THE RENAL SYSTEM

Introduction
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.
Although they 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 summarised 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
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.
THE STRUCTURE OF THE RENAL SYSTEM
Urine is produced in the kidneys from water and wastes extracted from the blood.

The rest of the urinary system is concerned with the storage and ducting of the
urine to the outside of the body - Figure 01.

Figure 01 - Structure of the renal system

The kidneys are large, bean shaped organs which lie on the dorsal side of the
visceral cavity, roughly level with the waistline. Blood is supplied to the kidneys
by the renal arteries which branch off the aorta. The kidneys and are drained by the
the renal veins into the inferior vena cava. From the kidneys, urine passes to the
urinary bladder via the ureters. Urine is passed to the outside environment via the
urethra (this is routed differently in males and females).
MACROSTRUCTURE OF THE KIDNEY
The kidneys are protected by a tough fibrous coat called the renal capsule. Under

the capsule, the arrangement of nephrons and capillaries in the kidney produce the
appearance of distinct regions when viewed in longitudinal section. The outer
cortex region surrounds darker triangular structures called pyramids which
collectively form the medulla. The inner part of the kidney, the renal pelvis,
collects the urine draining from the nephron tubules and channels it into the ureter Figure 02.

Figure 02 - Sectioned view of the kidney

MICROSTRUCTURE OF THE KIDNEY

The basic functional unit of the kidney is the nephron. There are over one million
nephrons in each human kidney and together they are responsible for the complex
water regulation and waste elimination functions of the kidneys. The heads of the
nephrons are in the cortical region and the tubular component then descends
through the medulla and eventually drains into the renal pelvis - Figure 03.

Figure 03. Arrangement of nephrons in the kidney

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 - Figure 04. 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.

Figure 04. The Bowman's capsule and glomerulus

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
- Figure 05.

Figure 05. Structure of the nephron

PERITUBULAR CAPILLARIES
The nephrons are surrounded by a fine network of capillaries called the peritubular
capillaries. These perform an important role in direct secretion, selective
reabsorption and the regulation of water (see below).
DIRECT SECRETION
In addition to glomerular filtration, some substances are secreted directly from the
adjacent peritubular capillaries into the proximal tubule. These substances include
potassium ions and some hormones.
SELECTIVE REABSORPTION
Ultrafiltration is indiscriminate except for size of particle and useful substances are
filtered from the blood as well as wastes. This situation is obviously unsatisfactory
as the body would soon be depleted of amino acids, glucose and sodium etc. which
would need to be replenished from external sources. To resolve this problem,
useful substances in the filtrate are reabsorbed back into the peritubular capillaries
as the filtrate passes along the tubule, leaving only the wastes which are eliminated
in the urine. This process is shown in the animation in Figure 06.

Figure 06. Selective reabsorption of essential nutrients

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 - Figure 07.

Figure 07. Release of ADH from the posterior pituitary into the bloodstream

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 - Figure 08.

Figure 08 Reabsorption of water from the filtrate under the influence of ADH

Over 99% of the filtrate produced each day can be reabsorbed. The amount of
water reabsorbed from the filtrate back into the blood depends on the water
situation in the body. When the body is dehydrated, most of the filtrate is
reabsorbed but note that even in cases of extreme of water shortage, the kidneys
will continue to produce around 500 ml of urine each day in order to perform their
excretory function.
THE MICTURION REFLEX
Micturition is another word for urination and in most animals it happens
automatically. As the bladder fills with urine, stretch receptors in the wall of the
bladder send signals to the parasympathetic nerves to relax the band of smooth
muscle that forms the internal urethral sphincter. As the muscle relaxes, the urethra
opens and urine is voided to the outside environment.
A second sphincter, the external urethral sphincter is skeletal muscle controlled by
motor neurons - Figure 09. These neurons are under conscious control and this
means we are able to exercise control over when and where we urinate. This
control is a learned response that is absent in the new-born infant.

Figure 09. The urinary bladder and urethra

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
The long-term control of blood pressure is via the renin-angiotensin-aldosterone
(RAA) system. This system is also one of the body's compensatory mechanisms to
a fall in blood pressure. The kidneys release renin into the bloodstream and this
converts angiotensinogen to angiotensin I which in turn is converted to angiotensin
II by angiotensin converting enzyme in the capillaries of the lungs. Under the
influence of Angiotensin II, aldosterone levels increase. This increases blood
sodium levels by decreasing the amount of salt excreted by the kidneys. Retaining
salt instead of excreting it into urine increases the osmolarity of the blood and so
the blood volume. As the volume increases, so does the blood pressure.
Angiotensin II is also a potent vasoconstrictor which raises blood pressure by
increasing vascular resistance - Figure 10.

Figure 10. The Renin, angiotensin, aldosterone response to a fall in blood pressure

ACID BASE BALANCE

The body controls the acidity of the blood very carefully because any deviation
from the normal pH of around 7.4 can cause problems - especially with the nervous
system. Deviations in pH can occur due to trauma or diseases such as diabetes,
pneumonia and acute asthma. The mechanisms that resist and redress pH change
are...
1. Minor changes in pH are resisted by plasma proteins acting as buffers in the
blood.
2. Adjustment to the rate and depth of breathing. An increase in acidity (decrease in
pH) increases the rate and depth of breathing which gets rid of carbon dioxide from
the blood and so reduces acidity.
3. The kidneys respond to changes in blood pH by altering the excretion of acidic
or basic ions in the urine. If the body becomes more acidic, the kidneys excrete
acidic hydrogen ions (H+) and conserve basic bicarbonate ions (HCO3-). If the
body becomes more basic, the kidneys excrete basic bicarbonate ions and conserve
acidic hydrogen ions.
Together, these three mechanisms maintain tight control over the pH of the body.
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