Nephrons

The kidney consists of over a million individual filtering units called nephrons. Each nephron consists
of a filtering body, the renal corpuscle, and a urine‐collecting and concentrating tube, the renal
tubule. The renal corpuscle is an assemblage of two structures, the glomerular capillaries and the
glomerular capsule, shown in Figure 1.

The glomerulus is a dense ball of capillaries (glomerular capillaries) that branches from the afferent
arteriole that enters the nephron. Because blood in the glomerular capillaries is under high pressure,
substances in the blood that are small enough to pass through the pores (fenestrae, or endothelial
fenestrations) in the capillary walls are forced out and into the encircling glomerular capsule. The
glomerular capillaries merge, and the remaining blood exits the glomerular capsule through the
efferent arteriole.

The glomerular capsule is a cup‐shaped body that encircles the glomerular capillaries and collects
the material (filtrate) that is forced out of the glomerular capillaries. The filtrate collects in the
interior of the glomerular capsule, the capsular space, which is an area bounded by an inner visceral
layer (that faces the glomerular capillaries) and an outer parietal layer. The visceral layer consists of
modified simple squamous epithelial cells called podocytes, which project branches that bear fine
processes called pedicels. The pedicels' adjacent podocytes mesh to form a dense network that
envelops the glomerular capillaries. Spaces between the pedicels, called filtration slits, are openings
into the capsular space that allow filtrate to enter the glomerular capsule.

The renal tubule consists of three sections:

The first section, the proximal convoluted tubule (PCT), exits the glomerular capsule as a winding
tube in the renal cortex. The wall of the PCT consists of cuboidal cells containing numerous
mitochondria and bearing a brush border of dense microvilli that face the lumen (interior cavity). The
high‐energy yield and large surface area of these cells support their functions of reabsorption and
secretion.

The middle of the tubule, the nephron loop, is shaped like a hairpin and consists of a descending
limb that drops into the renal medulla and an ascending limb that rises back into the renal cortex. As
the loop descends, the tubule suddenly narrows, forming the thin segment of the loop. The loop
subsequently widens in the ascending limb, forming the thick segment of the loop. Cells of the
nephron loop vary from simple squamous epithelium (descending limb and thin segment of
ascending limb) to cuboidal and low columnar epithelium (thick segment of ascending limb) and
almost entirely lack microvilli.

The final section, the distal convoluted tubule (DCT), coils within the renal cortex and empties into
the collecting duct. Cells here are cuboidal with few microvilli.

Renal tubules of neighboring nephrons empty urine into a single collecting duct. Here and in the final
portions of the DCT, there are cells that respond to the hormones aldosterone and antidiuretic
hormone (ADH), and there are cells that secrete H + in an effort to maintain proper pH.
Various collecting ducts within the medullary pyramids merge to form papillary ducts, which drain
eventually into the renal pelvis through the medullary papillae. Urine collects in the renal pelvis and
drains out of the kidney through the ureter.

The efferent arteriole carries blood away from the glomerular capillaries to form peritubular
capillaries. These capillaries weave around the portions of the renal tubule that lie in the renal
cortex. In portions of the nephron loop that descend deep into the renal medulla, the capillaries
form loops, called vasa recta, that cross between the ascending and descending limbs. The
peritubular capillaries collect water and nutrients from the filtrate in the tubule. They also release
substances that are secreted into the tubule to combine with the filtrate in the formation of urine.
The capillaries ultimately merge into an interlobular vein, which transports blood away from the
nephron region.

There are two kinds of nephrons:

Cortical nephrons, representing 85 percent of the nephrons in the kidney, have nephron loops that
descend only slightly into the renal medulla (refer to Figure 1).

Juxtamedullary nephrons have long nephron loops that descend deep into the renal medulla. Only
juxtamedullary nephrons have vasa recta that traverse their nephron loops (refer to Figure 1).

The juxtaglomerular apparatus (JGA) is an area of the nephron where the afferent arteriole and the
initial portion of the distal convoluted tubule are in close contact. Here, specialized smooth muscle
cells of the afferent arteriole, called granular juxtaglomerular (JG) cells, act as mechanoreceptors
that monitor blood pressure in the afferent arteriole. In the adjacent distal convoluted tubule,
specialized cells, called macula densa, act as chemoreceptors that monitor the concentration of Na +
and Cl – in the urine inside the tubule. Together, these cells help regulate blood pressure and the
production of urine in the nephron.

The operation of the human nephron consists of three processes:

Glomerular filtration

Tubular reabsorption

Tubular secretion

These three processes, which determine the quantity and quality of the urine, are discussed in the
following sections.

Glomerular filtration
When blood enters the glomerular capillaries, water and solutes are forced into the glomerular
capsule. Passage of cells and certain molecules are restricted as follows:

The fenestrae (pores) of the capillary endothelium are large, permitting all components of blood
plasma to pass except blood cells.

A basement membrane (consisting of extracellular material) that lies between the capillary
endothelium and the visceral layer of the glomerular capsule blocks the entrance of large proteins
into the glomerular capsule.

The filtration slits between the pedicels of the podocytes prevent the passage of medium‐sized
proteins into the glomerular capsule.