Renal Microcirculation

Homer W. Smith
From Fish to Philosopher, 1961

The Stuff of Philosophy

Recognizing that we have the kind of internal
environment we have because we have the kind of
kidneys that we have, we must acknowledge that our
kidneys constitute the major foundation of our
physiological freedom. Only because they work the way
they do has it become possible for us to have bones,
muscle, glands, and brains. Superficially it might be said
that the function of the kidneys is to make urine; but in
a more considered view one can say that the kidneys
make the stuff of philosophy itself.
Homer W. Smith
From Fish to Philosopher, 1961

Renal Microcirculation - LOs

Describe the renal microcirculation, recognize its
characteristics, and understand how its specific structure
determines specific renal functions.
Understand the structural specificity of the renal
microcirculation in relation to renal function and to other
vascular beds
Recognize the distribution of hydrostatic and oncotic
pressures in the renal vasculature
Correlate pressure values with functional characteristics
of the microcirculatory unit
State the four basic elements of renal function:
glomerular filtration, tubular reabsorption, tubular
secretion, and endocrine function

The Naked Nephron

The Nephron Wrapped by Vessels

Peculiar Facts About The Renal Circulation

The outer part of the kidney, the renal cortex,
receives most of the kidney's blood flow.
Blood flow in the renal medulla accounts for only 1
to 2 per cent of the total renal blood flow.
Flow to the renal medulla is supplied by a
specialized portion of the peritubular capillary
system called the vasa recta.
Vasa Recta descend into the medulla in parallel
with the loops of Henle and then loop back along
with the loops of Henle and return to the cortex
before emptying into the venous system.

The Glomerulus: A very high efficiency filter: what

makes the glomerulus such a good filter ?
Large surface area
High membrane permeability to water and small solutes

Elevated hydrostatic pressure leading to high net

ultrafiltration pressure (overcoming plasma oncotic
pressure)
High plasma flow rate (kidney receives 25% of cardiac
output

Optimum sieving characteristics prevent loss of plasma

proteins (permselectivity)
* the determinants of glomerular filtration rate

The Glomerulus: A very high efficiency filter: what

makes the glomerulus such a good filter ?
Large surface area:

The total length of the capillaries in a

single glomerulus is 0.95 cm, making a
total of 19 km for all 2-million
glomeruli.
The total surface area of all
glomerular capillaries is 6,000 cm2.
The total filtration surface area is
516.1 cm2.

Glomerular capillary surface area changes

CONTRACTED

RELAXED

Mesangial cell
(MC) contraction
and relaxation
mediates changes in
glomerular size by
varying the
number of open
capillary loops

The Glomerulus: A very high efficiency filter: what

makes the glomerulus such a good filter ?
Large surface area
High membrane permeability to water and small solutes

The Glomerulus: A very high efficiency filter: what

makes the glomerulus such a good filter ?
Large surface area
High membrane permeability to water and small solutes

Elevated hydrostatic pressure leading to high net

ultrafiltration pressure (overcoming plasma oncotic
pressure)

FILTRATION IN SYSTEMIC CAPILLARIES

The Afferent Arteriole

Is the first of two resistor sites in the renal
microcirculation
Mediates myogenic autoregulation in response to
changes in perfusion pressure
Is a target for local and systemic vasoconstrictors:
e.g. norepinephrin, angiotensin II, thromboxane
A2, endothelins, adenosine, leukotrienes
Is a target for vasodilators: NO, prostaglandin- I2,
lipoxins
Is the effector arm for tubuloglomerular feedback
(TGF)
Is affected in diabetes and hypertension

The Efferent Arteriole

Is the second of two resistor sites in the
renal microcirculation
Is a target for local and systemic
vasoconstrictors and vasodilators
Is preferentially constricted (more than the
afferent) at low concentrations of
angiotensin II
Gives rise to peritubular capillaries and
vasa recta

ROLE OF THE MICROCIRCULATION IN RENAL AUTOREGULATION

The Glomerulus: A very high efficiency filter: what

makes the glomerulus such a good filter ?
Large surface area
High membrane permeability to water and small solutes

Elevated hydrostatic pressure leading to high net

ultrafiltration pressure (overcoming plasma oncotic
pressure)
High plasma flow rate (kidney receives 25% of cardiac
output

Optimum sieving characteristics prevent loss of plasma

proteins (permselectivity)
* the determinants of glomerular filtration rate

It is the tight and

clever coupling of
nephron segments to
the renal
microcirculation that
enables the kidney to
effect the three
principal processes of
filtration, reabsorption, and
secretion which
underlie its clearance
functions.