RENAL PHYSIOLOGY Urine formation involves 3 main processes: 1- Glomerular filtration: during this process, blood is filtered.

It occurs in the Renal corpuscle. Blood pressure forces water and small molecules from blood in Glomerulus into the Bowmans capsule. 2- Tubular reabsorption: Many useful substances from the Renal tubule (filtrate) are returned to the blood in Peritubular capillaries and Vasa recta. 3- Tubular secretion: additional waste materials are transported from the plasma in Peritubular capillaries into the fluid (filtrate) in the Renal tubule. This process adds waste materials or excess substances to the filtrate from the blood.

GLOMERULAR FILTRATION: Glomerular filtration membrane: 1- Glomerular endothelial cells: are quite leaky, have large pores (fenestrations). They allow substances to pass through except Blood cell and Platelets. Located between Glomerular capillaries and in the left cleft between Afferent and Efferent arterioles are Mesangial cells. These contractile cells help regulate Glomerular filtration. 2- Basal lamina: layer of acellular material between Endothelial cells and Podocytes. They prevent the filtration of large proteins. 3- Extending from Podocytes: are thousands of foot-like process, called Pedicels. They wrap around Glomerular capillaries. The spaces between them are called Filtration slits. A thin membrane, slit membrane, extends across each filtration slits. They allow the passage of Water, Glucose, Vitamins, Amino acids, very small Plasma proteins, 1% Albumin, Ammonia, Urea, and Ions. Principle of Filtration: use pressure same as Capillary exchange but volume is more in filtration at Renal corpuscle than capillaries because of 3 reasons: a. Glomerular capillaries provide a large surface area. The Mesangial cells regulate how much of this area is available for filtration. When theyre relaxed, the surface area is maximum; when they contract, the available surface area decreases. b. Filtration membrane is thin and porous. Capillaries are 50% more leaky.

c. Blood pressure in Glomerular capillaries is high because Afferent arterioles have larger diameter than Effect arterioles. Glomerular filtration: This process occurs in the Renal corpuscle across the endothelial capsular membrane. The fluid that enters the Bowmans capsule is called filtrate. This process is not very selective. Almost all the components of plasma are filtered with the exception of large proteins and formed elements. The filtrate contains Water, Glucose. Amino acids, Urea, Uric acid, Creatinine and Electrolytes that is: Na+, Cl-, Ca2+, HCO3-, PO43-, SO42-. Net filtration pressure (NFP): Blood filtering depends on 3 main pressures: 1- Glomerular blood hydrostatic pressure (GBHP): This pressure pushes water and solutes in the blood plasma into the Bowmans capsule. GBHP favors filtration. GBHP = 55 mmHg 2- Capsular hydrostatic pressure (CHP): The pressure exerted by fluid in the Bowmans capsule pushes fluid from the B. capsule back into the Glomerulus wall. CHP opposes filtration. CHP = 15 mmHg 3- Blood colloidal osmotic pressure (BCOP): The pressure caused by unfiltered proteins remaining within the Glomerular capillaries. It moves water out of the filtrate to back into blood in Glomerulus. BCOP opposes filtration. BCOP = 30 mmHg

The amount of filtrate that flows out of all the Renal corpuscles of both kidneys each minute is called Glomerular filtration rate (GFR). In a normal adult GFR is 125 mL/min, which is about 180 Liters (48 gallons) per day. Regulation of GFR: To maintain homeostasis of body fluids, the kidney maintains constant GFR 1- Renal auto-regulation of GFR: The phenomenon, by which a mechanism within an organ or tissue maintains a constant blood flow through the part even though Arterial blood pressure is changing, is called auto-regulation. When NFP or GFR is low, Juxtaglomerular apparatus (JGA) inhibit their release of vasoconstrictor substances. So, the Afferent arterioles dilate, more blood flows through Glomerulus, thus NFP and GFR increases.

2- Hormonal control of GFR: 2 hormones influence the regulation of Blood pressure and GFR: - Angiotensin II decrease - Atrial Natriuretic Peptide (ANP) increase

TUBULAR REABSOPTION: About 99% of the filtrate is reabsorbed as it passes through the tubule. Substances needed by the body are returned back into the blood in Peritubular capillaries from the filtrate. Reabsorption is carried out through both passive and active processes. It occurs throughout the Renal tubule, but mostly in Proximal convoluted tubule (PCT). Various segments of Renal tubule are adopted to reabsorb specific substances and use particular mode of transport. Hormonal regulation of Tubular reabsorption and Tubular secretion: 1- Angiotensin II When Blood pressure is low, so is GFR, JGA cells detect the decrease in delivery of Na+, Cl-, H2O and release enzyme Renin. Angiotensinogen
enzyme Renin

Angiotensin I

(Angiotensinogen: a plasma protein produced by liver) Angiotensin I

Pulmonary and Renal enzymes

Angiotensin II

Angiotensin II has many effects: a. It decreases the GFR by causing vasoconstriction of the Afferent arterioles. b. It enhances reabsorption of Na+, Cl-, and water in the Proximal convoluted tubule by stimulating the activity of Na+/ H+ antiporters. c. It stimulates the Adrenal cortex to release Aldosterone, a hormone that in turn stimulates the principal cells in collecting ducts to reabsorb more Na+ and Cl- and secrete more K+. The osmotic consequence of reabsorbing more Na+ and Cl- is that more water is reabsorbed, which causes an increase in blood volume and blood pressure. 2- Posterior pituitary: releases ADH, causes retention of water by kidneys, thus Blood volume increase. So is Blood pressure. Stimulus for ADH secretion: a. Hemorrhage or severe dehydration. b. Increase in Osmotic pressure of plasma and Extracellular fluid (ECF).

3- Atrial Natriuretic Peptide (ANP): It is secreted by cells of Atria (upper chambers) of the heart. When cardiac cells are stretched due to increased Blood volume, it inhibits the secretion of Renin, ADH, Aldosterone. It promotes excretion of water (diuresis) and Na+ (natriuresis) 4- Parathyroid hormone: causes the reabsorption of Ca2+ in Distal convoluted tubule (DCT) TUBULAR SECRETION: This process is opposite of tubular reabsorption. The substances which are not needed by the body or are in excess are discharged into the urine. These substances are H+, NH3+, K+, Creatinine and Penicillin. As Na+ are reabsorbed, K+ are secreted. Secretion of large amount of H+ occurs in Proximal convoluted tubule (PCT).

URETERS Ureter: There are 2 Ureters, retroperitoneal, about 25-30 cm long. Function: To transport urine to Urinary bladder by peristalsis contractions of Muscularis. Ureters pass obliquely through the wall of Urinary bladder. The pressure in the Urinary bladder compresses the Ureters, thus prevents back flow of urine. This acts as a physiological valve. URINARY BLADDER Urinary bladder: Hollow muscular organ in the pelvic cavity, posterior to the pubic symphysis. In male: Anterior to Rectum In female: Anterior to Vagina and Inferior to Uterus

Shape changes with urine content. In the floor of Urinary bladder, there is a triangular area called Trigone, whose 3 angles are 3 opening: 2 Openings as of Ureters (to Urinary bladder), posteriorly at the Base. 1 Opening as to Urethra, located anteriorly at the Apex.

Histology: The wall of Urinary bladder composed of 3 layers: 1. Mucosa: Transitional epithelium, prevents rupture of the organ. 2. Muscularis: consist of 3 layers of Smooth muscles, collectively called Detrusor muscles. 3. Serosa: outermost layer of parietal peritoneum. Only found on Upper bladder surface. Elsewhere, the out coat is covered by fibrous CT.

Internal sphincter: upper, smooth muscles. External sphincter: lower, skeletal muscles. URETHRA Male urethra: about 20 cm long, 2 bends give S-shaped appearance. 3 sections: prostatic urethra, membranous urethra, and penile urethra. Female urethra: shorter, 4 cm long, straight tube to urethral orifice, more prone to Urinary tract infection.

Micturition: the act of urination or voiding, controlled by Spinal reflex, also influenced by Cerebral cortex. URINARY TRACT DISEASE Cystitis: Inflammation and infection of Urinary bladder. Its dangerous because it can reach up to Ureters. Pyelonephritis: Urinary tract infection in Renal pelvis (kidney), generally due to bacteria. If untreated, severely impairs their function. Glomerulonephritis: Inflammation of kidney, involves Glomeruli, generally due to Streptococcus bacteria.