Renal Physiology

Functional Anatomy

November 7, 2023 Kidney - Functional Anatomy 1

Functions
 Maintenance of body fluids composition
 Volume of fluid
 Osmolarity
 Electrolyte content
 pH
 Excretion of metabolic end products
 Urea, creatinine, uric acids
 Toxins, drugs

November 7, 2023 Kidney - Functional Anatomy 2

Functions
 Production & secretions of enzymes and
hormones
 Renin by JGA cells
 1,25 – dihydroxyvitamin D3
 Prostaglandins
 Kinins
 Erythropoietin

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Functions
 Metabolic functions
 Ammoniagenesis
 Gluconeogenesis

 Catabolism of small mol.wt proteins

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 Functional anatomy
 Kidneys are encapsulated
organs
 Located in retro-peritoneal
area
 On either side of aorta &
IVC
 Each kidney
 Weigh 115 to 170g
 11 – 14 cm
From: Davidson’s Principles and
Practice of Medicine; 20th edition

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 Functional anatomy
 Medial side is indented
 Form hilum
 Through which pass the
renal artery and vein,
lymphatics, nerve
supply and ureter.

Koeppla & Straton

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 Functional anatomy
 Two major region
 Cortex
 Medulla
 The cortex form the outer
layer contains
 Glomeruli
 Much of proximal tubules
 Some of distal tubule

Koeppla & Straton

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 Functional anatomy
 The medulla is divided into
cone shaped masses of
tissue
 Renal pyramids
 Renal pyramids
 Bases in cortical –medulla
border
 Terminate in the papilla which
projects into the space of renal
pelvis

Koeppla & Straton

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Functional anatomy
 The outer border of the
pelvis is divided into
 Open – ended pouches

called
 Major calices that extend
downward and divided into
 Minor calices which collect
urine from the tubules of each
papilla.

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Functional anatomy
 The walls of calices,
pelvis,and ureters
 Contain contractile
elements
 Propel urine towards
the bladder

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 Functional Anatomy
 The medulla is
important for
 Concentrating
urine
 ECF in this region
has higher solute
conc
 As much as 4
times higher
Koeppla & Straton

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Blood Supply
 Kidney has extensive
vasculature
 Accommodate 20 to
25% of the CO
 Main renal artery
branches
 Segmental arteries
 Interlobar arteries

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 Blood Supply
 The interlobar arteries
branch into
 Arcuate arteries
 Arcuate arteries
 Interlobular arteries
 Afferent arterioles
 Glomerular capillaries

Koeppla & Straton

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 Blood Supply
 Distal end of
glomerular capillaries
coalesce to form
 Efferent arteriole
which lead to
 Peritubular capillaries
 Peritubular capillaries
empty into venules.
Davidson’s Principles &
Practice of Medicine

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 Blood Supply
 Renal circulation has 2
capillary beds
 Glomerular
 Peritubular
 Arranged in series
 Separated by efferent
arterioles
 Help regulate the
hydrostatic pressure
Davidson’s Principles &
Practice of Medicine

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 Blood supply
 At the glomerular
capillaries
 Hydrostatic pressure = 60
mm Hg
 At peritubular capillaries
 Hydrostatic pressure = 13
mm Hg
 Promote reabsorption of
fluid

Davidson’s Principles &

Practice of Medicine

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 Blood Supply
 By adjusting resistance
 Afferent & efferent
arterioles
 Kidney can regulate
hydrostatic pressure
 In both capillary net work
 Change the rate of
 GFR
 Tubular re-absorption
Davidson’s Principles &
Practice of Medicine

November 7, 2023 Kidney - Functional Anatomy 17

Blood Supply
 Most of renal vascular
resistance is determined by
 Interlobular arteries, afferent
and efferent arterioles
 Resistance of these vessels
is controlled by
 SNS, hormones, and local
internal renal control
mechanisms

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Blood Supply
 Kidney have effective
mechanisms of
maintaining
 renal blood flow and GFR
relatively constant at BP
range of 80 –170mmHg
 This capacity is
completely intrinsic to the
kidneys.

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Medullary Blood Supply
 Blood supplying
medulla
 Also postglomerular
 Specialized peritubular
vessels
 Vasa recta

November 7, 2023 Kidney - Functional Anatomy 20

Medullary Blood Supply
 Vasa recta
 Arise from efferent
arterioles of
 Juxtamedullary
glomeruli
 Form hairpin loops
dipping into medulla

November 7, 2023 Kidney - Functional Anatomy 21

Medullary Blood supply
 Blood flow in the vasa
recta of the renal medulla
is very low compared
with flow in the renal
cortex
 It is ≈ 1 – 2% of total
renal blood flow

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 The Nephron
 Functional unit of the
kidney
 About 1 mil. In each
kidney
 Not regenerated
 After 40 yrs, decrease of
about 10% every 10 yrs

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 The Nephron
 Each nephron has
 Glomerulus
 Proximal convoluted tubule
 Proximal straight tubule
 Thin descending limb of loop of
Henle
 Thin ascending limb
 Thick ascending limb
 Macula densa
 Distal convoluted
 Connecting tubule

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 The Nephron
 Several nephrons
 Coalesce to empty into a
collecting duct
 Outer medullary collecting
duct
 Inner medullary collecting
duct

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The Glomerulus

 Composed of
 Network of branching and
anastomosing glomerular
capillaries
 which are covered by
epithelial cell
 Total glomerulus is
 Encased in Bowman’s
capsule.

November 7, 2023 Kidney - Functional Anatomy 26

 G-C
Membrane
 Composed of 3
layers
 Endothelium of the
capillary
 Basement
membrane
 Epithelial cells
(podocytes)
surrounding the
outer surface of
basement
membrane

From: Human
Physiology by
Silverthon
November 7, 2023 Kidney - Functional Anatomy 27
 G-C
Membrane

 Endothelium
 Thousand of

fenestrae

From: Human
Physiology by
Silverthon
November 7, 2023 Kidney - Functional Anatomy 28
Glomerular Capillary Membrane
 Basement membrane
consist of
 Meshwork of collagen and
proteoglycan fibrillae that
have large spaces
 Effectively prevents
filtration of plasma
protein
 Because of strong negative
electrical charges
associated with
proteoglycan.

November 7, 2023 Kidney - Functional Anatomy 29

 G-C
Membrane
 Epithelial cell are
not continuous
 Have long foot
like processes
(podocytes)
which are
separated by
gaps called slit
pores

From: Human
Physiology by
November 7, 2023 Silverthon
Kidney - Functional Anatomy 30
 Tubule
 Tubules composed of
 Proximal tubule
 Loop of Henle
 Distal tubule
 Fluid filtered from
capillaries
 Flow into Bowman’s
capsule then
 The proximal tubule
which lies in the cortex

Koeppla & Straton

November 7, 2023 Kidney - Functional Anatomy 31

 Tubule
 Loop of Henle dips
into renal medulla
 Descending limb
 Thin
 Ascending limb
 Lower end thin
 Upper end thick

Koeppla & Straton

November 7, 2023 Kidney - Functional Anatomy 32

 Tubule
 End of thick
ascending limb
 Short segment known as
macula densa
 Distal tubule
 In cortex
 Connecting tubule
 Cortical collecting
tubule
Koeppla & Straton

November 7, 2023 Kidney - Functional Anatomy 33

 Tubule
 Several cortical
collecting duct join
 Form single lager

duct that run down

into the medulla
 Medullary collecting
duct

Koeppla & Straton

November 7, 2023 Kidney - Functional Anatomy 34

 Nephron
 The collecting duct
merge
 Form larger duct that
eventually empty
 Into renal pelvis
through the tips of renal
papillae

Koeppla & Straton

November 7, 2023 Kidney - Functional Anatomy 35

 Cortical
Nephrons

 Cortical nephrons
 Glomeruli in outer
cortex
 Give rise to short loops of
Henle that bend at the
junction of inner and outer
medulla

November 7, 2 Kidney - Functional Anatomy 36

023
 J-M Nephrons
 Juxta medullary nephrons
(20 –30%)
 Glomeruli lie deep in the
renal cortex near the
medulla
 Give rise to loops of Henle
which descend all the way
to the papillary tips
 Specialized peritubular
capillaries
 Vasa recta

November 7, 2023 Kidney - Functional Anatomy 37

 J-M Nephron

 Long efferent arterioles

 Extend downward into
the outer medulla and then
divide into vasa recta

November 7, 2023 Kidney - Functional Anatomy 38

 J-M Nephron
 Vasa recta lie side by side
with the loop of Henle
 Return toward the

cortex
 Empty into the cortical

veins
 Vasa recta
 Plays essential role in the
formation of concentrated
urine.

November 7, 2023 Kidney - Functional Anatomy 39

References
 Textbook of Medical Physiology
 By Guyton
 Physiology
 By Charles H. Tadlock
 Human physiology an intergrated Aproach
 By Dee Unglaub Silverthon
 Davidson’s Principles & Practice of Medicine

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