Renal Anatomy

Renal Anatomy
Vimar A. Luz, MD, FPCP, DPSN
M.D.

Rosella N. Blancas,

Gross Features:








paired retroperitoneal organ
Upper pole: T12; Lower pole: L3
Weight:
adult man: 125 -170 g
adult woman: 115 - 155 g
Length: 11 to 12 cm
Width: 5.0 to 7.5 cm
Thickness: 2.5 to 3.0 cm
Hilus: renal pelvis, the renal artery and
vein, the lymphatics, and a nerve.
Blood supply: single renal artery
Anterior branch: 3 segmental or lobar
arteries supply the upper, middle, and
lower thirds of the anterior surface of the
kidney
Posterior branch: > ½ of the posterior
surface; small apical segmental branch

Gross Features
Relation to other layers:
• The renal fascia relates to the other layers in
the following manner (moving from innermost
to outermost):
renal cortex
renal capsule
perinephric fat (or "perirenal fat")
renal fascia
paranephric fat (or "pararenal fat")
peritoneum (anteriorly)
transversalis fascia (posteriorly)

Cut surface of a bisected kidney:

pale outer region
(the cortex)
• darker inner region
(the medulla)
8 to 18 striated conical
masses (renal pyramids)
Base: corticomedullary
boundary
Apex: renal pelvis to form
a papilla : 10 - 25 small
openings that
represent the distal
ends of the collecting
ducts (of Bellini) →
area cribrosa

Renal cortex:
- 1 cm in thickness
- renal columns of Bertin
- "medullary rays of Ferrein“ - formed
by the collecting ducts and the straight
segments of the proximal and distal
tubules.
• Renal pelvis: expanded portion of the
upper urinary tract
• Major calyces: 2 or 3 outpouchings,
extend outward from the upper dilated
end of the renal pelvis
Minor calyces: extend toward the papillae of the pyramids and drain
the urine formed by each pyramidal unit.
Ureters: lower portion of the renal pelvis at the ureteropelvic junction,
descend a distance ∼ 28 - 34 cm to open into the fundus of the urinary
bladder.

THE NEPHRON

functional unit of the kidney 0.4 ×
10 6 to 1.2 × 10 6
Essenttal components:
renal or malpighian corpuscle
(glomerulus and Bowman's
capsule)
proximal tubule
the thin limbs
distal tubule
connecting segment or connecting
tubule
•Two main populations of
nephrons:
(1) possessing a short loop of
Henle (7x more)
(2) long loop of Henle

THE NEPHRON



Length of the loop of Henle is generally related to the position
of its parent glomerulus in the cortex.
Superficial and midcortical locations : short loops of Henle
Juxtamedullary region: long loops of Henle

Division of the kidney (cortical & medullary )and the further
subdivision of the medulla (inner and outer zones) : relating
renal structure to the ability of an animal to form a maximally
concentrated urine
Countercurrent hypothesis for urine : the maximal urine
concentration that can be achieved is directly related to the
length of the multiplier system.

Renal Corpuscle (Glomerulus)


capillary network lined by a
thin layer of endothelial cells
central region of mesangial
cells with surrounding
mesangial matrix material
the visceral epithelial cells
(Podocytes) and the
associated basement
membrane
average diameter: 200 µm
The diameters of glomeruli
from juxtamedullary
nephrons: are 20% greater
than superficial glomeruli

Renal Corpuscle (Glomerulus)
• Responsible for the production
of an ultrafiltrate of plasma
• Filtration barrier
4.fenestrated endothelium
5.peripheral GBM
6.slit pores between the foot
processes of the visceral
epithelial cells
• Mean area of filtration surface
per glomerulus: 0.136 mm2 in the
human kidney

Mesangial cells

Parietal Epithelial cell

Endothelial cell

Visceral Epithelial cell

Endothelial cell


glomerular capillaries are lined by a thin fenestrated
endothelium
human kidney range
fr 70 - 100 nm
Thin diaphragms: extend across
the fenestrae w/c when present,
are not believed to represent a
significant barrier to the passage
of macromolecules.
surface is negatively charged
because of the presence of a
polyanionic surface glycoprotein, podocalyxin (principal
sialoprotein of glomerular epithelial cells)

Endothelial cell



synthesize both nitric oxide (EDRF) and endothelin-1
(vasoconstrictor)
Express vascular endothelial growth factor (VEGF) receptors
VEGF: regulator of microvascular permeability that is
produced by the glomerular VEC (Podocytes)
- In vitro studies demonstrated that VEGF increases
endothelial cell permeability and induces the
formation of endothelial fenestrations.
- endothelial cell survival and repair in glomerular diseases
and an important regulator of endothelial cell function and
permeability.
form the initial barrier to the passage of blood constituents
from the capillary lumen to Bowman's space.
contribute to the charge-selective properties of the glomerular
capillary wall through their negative surface charge.

Visceral Epithelial Cells (podocytes)


largest cells in the glomerulus
long cytoplasmic processes
(trabeculae) that extend from the
main cell body and divide into
individual foot processes (pedicels),
that come into direct contact with
the GBM.
Distance between adjacent foot
processes near the BM: 25 to 60 nm.
filtration slit membrane (slit
diaphragm) - 60 nm. fr the BM.
- role in establishing the permselec
tive properties of the filtration
barrier is still a matter of dispute.

Filtration slit / slit pore

Visceral Epithelial Cells (podocytes)
Nephrin protein - a key component of
filtration barrier
• membrane components on the
surface of the visceral epithelial
cells (slit diaphragm)
CD2-associated protein (CD2AP) –
slit diaphragm; connect nephrin to cytoskeleton
Functions:
Endocytosis (lysosomes ) uptake of proteins and other components
from the ultrafiltrate
Synthesis and maintenance of the GBM, type IV collagen, and
glycosaminoglycan , PgE2 and thromboxanes.

Mesangial Cells





Mesangium : cells + matrix
Irregular in shape, with a dense nucleus
and elongated cytoplasmic processes that
can extend around the capillary lumen and
insinuate themselves between the BM and
the overlying endothelium.
provides structural support for the
glomerular capillary loops
contractile properties
regulation of glomerular filtration
exhibit phagocytic properties (clearance or disposal of
macromolecules from the mesangium)
generation and metabolism of the extracellular mesangial
matrix and participate in various forms of glomerular injury

Glomerular Basement Membrane


central dense layer (lamina densa)
two thinner, more electron-lucent
layers, the lamina rara externa and
the lamina rara interna
layered configuration results from
the fusion of endothelial and epithelial
BM during development.
mean width: 315 nm - 329 nm
biochemical composition:
glycoproteins (type IV collagen,
laminin, fibronectin, entactin/
nidogen, various heparan sulfate
proteoglycan (perlecan and agrin)

Glomerular Basement Membrane




possesses fixed, negatively charged sites that influence the
filtration of macromolecules
anionic sites : glycosaminoglycans rich in heparan sulfate
Glomerular capillary wall: sieve or filter that allows the
passage of small molecules but almost completely restricts
the passage of molecules the size of albumin or larger.
size-selective and charge-selective properties
Fenestrated endothelium
GBM
epithelial slit
diaphragm
Fenestrated endothelium (negative surface charge) excludes
formed elements of the blood and probably plays a role in
determining the access of proteins to the GBM - - - plays a
role in establishing the ultrafiltration characteristics of the
glomerular capillary wall.
principal structure responsible for the charge-selective
permeability properties of the glomerulus

Parietal Epithelial cells


parietal epithelium: forms the outer wall
of Bowman's capsule
- continuous with the visceral epithelium
at the vascular pole.
- squamous in character, but at the
urinary pole there is an abrupt transition
to the taller cuboid cells of the proximal
tubule
thickness of the BM of Bowman's
capsule :1200 to 1500 nm.
In RPGN the parietal epithelial cells
proliferate to contribute to the formation
of crescents.

Peripolar Cells:


component of the JG apparatus
located at the origin of the glomerular tuft in Bowman's space
and is interposed between the visceral and parietal epithelial
cells
In most animals studied so far, they have been localized
predominantly in glomeruli in the outer cortex
are ideally situated to release factors into Bowman's space
that might affect subsequent tubule transport events.

Juxtaglomerular Apparatus

Juxtaglomerular Apparatus


located at the vascular pole of the
glomerulus
Vascular component: composed of
the terminal portion of the afferent
arteriole, the initial portion of the
efferent arteriole, and the extraglomerular mesangial region.
Tubule component : macula densa,
(that portion of the thick ascending limb that is in contact with
the vascular component)
Represents a major structural component of the reninangiotensin system.
Role: regulate glomerular arteriolar resistance and GF and to
control the synthesis and secretion of renin.

Juxtaglomerular Granular Cells
Within the vascular component:
2. Juxtaglomerular granular cells (epithelioid / myoepithelial
cells)
3. Agranular extraglomerular mesangial cells (lacis cells or
pseudomeissnerian cells of Goormaghtigh)
• Located primarily in the walls of the afferent and efferent
arterioles, but they are also present in the extraglomerular
mesangial region.
• are characterized by the presence of
numerous membrane-bound granules that
represent renin or its precursor.
• Immunohistochemical studies: presence
of both renin and angiotensin II in the
JG granular cells, with activities being
highest in the afferent arteriole.

Extraglomerular Mesangium (Lacis / Cells of
Goormaghtigh)

Located between the afferent and efferent arterioles in close
contact with the macula densa
In contact with the arterioles and the macula densa, and gap
junctions are commonly observed between the various cells of
the vascular portion of the JG apparatus
Serve as a functional link between the macula densa and the
glomerular arterioles and mesangium.

EM

Macula Densa

a specialized region of the thick
ascending limb adjacent to the
hilus of the glomerulus.
lacks the lateral cell processes and
interdigitations that are charac
teristic of the thick ascending limb.
sense changes in the luminal
concentrations of Na and Cl
via absorption of Na and Cl across the luminal membrane by
the Na+ -K+ -2Cl- cotransporter.

Proximal Tubule



begins abruptly at the urinary pole
of the glomerulus
Length:14 mm (human);
Outside diameter: 40 µm
Reabsorbs the bulk of filtered water and
solutes
Prominent brush border (↑ luminal cell
surface area) and extensive interdigita
tion by basolateral cell processes that extends to the
leaky jxn providing a greatly increased passage for the passive ion transport
Generally divided into 3
segments: S1, S2, S3

Proximal Tubule
It consists of:
Pars convoluta (initial convoluted
portion)
- direct continuation of the parietal
epithelium of Bowman's capsule
Pars recta (straight portion)
- located in the medullary ray;
contains a well-developed
endocytic-lysosomal apparatus that
is involved in the reabsorption and
degradation of macromolecules
from the ultrafiltrate.

Loop of Henle:
Consists of:
2. Straight portion of the proximal tubule
3. Thin ascending limb
- impermeable to water
5. Thin descending limb
- highly permeable to water (aquaporin-1)
7. Thick ascending limb (diluting segment)
- water impermeable (carried away into the
cortex to the systemic circ.) but reabsorbs
considerable amounts of salt that is trapped in the medulla(Na-K-2Cl cotransporter)
- Tam-Horsefall pretein
Before transition to the DCT. Thick AL contains
the macula densa.

Distal Covoluted Tubule

Exhibits the most extensive basolateral
interdigitation of cells and greatest
density of mitochondria.
Na-Cl cotransporter – speific
Na transporter (Thiazide diuretics)

COLLECTING DUCT SYSTEM
Includes:
• Connecting tubule
• Cortical collecting ducts
• Medullary CD
Outer MCD
Inner MCD
Connecting tubule (CNT) :
- Joining of 2 nephrons
- 2 types of cell:
1. CNT cell
2. Intercalated cell
Both share sensitivity to ADH; CNT cell lacks
sensitivity to mineralocorticoids

Collecting Ducts:
Lined by 2 types of cells:
2. Principal cells (CD)
Contain luminal shuttle system for
aquaporin -2 under the control of
vasopressin (permeability from zero
to permeable)
• Luminal Amloride-sensitive Na channel – involved in the
responsiveness of the cortical collecting ducts to aldosterone.
• Inner medulary collecting ducts – expresses urea transporter
UTB1 w/c in an ADH – dependent fashion accounts for the
recycling of urea (urine concentrating mechanism)

Collecting Ducts:
2. Intercalated cells (IC)
2 types:
a. Type A cells – express H-ATPase at
their luminal memb.; secretes proton
b. Type B – basolateral membrane;
secrete HCO3 ions and reabsorb
protons.
• Final regulators of fluid and electrolye balance
• Impt roles in handling NA,Cl, K and acid-base.
• Urine concentrating capability

INTERSTITIUM


Comparatively sparse:
5-7%: cortex (↑ w/ age); 3-4%: outer stripe; 10%: inner stripe
30%: inner medulla
Fibroblast: central cells; forms the scaffold frame
renal cortex: ecto 5 nucleotidas enzyme (5’-NT) –
synthesizes epoetin
renal medulla: Lipid-laden IC; produce large
amount of glycosaminoglycans and Vasoactive lipids (Pg E2)
Dendritic cells- MHC class II antigen
Extracellular matrix, fibrils and interstitial fluid

Thank
You !

Thank
Renal Anatomy
You !
M.D.

Rosella N. Blancas,

Sign up to vote on this title
UsefulNot useful