HISTOLOGY OF KIDNEY

The kidney made up of a medullary pyramid (actually cone-shaped)

and the base of which is enveloped by the cortex.
Nephrons arise in the cortex, loop down into the medulla and return to
the cortex. From here they drain into collecting ducts that descend
again into the medulla to discharge urine from the apex of the
medullary pyramid. The apical part of the pyramid (known as the
renal papilla) is enveloped by a funnel-shaped renal pelvis, which
represents the dilated proximal part of the ureter.
The human kidney is made up of 10-18 lobes. The renal medulla is
made up of multiple medullary pyramids separated by medullary
extensions of the cortex. Each renal papilla is surrounded by a branch
of the renal pelvis called a calyx; the whole urinary collecting system
within the kidney being described as the pelvicalyceal system. The
space between the branches of the pelvicalyceal system is filled with
fatty supporting tissue and is known as the renal sinus.
The kidney is invested by a tough fibrous capsule, which is
surrounded by a thick layer of perinephric fat that is in turn encased
in a delicate condensation of connective tissue, known as Gerota's fascia. The fat around the kidney
cushions it against trauma.

CORTEX
The renal cortex is easily identified by the presence of renal
corpuscles, which are absent in the renal medulla. However, the
bulk of the cortex is occupied by the proximal and distal
convoluted tubules. The arcuate arteries and veins help to
demarcate the cortex from the medulla

The prominent brush border of the PCT is contrasted with the

lack of brush
border in the DCT.

MEDULLA
The renal medulla consists of closely packed tubules of two types: the
loop of Henle and the collecting tubules and ducts as well as the vasa
recta

RENAL PAPILLA
Ducts of Bellini DB, the largest of
the collecting ducts, converge to
drain urine through a number of
holes (cribriform area) at the tip
of the papilla. At the poles of the
human kidney, the papillae are
often fused to form complex
papillae.

The pelvicalyceal system PCS represents the proximal end of the ureter U and as such is lined by typical
urinary (transitional) epithelium E. The wall of the pelvis contains smooth muscle SM, continuous with that
of the ureter.

NEPHRON
The functional and structural unit of the kidney, the nephron, consists of a renal corpuscle (including the
glomerulus) and a long folded renal tubule.
The human kidney contains approximately one million nephrons.
Types of nephron
Cortical nephrons (80-85%)
Renal corpuscles lie in the outer portion of the renal cortex
Short nephron loops that lie mainly in the cortex and penetrate only into the outer region of the
renal medulla
Receive their blood supply from peritubular capillaries that arise from efferent arterioles
Juxtamedularry nephrons (15-20%)
Renal corpuscles lie deep in the cortex, close to medulla
Long nephron loop that extends into the deepest region of the medulla.
Receive their blood supply from peritubular capillaries and from the vasa recta that arise from
efferent arterioles

Renal corpuscle
The renal corpuscle is a combination of two structures, Bowman's capsule and the glomerulus.

Bowman's capsule consists of a single layer of flattened squamous epithelial cells resting on a
basement membrane; it is derived from the distended, blind end of the renal tubule.

The glomerulus is a globular network of anastomosing capillaries, which invaginates Bowman's

capsule.
Thus the capillary loops of the glomerulus are invested by the visceral layer of Bowman's capsule: a
highly specialised layer of epithelial cells called podocytes.
A small amount of tissue remains to support the capillary loops and differentiates to form the mesangium
The visceral layer is reflected around the vascular stalk of the glomerulus to become continuous with the
parietal layer that constitutes Bowman's capsule proper.

The space between the two layers is known as Bowman's space and is continuous with the lumen of the
renal tubule; the parietal epithelium of Bowman's capsule is continuous with the epithelium lining the
renal tubule.
The afferent arteriole, which supplies the glomerulus, and the efferent arteriole, which drains it, enter
and leave the corpuscle at the vascular pole that is usually situated opposite the entrance to the renal
tubule, the
urinary pole

Renal tubule
The renal tubule extends from Bowman's capsule to its junction with a collecting duct.
It is up to 55 mm long in humans and is lined by a single layer of epithelial cells.
It has a convoluted shape and has four distinct zones :
1. The proximal convoluted tubule (PCT)
The longest
Most convoluted section of the tubule
Responsible for the reabsorption of approximately 65% of the ions and water of the glomerular
filtrate
Confined to the renal cortex and make up the greater part of its bulk
2. The loop of Henle
Includes the distal straight part of the proximal tubule, the pars recta, the thin descending and
ascending limbs, and the thick ascending limb
The length varies from short to long depending on the location of the renal corpuscle of the
particular nephron.
The final part of the ascending limb makes contact with the afferent arteriole. Because the
columnar tubule cells in this region are crowded together, they are known as the macula densa
Along side the macula densa, the wall of the afferent arteriole (and sometimes the efferent
arteriole) contains modified smooth muscle fibers called juxtaglomerular cells (JG).
Together with the macula densa, they constitute the juxtaglomerular apparatus (JGA)
The JGA helps regulate blood pressure within the kidney
The main function is to generate a high osmotic pressure in the extracellular fluid of the renal
medulla; the mechanism by which this is achieved is known as the counter-current multiplier
system
3. The distal convoluted tubule (DCT)
Is a continuation of the thick limb of the loop of Henle after its return to the cortex
Shorter and less convoluted than the PCT
Responsible for reabsorption of sodium ions, an active process controlled by the adrenocortical
hormone aldosterone. Sodium reabsorption is coupled with the secretion of hydrogen or potassium
ions into the DCT, the secretion of hydrogen ions resulting in a net loss of acid from the body.

4. The collecting tubule

Is the straight terminal portion of the nephron
2 different types of cells are present :
Most are principal cells, which have receptors for both antidiuretichormone (ADH) and
aldosterone, two hormones that regulate their functions
A smaller number are intercalated cells, which play a role in the homeostasis of blood pH
Several collecting tubules converging to form a collecting duct. The collecting ducts descend
through the cortex in parallel bundles called medullary rays
Progressively merging in the medulla to form the large ducts of Bellini which open at the tips of
the renal papillae to discharge urine into the pelvicalyceal system
The collecting tubules and ducts are not normally permeable to water. However, in the presence of
antidiuretic hormone (ADH) secreted by the posterior pituitary, the collecting tubules and ducts
become permeable to water
Thus the high osmotic pressure generated by the counter-current multiplier system into the
interstitial tissues of the medulla removes water that is returned to the general circulation via the
vasa recta
The loops of Henle and ADH thus provide a mechanism for the production of urine that is
hypertonic with respect to plasma.