Renal

Physiolog
y
 Objectives
At the end of this lesson the students are expected to:
o List functions of the renal system.
o Discuss the components of renal system.
o Explain the functional structures of the kidney.
o Discuss the process of urine formation
 Major Functions of the Kidneys
1. Regulation of:
Body fluid osmolarity and volume

Electrolyte and nutrients balance

Acid-base balance

Blood pressure
2. Excretion of:
ª Metabolic products
ª Foreign substances (drugs and other chemicals etc.)
ª Excess substances (water, etc)

3. Synthesis of:
 Erythropoeitin
 Renin

4. Involved in gluconeogenesis and Vitamin D

activation
 Renal system
• The renal system composed of:
– 2 Kidneys: formation of urine
– Paired Ureters: transport
urine from the kidneys to the
bladder
– Urinary Bladder: provides a
temporary storage reservoir
for urine
– Urethra: transports urine
from the bladder out of the
body
Gross Anatomy of the Kidney

Kidneys are paired bean-

shaped structures
 are located retroperitoneally in
the abdominal cavity
Vertically extend from T12-L3
 Functional Anatomy of the kidney

The kidney has 2 layers:

1. Cortex: outer layer of the kidney (containing the upper
portion of the nephrons)
2. Medulla: inner layer
 Triangular shaped pyramids
• Collecting tubules and loops of Henle portion of
the nephrons
 The renal columns.

• Blood vessels run to and from the cortex.

 Microanatomy of the Kidneys

 Kidneys are made up of nephrons

 The Nephron
o Nephrons are functional
and structural units of the
kidney.

o Each kidney is made up of

about 1 million nephrons

o Each nephron has two

major components:
 Glomerulus
 A long tube

Basic  tubular  segments  of  the  nephron.

 Glomerulus
• Glomerulus is a tuft of capillaries enclosed by Bowman
capsule portion of renal tubule.
 Through which large amounts of fluid are filtered from
the blood.
 Cont’d

• Glomerular capillary have high hydrostatic pressure

(about 60 mm Hg).

• It consists of glomerular capillaries interposed

between afferent arteriole on one end and efferent
arteriole on the other end.
 Nephron…cont’d

 Renal tubules: in which the filtered fluid is converted into

urine
 Function: Reabsorption and secretion

 Proximal convoluted tubule (PCT)- Place of major

absorption
 Loop of Henel (descending/ascending, thin/thick
segment)
- Thin segment cells in descending limb: hyperosmolar
- Thin segment cells in ascending limb: hyposmolar
 Cont’d

 Distal convolluted tubules: Thick segment ascending limb

and DCT cells are similar to PCT- they also allow secretion
and reabsorption but not as much as in PCT.

 Collecting ducts: allow minor amounts of secretion and

reabsorption.
 Distal convoluted tubule & Collecting duct is site of ADH
activity
Glomerulus →Proximal tubule(cortex) →loop of Henle(medulla)
→distal tubule (cortex) → cortical collecting tubule → medullary
collecting tubule → collecting duct.
 Renal blood flow
• Blood flow to the two kidneys is normally about 22
percent of the cardiac output, or 1200 ml/min.
 Blood flow >> metabolic need: Supplies plasma for
glomerular filtration
 Cont’d…

 The renal circulation is unique in that it has two capillary

beds, the glomerular and peritubular capillaries
 Which are arranged in series and separated by the efferent
arterioles.

• High hydrostatic pressure in the glomerular capillaries

(about 60 mm Hg) causes rapid fluid filtration,

• Whereas, low hydrostatic pressure in the peritubular

capillaries (about 13 mm Hg) permits rapid fluid
reabsorption.
 The Juxtaglomerular Apparatus
 The juxtaglomerular apparatus is a specialized organ
situated near the glomerulus of each nephron.
 Consists the distal convoluted tubule, afferent and efferent
arterioles.
 Functions of the JGA Cells:

• The juxtaglomerular apparatus consists of:

1) Macula densa (chemoreceptors)

 Is a group of cells lining the end portion of distal
convoluted tubule.
 Regulates the glomerular filtration rate via sensing the
salt (Na+) concentration in the distal tubule.
 Cont’d…

2. Juxtaglomerular cells (mechanoreceptors)

 Situated in the walls of the afferent and efferent arterioles.

 Secrete renin into the blood of the arterioles.

 They are modified smooth muscle cells which can also
regulate arteriolar tone.
 Mechanisms of Urine Formation
 Urine formation and adjustment of
blood composition involves three
major processes

1. Glomerular filtration
2. Reabsorption of substances from
the renal tubules into the blood
3. Secretion of substances from the
blood into the renal tubules
 1) Glomerular filtration (GF)

• GF is the process by which the blood is filtered while

passing through the glomerular capillaries by filtration
membrane.
• It is the first process of urine formation.
• All the substances of plasma are filtered except the plasma
proteins and blood cells.
 Cont’d

Glomerular filtration rate (GFR)

 Is defined as the total quantity of filtrate formed in all the
nephrons of both the kidneys in the given unit of time.
The filtrate flows to bowman’s capsule and then to proximal
tubule.
Normal GFR is 125 mL/minute or about 180 L/day
Is determined by net filtration pressure and filtration coefficient

 GFR=Kf ᵡ Net FP
Excreation rate=Filtration-reabsorbtion+secreation
 Pressures determining GFR

1. Glomerular Capillary hydrostatic pressure

• Glomerular capillary pressure is the pressure exerted by the
blood in glomerular capillaries.
• It is high pressure (60 mm Hg) which is important to filter
substances to the tubules.

2. Capilary colloidal Osmotic Pressure

It is the pressure exerted by plasma proteins in the glomeruli.

• It opposes glomerular filtration.

 3. Hydrostatic Pressure in Bowman Capsule

• It is the pressure exerted by the filtrate in Bowman capsule.

• It also opposes glomerular filtration.

4) Bowman’s capsule Oncotic pressure (0 mmHg).

• Net Filtration Pressure: is the balance between pressure

favoring filtration and pressures opposing filtration.
 NFP = 60 – (32 + 18)
= 10 mm Hg
• This 10 mm Hg cause filtration to occur
 2) Tubular reabsorption
 Tubular reabsorption is the process by which water
and other substances are transported from renal tubules
back to the blood.
 It is the 2nd Step in urine formation
 The tubular cells reabsorb only the substances
necessary for the body.

 About 178.5 L/day (99%) of filtrate reabsorb, 1.5 L/day
(<1%) lost as urine
Concept of reaborption
 Cont’d…

 The reabsorbed substances move into the interstitial fluid of

renal medulla and, from here, the substances move into the blood
in peritubular capillaries.
 Peritubular capillaries provide nutrients for tubules and retrieve
the fluid that the tubules reabsorb.
 Normally amino acids and glucose are totally reabsorbed
 Reabsorb 99% H2O, 99.5% Na+ and 50% urea.

• Most reabsorption occurs in Proximal convoluted tubules

 Reabsorption from proximal tubule

 65% of the filtered load of NaCl and water

reabsorption occurs in PCT
 100% of glucose and amino acid
transported occurs in the first half of PCT
by active co-transport.
 In the second half of the proximal tubule,
sodium is reabsorbed, mainly with chloride
ions.
Amino acids
 Reabsorption from the Loop of Henle

• The descending part of the thin segment is highly permeable

to water and moderately permeable to most solutes.
 About 20 per cent of the filtered water is reabsorbed here.

• The ascending limb is virtually impermeable to water, the

tubular fluid becomes very dilute

• In the thick segment of the loop of Henle, these three ions

(Na+, K+, Cl- ) are reabsorbed by Na+-K+-2Cl- ATPase.
 Distal convoluted & cortical collecting tubules

• In the absence of ADH, this portion of the tubule is

impermeable to water
• In the early distal tubule, Sodium and chloride are
reabsorbed via Na+/Cl co-transporter
 Which is under the control of the hormone called
aldosterone.
• The late distal tubule and cortical collecting tubule are
composed of two cell types, the principal cells and
intercalated cells.
 Cont’d.

• The principal cells reabsorb sodium and water from the

lumen and secrete potassium ions into the lumen.
• Intercalated cells are responsible for acid-base balance
effect of kidney

From medullary collecting duct

• This portion of the tubule reabsorb less than 10% of the
filtered water and sodium
 The permeability of this portion of tubule to water is
controlled by the level of ADH
 3: Secretion
• Secretion is transport of substances from the peritubular
blood or interstitial fluid to the renal tubules

o Which is the 3rd process of urine

formation
o Occurs as an active transport by the
cells of the nephron tubule.
o It occurs mainly in the:
 Proximal & distal convoluted tubule
 Collecting tubule.
 cont’d…

 Secretion is done for three purposes:

I. To release any residues of toxins and drugs which

haven't been filtered
II. To establish electrolyte balance

III. To maintain acid-base balance

 Urine

Physical Characteristics of Urine

• Clear, pale to deep yellow in color
• Odor
– Fresh urine is slightly aromatic
• pH
– Slightly acidic (pH = 6) with a range of 4.5 to 8.0
Chemical Composition of Urine
• Urine is 95% water and 5% solutes
• Wastes include urea and creatinine
• Other normal solutes include:
– Sodium, potassium, calcium, and bicarbonate ions
Thank you