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The Renal System Juxtaglomerulous apparatus &bladder

By Associate Professor Dr /Sohair Aly Hassan College of medicine,[RCMP] Perak &National Research Center/Cairo, Egypt

Chapter 14: The Kidneys and Regulation of Water and Inorganic Ions

L objectives
At the end of this lecture, the students should be able to: discuss the functional unit of the kideny Nephron discuss the blood flow to the kidney c) explain the basic mechanisms of Glomerular filtration, tubular reabsorption and secretion discuss the different cell types in the juxtaglomerular apparatus

Section A: Basic Principles of Renal Physiology:


1- Glomerular filtration

2- Tubular reabsorption
3- Tubular secretion

Figure 14-1

The paired kidneys form a filtrate of the blood that is modified by reabsorption and secretion; urine designated for excretion moves along the ureters to the bladder.

Figure 14-2

Fluid filtered from the blood in the glomerular capillaries is altered by reabsorption and secretion along the length of the 1,000,000 nephrons/kidney.

Nephrone

Create osmotic gradient assisting in water reasorption

Figure 14-3

Due to the hydrostatic pressure of the cardiac pump, fluid is filtered from the blood through fenestra in the glomerular capillaries into slit pores in the capsule.

Figure 14-4
The outer layer of the kidney is the renal cortex; it is the site of glomerular filtration and the convoluted tubules. The inner part of the kidney is the renal medulla; this is the location of the longer loops of Henle, and the drainage of the collecting ducts into the renal pelvis and ureter.

Figure 14-5

The intersection of the macula densa in the distal tubule with the afferent and efferent arterioles forms the juxtaglomerular apparatus, which secretes the endocrine signal known as renin into blood in the afferent arteriole.

juxtaglomerular cells (JG cells, or granular cells) are


cells in the kidney that synthesize, store, and secrete the enzyme renin. They are specialized smooth muscle cells in the wall of the afferent arteriole that delivers blood to the glomerulus. In synthesizing renin, they play a critical role in the renin-angiotensin system and thus in renal autoregulation, the self-governance of the kidney

1. Glomerular filtration refers to the movement of fluid and solutes from the glomerular capillaries into Bowmans space.

Figure 14-6

1. Glomerular filtration refers to the movement of fluid and solutes from the glomerular capillaries into Bowmans space.

2. Tubular secretion refers to the secretion of solutes from the peritubular capillaries into the tubules.

Figure 14-6

1. Glomerular filtration refers to the movement of fluid and solutes from the glomerular capillaries into Bowmans space.

2. Tubular secretion refers to the secretion of solutes from the peritubular capillaries into the tubules. 3. Tubular reabsorption refers to the movement of materials from the filtrate in the tubules into the peritubular capillaries.

Figure 14-6

Figure 14-7

Substance X is filtered and secreted but not reabsorbed. Substance Y is filtered and some of it is reabsorbed. Substance Z is filtered and completely reabsorbed. Glucose

Figure 14-8

Formation of the glomerular filtrate in Bowmans capsule is the outcome of opposing pressures:

hydrostatic pressure from the heart favors filtration, osmotic and hydrostatic pressure of the filtrate oppose it.

GLOMERULAR FILTRATION Depends upon the interaction of a number of forces:

1. Glomerular blood hydrostatic pressure (GBHP) - This is the chief force. It is the pressure of blood in the glomerular capillaries, i.e., 75mm.

2. Capsular hydrostatic pressure (CHP) - CHP is a back pressure due to the presence of fluid already in the renal tubule and the resistance of the tubule walls. 3. Blood Colloid osmotic pressure (BCOP) - The presence of non-filtrating proteins in the blood of the glomerular capillaries creates an osmotic pull on water in the relatively protein-free filtrate.

Pressure #1 is opposed by Pressures #2 and #3, This produces an effective filtration pressure (Peff) of 25mm Hg

Figure 14-9

http://www.wisconline.com/objects/Vie wObject.aspx?ID=ap22 04

As vasodilation and vasoconstriction of the afferent and efferent arterioles alter the blood flow through the glomerular capillaries, there are corresponding alterations in the glomerular filtration rate (GFR).

Glomerular Filtration
[GFR ]is the volume of fluid filtered from the glomeruli into Bowmans space per unite time Determined by permeability of the corpuscular membranes Surface area available for filtration GFR for normal person is 125ml/min or 180L /day / the renal plasma flow is about 625 ml/min in a 'normal' kidney clearance values/ml/min

Figure 14-10
The luminal section of the plasma membrane of the tubule cells faces the filtrate,

whereas the basolateral section is in close proximity to the peritubular capillary.

Reabsorpition
Tubular reapsorpition Diffusion Mediated have a limited amounts of material they can transport/unit time [transport maximum Tm] this is because the binding site on the membrane transport proteins become saturated when the concentration of the transported substance increases to a certain level. Eg glucose[normal is 150 mg/100ml Fig 14-11
Glucouria when start to appear in urine[in hyperglycemia] or Drop in the nephron efficiency to reabsorb the excess of filtered load of glucose[nephropathy] active

Tubular Secretion move substances from peritubular capillaries into the tubular lumen Occure by diffusion Mediated transport Substances secreted are H,K, choline , creatinine penicillin

Kidney Concept of Clearance


Is the vol of plasma from which the substance is completely removed [cleared] by kidney per unit time. Cs= Mass of S excreted/unit time/plasma concentration of S

Figure 14-11

CONCEPT OF RENAL CLEARANCE

Inulin, a biologically inert polysaccharide, can be used to estimate the glomerular filtration rate since it is filtered, but not reaborbed or secreted.

Figure 14-12

Release of urine from the bladder, called micturition, is coordinated by a combination of smooth and skeletal muscle relaxation and contraction.

MICTURITION
Micturition is the process by which urine is expelled from the bladder. The neural mechanism causing micturition is called Micturition reflex.

Micturition cycle occurs two phases . it consist of a filling phase and emptying phase. Each phase requires a coordination interaction between the bladder and the nervous system. Urine formed by the nephrone is ultimately carried to the urinary bladder. Where it is stored till a voluntary signal is given by the central nervous system [CNS].

The signal is initiated by the stretching of the urinary bladder as it gets filled with urine. In response ,the stretch receptors on the walls of the bladder send signals to the CNS.
The CNS passes on motor messages to initiate the contraction of smooth muscles of the bladder . The simultaneous relaxation of the urethral sphincter causing the release of urine. This type urine releasing process are called MICTURITION

Bladder control problems


For the urinary system to do its job, muscles and nerves must work together to hold urine in the bladder and then release it at the right time. Nerves carry messages from the bladder to the brain to let it know when the bladder is full. They also carry messages from the brain to the bladder, telling muscles either to tighten or release . A nerve problem might affect your bladder control if the nerves that are supposed to carry messages

in case nerve damage?


Nerves that work poorly can lead to three different kinds of bladder control problems. 1-Overactive bladder. Damaged nerves may send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. The symptoms of overactive bladder include
urinary frequency-defined as urination eight or more times a day or two or more times at night urinary urgency-the sudden, strong need to urinate immediately urge incontinence-leakage of urine that follows a sudden, strong urge to urinate

2-Poor control of sphincter muscles. Sphincter muscles surround the urethra and keep it closed to hold urine in the bladder. If the nerves to the sphincter muscles are damaged, the muscles may become loose and allow leakage or stay tight when you are trying to release urine.

Urine retention.

For some people, nerve damage means their bladder muscles do not get the message that it is time to release urine or are too weak to completely empty the bladder. If the bladder becomes too full, urine may back up and the increasing pressure may damage the kidneys. Or urine that stays too long may lead to an infection in the kidneys or bladder. Urine retention may also lead to overflow incontinence.

What causes nerve damage?


Many events or conditions can damage nerves and nerve pathways. Some of the most common causes are vaginal childbirth infections of the brain or spinal cord diabetes stroke accidents that injure the brain or spinal cord multiple sclerosis heavy metal poisoning