Urine Excretion and Plasma

Clearance
Dr. Debby Mirani Lubis, M.Biomed
 LO
• Plasma clearance
• Clearance rates for inulin and PAH.
• The kidneys can excrete urine of
varyingconcentrations depending on body needs.
• Handling of Sodium and Water by Various Tubular
Segments of the Nephron
• Urine is temporarily stored in the bladder
• Micturition Reflex
 Urine Excretion
• Of the 125 mL of plasma filtered per minute,
typically 124 mL/min are reabsorbed, so the final
quantity of urine formed averages 1 mL/min.
• A relatively small change in the quantity of filtrate
reabsorbed  a large change in the volume of
urine formed.
• For example, a reduction of less than 1% in the
total reabsorption rate, from 124 to 123 mL/min,
increases the urinary excretion rate by 100%,
from 1 to 2 mL/min.
 Plasma clearance
• Plasma clearance is the volume of plasma
cleared of a particular substance per minute.
• By excreting substances in the urine, the
kidneys clean or “clear” the plasma flowing
through them of these substances.
• Plasma clearance is actually a more useful
measure than urine excretion;
• Plasma clearance expresses the kidneys’
effectiveness in removing various substances
• Plasma clearance can be calculated for any
plasma constituent as follows:

• The plasma clearance rate varies for different

substances, depending on how the kidneys
handle each substance.
Plasma clearance for substances handled
in different ways by the kidneys.
Plasma clearance for substances handled
in different ways by the kidneys.
• Clearance rates for inulin and para-
aminohippuric acid (PAH) can be used to
determine the filtration fraction.
• If you know the rates of inulin clearance (GFR)
and PAH clearance (renal plasma flow) you can
easily determine the filtration fraction,
Filtration Fraction
 The kidneys can excrete urine of varying
concentrations depending on body needs.
• The ECF osmolarity (solute concentration)
depends on the relative amount of H2O
compared to solute.
• At normal fluid balance and solute concentration,
the body fluids are isotonic at an osmolarity of
300 milliosmols per liter (mOsm/L)
• If too much H2O is present relative to the solute
load, the body fluids are hypotonic,
• However, if a H2O deficit exists relative to the
solute load, the body fluids are too concentrated
or are hypertonic,
Handling of Sodium and Water by Various
Tubular Segments of the Nephron
Urine is temporarily stored in the bladder
• Peristaltic (forward-pushing) contractions of
the smooth muscle within the ureteral wall
propel the urine forward from the kidneys to
the bladder.
• Bladder smooth muscle is richly supplied by
parasympathetic fibers, stimulation of which
causes bladder contraction.
• If the passageway through the urethra to the
outside is open, contraction empties urine
from the bladder.
• The exit from the bladder, however, is guarded
by two sphincters, the internal urethral
sphincter and the external urethral sphincter.
 Role of the Urethral Sphincters
• A sphincter is a ring of muscle that can
variably close off or permit passage through
an opening
• The internal urethral sphincter is smooth
muscle and, accordingly, under involuntary
control.
• the urethra is encircled by a layer of skeletal muscle, the
external urethral sphincter.
• The motor neurons that supply the external sphincter and
pelvic diaphragm fire continuously at a moderate rate
unless they are inhibited, keeping these muscles tonically
contracted so that they prevent urine from escaping
through the urethra.
• Furthermore, because the external sphincter and pelvic
diaphragm are skeletal muscle and thus under voluntary
control, the person can deliberately tighten them to
prevent urination from occurring even when the bladder is
contracting and the internal sphincter is open.
 Micturition Reflex
• Micturition, or urination, the process of bladder emptying, is
governed by two mechanisms: the micturition reflex and voluntary
control.
• The micturition reflex is initiated when stretch receptors within the
bladder wall are stimulated
• The bladder in an adult can accommodate 250 to 400 mL of urine
before the tension within its walls begins to rise sufficiently to
activate the stretch receptors
• The greater the distension beyond this, the greater the extent of
receptor activation.
• Afferent fibers from the stretch receptors carry impulses into the
spinal cord and eventually, via interneurons, stimulate the
parasympathetic supply to the bladder and inhibit the motor-
neuron supply to the external sphincter.
• Parasympathetic stimulation of the bladder causes it to contract.
Reflex and
voluntary
control of
micturition