CHAPTER V ANATOMY AND PHYSIOLOGY This chapter contains the anatomy and physiology of Renal System of the body

which is involved in the disease.

THE RENAL SYSTEM

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The chemical composition of body fluids is important for the well-being of the cells of the body. The circulatory system is mainly responsible for the physical transport of fluids but not for the composition of those fluids. This function is largely the responsibility of the kidneys.

Kidneys The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid-base balance, and regulation of blood pressure (via maintaining salt and water balance). They serve the body as a natural filter of the blood, and remove wastes which are diverted to the urinary bladder. In producing urine, the kidneys excrete wastes such as urea and ammonium; the kidneys also are responsible for the reabsorption of water, glucose, and amino acids. The kidneys also

produce hormones including calcitriol, erythropoietin, and the enzyme renin. Located at the rear of the abdominal cavity in the retroperitoneum, the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter, itself a paired structure that empties into the urinary bladder. Renal physiology is the study of kidney function, while nephrology is the medical specialty concerned with kidney diseases. Diseases of the kidney are diverse, but individuals with kidney disease frequently display characteristic clinical features. Common clinical conditions involving the kidney include thenephritic and nephrotic 16

syndromes, renal cysts, acute kidney injury, chronic kidney disease, urinary tract infection, nephrolithiasis, and urinary tract obstruction. Various cancers of the kidney exist; the most common adult renal cancer is renal cell carcinoma. Cancers, cysts, and some other renal conditions can be managed with removal of the kidney, or nephrectomy. When renal function, measured by glomerular filtration rate, is persistently poor,dialysis and kidney transplantation may be treatment options. Although they are not severely harmful, kidney stones can be a pain and a nuisance. The removal of kidney stones includes sound wave treatment, which breaks up the stones into smaller pieces which are then passed through the urinary tract. One common symptom of kidney stones is a sharp pain in the medial/lateral segments of the lower back. Although the kidneys help with various physiological functions, the kidneys' main roles are the removal of wastes and the maintenance of the body's water balance. The functions of the kidneys can be summarized as follows:

1. Control of the body's water balance. The amount of water in the body must be balanced against the amount of water which we drink and the amount we lose in urine and sweat etc. 2. Regulation of blood pressure via the renin-angiotensin-aldosterone system 3. Regulation of blood electrolyte balance - Na+, Ca2+, K+ etc. 4. Excretion of metabolic wastes such as urea, creatinine and foreign substances such as drugs and the chemicals we ingest with our food 5. Help in the regulation of the bodys acid base balance 17

6. Regulation of red blood cell production via the hormone erythropoietin 7. Help in the production of vitamin D As this list indicates, the renal system is very important to the normal functioning of the body.

Nephrons

Nephron is the basic structural and functional unit of the kidney. Its chief function is to regulate the concentration of water and soluble substances like sodium salts by filtering the blood, reabsorbing what is needed and excreting the rest asurine. A nephron eliminates wastes from the body, regulates blood volume and blood pressure, controls levels of electrolytes and metabolites, and regulates blood pH. Its functions are vital to life and are regulated by the endocrine system by hormones such as antidiuretic hormone,aldosterone, and parathyroid hormone.[1] In humans, a normal kidney contains 800,000 to 1.5 million nephrons.

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Renal Corpusle Renal corpuscle is the initial blood-filtering component of a nephron. It consists of two structures: a glomerulus and a Bowman's capsule. The glomerulus is a small tuft of capillaries containing two cell types. Endothelial cells, which have large fenestrae, are not covered by diaphragms. Mesangial cells are modified smooth muscle cells that lie between the capillaries and the glomerulus. They regulate blood flow by their contractile activity and secrete extracellular matrix, prostaglandins, and cytokines. Mesangial cells also have phagocytic activity, removing proteins and other molecules trapped in the glomerular basement membrane or filtration barrier. The Bowman's capsule has an outer parietal layer composed of simple squamous epithelium. The visceral layer, composed of modified simple squamous epithelium, is lined by podocytes. Podocytes have foot processes, pedicels that wrap around glomerular capillaries. These pedicels interdigitate with pedicels of adjacent podocytes forming filtration slit. The renal corpuscle filtration barrier is composed of: the fenestrated endothelium of glomerular capillaries, the fused basal lamina of endothelial cells and podocytes, and the filtration slits of the podocytes. This barrier permits passage of water, ions, and small molecules from the bloodstream into Bowman's space (the space between the visceral and parietal layers). Large and/or negatively charged proteins are prevented from passing into Bowman's space, thus retaining these proteins in the circulation. The basal lamina is composed of 3 layers: lamina rara externa, lamina densa, and lamina rara interna. The lamina rara externa is adjacent to the podocyte processes. The lamina densa is the central layer consisting of type IV collagen and laminin. This layer acts as a selective macromolecular filter, preventing the passage of large protein molecules into 19

Bowman's space. The lamina rara interna is adjacent to endothelial cells. This layer contains heparan sulfate, a negatively charged glycosaminoglycan that contributes to the electrostatic barrier of the glomerular filter. Bowmans capsule

The Bowman's capsule (or capsula glomeruli, glomerular capsule) is a cup-like sac at the beginning of the tubular component of a nephron in the

mammalian kidney that performs the first step in the filtration of blood to form urine. A glomerulus is enclosed in the sac. Fluids from blood in the glomerulus are collected in the Bowman's capsule (i.e., glomerular filtrate) and further processed along the nephron to form urine. This process is known as ultrafiltration. Glomerulus A glomerulus is a capillary tuft that is involved in the first step of filtering blood to form urine.

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A glomerulus is surrounded by Bowman's capsule, the beginning component of nephrons in the vertebrate kidney. A glomerulus receives its blood supply from an afferent arteriole of the renal circulation. Unlike most other capillary beds, the glomerulus drains into an efferent arteriole rather than a venule. The resistance of these arterioles results in high pressure within the glomerulus, aiding the process of ultrafiltration, where fluids and soluble materials in the blood are forced out of the capillaries and into Bowman's capsule. A glomerulus and its surrounding Bowman's capsule constitute a renal corpuscle, the basic filtration unit of the kidney. The rate, at which blood is filtered through all of the glomeruli, and thus the measure of the overall renal function, is the glomerular filtration rate (GFR).

Renal Tubule Renal Tubule is an important structure in the kidney that contains tubular fluid, a filtrate that eventually becomes urine, and is excreted from the body. Renal tubules are part of the nephron, the basic functional unit of the kidney. Each normal human kidney has about 800,000 to one million nephrons, and each nephron has a renal tubule. The renal tubule is the end of the nephron. After the tubular fluid leaves the renal tubules, it passes on the collecting duct system, which connects the nephron to the ureter, through which urine is excreted. The renal tubule has many important components. The tubular fluid begins as glomular filtrate, consisting of fluid filtered out of the blood by the glomerulus, another portion of the nephron. As the filtrate leaves the 21

glomerulus, it enters the proximal tubule, the first portion of the renal tubule. The proximal tubule in turn is divided into two parts: the convoluted portion, or pars convoluta, and the straight portion, or pars recta. The pars convoluta has greater cell complexity, but the difference in function between the two parts of the proximal tubule is not fully understood. The proximal tubule regulates the pH of the filtrate, secretes organic acids that the body does not need into the filtrate, and reabsorbs water and sodium into the blood through the peritubular capillaries. Proximal Convoluted Tubule Proximal convoluted tubule is the convoluted portion of the vertebrate nephron that lies between Bowman's capsule and the loop of Henle, is made up of a single layer of cuboidal cells with striated borders, and functions especially in the resorption of sugar, sodium and chloride ions, and water from the glomerular filtrate. Loop of Henle The loop of Henle is a part of a nephron, a tiny tube inside the kidneys which filters solutes. Each kidney contains hundreds of thousands of individual nephrons which pass between the cortex of the kidneys and the medulla, connecting to collecting ducts which route urine to the ureter so that it can be expressed. The loop of Henle is an important part of the whole system, as it allows the kidneys to filter out salt and maintain the correct balance of water in the body. Distal Convoluted Tubule Distal convoluted tubule is the convoluted portion of the vertebrate nephron that lies between the loop of Henle and the nonsecretory part of the nephron and that is concerned especially with the concentration of urine. It acts as a site for selective

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secretion and reabsorption as water and ions pass between the blood and the filtrate across the tubule membrane. The DCT's are involved in pH Regulation as well as tubular excretion (excretion of Ammonia, Uric Acid, Urea, Creatinine, Hydrogen, antibiotics,and other nitrogenous wastes).Also the distal covulated tubule reabsorved molecules and act when the body response to loss of water.

Collecting Duct The main function of the collecting ducts is to collect all the urine from the nephrons. The permeability to water is mediated by the pituitary gland hormone (ADH).

Blood flow to the Renal System

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Inferio r Vena Cava Renal vein Interl obar vein Arcuat e vein
Urine Formation

Aor ta

Rena l Arter y

Interl obar veins

Interlo bar artery Afferent arteriole Glomer Effere ular nt arteri Periorbi ole tal capillar ies

The key area of interface between the circulatory system and the tubular part of the kidney is the knot of glomerular capillaries in the Bowman's capsule. Those liquid parts of the blood that are able to cross through the filtration membrane of the capillaries pass into the Bowman's capsule and then into the tubular section of the nephron

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The filtration membrane only allows water to pass through it and small molecules that will dissolve in water such as waste (urea, creatinine etc.) glucose, amino acids and ions. Large proteins and blood cells are too large to be filtered and remain in the blood. The filtered fluid or filtrate enters the proximal tubule and then into the loop of Henle which is the part of the nephron which dips in and out of the medulla. From the loop of Henle, the filtrate travels through the distal tubule and then into a common collecting duct which passes through the medulla and into the renal pelvis.

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WATER REGULATION BY THE KIDNEYS The water content of the body can vary depending on various factors. Hot weather and physical activity such as exercise make us sweat and so lose body fluids. Drinking tends to be at irregular intervals when socially convenient. This means that sometimes the body has too little water and needs to conserve it and sometimes too much water and needs to get rid of it. Most of the control of water conservation takes place in the distal and collecting tubules of the nephrons under control of anti-diuretic hormone, (ADH), sometimes called vasopressin. This hormone is released by the posterior pituitary under control of the hypothalamus in the mid-brain area. The hypothalamus monitors the water content of the blood. If the blood contains too little water (indicating dehydration) then more ADH is released. If the blood contains too much water (indicating over-hydration) then less ADH is released into the blood stream.

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ADH released from the pituitary travels in the blood stream to the peritubular capillaries of the nephron. ADH binds to receptors on the distal and collecting tubules of the nephrons which causes water channels to open in the tubule walls. This allows water to diffuse through the tubule walls into the interstitial fluid where it is collected by the peritubular capillaries. The more ADH present, the more water channels are open and the more water is reabsorbed.

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