Renal Tutorial

PEGGY CHEN & JOYCE LAM

Figure 14.02

Glomerulus
(glomerular capillaries)

Renal corpuscle
Bowman’s space in
Bowman’s capsule

Renal tubule
Proximal convoluted tubule
Proximal tubule

Proximal straight tubule

Descending thin limb of Henle’s loop

Ascending thin limb of Henle’s loop Loop of Henle

Thick ascending limb of Henle’s loop

(containing macula densa at end)

Distal convoluted tubule Distal convoluted tubule

Cortical collecting duct

Collecting duct system
Medullary collecting duct

Renal pelvis
 Formation of urine

Amount Amount Amount Amount

excreted = filtered + secreted - reabsorbed
Forces Figure 14.08
involved in
filtration

(oncotic pressure)
 Concept of clearance

Clearance: the volume of plasma from

which that substance is completely
removed (“cleared”) by the kidneys per
unit time. Mass of S excreted per unit time
Clearance of S (Cs) = Plasma concentration of S (Ps)

Mass of S excreted per unit time

= Urine concentration of S (Us) x Urine volume per unit time (V)

UsV
 Cs =
Ps
 GFR ?

Urine volume = 2.4 L/day

Inulin concentration in the urine
= 300 mg/L
Amount of inulin excreted in the urine
= 2.4 L/day x 300 mg/L
=720 mg/day
CIN = 720 mg/day  4 mg/L = 180 L/day

 GFR = CIN = 180 L/day

Attention!!
Plasma concentration of sodium
is NOT a marker for total body
sodium.

PNa only reflects the relative

relationship of total body Na and
water.
Renal regulation of  Na+ and H2O loss due to
diarrhea
sodium  Plasma volume

-control by GFR  Venous pressure

 Venous return

 Atrial pressure

 Ventricular end-diastolic vol

Reflexes
mediated by
 Stroke volume
venous, atrial
and arterial
baroreceptors  Cardiac output

 Activity of renal  Arterial blood pressure

sympathetic nerves
Vander’s, 10th ed.
Fig. 14-18, page 547. Kidneys
(9th ed. Fig. 14-17  Constriction of a.a.
page 535)
Direct effect
 Net GF pressure

 GFR

 Na+ and H2O excreted

  Plasma volume

Regulation of renin secretion

by extracellular fluid volume
(important mechanisms for Na  Activity of  Arterial  GFR, which causes
renal pressure  flow to macula densa
balance) sympathetic (direct
nerve effect of less
stretch)  NaCl delivery to
macula densa

Renal juxtaglomerular cells

Aldosterone does NOT
 Renin secretion
stimulate H2O reabsorption
directly in the CCD.  Plasma renin

 Plasma angiotensin II

Adrenal cortex
 Aldosterone secretion
Vander’s 10th ed.
Fig. 14-20, page 549  Plasma aldosterone
(9th ed. Fig. 14-19
page 537) CCD
 Sodium and H2O reabsorption

 Sodium and H2O excretion

Action of ANP
Vasa recta:
blood vessels in the
medulla

Its hairpin-loop
structure, minimizes
excessive loss of solute
from the interstitium.
with
with vasopressin
vasopressin
with without
with vasopressin
vasopressin
vasopressin

50

50

50

50

50

50
Osmoreceptor
control of
vasopressin
secretion
Baroreceptor
control of
vasopressin
secretion
Regulation of Figure 14.26
K+ secretion by
dietary intake
and
aldosterone
K+ secretion can
occur when
renin-
aldosterone
system is
activated by
other causes
Table 14.07

(loss of CO2)
Addition of new HCO3- to the plasma-2

Mainly in
proximal
tubule

This process is
also called “H+
excretion
bound to NH3”
 Classification of acidosis and alkalosis

H+ HCO3- PCO2
Resp acidosis
Resp alkalosis
Met acidosis
Met alkalosis

CO2 + H2O H2CO3 HCO3- + H+

[HCO3-]
pH = 6.1 + log10
[CO2]
 Loop diuretics
• Acts on the thick
ascending limb of the loop
of Henle.
• Inhibits cotransport of
sodium, chloride and
potassium (Na+-K+-2Cl-
cotransporter).
• One of the commonly
used diuretics.
• e.g. furosemide
 Potassium-sparing diuretics
• Inhibit sodium reabsorption
in the CCD, and also inhibits
potassium secretion there.
Thus, unlike the other
diuretics, plasma
concentration of potassium
does not decrease.
• Either block the action of
aldosterone or block the
(aldosterone-regulated)
epithelial sodium channel in
the CCD.
• e.g. amiloride,
spironolactone
 Sample Final Question 1

A patient brought into the laboratory a urine sample collected for a

period of 24 hrs. In the sample, urine concentration of creatinine
was 7.5 mmol/L, urine volume was 2 L. Serum creatinine measured
at the same time was 150 micromol/L. What is the estimated
glomerular filtration rate of this patient?

a) 180 L per day.

b) 120 L per day.

c) 100 L per day.

d) 80 L per day.

e) None of the above values are CORRECT.

 Sample Final Question 1

A patient brought into the laboratory a urine sample collected for a

period of 24 hrs. In the sample, urine concentration of creatinine
was 7.5 mmol/L, urine volume was 2 L. Serum creatinine measured
at the same time was 150 micromol/L. What is the estimated
glomerular filtration rate of this patient?

a) 180 L per day.

b) 120 L per day.

c) 100 L per day.

d) 80 L per day.

e) None of the above values are CORRECT.

 Sample Final Question 2

If a healthy person drinks a large amount of water,

a) plasma concentration of anti-diuretic hormone (ADH)

will become high.

b) plasma osmolality will become high.

c) urine osmolality will become low.

d) plasma concentration of aldosterone will become high.

e) None of the above is CORRECT.

 Sample Final Question 2

If a healthy person drinks a large amount of water,

a) plasma concentration of anti-diuretic hormone (ADH)

will become high.

b) plasma osmolality will become high.

c) urine osmolality will become low.

d) plasma concentration of aldosterone will become high.

e) None of the above is CORRECT.

 Sample Final Question 3

If a person has a lung disease and is not able to eliminate carbon

dioxide effectively, it leads to an acid-base disorder. Which of the
following is FALSE about this person’s acid-base problem?

a) If the renal compensation is appropriate, HCO3- should be low.

b) Blood pH should be low.

c) This condition is called “respiratory acidosis”.

d) Plasma concentration of hydrogen ion should be high.

e) None of the above statements is FALSE.

 Sample Final Question 3

If a person has a lung disease and is not able to eliminate carbon

dioxide effectively, it leads to an acid-base disorder. Which of the
following is FALSE about this person’s acid-base problem?

a) If the renal compensation is appropriate, HCO3- should be

low.

b) Blood pH should be low.

c) This condition is called “respiratory acidosis”.

d) Plasma concentration of hydrogen ion should be high.

e) None of the above statements is FALSE.

 Sample Final Question 4

Regarding the renin-angiotensin system, which of the following

statements is TRUE?

a) Angiotensin converting enzyme converts renin to angiotensin I.

b) Renin secretion will increase when parasympathetic nerve is

stimulated in the kidney.

c) Renin is secreted by macula densa cells.

d) Angiotensin I is produced by the liver.

e) None of the above statements is TRUE.

 Sample Final Question 4

Regarding the renin-angiotensin system, which of the following

statements is TRUE?

a) Angiotensin converting enzyme converts renin to angiotensin I.

b) Renin secretion will increase when parasympathetic nerve is

stimulated in the kidney.

c) Renin is secreted by macula densa cells.

d) Angiotensin I is produced by the liver.

e) None of the above statements is TRUE.

 Sample Final Question 5

Which of the following statements regarding the body fluid is

TRUE?

a) Water consists about 60% of body weight.

b) The majority of body water is in the extracellular space.

c) Sodium is the major intracellular solute.

d) Plasma concentration of Na+ is a marker of total body sodium.

e) None of the above statements is TRUE.

 Sample Final Question 5

Which of the following statements regarding the body fluid is

TRUE?

a) Water consists about 60% of body weight.

b) The majority of body water is in the extracellular space.

c) Sodium is the major intracellular solute.

d) Plasma concentration of Na+ is a marker of total body sodium.

e) None of the above statements is TRUE.

 Sample Final Question 6

Regarding tubular handling of Na+, which of the following statements is

FALSE?

a) Na+ reabsorption is an active process and requires Na+-K+-ATPase on the

basolateral membrane.

b) In the cortical collecting duct, Na+ enters cells mainly via Na+ channel.

c) Quantitatively, proximal tubule is the most important segment of the tubule

for Na+ reabsorption.

d) Hormonal control of Na+ reabsorption occurs mainly at the thick ascending

limb of Henle’s loop.

e) None of the above statements is FALSE.

 Sample Final Question 6

Regarding tubular handling of Na+, which of the following statements is

FALSE?

a) Na+ reabsorption is an active process and requires Na+-K+-ATPase on the

basolateral membrane.

b) In the cortical collecting duct, Na+ enters cells mainly via Na+ channel.

c) Quantitatively, proximal tubule is the most important segment of the tubule

for Na+ reabsorption.

d) Hormonal control of Na+ reabsorption occurs mainly at the thick

ascending limb of Henle’s loop.

e) None of the above statements is FALSE.

 Sample Final Question 7

Which of the following statements regarding potassium is TRUE?

a) Potassium is a major extracellular ion.

b) Approximately 20% of the daily intake of potassium is excreted in

the urine.

c) Cortical collecting duct is a major site of potassium secretion in the

tubule.

d) Aldosterone stimulates potassium reabsorption in the distal

convoluted tubule.

e) None of the above statements is TRUE.

 Sample Final Question 7

Which of the following statements regarding potassium is TRUE?

a) Potassium is a major extracellular ion.

b) Approximately 20% of the daily intake of potassium is excreted in

the urine.

c) Cortical collecting duct is a major site of potassium

secretion in the tubule.

d) Aldosterone stimulates potassium reabsorption in the distal

convoluted tubule.

e) None of the above statements is TRUE.

 Sample Final Question 8 (Type B)

Which of the following components of the blood is/are

filtered freely into the Bowman’s space?

a) Red blood cells.

b) Chloride ion.

c) Triglyceride.

d) Free calcium ion (not bound to albumin).

 Sample Final Question 8 (Type B)

Which of the following components of the blood is/are

filtered freely into the Bowman’s space?

a) Red blood cells.

b) Chloride ion.

c) Triglyceride.

d) Free calcium ion (not bound to albumin).

 Sample Final Question 9 (Type B)

Which of the following statements is/are TRUE?

a) Filtered load of Na is always larger than urinary excretion of

Na.

b) Filtered load of creatinine is approximately equal to urinary

excretion of creatinine.

c) Filtered load of glucose is usually larger than urinary

excretion of glucose.

d) Filtered load of PAH (para-amino hippurate) is usually larger

than urinary excretion of PAH.
 Sample Final Question 9 (Type B)

Which of the following statements is/are TRUE?

a) Filtered load of Na is always larger than urinary

excretion of Na.

b) Filtered load of creatinine is approximately equal to

urinary excretion of creatinine.

c) Filtered load of glucose is usually larger than

urinary excretion of glucose.

d) Filtered load of PAH (para-amino hippurate) is usually larger

than urinary excretion of PAH.
 Sample Final Question 10 (Type B)

Renal artery is a vessel, which gives blood supply to the kidney.

When the lumen of the renal artery becomes narrow, blood
supply to the kidney is reduced. Such condition is called
“renal artery stenosis”. What is/are the consequence(s) of
renal artery stenosis?

a) Plasma concentration of renin will increase.

b) Plasma concentration of aldosterone will increase.

c) Tubular reabsorption of sodium will increase.

d) Extracellular fluid volume will increase.

 Sample Final Question 10 (Type B)

Renal artery is a vessel, which gives blood supply to the kidney.

When the lumen of the renal artery becomes narrow, blood
supply to the kidney is reduced. Such condition is called
“renal artery stenosis”. What is/are the consequence(s) of
renal artery stenosis?

a) Plasma concentration of renin will increase.

b) Plasma concentration of aldosterone will increase.

c) Tubular reabsorption of sodium will increase.

d) Extracellular fluid volume will increase.

 Sample Final Question 11 (Type B)

Which of the following segments of nephron is/are

proximal (closer to the glomerulus) to the ascending limb
of Henle’s loop?

a) Cortical collecting duct.

b) Thin descending limb of Henle’s loop.

c) Distal convoluted tubule.

d) Proximal convoluted tubule.

 Sample Final Question 11 (Type B)

Which of the following segments of nephron is/are

proximal (closer to the glomerulus) to the ascending limb
of Henle’s loop?

a) Cortical collecting duct.

b) Thin descending limb of Henle’s loop.

c) Distal convoluted tubule.

d) Proximal convoluted tubule.

 Sample Final Question 12 (Type B)

Which of the following statement(s) regarding the kidneys

is/are CORRECT?

a) When the kidney function is impaired, people get

anemic.

b) Kidneys are positioned within the peritoneal cavity.

c) When the kidney function is impaired, serum calcium

concentration usually falls.

d) Antibiotics are never excreted in the urine.

 Sample Final Question 12 (Type B)

Which of the following statement(s) regarding the kidneys

is/are CORRECT?

a) When the kidney function is impaired, people

get anemic.

b) Kidneys are positioned within the peritoneal cavity.

c) When the kidney function is impaired, serum

calcium concentration usually falls.

d) Antibiotics are never excreted in the urine.

 Sample Final Question 13 (Type B)

Which of the following combination(s) are TRUE?

a) Diarrhea-metabolic acidosis.

b) Renal failure-metabolic acidosis.

c) Vomiting-metabolic alkalosis.

d) Hyperventilation-respiratory alkalosis.
 Sample Final Question 13 (Type B)

Which of the following combination(s) are TRUE?

a) Diarrhea-metabolic acidosis.

b) Renal failure-metabolic acidosis.

c) Vomiting-metabolic alkalosis.

d) Hyperventilation-respiratory alkalosis.
 Sample Final Question 14 (Type B)

Which of the following statements regarding diuretics

is/are TRUE?

a) Furosemide acts at the thin descending limb of Henle’s

loop.

b) Potassium-sparing diuretics stimulates Na reabsorption

at the cortical collecting duct.

c) Diuretics increase extracellular fluid volume.

d) Diuretics are commonly used to treat hypertension.

 Sample Final Question 14 (Type B)

Which of the following statements regarding diuretics is/are

TRUE?

a) Furosemide acts at the thin descending limb of Henle’s loop.

b) Potassium-sparing diuretics stimulates Na reabsorption at

the cortical collecting duct.

c) Diuretics increase extracellular fluid volume.

d) Diuretics are commonly used to treat hypertension.

 Sample Final Question 15 (Type B)

Which of the following statements regarding the anatomy

of the kidney is/are FALSE?

a) Each kidney contains ~one million nephrons.

b) Foot processes are part of the tubular epithelial cells.

c) Macula densa cells are located at the terminal portion of

the thick ascending limb of Henle’s loop.

d) The fluid in the Bowman’s space usually has a high

concentration of protein.
 Sample Final Question 15 (Type B)

Which of the following statements regarding the anatomy of the

kidney is/are FALSE?

a) Each kidney contains ~one million nephrons.

b) Foot processes are part of the tubular epithelial

cells.

c) Macula densa cells are located at the terminal portion of the

thick ascending limb of Henle’s loop.

d) The fluid in the Bowman’s space usually has a high

concentration of protein.
 Sample Final Question 16 (Type B)

Regarding the countercurrent multiplier system, which of the

following statement(s) is/are FALSE?

a) When the tubular fluid enters from the proximal tubule to the
descending limb of Henle’s loop, the tubular fluid is isoosmotic.

b) As the tubular fluid moves along the descending limb of Henle’s

loop, water is reabsorbed and the fluid becomes hyperosmotic.

c) The thick ascending limb of Henle’s loop is impermeable to water.

d) The hair-pin loop structure of the vasa recta is suitable for the
effective removal of solutes from the interstitium.
 Sample Final Question 16 (Type B)

Regarding the countercurrent multiplier system, which of the

following statement(s) is/are FALSE?

a) When the tubular fluid enters from the proximal tubule to the
descending limb of Henle’s loop, the tubular fluid is isoosmotic.

b) As the tubular fluid moves along the descending limb of Henle’s

loop, water is reabsorbed and the fluid becomes hyperosmotic.

c) The thick ascending limb of Henle’s loop is impermeable to water.

d) The hair-pin loop structure of the vasa recta is suitable for

the effective removal of solutes from the interstitium.