatic pressure inside the glomerular
capillaries promote filtration (arrow down). The hydrostatic pressure in
the Bowman’s capsule outside the capillaries opposes the filtration
(arrow up). The colloid osmotic pressure of the Glomerular plasma
membrane, also opposes filtration (arrow up).
Under normal conditions, the concentration of protein in the
glomerular filtrate is so low that the colloid osmotic pressure of the
Bowman’s capsule is considered to be zero (0). That is why there is no
Bowman’s capsule colloid osmotic pressure because the protein
content of glomerular filtrate is very negligible.
Memorize this equation!
The glomerular hydrostatic pressure is at 60 mmHg normally. There is a
60 mmHg pressure that will now promote filtration of blood. In
opposition, there is a Bowman’s capsule pressure of 18 mmHg that
opposes filtration and a glomerular colloid osmotic pressure of 32
mmHg that also opposes filtration.
In math equation form:
Promotes filtration - opposes filtration = net filtration pressure
60 mmHg - (32 mmHg + 18 mmHg) = 10 mmHg
The net filtration pressure of 10 is already sufficient enough to filter the
necessary waste materials or to produce a glomerular ultrafiltrate.
In cases where there is an increase in your hydrostatic pressure (e.g.,
hypertension), there will be a reduced filtration coefficient (such as in
cases of uncontrolled hypertension or diabetes mellitus). Since there is
already destruction of capillaries, there will be a reduced filtration
coefficient.
↑ hydrostatic pressure = ↓ filtration coefficient (Kf)
In cases where the afferent arteriole undergoes constriction, what
happens to the glomerular hydrostatic pressure?
—----Glomerular hydrostatic pressure will increase because of the
stenosis or constriction.
Like a water hose, if there is constriction or obstruction, its pressure will
increase. Similarly, if the glomerular hydrostatic pressure increases, it
will also promote filtration.
↑ glomerular hydrostatic pressure = ↑ rate of filtration
In cases where the Bowman’s capsule pressure increases (e.g. urinary
obstruction or renal stones), the glomerular filtration rate will decrease
since the Bowman’s capsule opposes filtration.
↑ Bowman’s capsule pressure = ↓ rate of filtration
There is actually a very delicate balance between the hydrostatic
pressure, the colloid osmotic pressure and the Bowman’s capsule
pressure so that glomerular ultrafiltrate can be produced.
Structure of a Nephron
Glomerulus
● Coil of 8 capillary lobes, collectively as “capillary tuft”
● Nonselective filter (filters substances with a molecular weight
of less than 70,000)
● Receives blood from the afferent arterioles
● Empties blood into the efferent arterioles
● Function – Filtration
Figure 23. Glomerulus
3 MAJOR LAYERS OF GLOMERULAR CAPILLARY MEMBRANE
I. Endothelium
● Perforated by small holes (fenestrae)
● Pores increase capillary permeability but do not allow
passage of large molecules and blood cells
II. Basement Membrane
● Meshwork of collagen and proteoglycan fibrillae
● Strong negative charges repel the negatively charged albumin
● Primary restriction point for plasma proteins
○ Proteins are normally absent in urine
○ In diabetes mellitus, the function of the basement
membrane is compromised. That is why in cases of
diabetic incipient nephropathy or uncontrolled
diabetes mellitus, proteins can be often found in
urine.
ATRÓ 2024 | 8
AUBF: RENAL ANATOMY AND PHYSIOLOGY
III. Epithelial cells (podocytes)
● Foot processes are separated by gaps called slit-pores
Figure 24. Glomerular Capillary Membrane
This is the glomerular capillary membrane. It is endowed with special
characteristic structures. There is the capillary endothelium which is
perforated with small holes of the fenestrae, similar to the fenestrated
capillaries in the liver. Although you can see that the fenestrations are
relatively large, the endothelial cells are richly endowed with negative
charges, which can repel plasma proteins.
Surrounding the endothelium is the basement membrane. It also
consists of a meshwork of collagen and proteoglycan fibrillae that have
large spaces through which large amounts of water and small solutes
can filter.
The primary restriction point of the plasma proteins is the basement
membrane because of their strong negative electrical charges
associated with the proteoglycans.
What is the primary restriction point?
—----Basement membrane - has the strongest negative electrical
charges because of the proteoglycans present on the membrane
Although the endothelium has the same ability because of its fixed
negative charges, the primary restriction point will always be the
basement membrane.
Then the final part of the glomerular membrane is the layer of epithelial
cells that line with the outer surface of the glomerulus. These cells are
not continuous but have long foot-like processes called podocytes.
They encircle the outer surface of capillaries. These foot processes are
further separated by gaps called slit pores, through which the
glomerular filtrate moves. The epithelial cells which also have negative
charges provide additional restriction point to your filtration of your
plasma proteins, thus all layers of your Glomerular capillary wall
provide a barrier to filtration of plasma proteins.
So that is why if there will be glomerular damages like in cases of
Glomerulonephritis and Incipient diabetic nephropathy, so if there
will be compromise in this Glomerular capillary membranes, you would
expect to find proteins in your urine but if there won’t be any
compromise or there won’t be any destruction of these layers, well of
course, it is not normal that you find proteins in your urine.
PERITUBULAR CAPILLARIES
● Arise from the efferent arteriole that drains the glomerulus
● Closely associated with the renal tubules as you can see
in the illustration
● Since they are associated with your renal tubules, they are
more adapted for absorption
● Readily absorbs solute and water from the tubule cells
● Help in the reabsorption of water and glucose molecules
especially from the Proximal convoluted tubule into the
bloodstream
Figure 25. Peritubular Capillaries
JUXTAGLOMERULAR APPARATUS
● Region of the nephron where the Distal Convoluted Tubule
(DCT) comes in contact with the Afferent Arteriole.
● controls the rate of the glomerular blood flow depending on
various factors such as your hydration, your blood flow, and
even your ion concentration.
● includes the (1) macula densa and the (2) juxtaglomerular
cells as you can see in the picture. So what’s the difference?
○ Macula densa - a short segment of the distal
convoluted tubule that is located directly adjacent to
the afferent and the efferent arterioles at the
vascular pole.
○ JG Cells - are within the interstitium between the
macula densa and vascular pole. They secrete
renin in response to hypoperfusion, such as in
cases of dehydration, and hypotension.
● DCT contains macula densa which acts as
chemoreceptors/osmoreceptors that detect changes in solute
concentration of the filter
Figure 26. Juxtaglomerular Apparatus
ATRÓ 2024 | 9
AUBF: RENAL ANATOMY AND PHYSIOLOGY
MECHANISMS OF URINE FORMATION
Figure 27. (Most important for MTs to know by heart)
IMPORTANT: So Doc is just flashing this back so that we will really
familiarize ourselves with the values, glomerular hydrostatic pressure,
glomerular colloid osmotic pressure, and the bowman’s capsule
pressure. So please know this by heart since this is a very high yield
diagram so the net filtration pressure again is 10 mmHg, so this is
already sufficient enough to cause production of your Glomerular
ultrafilter.
Processes of Urine Formation
1 Ultrafiltration Glomerular Filtration
2 Selective reabsorption Reabsorption of substances from renal
into peritubular capillary blood
3 Secretion Secretion of substances from
peritubular capillary blood into the renal
tubules (vice versa with step 2)
4 Excretion Urinary excretion
Please remember those steps
Figure 28. Process of Urine Formation
1. GLOMERULAR FILTRATION:
● Urine formation begins with filtration from the glomerular
capillaries into the Bowman's capsule of a large amount of
fluid that is virtually free of protein.
○ So that is your ultrafiltrate.
● Most substances in the plasma, except for proteins, are freely
filtered so that their concentrations in the glomerular filtrate in
the Bowman's capsule are almost the same as in plasma.
○ As I have said, Glomerulus is non-selective. It
filters anything as long as the molecular weight is
less than 70,000.
● Glomerular Hydrostatic Pressure - created by the smaller
size of the efferent arteriole and glomerular capillaries
○ It is important that the efferent arteriole is smaller
in size. Why? Because having the same calibers of
both the efferent and afferent arteriole will result in
no renal blood flow. So afferent should be bigger
than efferent so there is a specific hydrostatic
pressure which will promote filtration.
○ To overcome the opposition of pressures from the
fluid within Bowman's capsule and colloidal pressure
of unfiltered plasma and proteins, the glomerular
capillaries with the afferent arteriole much bigger
than your efferent arteriole will now produce the
glomerular hydrostatic pressure.
○ Increasing or decreasing the size of the afferent
arteriole to maintain the glomerular blood pressure
at a constant rate regardless of fluctuations in the
Systemic Blood Pressure (SBP).
■ That is the beauty of your renal
autoregulation. If ever there is less renal
blood flow that comes into the kidney, so
the afferent arteriole constricts so that it
will increase the renal blood pressure
again. But if there is an increase in the
renal blood pressure, the afferent arteriole
will now dilate for the renal blood pressure
to decrease.
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
Figure 29. Renin-Angiotensin System
● Physiological system that regulates the blood pressure.
● Renin: enzyme that is secreted into the blood from
specialized cell that encircle the arterioles at the entrance of
your glomeruli.
○ We call this the juxtoglomerular cells.
● Renal capillary networks and renin-secreting cells w/c
composes the juxtaglomerular apparatus including the macula
densa are sensitive to changes in blood flow and blood
pressure. The primary stimulus for increased renin secretion
is decreased blood flow to the kidneys.
● This might be caused by loss of sodium and water like in
diarrhea, persistent vomiting, excessive perspiration, renal
artery stenosis, narrowing of renal artery. This would activate
your RAAS.
● Renin catalyzes the conversion of a plasma protein called
“Angiotensinogen” into a decapeptide called Angiotensin.
● An enzyme in the serum called Angiotensin-converting
enzyme (ACE) then converts your angiotensin I into an
octapeptide w/c is Angiotensin II.
● Angiotensin II acts vio receptors in adrenal glands to
stimulate the secretion of aldosterone (hormone produced by
adrenal gland that stimulates salt and water reabsorption by
kidney.)
○ If there is salt and water reabsorption, there is also a
ATRÓ 2024 | 10
AUBF: RENAL ANATOMY AND PHYSIOLOGY

rise in blood pressure. If there is salt, there is also Molecular Weight

water. It also causes constriction of small arteries
and arterioles which can also cause an increase in Substance Molecular Weight Filterability
blood pressure.
Water 18 1.0
○ Angiotensin II can also further constrict blood
Sodium 23 1.0
vessels via inhibitory actions on the reuptake in the
nerve terminals of the hormone norepinephrine. Glucose 180 1.0
■ Norepinephrine - vasodilatory hormone. If Insulin 5,500 1.0
it inhibits the reuptake of norepinephrine, Myoglobin 17,000 0.75
then it can cause vasoconstriction. Albumin 69,000 0.005

Filtration, Reabsorption, and Excretion Rates of Different ● The illustration shows the filterability of solutes that is
Substances by the Kidneys: inversely related to their size. We all know that the
glomerular capillary membrane is thicker than most other
capillaries, but it is also much more porous (meaning, it has
Amount Amount Amount % of Filtered
more holes) and therefore, filters fluid at a very high rate.
Filtered Reabsorbed Excreted Load
● So despite the high filtration rate, the glomerular filtration
Reabsorbed
barrier is selective in determining whether the molecules will
Glucose 180 180 0 100
filter based on their size and electrical charge.
(g/day)
○ filterability of 1 means that the substance is freely
Bicarbonate 4,320 4,318 2 >99.9 filtered as water.
(mEg/day) ○ filterability of 0.75 means that it is filtered only 75%
Sodium 25,560 25,410 150 99.4 as rapidly as water. As you can see, only myoglobin
(mEg/day) is 0.75. So electrolytes (such as your sodium) and
Chloride 19,440 19,260 180 99.1 small organic compounds (such as your glucose)
(mEg/day) are actually freely filtered.
Potassium 756 664 92 87.8 ● Your albumin is a plasma protein and the filterability rapidly
(mEg/day) decreases. So if it approaches already 0. So, again,
Urea 46.8 23.4 23.4 50 because of the inherent negative charges of the glomerular
(g/day) capillary.
Creatinine 1.8 0 1.8 0
(g/day) 2. TUBULAR REABSORPTION

This is the renal handling of several substances that are freely filtered
in the kidneys and reabsorbed at variable rates. There are 2 things that
are apparent in this.
1. The process of glomerular filtration and tubular reabsorption
are quantitatively large, relative to your urinary excretions.
○ Even a small change in glomerular filtration/ tubular
reabsorbtion can potentially cause a relatively large
change in your urinary excretion.
2. Unlike your glomerular filtration (relatively non-selective;
glomerulus is non-selective, essentially all solutes in the
plasma are filtered except for plasma proteins/ substances
bound to them), however, the tubular reabsorption is very
highly selective.
○ Some substances like glucose and amino acids that
are filtered in glomerulus are almost completely
reabsorbed from the tubules so the urinary excretion
rate is essentially 0. Glucose is 0.
○ Many of the ions in plasma like sodium chloride and
bicarbonate are also highly reabsorbed, but the
rates of reabsorption and urinary excretion are
variable, depending on the needs of the body.
○ So waste products such as your urea and
creatinine, conversely are poorly reabsorbed from
the tubules and are excreted in relatively large
amounts.
○ So that is why, in body fluids, when we are doubting
the identification of the specimen, whether or not it is
urine, we often test for creatinine since the
creatinine is reabsorbed poorly and excreted in
relatively large amounts in the urine. So once the
creatinine is elevated, then that is most likely urine.
○ So therefore, by controlling the rate at which they
reabsorb different substances, the kidneys actually
also regulate the excretion of solutes independently
of one another; a capability which is very essential
for the precise control of your body fluid
composition.
Filterability of Substances by Glomerular Capillaries Based on
● Also called the Tubular Processing of the Glomerular
Filtrate
○ Very selective unlike glomerular filtration which is
relatively nonselective
○ Reabsorption of water and solutes include active
and passive transport mechanisms as in other
cell membranes.
■ I hope you remember your active and
passive transport. It was discussed in
Physiology.
■ And eventually, urine that is formed and all
the substances found in the urine actually
represent the sum of the three processes,
which are again: (1) Glomerular filtration,
(2) Tubular reabsorption, and (3) Tubular
secretion.
RECAP!!
Cellular Mechanisms Involved in Tubular Reabsorption
1. Active Transport
○ Substances to be transported should combine with a
carrier protein
■ E.g., sodium-potassium atpase pump
○ The energy created transfers the substances across
the cell membranes back into the blood.
○ Examples:
■ Reabsorption of glucose, amino acids, and
salts in the proximal convoluted tubule
(PCT), chloride (Cl) in loop of Henle, and
sodium (Na) in the distal convoluted tubule
(DCT)
2. Passive Transport
○ Movement of molecules across a membrane caused
by differences in their concentration on opposite
sites of the membrane
■ E.g., Water reabsorption in all parts of the
nephron is governed by your passive
transport, except ascending loop of
ATRÓ 2024 | 11
AUBF: RENAL ANATOMY AND PHYSIOLOGY
Henle
● Because the ascending loop of
Henle is impermeable to water.
Figure 30. Reabsorption of filtered water and solutes.
This is a diagram/illustration that portrays the reabsorption of
filtered water and solutes from the tubular lumen across the tubular
epithelial cells; through the renal interstitium and back into the blood.
So solutes are transported through the cell. If it’s through the
cell, (transcellular path), by passive diffusion or active transport OR if
it’s between the cells (paracellular path), it is also by diffusion. So
water is transported through the cells and between the tubular cells by
the process called osmosis. So transport of water and solutes from
your interstitial fluid into the peritubular capillaries occurs by
ultrafiltration.
References:
Figure 31. Basic Mechanism for Active Transport of Sodium through
Tubular Epithelial Cells.
Here in this figure, we also have the basic mechanism of your
active transport of sodium through the tubular epithelial cells. As you
can see, the sodium-potassium pump transports sodium from the
interior of the cell across the basolateral membrane, creating a low
intracellular sodium concentration and a negative intracellular electrical
potential.
So the low intracellular sodium concentration and the negative
intracellular electrical potential will now cause the sodium ions to diffuse
from the tubular lumen into the cell through the brush border.
3. TUBULAR SECRETION
● Involves passage of the substances from the blood in the
peritubular capillaries to the tubular filtrate
● 2 Major functions:
○ Elimination of waste products not filtered by the
glomerulus
○ Regulation of acid-base balance through the
secretion of H ion
■ In cases that the body is very acidotic, it
will secrete hydrogen ions into the urine so
that the body goes back to normal pH.
BASIC FACTS TO REMEMBER:
● Glomerular capillaries have a much higher rate of filtration
than most other capillaries because of a high glomerular
hydrostatic pressure (60 mmHg) and a large glomerular
filtration coefficient.
● Normal adults: GFR: 125 mL/min or 180 L/day
● The fraction of plasma filtered is about 20% of the total
blood flowing to the kidneys per minute or your total cardiac
output.
○ glomerular filtration rate is approximately 180
L/day
○ tubular reabsorption is 178.5 L/day.
○ So we leave 1.5 L/day of fluid to be excreted in the
urine. So that’s the normal approximate range.
○ And the relatively constant and normally not affected
by changes in arterial pressures because of the
renal autoregulation. So no matter how high or low
the blood pressure is, the kidney will still
compensate and will still excrete the 1.5 L/day
requirement because of the renal autoregulation
capacity of the kidney and also the adaptive
mechanisms in the renal tubules that allows them
to increase the absorption rate when the GFR rises
or falls.
– end –
● None mentioned
ATRÓ 2024 | 12