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Chapter 26: Urine Formation By the Kidneys. I.

Glomerular Filtration, Renal Blood Flow and Their Control
Guyton and Hall, Textbook of Medical Physiology, 12th edition

Multiple Functions of the Kidney • Excretion of Metabolic Waste Products, Foreign Chemicals, Drugs, and Hormone Metabolites a. Eliminate waste products of metabolism that are no longer needed ( i.e. urea, creatinine, uric acid, hb breakdown products) b. Also rapidly eliminate most toxins, pesticides, drugs, food additives

Functions (cont.) • Regulation of Water and Electrolyte Balances a. For homeostatsis, excretion of electrolytes must match intake

b. Governed mostly by eating habits

Functions (cont.) • Regulation of Arterial Pressure a. By excreting variable amounts of sodium and water b. Short-term-by secreting hormones and vasoactive factors (i.e. renin) • Glucose Synthesis

a. Gluconeogenesis-synthesize glucose from amino acids and other precursors during prolonged fasting.

Functions (cont. Kidney is the only means of eliminating sulfuric and phosphoric acids (generated by the metabolism of proteins . By excreting acids and by regulating the body fluid buffer stores b.) • Regulation of Acid-Base Balance a.

25-Dihydroxyvitamin D3 Production a.Functions (cont. Secretes erythropoietin which stimulates the production of red blood cells • Regulation of 1.) • Regulation of Erythrocyte Production a. Produces the active form (calcitriol) b. Calcitriol is necessary for the normal calcium deposition in bone and calcium reabsorption by the gastrointestinal tract .

Physiologic Anatomy of the Kidneys • General Organization of the Kidneys and Urinary Tract Fig.2 General Organization of the Kidneys and Urinary System . 26.

3 Renal Blood Supply . 26.Physiologic Anatomy of the Kidneys • Renal Blood Supply Fig.

b. d.Physiologic Anatomy of the Kidneys • The Nephron-functional unit of the kidney a.000 Decrease with age or injury (cannot be replaced) Contains the glomerulus (Bowman’s capsule) Proximal and distal convoluted tubules Loop of Henle Macula densa Collecting ducts . e. f. g. c. Each kidney contains 800.000-1.000.

4 Basic tubular segments of the nephron .Physiologic Anatomy of the Kidneys Figure 26.

Physiologic Anatomy of the Kidneys • Regional Differences in Nephron Structure: Cortical and Juxtaglomerular Nephrons Figure 26.5 Cortical and juxtaglomerular nephrons .

The bladder fills progressively until the tension within the walls rises above a threshold level b.Physiologic Anatomy of Urinary Bladder • Micturition-process by which the urinary bladder empties when it becomes filled a. The micturition reflex empties the bladder or stimulates a conscious desire to urinate c. It is an autonomic reflex that can be altered by centers in the cerebral cortex .

Neck-funnel shaped extension which connects with the urethra The smooth muscle of the bladder is the detrusor muscle and its contraction is a major step in emptying the bladder.Physiologic Anatomy of Urinary Bladder • Bladder Anatomy-smooth muscle chamber composed of two main parts: a. . Body-where the urine collects b.

6 Anatomy of the urinary bladder in males and females . 26.Fig.

26.7 Innervation of the urinary bladder .• Innervation of the Bladder-pelvic nerves through the saccral plexus Fig.

Transport of Urine • No significant changes in urine composition from the renal calyces to the ureters to the bladder • Peristaltic contractions in the smooth muscle of the ureter are enhanced by parasympathetic stimulation and inhibited by sympathetic stimulation .

26.Micturition Reflex Fig.8 Normalcystometrogram showing acute pressure waves caused by micturition reflexes .

Micturition Reflex • As the bladder fills. micturition contractions occur • Initiated by stretch receptors in the bladder • When partially filled. the contractions relax spontaneously • The reflex is “self-regenerative” .

Return of the pressure to the basal tone .Micturition Reflex • Reflex is a Single Complete Cycle a. Progressive and rapid increase of pressure b. A period of sustained pressure c.

Urine Formation Fig.9 Basic kidney processes that determine the composition of urine . 26.

Urine Formation • Sum of three renal processes .

26. The substance is freely filtered but is not reabsorbed but secreted from the peritubular capillaries into the renal tubules Fig. The substance is freely filtered but not excreted because all is reabsorbed.10 . D. The substance is freely filtered but not reabsorbed B.A. The substance is freely filtered but part is reabsorbed C.

Does not include calcium and fatty acids that are bound to proteins . Salts and organic molecules are similar to those in plasma c. Protein free and cell free b.Glomerular Filtration • Composition of the Filtrate a.

) • GFR (Glomerular Filtration Rate) a. Determined by (1) the balance of hydrostatic and colloid osmotic forces acting on the capillary membrane.Glomerular Filtration (cont. . and (2) the product of the permeability and filtering surface area of the capillaries b.

Basement membrane c.Glomerular Capillary Membrane • Consists of Three Major Layers a. Endothelium of the capillary b. Layer of epithelial cells (podocytes) .

B: Cross-section of the capillary membrane and its major components . 26.11 A: Basic ultrastructure of the glomerular capillaries.Fig.

0 0.0 1.0 1.0 1.500 17.1 Filterability of substances by glomerular capillaries based on molecular weight Substance Water Sodium Glucose Inulin Myoglobin Albumin Molecular Weight 18 23 180 5.) • Filterability of Solutes is Inversely Related to Their Size Table 26.Membrane (cont.000 69.000 Filterability 1.005 .75 0.

) • Negatively Charged Large Molecules Are Filtered Less Easily Than Positively Charged Molecules of Equal Molecular Size Fig.12 Effect of molecular radius and electrical charge of dextran on its filterability by glomerular capillaries .Membrane (cont. 26.

Fig. 26.Determinants of the GFR • GFR is determined by (1) sum of the hydrostatic and colloid forces across the glomerular membrane (net filtration pressure). and (2) the glomerular capillary filtration coefficient.13 .

Determinants of the GFR • Increased glomerular capillary filtration coefficient increases GFR • Increased Bowman’s capsule hydrostatic pressure decreases GFR • Increased glomerular capillary colloid osmotic pressure decreases GFR .

Fig. . 26.14 Increase in colloid osmotic pressure in plasma flowing through the glomerular capillary.

15 Effect of change in afferent or efferent arteriole resistance on GFR and renal flow. 26.) • Increased glomerular capillary hydrostatic pressure increases GFR Fig. .Determinants of the GFR (cont.

Renal Blood Flow • Renal Blood Flow and Oxygen Consumption Fig. 26.16 Relationship between sodium reabsorption and oxygen consumption .

3 Approximate pressures and vascular resistances in the circulation of a normal kidney Percentage of Total Renal Vascular Resistance Vessel Beginning End Renal Artery 100 100 0 Interlobar. Interlobar. 100 85 16 85 60 59 18 8 4 60 59 18 8 4 Approx.) • Determinants of Renal Blood Flow Table 26. Efferent arteriole Peritubular capill.Renal Blood Flow (cont. 4 26 1 43 10 4 0 . and interlobular arteries Afferent arteriole Glomerular capill. arcuate. and interlobular veins Renal vein Approx. arcuate.

Physiologic Control of GFR and Renal Blood Flow • Sympathetic Nervous System Activation Decreases GFR • Hormonal and Autacoid Control of Renal Circulation Hormone or Autacoid Norepinephrine Epinephrine Endothelin Angiotensin II Effect on GFR Decreases Decreases Decreases Constricts efferent arterioles Endothelian NO Prostaglandins Increases Increases .

17 Autoregulation of renal blood flow and GFR but lack of autoregulation of urine flow during changes in renal arterial pressure . 26.Autoregulation of GFR and Renal Blood Flow Fig.

An afferent arteriolar feedback mechanism b.Tubuloglomerular Feedback and Autoregulation of GFR • Links changes in NaCl concentration at the macula densa with the control of renal arteriolar resistance • Two components a. An efferent arteriolar feedback mechanism .

. 26. demonstrating its possible feedback role in the control of nephron function.18 Structure of the juxtaglomerular apparatus.Fig.

• Decreased macula densa NaCl causes dilation of afferent arterioles and increased renin release Fig.19 . 26.

• Myogenic Autoregulation of Renal Blood Flow and GFR a. Ability of blood vessels to resist stretching during increased arterial pressure b. Stretch allows the release of calcium from ECF into the cells causing them to contract • High protein intake and increased blood glucose also increase renal blood flow .