The Kidney

-: Kidney Functions
: Kidney Function Test Its a test measuring the Bilirubin , Creatinine , Uric acid and Urea level and it reflect the wellness of the kidney (within the normal . ( average

:Excretion of Metabolic Waste Products(Urea (from protein metabolism (Uric acid (from nucleic acid metabolism (Creatinine (from muscle metabolism (Bilirubin (from hemoglobin metabolism : Excretion of Foreign Chemicals.Pesticides , Food additives , Toxin and Drugs : Secretion Metabolism and Excretion of Hormones:Hormones produced in the kidneyRenal erythropoetic factor(dihydroxycholecalciferol (Vitamin D 1,25Renin-

: Hormones metabolized and excreted by the kidney (.Most peptide hormones (e.g., insulin, angiotensin II, etc -

. And the most important one is the erythropoietin factor

Because of this most of whom complaining of renal failure have . anemia because there is low production of Erythropoetin Regulation of acid-base balance (in addition to respiratory system) : -Excretion acids ( kidneys are the only means of excreting nonvolatile acids ) ( Regulation body fluid buffers (e.g. bicarbonate Regulation of water and electrolytes balances: Sodium and Water Potassium Hydrogen Ions Calcium, Phosphate, Magnesium Regulation of arterial pressure: Endocrine Organ renin-angiotensin system prostaglandins kallikrein-kinin system Control of Extracellular Fluid Volume

SO to sum up here are the main functions of the kidneys : Excretion of metabolic waste products: urea, creatinine, bilirubin, hydrogen Excretion of foreign chemicals: drugs, toxins, pesticides, food additives Secretion, metabolism, and excretion of hormones - renal erythropoetic factor - 1,25 dihydroxycholecalciferol (Vitamin D) - Renin Regulation of acid-base balance Gluconeogenesis: glucose synthesis from amino acids Control of arterial pressure Regulation of water & electrolyte excretion -Now in order of you to understand the kidney work you should now a little about its anatomy : (doctor indicate that he will not ask us about this but its really helping to now this) At level of kidney we have : abdominal aorta >> renal artery >> segmental artery >> interlobar arteries > > Arcuate arteries >> interlobular arterioles At level of Nephron (functional unit of the kidney): Interlobular arterioles >> afferent arteriole >> glomerulus ( bowman's capsule) and here happen the filtration (We have 3 layers glomerulus ( a network of capillaries ) : 1-Epithelium of the glomerulus 2-Basement membrane (highly negative charge) 3-Endothelium (Wall of bowman's capsule) . the filtrate should cross these three layers . >> efferent arteriole >> network pretubular capillary (its the only place where the arteriole com from capillary )

And these functions are acomplished by a sereis of processes like : Filtration .. reabsorption . Secretion . Excertion of urine .
About 180 L of blood are filtered through the kidneys daily , 178.5 L are reabsorbed and 1.5 L are excreted as urine. so most of the filtered fluid is reabsorbed again .

the reabsorption process is important because we have 3L of plazma in our bodies which is filtered 60 times aday so without this process all the plazma will be gone with the urine . the kidneys get its arterial supply by the renal artery which is a branch of the abdominal aorta. The functional unit of the kidney is the Nephron which is composed of Bowman's capsule , proximal tubule, loop of Henle ( ascending and descending) , distal tubule & collecting duct . in Bowman's capsule there's a network of capillaries (all from the afferent branch of renal artery) From the other side of the capillaries of the glomerulus there is the efferent arteriole and from the efferent arteriole we get the Peritubular capillaries which are involved in the processes reabsorption and secretion ( PS: the reabsorption and the secretion happened between the pretubular capillaries and the tubules .. Filtration occurs between the glomerulus and Bowman's capsule ) 20% of the blood that enters the kidney by the afferent arteriole is filtered the rest of the blood continue to the efferent arteriole then at the pretubular capillaries there will be either reabsorption of the materials that the body needs (like amino acids , electrolytes , water ..) or - Every one must have minimal urine output which is 500 ml why ? . secretion to dissolve soled toxin If there is no intake of water the patent will die because we have to excrete the minimal amount which come from the plasma that has 90% content of water

SO :

Filtration: somewhat variable, not selective (except for proteins), averages 20% of renal plasma flow Proteinsare not filtered Because: 1- they have high molecular weight (large in size) 2- they are negatively charged and the basement membrane of theBowman's capsule is also negative . ( so there will be a repel between the basement membrane and the proteins ) - In some cases we might have some proteins with low M.W but It's amount in urine shouldn't be higher than 150 mg daily. - The presence of proteins in urine (known as Proteinuria) indicates that we have a problem in the kidney. Its occurs between the glomerulus and the bowmans capsule . Reabsorption: highly variable and selective, most electrolytes (e.g. Na+, K+, Cl-) and nutritional substances (e.g. glucose) are almost completely reabsorbed; most waste products (e.g. urea) poorly reabsorbed Secretion: variable; important for rapidly excreting some waste products (e.g. H+), foreign substances (including drugs), and toxins.

- Renal Handling of Water and Solutes :

Filtration
Water (liters/day) Sodium (mmol/day) Glucose

180 25560 180

Reabsorpti on 179 25410 180

Excretion 1 150 0

(gm/day) Creatinine (gm/day)

1.8

1.8

Notioce here that the glucose is fully reabsorbed . if we fined glucose in the urine ( excertion for glucose was more than 0 ) this means that we have glucose urea or hyperglycemisa which happens in diapetas maletus . Creatinine is a toxic material so all of the filtered creatinine will be excreted Filtration depend on the molecular size & its charge

Sorry 4 any mistake done by : Mohammad Owesat