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fluids
CHAPTER ONE
Auto regulation:
processes in which glomerulus has to be kept fairly
constant.
Auto regulation of GFR is achieved by auto regulation of
renal blood flow and a feedback mechanism known as
"glomerular tubular balance".
.
Filtration cont’d…
Glomerular Tubular balance:
When there is a decrease in GFR, there is a resulting
decrease in the fluid flow rate within the tubule
At the loop of Henle, there is greater time for reabsorption
of sodium and chloride ions.
Therefore there is a decrease in the number of sodium and
chloride ions reaching the distal tubule which is detected
by the macula densa.
This in turn decreases the resistance in the afferent
arteriole which results in an increase in renal blood flow.
It also increases rennin release from the juxtaglomerular
apparatus which stimulates angiotensin II production
causing constriction of the efferent arteriole.
figure 4.
figure 4.
Filtration cont’d…
juxtaglomerular complex:
consists of macula densa cells which are special
distal tubular epithelial cells which detect chloride
concentration and modified smooth muscle cells,
juxtaglomerular cells, in the walls of the afferent and
efferent arteriole. These cells produce rennin.
Rennin is an enzyme which converts the plasma protein
angiotensinogen to angiotensin I.
Filtration cont’d…
angiotensin II which causes vasoconstriction and an
increase in blood pressure.
Angiotensin II also stimulates the adrenal gland to produce
aldosterone which causes water and sodium retention
which together increase blood volume.
This is a negative feedback system.***
When blood volume, renal perfusion and GFR improve the
system feeds back to switch off or turn down the response
to the stimulus.
Renin-angiotensin-aldosterone axis
Descending
Tubule: H2O
permeable, Salt
impermeable.
Ascending Tubule:
Salt permeable,
H2O permeable.
Medullary Osmotic
gradient is
maintained by the
blood in Vasa
Recta in isotonic to
interstitial fluid
Selective and Passive Re-absorption
cont’d…
Distal Tubule and Collecting Duct:
The final concentration of urine depends upon the amount
of antidiuretic hormone (ADH) secreted by the posterior
lobe of the pituitary.
If ADH is present the distal tubule and the collecting duct
become permeable to water.
As the collecting duct passes through the medulla with a
high solute concentration in the interstitium, the water
moves out of the lumen of the duct and concentrated urine
is formed.
In the absence of ADH the tubule is minimally permeable
to water so large quantities of dilute urine is formed.
Distal Tubule and Collecting Duct
cont’d…
There are cells within the hypothalamus,
osmoreceptors, which are sensitive to changes in
osmotic pressure of the blood. If there is low water
intake, there is a rise in osmotic pressure of the
blood, and after excess intake of water, the reverse.
Nerve impulses from the hypothalamus stimulate the
posterior pituitary to produce ADH when the osmotic
pressure of the blood rises.
As a result water loss in the kidney is reduced
because ADH is secreted, and water reabsorbed in
the collecting duct.
Regulation of the Water and electrolytes
Addition of new HCO3- to plasma by secretion
of H+
When you use up filtered HCO3- in tubule and still have excess
H+ (acidosis), then you must combine H+ with another buffer
e.g. H3PO4.Unusual since lots of HCO3- in tubular fluid!
Gives net gain of HCO3- to plasma.
Maintenance Acid / Base Function
Kidneys really important for acid-base balance, along
with respiratory system.
Although the lungs excrete a large amount of CO2, a
potential acid formed by metabolism, the kidneys are
crucial for excreting non-volatile acids.
To maintain acid-base balance, kidney must not only
reabsorb virtually all filtered HCO3-, but must also secrete
into the urine the daily production of non-volatile acids.
Maintenance Acid / Base Function
Sources of H+ gain and loss
H+ Gain
CO2 in blood (combine with H2O via carbonic
anhydrase)
Nonvolatile acids from metabolism (e.g. lactic)
Loss of HCO3- in diarrhoea or non-gastric GI fluids
Loss of HCO3- in urine
H+ Loss
Use of H+ in metabolism of organic anions
Loss of H+ in vomit
Loss of H+ in urine
Hyperventilation (blow off CO2)
Addition of new HCO3- to plasma by excretion
of ammonium (NH4+)
Antidiuretic Hormone
(ADH)/Arginine Vasopressin
(AVP)
Increases permeability of
collecting ducts to H2O by
inserting H2O channels
(Aquaporins).
Helps you make small amount
of concentrated urine.
.
Renin-angiotensin-aldosterone axis
Urine
A fluid extracted by the kidneys, pass through the
ureters, stored in the bladder, and discharge through
the urethra.
in the presence of disease conditions, depending on
the abnormality, the urine will have abnormal
constituents.
The Composition of Urine
Normal urine
Freshly voided urine from healthy individuals is clear
and pale yellow in color
Having aromatic odor from volatile organic acids, and
specific gravity about 1.024
.It is slightly acidic (pH 5.0 to 6.0) and contains 95 %
water.
The Composition of Urine
Renal threshold :
Highest concentration of a substance, which is present
in the blood before it is found in the urine.
glucose is a high threshold substance, because it is
completely absorbed from the glomerular filtrate and is
only found in the urine, when the blood glucose level is
markedly raised.
But urea and creatinine are always present in the urine
independent of the blood level because very little if any
of these substance is reabsorbed.
Answer the Following Questions:
1. Discus the urinary system components with their
respective function.
2. Explain the renal blood flow and anatomical sections of the
kidneys.
3. Explain how Urine is formed by the nephrons.
4. Discus about renal hormones and their functions.
5. Calculate the CcCr of a patient who voided 1500 ml of
urine in 24 hrs.
The serum and urine concentration of creatinine of the
patient are 0.28 mmol/l and 10.5mmol/l respectively.
6. Classify the normal and abnormal constituents of urine.
7 Discuss about the renal threshold.
The next chapter will be dealing
with collection and preservation of
urine specimen