EXCRETORY

SYSTEM
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DEVELOPMENT OF EXCRETORY SYSTEM

EXCRETORY SYSTEM

CONTENTS
DEVELOPMENT OF EXCRETORY SYSTEM ....................................................................................................................... 5
ANATOMY OF EXCRETORY SYSTEM .............................................................................................................................. 5
GENERAL FEATURES OF ANATOMY OF EXCRETORY SYSTEM .................................................................................... 5
ANATOMY OF KIDNEY ............................................................................................................................................... 6
ANATOMY OF URETER .............................................................................................................................................. 7
PHYSIOLOGY OF EXCRETORY SYSTEM ........................................................................................................................... 8
GENERAL FEATURES OF PHYSIOLOGY OF EXCRETORY SYSTEM ................................................................................ 8
RENIN ANGIOTENSIN SYSTEM ................................................................................................................................... 9
PHYSIOLOGY OF MICTURITION ............................................................................................................................... 10
GLOMERULAR FUNCTION ....................................................................................................................................... 10
TUBULAR FUNCTION ............................................................................................................................................... 11
COUNTER CURRENT MECHANISM .......................................................................................................................... 12
CONCENTRATION OF URINE ................................................................................................................................... 12
CONGENITAL DISEASES OF KIDNEY ............................................................................................................................. 13
GENERAL FEATURES OF CONGENITAL DISEASES OF KIDNEY .................................................................................. 13
POLYCYSTIC KIDNEY DISEASE .................................................................................................................................. 14
CYSTIC DISEASES OF KIDNEY ................................................................................................................................... 15
NEPHRONOPHTHISIS ............................................................................................................................................... 15
POSTERIOR URETHRAL VALVE ................................................................................................................................. 15
VESICOURETERIC REFLUX ........................................................................................................................................ 16
URETEROCELE ......................................................................................................................................................... 16
HYDRONEPHROSIS .................................................................................................................................................. 16
HYPOSPADIASIS ....................................................................................................................................................... 17
EPISPADIASIS ........................................................................................................................................................... 17
PHIMOSIS AND PARAPHIMOSIS .............................................................................................................................. 17
PEYRONIES DISEASE ............................................................................................................................................... 18
PRIAPISM................................................................................................................................................................. 18
ACUTE RETENTION OF URINE ................................................................................................................................. 18
GLOMERULAR DISEASES ............................................................................................................................................. 18
GENERAL FEATURES OF GLOMERULAR DISEASES ................................................................................................... 18
MINIMAL CHANGE DISEASE .................................................................................................................................... 19
NEPHROTIC SYNDROME .......................................................................................................................................... 19

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DEVELOPMENT OF EXCRETORY SYSTEM

EXCRETORY SYSTEM

POST STREPTOCOCCAL GLOMERULONEPHRITIS ..................................................................................................... 21

MEMBRANOUS GLOMERULONEPHRITIS ................................................................................................................ 21
MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS ............................................................................................ 21
MESANGIOPROLIFERATIVE GLOMERULONEPHRITIS .............................................................................................. 22
FOCAL SEGMENTAL GLOMERULONEPHRITIS .......................................................................................................... 22
FOCAL SEGMENTAL GLOMERULOSCLEROSIS .......................................................................................................... 22
COLLAPSING GLOMERULOPATHY ........................................................................................................................... 23
IGA NEPRHOPATHY ................................................................................................................................................. 23
RAPIDLY PROGRESSING GLOMERULONEPHRITIS .................................................................................................... 23
ALPORT SYNDROME ................................................................................................................................................ 24
GOODPASTURE SYNDROME .................................................................................................................................... 24
DIABETIC NEPHROPATHY ........................................................................................................................................ 25
CHRONIC GLOMERULONEPHRITIS .......................................................................................................................... 25
RENAL TUBULAR ACIDOSIS ......................................................................................................................................... 25
KIDNEY STONES ........................................................................................................................................................... 26
GENERAL FEATURES OF RENAL STONES ................................................................................................................. 26
TYPES OF RENAL STONES ........................................................................................................................................ 27
DIAGNOSIS OF RENAL STONES ................................................................................................................................ 28
MANAGEMENT OF RENAL STONES ......................................................................................................................... 28
NEPHROCALCINOSIS ............................................................................................................................................... 29
RENAL TUBERCULOSIS ................................................................................................................................................ 30
GENERAL FEATURES OF RENAL TUBERCULOSIS ...................................................................................................... 30
DIAGNOSIS OF RENAL TUBERCULOSIS .................................................................................................................... 30
MANAGEMENT OF RENAL TUBERCULOSIS ............................................................................................................. 30
RENAL TRAUMA .......................................................................................................................................................... 30
RENAL TUMORS .......................................................................................................................................................... 31
FEATURES OF RENAL TUMORS ................................................................................................................................ 31
RENAL CELL CARCINOMA ........................................................................................................................................ 31
WILMS TUMOR ...................................................................................................................................................... 33
RENAL FAILURE ........................................................................................................................................................... 34
GENERAL FEATURES OF RENAL FAILURE ................................................................................................................. 34
ACUTE RENAL FAILURE ............................................................................................................................................ 35
ACUTE TUBULAR NECROSIS .................................................................................................................................... 35
PRERENAL AZOTEMIA ............................................................................................................................................. 35
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DEVELOPMENT OF EXCRETORY SYSTEM

EXCRETORY SYSTEM

CHRONIC RENAL FAILURE ....................................................................................................................................... 36

INTERSITIAL NEPHRITIS ........................................................................................................................................... 37
PAPILLARY NECROSIS .............................................................................................................................................. 37
ACUTE PYELONEPHRITIS ......................................................................................................................................... 38
CHRONIC PYELONEPHRITIS ..................................................................................................................................... 38
EMPHYSEMATOUS PYELONEPHRITIS ...................................................................................................................... 38
XANTHOGRANULOMATOUS KIDNEY....................................................................................................................... 38
CHINESE HERB AND BALKAN NEPHROPATHY ......................................................................................................... 39
HEMODIALYSIS ........................................................................................................................................................ 39
RENAL TRANSPLANTATION ..................................................................................................................................... 39
RENAL VASCULAR DISORDERS .................................................................................................................................... 40
RENAL ARTERY DISORDER ....................................................................................................................................... 40
RENAL VEIN DISORDER............................................................................................................................................ 40
RENAL IMAGING ......................................................................................................................................................... 41
URINARY BLADDER...................................................................................................................................................... 41
GENERAL FEATURES OF BLADDER........................................................................................................................... 41
URINARY BLADDER CANCER .................................................................................................................................... 42
BLADDER INJURIES .................................................................................................................................................. 43
URETHRA ..................................................................................................................................................................... 44
GENERAL FEATURES OF URETHRA .......................................................................................................................... 44
URETHRAL INJURIES ................................................................................................................................................ 44
URETHRAL STRICTURE ............................................................................................................................................. 45
URINALYSIS ................................................................................................................................................................. 45
DRUGS ACTING ON KIDNEY......................................................................................................................................... 46
GENERAL FEATURES OF DRUGS ACTING ON KIDNEY .............................................................................................. 46
LOOP DIURETIC ....................................................................................................................................................... 46
THIAZIDE DIURETIC ................................................................................................................................................. 47
ALDOSTERONE ANTAGONIST .................................................................................................................................. 47
CARBONIC ANHYDRASE INHIBITORS ....................................................................................................................... 48
OSMOTIC DIURETICS ............................................................................................................................................... 48

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DEVELOPMENT OF EXCRETORY SYSTEM

EXCRETORY SYSTEM

KEY TO THIS DOCUMENT

Text in normal font Must read point.
Asked in any previous medical entrance
examinations
Text in bold font Point from Harrisons
text book of internal medicine 18th
edition
Text in italic font Can be read if
you are thorough with above two.

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DEVELOPMENT OF EXCRETORY SYSTEM

EXCRETORY SYSTEM

DEVELOPMENT OF EXCRETORY SYSTEM

Kidney ascend to become abdominal
organ by
Full number of nephrons at
PCT develops from
Collecting tubules of kidney develop from
Epithelium of ureter develops from
Ureter develops from
Ureter develops from
Trigone of bladder is derived from
Derivative of mesonephric duct
NOT a derivative of Mesonephric duct
NOT derived from mesonephric duct
NOT a derivative of Urogenital sinus
Defect of these may result in renal agenesis
Renal agenesis

Does NOT result in renal agenesis

Urorectal septum separates cloaca into
Urachus fistula
Umbilical vesicle attains full development n
MC renal vascular anomaly
Accessory renal arteries
Fetal kidney maturity is assessed by

5 8 weeks
36 weeks of gestation
Metanephric tubules
Ureteric bud
Mesonephros
Ureteric bud
Mesonephric duct
Mesonephric duct
Ureteric bud, Vas deferens, Trigone of bladder
Rete testis
Renal parenchyma
Ejaculatory duct
Nephrogenic bud, ureteric bud, blastema of
nephrogenic tissue
Defect in ascent of metanephron, Defective formation
of nephritic tissue, effect of ureteric bud and
mesonephros
Failure of descent of nephritogenic tissue to lumbar
area
Rectum and urogenital sinus
Patent allantois
4 weeks
Supernumerary renal arteries
End arteries, NOT very rare, Vascular anomaly, 2-4 in
number, Hydronephrosis
Amniotic fluid creatinine

ANATOMY OF EXCRETORY SYSTEM

GENERAL FEATURES OF ANATOMY OF EXCRETORY SYSTEM
Normal capacity of renal pelvis
Calyces in each kidney
Column of Bertin
Renal collar put around
Renal collar which surrounds aorta has its two limbs spit
by
Each kidney contains
Structure NOT present in renal medulla
Percentage of juxtamedullary nephrons of total
nephrons
Juxtamedullary nephrons depend on
Length of DCT

7 ml
7
Intrapapillary extension of renal cortex
Renal vein
Left renal vein
One million nephrons
Juxtaglomerular apparatus
15%
Vasa recta
5 mm

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ANATOMY OF EXCRETORY SYSTEM

EXCRETORY SYSTEM
Macula densa in kidney is in close relation to
Column of Bellini in kidney
Duct of Bellini are seen in
Urethral crest is situated in
Narrowest part of urethra

DCT
Tongue like papillary projection
Kidney
Prostatic urethra
External meatus

ANATOMY OF KIDNEY
Total number of glomeruli at birth
Right kidney
Immediately anterior to hilum of kidney
Most anterior in renal sinus
Anterior relations of kidney
Injured while exposing kidney from behind
Structures liable to injury on exposing kidney from
behind
Relationship of structures at hilum of kidney from
anterior to posterior is
NOT an anterior relation of right kidney
NOT a posterior relation of both kidney
Bloodless line of Brodel is seen in
Brodel line
Blood supply of kidney

NOT involved in anastomosis around kidney

Left renal vein
Tributaries of left renal vein
Renal fascia is fused posteriorly with
Cells belonging to this type of epithelium are provided
with extra reserve of cell membrane
Cells of kidney having secretory function
Apical membrane of proximal tubular cells, expanded
surface created by dense array of microvilli
Brush border cells are found in
Proximal convoluted tubule
Ansa nephroni (loop of Henle) is lined by
Cuboidal epithelium lines
Distal convoluted tubule
Types of cells in cortical collecting duct

9 lakh glomeruli
Renal vein is shorter than left, Related to duodenum,
Right kidney placed at lower level than left
Duodenum
Renal vein
SECOND part of duodenum, Liver, Hepatic flexure,
Adrenal
Ilioinguinal nerve, Subcostal nerve, Iliohypogastric
nerve
Ilioinguinal nerve, subcostal nerve, iliohypogastric nerve
Renal vein, renal artery, renal pelvis
Third part of duodenum
th
9 rib
Kidney
Two third of the way along a line from
hilum to lateral margin of kidney
NOT a portal circulation, Stellate veins drain superficial
zone, Renal artery divides into five segmental arteries
before entering hilum, Its segmental arteries are end
arteries
Cortical arteries
Posterior and inferior to superior mesenteric artery
Left adrenal vein, Left testicular vein, Diaphragmatic
vein
Fascia of psoas major muscle
Transitional
Type I medullary cells
Brush border
Proximal Convoluted tubule
Leaky epithelium with low resistance
Squamous and columnar epithelium
Distal convoluted tubule
Tight epithelium with high resistance
Prinicipal cells secrete K+ and reabsorb Water and Na+ site of action of aldosterone and potassium sparing
diuretics, Type A intercalated cells acid secretion and
bicarbonate reabsorption, Type B intercalated cells Acid
reabsorption and bicarbonate secretion

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ANATOMY OF EXCRETORY SYSTEM

EXCRETORY SYSTEM
Maximum cold storage duration for kidney
Cold ischemic time of kidney
Cold ischemic time is extended by

48 hours
48 72 hours
University of Wiscosin solution (rich is lactobionate and
raffinose)
Hydronephrosis, Perinephric abscess, Retroperitoneal
mass

Obliteration of Psoas shadow in X-ray

ANATOMY OF URETER
Ureter

Ureter
Ureter crosses
Ureter relation
Left ureter is related to
Anterior relations of right ureter

Structures crossing right ureter anteriorly

Structure NOT crossing right ureter anteriorly
NOT true
Anatomical landmark for left ureter
NOT true about ureter
Lined by transitional epithelium
Ureter is lined by
Urothelium does NOT line
Blood supply of left ureter
Ureter derives its blood supply
NOT a blood supply of ureter
Ureteric constriction
Narrowest part of ureter
Narrowest part of ureter is at
Ureters entry into bladder

Ureteric constriction NOT seen at

Ureteric constriction is NOT seen at
Autonomic ganglia is situated in ureter at
Ureter is diagnosed during operation by
Ureteric peristalsis is due to intact supply of
Peristalsis of ureter depends upon

Starts at hilum, Changes direction at ischial spine,

Enters pelvis in front of bifurcation of common iliac
artery
Gonadal vessel lies anterior to it
Uterine artery, Sigmoid mesocolon,
Anterior to Internal iliac artery, Genitofemoral Nerve,
Attachment of Mesentry
Left gonadal vessels, Sigmoid mesocolon, Internal iliac
artery
Descending part of duodenum, right colic and ileocolic
vessels, lower part of mesentery, terminal ileum, vas
defrens
Terminal ileum, Vas deferens, Right colic and ileocolic
vessels
Genitofemoral nerve (posterior)
Ureter is above uterine artery
Intersigmoid fossa
Pelvic course is same in both males and
females
Ureterourethral junction
Transitional epithelium
Membranous urethra, Collecting duct
Uterine artery, Inferior vesical artery, Testicular artery,
Common iliac artery
Renal artery, Gonadal vessel, Common iliac artery,
Inferior vesical artery
Inferior mesenteric artery
Ureteropelvic junction, Ureterovesicle junction,
Crossing of iliac artery
Ureterovesical junction
Ureteropelvic junction
At lateral angle of trigone, Makes an angle
Valveless, 25 cm long, Totally retroperitoneal, Enters
true pelvis after crossing iliac vessel
Ischial spine
Ischial spine
Lower Part
Peristaltic movements
Intrinsic smooth muscle pacemaker activity of renal
calyces
Pacemaker in smooth muscles of renal calyces

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PHYSIOLOGY OF EXCRETORY SYSTEM

EXCRETORY SYSTEM

PHYSIOLOGY OF EXCRETORY SYSTEM

GENERAL FEATURES OF PHYSIOLOGY OF EXCRETORY SYSTEM
Urine production begins at
Urine formation in Intrauterine Life
Maximum urinary concentrating capacity in full term
neonates
Neonatal kidney concentrating capacity equal to adult
kidney by
Neonatal kidney achieves concentrating ability of adult
kidney by
Resting ureteric pressure
Renal physiology

Renal physiology
Only filtered in glomerulus
Important in renal excretion of hydrogen ions
Sole channel of hydrogen ion excretion from body
Cells responsible for acid production in kidney
Acid is secreted by
Filtration barrier in nephron
Does NOT form a filtration barrier in nephron
Tubuloglomerular feedback is mediated by
Tubuloglomerular feedback is mediated by
Active reabsorption of sodium ions in kidney takes place
in
Potassium reabsorption in kidney occur
Aminoacids are reabsorbed in
Substance with Least renal clearance
Middle molecules are involved in
pathogenesis of
Size of middle molecules retained in uremia
Albumin is first to appear in urine because
Normal kidney does NOT allow passage of
Renal blood flow
Fluctuations in renal blood flow is regulated by
Prostaglandins increasing renal blood flow
Relaxation of mesangial cells of kidney is brought about
by
According to myogenic hypothesis of renal
autoregulation, afferent arterioles contract in response

2 months
3 months
600 700 mOsm/Lit
One year
1 year of age
0-5 cm of H2O
Distal tubule always receives hypoosmotic solution,
Kidneys receive 25% of cardiac output, GFR is controlled
by resistance in afferent and efferent arterioles,
Glomerulus receives capillaries from afferent arteriole
Sodium absorption occurs in DCT, Potassium is both
secreted and absorbed in tubules
Tc 99 m EC
Formation of bicarbonate from H2O and CO2 by
carbonic anhydrase
Urine
I cells
IC cells (Kidney)
Podocytes, Endothelial cell, Basement membrane
Mesangium
Macula densa
Sensing Nacl concentration in macula densa
Ascending limb of loop of henle, Distal tubule,
Collecting duct
PCT
PCT
Glucose
CRF
500 5000 daltons
It has molecular weight slightly greater than molecules
normally getting filtered
Albumin
20 % of cardiac output
Myogenic reflex
PGI2,PGE2
C-AMP
Opening of Ca2+ channels

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PHYSIOLOGY OF EXCRETORY SYSTEM

EXCRETORY SYSTEM
to stretch induced by
Renal autoregulation

In urinary system disease, GI symptoms appear because

of
Less than 400 ml urine in 24 hours
Urine output less than 100 ml per 24 hours
Schwartz formula for calculation of creatinine clearance
in a child depends on
NOT included in Schwartz formula for calculation for
creatinine clearance
Foley catheter 16 F means
Catheter material for long term use

Minimizes the impact of changes in

arterial blood pressure on renal Na+
excretion
Renogastric reflex
Oliguria
Anuria
Age, Method of estimation of creatinine, Mass
Severity of renal failure
16 mm outer diameter
Silicone

RENIN ANGIOTENSIN SYSTEM

JG cells
JG cells
Macula densa
Macula dense in kidney in relation to
JG apparatus in relation to
Lacis cells
Kidney produce
Hormone NOT secreted by kidney
True about hormones
Renin angiotensin system
Activation of rennin angiotensin system
results in
Renin
Renin secretion is increased by

Renin secretion is increased by

Renin is secreted by
Renin levels in old age
Rennin secretion is inhibited in
Rennin secretion is reduced by
Renin antagonist
Direct renin inhibitor
Physiologically inactive form
Angiotensin II

Smooth muscles cells of afferent arteriole

Modified afferent arteriolar cells.
Baroreceptors
Modified DCT, chemoreceptor, activates
JG cells
DCT
Glomerulus
Modified mesangial cells
Erythropoietin , Renin, 1,25 DHCC
Angiotensin I
Renin kidney, Renin substrate liver, ACE lung
epithelium, Angiotensinogen renal
Angiotensin is octapeptide, Aspartic acid is essential for
rennin activity, Catalysis site of ACE contain Zn++
Increased intravascular volume
Converts angiotensinogen to angiotension I
Increased Na+ in PCT, Decreased Na+ in DCT
Renal ischemia, Afferent arteriolar low pressure,
Sympathetic nerve stimulation
Prostaglandin
Juxtaglomerular cells
High
Hypervolemia
Beta blocker
Aliskerin
Aliskerin
Angiotensin I
Constriction of afferent arteriole, Autoregulation of
GFR, Secreted from endothelium, Release aldosterone,
Increased sodium and water reabsorption

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PHYSIOLOGY OF EXCRETORY SYSTEM

EXCRETORY SYSTEM
Angiotensin II
Angiotensin II
Most potent vasoconstrictor
Angiotensin II is converted to angiotensin
III by
Shortest peptide
NOT true about renin angiotensin system

Vasoconstriction, Stimulation of thirst, Increases ADH,

Aldosterone secretion
Stimulates vasopressin, suppresses renin
Angiotensin II
Aminopeptidase
Angiotensin III
ACE splits leucine valine bond, PRA is better than PRC

PHYSIOLOGY OF MICTURITION
Normal excretion of protein in urine per day
Micturition can be initiated at low bladder volume of
Bladder emptying cannot occur if volume below
Urge for micturition is felt when the bladder is filled
with
In a normal adult marked desire for micturition is felt
Elimination of waste product from a normal person
requires minimal amount of urine of
Post micturition dribbling is seen in

100 mg
10 ml
100 ml
100 200 ml of urine
When about 300 400 ml of urine has collected in
bladder
500 ml
Collection of urine in U shaped curve of bulb of penis

GLOMERULAR FUNCTION
Glomerular filtration

Most readily filtered by glomerular

capillaries
Glomerular capillaries are supplied by
Freely filtered by kidney across glomerular capillaries
Least filtered in Glomerulus
Which of these is NOT filterable completely?
Inulin clearance closely resembles
GFR
GFR is increased when
NOT true about glomerular filtration
In a normal person at resting condition, GFR is
Filtration pressure of glomeruli of kidney
Filtration pressure is controlled by
Inulin clearance
Effective renal blood flow in humans
If a substance is present in concentration of 2 mg% in
afferent arteriole and 0 mg% in efferent
Increased amount of para amino hippuric acid than
recommended level cause, renal plasma flow

Glucose concentration of glomerular filtrate is same as

plasma, Constriction of afferent arteriole decreases
glomerular hydrostatic pressure, Ureteric obstruction
increases hydrostatic pressure of Bowmans space
Polycationic dextran with molecular
weight of 25,000
Afferent arterioles
Glucose, Creatinine
Inulin
Inulin
GFR
Uv/p (v is volume per minute)
Increased renal blood flow, Afferent arteriole dilates
Glomerular oncotic pressure is less than that of filtrate
125 ml/min
15 mm Hg
Variation in caliber of arteriole
125 ml/min
625 ml
It is freely filtered in glomerulus
False low

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PHYSIOLOGY OF EXCRETORY SYSTEM

EXCRETORY SYSTEM
What is implied, if a drug has more renal clearance than
GFR
FALSE statement regarding criteria for substance used
to measure GFR
PAH is useful in estimating
Best for Glomerular function studies
Best test for GFR is with
Substances used to determine filtration fraction
GFR is best measured by
Normal filtration fraction
Renal plasma flow is estimated by
GFR is significantly increased by

Drug is secreted in tubules

It is reabsorbed by glomerulus
Renal Plasma Flow
Inulin, PAH
Inulin
Inulin and PAH
Tc 99m MAG3
20%
DTPA
Prostaglandins

TUBULAR FUNCTION
Types of transport by tubules
Amount of substances filtered per minute minus the
amount of substance that appears in urine
If clearance of a substance is greater than GFR, then
Site of lowest tubular fluid osmolarity during water
diuresis
Most sensitive index of tubular function
Glucose symport occurs with
Occurs along with glucose transport
Renal threshold for glucose in renal glycosuria
Nephron function
Fluid leaving PCT
Only filtered into renal tubules
Transport maximum
Tubular maximum for kidney in practice is actually less
than calculated value because
NO Tm value
Tm (tubular maximum) for glucose
Absorption of Potassium occurs in
Absorbed in PCT
Potassium is maximally absorbed in
Substances secreted in PCT
Secreted in DCT
Secreted in collecting duct
PCT have
PCT has
Bicarbonate is maximally absorbed in
Active reabsorption of glucose occurs in
In presence of vasopressin, greatest fraction of filtered
water is reabsorbed in which part of nephron
Maximum absorption of water

Cellular transport, paracellular transport (tight junction

associated pores)
Tubular Reabsorption
Tubular secretion must be present
6
Specific gravity of urine
Na+
Sodium symport
Low
Osmolality of intratubular content in PCT is isotonic to
surrounding interstitium
Isotonic
DTPA
Maximum reabsorption and secretion
Different nephrons have different transport maximum
Urea
375
PCT
Bicarbonate, Sodium, Phosphate
PCT
Organic acids, bases, oxalic acid, uric acid,
bile salts, H+
K+
K+, H+
Aquaporin 1
Na+ K+ ATPase
PCT
Proximal tubule
Proximal tubule
Proximal tubule

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PHYSIOLOGY OF EXCRETORY SYSTEM

EXCRETORY SYSTEM
NOT secreted in proximal tubule
Water reabsorption in tubules
Main driving force for water reabsorption
in PCT
Bulk of water reabsorption secondary to
Part of nephron most impermeable to
water
Principal site of absorption of sodium
In presence of vasopressin, the greatest fraction of
filtered water is reabsorbed in
Major portion of glomerular filtrate is absorbed in
NOT absorbed from PCT
Absorbed in DCT
NOT absorbed in DCT
Water deprivation test is used to assess
Function of late distal tubule and cortical
collecting tubule
Bicarbonate

Ion completely absorbed in tubules in a healthy

individual of normal diet
NOT true about bicarbonate

Phosphate
Bulk of water reabsorption occurs secondary to Na+
reabsorption
Active reabsorption of Na+
Sodium reabsorption
Ascending loop of henle
PCT
Proximal tubule
Proximal segment
H+
Water, Sodium, Chloride
Potassium
Distal tubular function
Reabsorption of sodium ions
Extracellular concentration 25 mmol, Intracellular
concentration 10 mmol. In kidney, bicarbonate is
produced by carbonic anhydrase
HCO37.5% solution gives 2 nmol

COUNTER CURRENT MECHANISM

Hyperosmolarity of renal medulla is due to increased
content of
Substances involved in countercurrent mechanism for
maintaining medullary gradient
In high sodium content of filtrate in renal medulla is
because
Increased medullary hyperosmolarity is due to
Prime driving force for counter current multiplier
Ion NOT handled by loop of Henle
Minimum amount of urine that should be excreted to
remove metabolic end products

Na+
NaCl, urea, water
At the loop of Henle there is countercurrent mechanism
Increased Na+, Increased urea, Increased K+
Reabsorption of Na+ in thick ascending limb
Urea
500 ml

CONCENTRATION OF URINE
Principle site of acidification of urine
Responsible for concentration of urine in kidney
NOT responsible for concentration of urine in kidney
Hormone regulating tubular reabsorption of water in
collecting duct
Hypertonic urine is excreted due to absorption of water
in

Collecting duct
Angiotensin II, Vasopressin, Aldosterone
Epinephrine
Aldosterone
Collecting duct

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