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Introduction to Urinalysis • Longer loops of Henle (extends to medulla)

• Concentration of urine, further reabsorption of water
External Anatomy of the Kidney
• Paired, reddish, bean-shaped (characteristic of hilum), retro Path of Urine Drainage
peritoneum 1. Collecting duct
• Right is slightly lower due to the space occupied by the liver 2. Minor calyx
• Length: 10-12 cm 3. Major calyx
• Width: 5-7 cm 4. Renal pelvis
• Thickness: 3 cm 5. Ureter
• Mass: 135-150 g 6. Urinary bladder
7. Urethra
Renal Hilum/Hilus
• Makes kidney bean shaped Blood Supply Pathway
• Indentation: entry of ureter 1. Renal artery
• Ureter 2. Arteries
• Blood vessels • Segmental à interlobar à arcuate à interlobular
• Nerves 3. Afferent arteriole
4. Glomerulus
Coverings of the Kidney (3 Layers) 5. Efferent arteriole
1. Renal fascia 6. Peritubular arteries
• Superficial layer 7. Vasa recta
8. Veins
• Anchors kidney to surrounding organs
• Interlobular à arcuate à interobar
• Dense irregular CT
9. Renal vein
2. Adipose capsule
• Middle
The Nephron & the Collecting Duct
• Protection: shock absorber
1. Renal corpuscle
• Fatty tissue
a. Glomerulus
3. Renal capsule
• Capillary network
• Deep
• Endothelium: fenestrated, “shield of negativity”
• Protection, shape nd
• Basement membrane: 2 barrier
• Dense irregular CT
b. Bowman’s capsule / glomerular capsule
Internal Anatomy
• Visceral: inner layer consisting of podocytes
1. Renal cortex
• Parietal: outer layer, simple squamous
• Superficial
• Light red
2. Renal tubule
• Renal columns a. Proximal convoluted tubule
o Extend into the medulla
• Simple cuboidal cells with microvilli
o Same composition as the cortex
b. Loop of Henle
2. Renal medulla
• Descending limb and thin ascending limb
• Deep, inner
o Simple squamous
• Dark red
• Thick ascending limb
• Renal pyramids o Simple cuboidal to low columnar
o House the renal papilla c. Distal convoluted tubule
3. Renal lobe
• Most of distal DCT
• Renal pyramid o Simple cuboidal
• Overlying cortex • Last part of DCT & CT
• 1/2 of each adjacent column o Simple cuboidal
4. Renal parenchyma § Principal cells – receptors for ADH,
• Cortex aldosterone
• Renal pyramids – functional portion where nephrons are § Intercalated cells – involved in blood pH
found regulation
5. Nephrons
• Functional unit Renal Physiology
• 1.3 million per kidney 1. Glomerular Filtration
• Renal plasma à glomeruli à ultrafiltrate
a. Cortical nephrons • Ultrafiltrate
• 85% of all nephrons o Same composition as blood plasma but normally free
• Primarily in the cortex of blood cells and proteins
• Removal of waste, reabsorption of nutrients o Sp.gr.: 1.010
• Glomerular Filtration Rate
b. Juxtamedullary nephrons o Amount of filtrate formed per minute
• Closer to medulla o 90-120 mL/min for both kidneys

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• Factors Affecting Filtration
a. Filtration membrane
• Structural factors
o Lining of glomerulus is negatively charged:
repel proteins
o Basement membrane layers contain
heparan sulfate – polyanionic proteoglycan
o Podocytes with finger-like processes create
filtration slots: negatively charged
b. Filtration pressure
• Net filtration pressure
o Net pressure that forces substances out the
glomerulus
o +10 mmHg
• Glomerular blood hydrostatic pressure (GBH)
o Results from the smaller size of efferent
arterioles & glomerular capillaries
o Enhances filtration
o +55 mmHg
• Capsular hydrostatic pressure (CHP)
o Pressure exerted by the fluid in the capsular
space
o –15 mmHg
o Prevents filtration (back to circulation)
• Blood colloid osmotic pressure (BCOP)
o Unfiltered proteins in glomerular capillaries
o –30 mmHg
o Prevents filtration
c. Feedback mechanism (RAAS)
• Renin-angiotensin-aldosterone system
• Juxtaglomerular apparatus
o Macula densa (distal convoluted tubule)
o Juxtaglomerular cells (afferent arteriole)
• Responds to changes in:
o Blood pressure
o Na content of plasma
• ↓ plasma Na à ↓ water retention (circulatory
system) à ↓ overall blood volumeà ↓ blood
pressure
o Macula densa senses changes in pressure
o Juxtaglomerular cells secrete renin
o Renin reacts with angiotensinogen à
angiotensin I à ACE: lungs à angiotensin II
§ ACE: angiotensin-converting enzyme
o Angiotensin II
§ Vasoconstriction
+
§ Stimulates reabsorption of Na (PCT)
§ Triggers release of aldosterone
+
• Reabsorption of Na (PCT, CD)
§ Triggers release of ADH
§ reabsorption of H2O (PCT, CD)
2. Tubular Reabsorption
• Proximal convoluted tubule – part of the nephron
performs majority of the reabsorption
• Water reabsorption – throughout the nephron
o Except ascending loop of Henle
a. Transport mechanism
• Passive
o No energy
o Along a gradient (high à low solute
concentration)
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• Active
o Energy
o Against a gradient (low à high)
o Carrier proteins – facilitate the movement of the
solutes
b. Transport capacity
• Capacity of renal tubules for reabsorption
1. Maximal tubular reabsorption capacity (Tm)
• Maximal rate of reabsorption of a solute
• Mg/min
• Varies with each solute
• Depends on the glomerular filtration rate: the
more solutes in renal tubules, the faster the GFR
• In some substances, the amount of solute
present increases the rate of absorption until it
reaches the maximum rate of absorption
2. Renal threshold
• The plasma concentration of a solute above
which the amount of solute present in the
ultrafiltrate exceeds the maximal tubular
reabsorptive capacity
• Once the renal threshold level has been reached,
increased amounts of solute are excreted (i.e.
lost) in the urine
• Glucose
o Renal threshold: 160-180 mg/dL
o Tm: 350mg/min
o Regardless of the amount of glucose in the renal
tubules, when concentration > 160-180 mg/dL,
the excess is excreted
o Note: Glucose appearing in urine of a patient
with normal blood glucose level = glomerular or
tubular damage
o Some solutes are not limited in the amount that
can be reabsorbed
o Other factors:
§ Tubular flow rate
§ Contact time
§ Concentration of other solutes
§ Transport inhibitors
§ Hormone levels
c. Renal concentrating mechanism
• Long loops of Henle (Juxtamedullary apparatus)
o Kidneys need to conserve water while
eliminating wastes
§ Depends on hypertonic states of renal
medulla with increasing osmolality
• Countercurrent mechanism
1. Countercurrent multiplication
• Process by which a progressively increasing
osmotic gradient is formed in the interstitial
fluid of the renal medulla as a result of
countercurrent flow
• Symporters in the ascending loop of Henle
(impermeable to water) causes a buildup of
sodium and chloride in the renal medulla
• Thick ascending limb constantly reabsorbs
Na & Cl, consequently concentrating in the
2
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interstitial fluid in the medulla à osmotic 2. H secretion to yield urine titratable acids
gradient (300 mOsm/L à 1200 mOsm/L)
• Main purpose:
o Not to concentrate lumen fluid
(tubules)
o But to establish the gradient
hypertonicity of the medulla

2. Counter current exchange

• Process by which solutes and water are
passively exchanged between the blood of
the vasa recta & interstitial fluid of the renal
medulla as a result of countercurrent flow
• Main purpose:
o Provide oxygen & nutrients to medulla
o Maintain the osmotic gradient 3.
+
H & NH3 secretion to yield ammonium salts

3. Final Concentration of Urine

• Last part of the DCT
• Collecting duct
• Influenced by ADH
o Makes the tubular cells permeable to water

Tubular secretions
• Blood à filtrate
• Removal of waste products
o Protein-bound, i.e. albumin (in peritubular capillaries)
o Increased affinity for tubular cells
o Dissociate from carrier (protein)
o Transported to filtrate (via tubular cell)
• Regulate acid-base balance (metabolic) • To yield ammonium salts, formed by glutaminase
from substrate glutamine
• Incompletely metabolized waste products
Focus the following:
o Thiamine
• Water, urea, Na, Cl, H, glucose, proteins
• Not metabolized:
o Radiographic contrast media
Urine composition
o Mannitol
• 95% water
• Not normal in plasma
o Penicillin and salicylates • 5% dissolved solutes
o Organic
Acid-base balance • Urea
• Maintain blood pH: 7.35-7.45 • Creatinine
• Uric acid
• 3 regulatory mechanisms: • Hippuric acid
+
1. H secretion to recover HCO3 • Others: carbohydrates, pigment, fatty acids, mucin,
enzymes, hormones
o Inorganic: electrolytes
§ Na, Cl, K, SO4, PO4, NH3, Mg, Ca
o Other substances
• Hormones
• Vitamins
• Medications
o Formed elements
§ Cells, casts, crystals, mucus, bacteria

Composition varies depending on:

• Dietary intake
• Physical activity
• Body metabolism
• Endocrine function
• Bicarbonates are readily filtered in the glomerulus • Body position
• H2O + CO2 passively transferred to renal tubular cell • Nutritional status
• General state of body
• State of the kidney