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FUNCTIONS of the KIDNEY

WABeresford

1 Remove waste and foreign materials, at the
least cost in useful materials and energy
2 Regulate (homeostasis) body’s water and
electrolyte levels, and the acid-base balance
3 To do 1 & 2 over a wide range of water, salt, &
protein dietary intakes, and degrees of muscular
activity
4 Allow cells to act on blood and an ultrafiltrate
of blood
5 Otherwise assist body’s functions - other
metabolic and controlling roles

KIDNEY: Overall architecture 1
Capsule
Cortex
Cortico-medullary
junction

{

Renal vein

}

URETER
Renal artery

Medulla

and renal vein & artery attach is the HILUS. The lung and lymph node also have a hilus. with distinctive hilar structures .KIDNEY: Overall architecture 2 Capsule Cortex Corticomedullary junction { Renal vein } Ureter Renal artery Medulla The indentation where the ureter.

ducts.round renal corpuscles (glomeruli).KIDNEY: Overall architecture 3 Cortex . & capillaries . convoluted tubules & capillaries Ureter Medulla - parallel tubules.

KIDNEY: Overall architecture 4 Blunt tip of pyramid is the PAPILLA dripping urine into } Pyramid Minor calyx urine Pelvis to collect Ureter Major calyces omitted Imagine three tiers of truncated funnels: minor calyces. & renal pelvis . major calyces.

KIDNEY: Overall architecture 5 LOBULE = the sector centered on one medullary ray LOBULE -. & itself centered on a collecting duct Pyramid Pyramid LOBE LOBE = a pyramid + the overlying cortex .an extension of Medullary ray medullary tissue into the cortex.

mostly straight proximals & distals Collecting duct Papillary duct .MORE RENAL STRUCTURES Cortical labyrinth = Medullary ray Corpuscles & convoluted tubules { { Medullary ray Medulla .straight tubules & no corpuscles Papilla with surface columnar epithelium Minor calyx lined with transitional epithelium Centered on collecting tubule.

KIDNEY: Blood flow 1 Inter-lobar artery 2 Arcuate artery 3 Inter-lobular artery 4 Renal artery 1 .

KIDNEY: Blood flow 2 Inter-lobular artery 4 6 Glomerulus Afferent arteriole 5 7 Efferent arteriole feeding Cortico-medullary junction is the site of both arcuate arteries & veins tortuous (cortex) or straight capillaries (medulla) 8 capillaries .

KIDNEY: Blood flow 3 Efferent arteriole 7 5 Afferent arteriole Glomerular capillary tuft Straight medullary 8 vessels (Vasa recta) 6 Veins Contorted capillary plexus 8 .

KIDNEY: Blood flow 4 Venous drainage Inter-lobar vein 11 Arcuate vein 10 Inter-lobular vein 9 Renal vein 12 .

RENAL CORPUSCLE Afferent arteriole Efferent arteriole Mesangial cells & matrix between roots of capillaries Glomerular capillary tuft Capsular space Start of Proximal tubule Visceral epithelium of podocytes Bowman’s capsule with simple squamous parietal epithelium .

RENAL CORPUSCLE 2 Afferent arteriole VASCULAR POLE Efferent arteriole Mesangial cells & matrix between roots of capillaries Glomerular capillary tuft Capsular space Bowman’s capsule URINARY POLE Start of Proximal tubule .

RENAL CORPUSCLE 3 Efferent arteriole Afferent Blood arteriole pressure drives the ultrafiltration Mesangial cells & matrix between roots of capillaries Glomerular capillary tuft Capsular space Visceral epithelium of podocytes Bowman’s capsule with simple squamous parietal epithelium Start of Proximal tubule The process puts at risk of loss from the body large quantities of water and valuable materials. so that the priority of the proximal tubule is to recover most of these .

FILTRATION BARRIER Fenestrated endothelium Basal lamina The charged proteoglycans of the BL help control what passes through Podocytes with Capsular space Capillary lumen Filtration slits between feet Capsular space Fenestration Basal lamina Filtration slit closed by a diaphragm .

determining the size of the molecules that can pass } BL Foot/pedicel of PODOCYTE Podocyte’s foot can be more or less spread on the basal lamina by actinbased mechanisms to regulate flow .FILTRATION BARRIER Detail } Filtration diaphragm comprising nephrin molecules interlocked. but spaced. in a zipper-like array.

PODOCYTE’S ROLES Interact with endothelial cells Create charge barrier to protein passage Counterbalance pressure Help keep capillary-loop shape Produce & maintain basal lamina Create size barrier to protein passage As listed by Shankland SJ. Kidney Int 2006. The podocyte’s response to injury: role in proteinuria and glomerulosclerosis.69:2131-2147 Fenestrated endothelium Basal lamina Podocytes with Capillary lumen Filtration slits between feet Capsular space .

Renal corpuscle Arched collecting tubule Distal tubule Proximal tubule * Interstitium ~ ~ NEPRON & ITS COLLEAGUES ~ ~ *~ ~ ~ * Collecting duct ~ Thin segment ~ ~ ~ ~ * Vasa recta ~ .

1 Generation & collection of ultrafiltrate NEPRON & ITS COLLEAGUES .Actions Renal corpuscle Distal tubule Proximal tubule 3 Fine electrolyte adjustment 2 Major reabsorption ~ Interstitium 4 * Arched collecting tubule ~ Adjustment of urine’s ~ water content & final pH ~ ~ ~ ~ Thin segment Collecting duct ~ ~ ~ ~ ~ Vasa recta ~ .

PROXIMAL TUBULE High cuboidal epithelium Eosinophilic cytoplasm Brush border .microvilli PAS+ Basal striation .membrane infoldings & mitochondria Few nuclei DISTAL TUBULE Lower cuboidal epithelium = wider lumen Less eosinophilic cytoplasm No brush border .few microvilli Still has Basal striation More nuclei .

COLLECTING DUCT Pale cuboidal cells Cell walls visible Luminal bulging No Basal striation An aquaporin is the membrane molecule used by the CD cells. under antidiuretic hormonal control . to allow water to return to the interstitium and thence to vascular retrieval .

JUXTAGLOMERULAR APPARATUS Renal corpuscle Reninsecreting JG cells Afferent arteriole 2 Arched collecting tubule Distal tubule Proxima l tubule ~ ~ Interstitium Distal tubule ~ ~ ~ ~ ~ Thin segment Collecting duct ~ ~ ~ ~ ~ Vasa recta ~ 3 Mesangium Renal corpuscle Flow & NaCl-sensing Macula densa Efferent arteriole 1 .

JUXTAGLOMERULAR APPARATUS 2 Reninsecreting JG cells Afferent arteriole High luminal flow results in VSMC Vasoconstriction Vascular smooth muscle cells Distal tubule for single-nephron tubuloglomerular feedback to relate glomerular flow to distal flow rate NaCl Mesangium Renal corpuscle Flow & NaCl-sensing Macula densa Efferent arteriole .

JUXTAGLOMERULAR APPARATUS 3 Afferent arteriole The renin-secreting JG cells are modified arteriolar smooth muscle cells. More can be recruited as needed. Reninsecreting JG cells Vascular smooth muscle cells NaCl Distal tubule Mesangium Renal corpuscle Efferent arteriole .

JUXTAGLOMERULAR APPARATUS 4 Reninsecreting JG cells Afferent arteriole Vascular smooth muscle cells Low distal NaCl causes JGDistal mediated renin release & tubule subsequent effects via angiotensin and aldosterone NaCl Mesangium Renal corpuscle Flow & NaCl-sensing Macula densa Efferent arteriole .

JUXTAGLOMERULAR APPARATUS 5 Vascular smooth muscle cells Reninsecreting JG cells Afferent arteriole Low distal NaCl causes JG-mediated renin release & subsequent effects via angiotensin and aldosterone Angiotensinogen Renin Angiotensin I Angiotensin II NaCl Renal corpuscle Aldosterone Efferent arteriole Converting enzyme .

JUXTAGLOMERULAR APPARATUS 6 JG cells Angiotensinogen Renin Angiotensin I Angiotensin II Zona glomerulosa Converting enzyme Vasoconstriction ] Aldosterone Sodium + water reabsorption DISTAL TUBULE (so blood pressure up) .

SOME RENAL DISEASES GLOMERULONEPHRITIS e.g.. mesangial-cell reaction RENAL ISCHEMIA Renal corpuscle TUBULAR epithelial NEPHROTOXICITY from aminoglycosides & heavy metals Arched collecting tubule Distal tubule Proximal tubule ~ ~ Interstitium FIBROSIS ~ ~ ~ ~ ~ Thin segment Collecting duct ~ ~ ~ ~ ~ Vasa recta ~ DIABETES INSIPIDUS pituitary or nephrogenic .