The Renal System

Lecture 1: organization of the renal system

Lecture 2: Reabsorption, secretion and excretion
Lecture 3: control of salt and water balance
Lecture 4: Acid-base balance
Lecture 5: clinical scenarios

Professor Veronica Campbell

Department of Physiology
vacmpbll@tcd.ie
https://medicine.tcd.ie/physiology/student/
 Suggested Reading
Sherwood

Principles of Renal Physiology

by Christopher Lote, 4th Edition, Kluwer Academic Publishers
 Lecture 1: The renal system
Components of renal system
Structure of nephron
Basic renal functions
Filtration
Assessment of filtration
 Functions of kidney
Maintain H2O and salt balance in the body
Maintain proper osmolarity of body fluids, primarily through
regulating H2O balance
Regulate the quantity and concentration of most ECF ions
Maintain proper plasma volume

Help maintain proper acid-base balance in the body

Excreting (eliminating) the end products (wastes) of bodily
metabolism
Excreting many foreign compounds

Producing erythropoietin
Producing renin
Converting vitamin D into its active form
 Urinary System
Urine forming organs
Kidneys

Structures that carry urine from the kidneys to the

outside for elimination from the body
Ureters
Urinary bladder
Urethra
Branches of renal artery

Interlobar
Arcuate
Interlobular
Afferent arteriole
 Congenital abnormalities

Renal agenesis failure of kidney to develop

1:2500

Unilateral agenesis development of 1 kidney

1:1000

Ectopic kidney abnormal location in pelvis

1:800

Horseshoe kidney - fused

 Ureters
Smooth muscle-walled duct
Exits each kidney at the medial border in
close proximity to renal artery and vein
Carry urine to the urinary bladder
 Urinary Bladder
Temporarily stores urine
Hollow, distensible, smooth muscle lining
wall
Periodically empties to the outside of the
body through the urethra
 Urethra
Conveys urine to the outside of the body
Urethra is straight and short in females
In males
Much longer and follows curving course from
bladder to outside
Dual function
Provides route for eliminating urine from bladder
Passageway for semen from reproductive organs
Kidney
 NEPHRON
Functional unit of the kidney

~ 1 million nephrons/kidney

Each nephron has two components

Vascular component
Tubular component

Arrangement of nephrons within kidney gives rise to two

distinct regions
Outer region
Renal cortex
Inner region
Renal medulla
Proximal convoluted
tubule
Efferent arteriole
Afferent arteriole
Glomerulus

Arcuate vein Distal convoluted tubule

Arcuate artery
Collecting duct

Vasa recta
Thick ascending limb
of the loop of Henl

Descending limb
loop of Henl
Thin ascending limb
of the loop of Henl
 Nephron
Two types of nephrons
Distinguished by location and length of
their structures
Juxtamedullary
nephrons (long Loops of Henle; 15%)
Cortical
nephrons (short Loops of Henle)
 Nephron
Vascular component
Glomerulus
Ball-like tuft of capillaries
From renal artery, inflowing blood passes through
afferent arterioles which deliver blood to glomerulus
Efferent arteriole transports blood from glomerulus
Efferent arteriole breaks down into peritubular capillaries
which surround tubular part of nephron
Peritubular capillaries join into venules which transport
blood into the renal vein
Water and solutes are filtered through glomerulus
as blood passes through it
Approx 25% C.O
200m

Renal artery
Afferent arteriole Efferent arteriole

Glomerulus PTC
FILTRATION

Renal vein
 5
4
2 1
Tubular component
Hollow, fluid-filled tube formed by a
single layer of epithelial cells
Components
1.Bowmans capsule
2. Proximal tubule 3 6
3. Loop of Henle
Descending limb
Ascending limb
4. Juxtaglomerular apparatus
5. Distal tubule
6. Collecting duct or tubule
 Distal convoluted
tubule
Proximal
convoluted
tubule
- Convoluted apical surface
- sa Collecting duct

Descending
thin limb of
loop of Henl
- Max water permeability
Basic Renal Processes

Glomerular filtration
Tubular reabsorption
Tubular secretion
 Glomerular Filtration
Fluid filtered from the glomerulus into
Bowmans capsule pass through three layers
of the glomerular membrane

Glomerular capillary wall

Single layer of endothelial cells
More permeable to water and solutes than capillaries
elsewhere in the body - highly fenestrated

Basement membrane
Acellular gelatinous layer
Composed of glycoproteins, collagen IV, laminin

Inner layer of Bowmans capsule

Consists of podocytes that encircle the glomerulus tuft
 Phagocytosis of macromolecules
4. Mesangial cells phagocytic; contractile and modify SA for filtration
 Glomerular Filtration
-The glomerular filtration rate (GFR) is about 125 ml/min in a normal adult

- Ultrafiltrate is cell and protein-free and the concentration of small solutes are
the same as in plasma

- The filtration barrier restricts movement of solutes on a basis of size and

charge.

- Serum albumin has a radius if about 3.5 nm (69kDa) but its negative charge
prevents its movement across basement membrane

- In some diseases the negative charge on the filtration barrier is lost so that
proteins are more readily filtered - a condition called proteinuria
 Forces Involved in Glomerular Filtration

Three physical forces involved

Glomerular capillary blood
pressure
Plasma-colloid osmotic
pressure
Bowmans capsule hydrostatic
pressure
 FILTRATION FRACTION

fraction of renal plasma flow that is filtered at the glomerulus

= Glomerular filtration rate

Renal blood flow
1100 ml/min Renal plasma flow
RPF
600 ml/min
glomerulus
20%
GFR Efferent
125 ml/min Arteriole
475 ml/min
renal
tubule vein

124 ml/min

Urine 1 ml/min
Assessment of GFR using inulin
 Vol. plasma inulin cleared/min = vol. plasma filtered/min (GFR)

e.g Inulin clearance rate = 30mg/ml urine x 1.25 ml urine/min

0.30 mg/ml plasma

= 125 ml plasma/min

[U].V
[P]

Clinical note: creatinine clearance used to estimate GFR

 Assessment of renal plasma flow with PAH
-para-aminohippuric acid
-Freely filtered and non-reabsorbed
-Any PAH not filtered is secreted from peritubular capillary

PAH clearance = renal plasma flow

[U].V
[P]

600ml/min
Glomerular filtration rate depends on:-

Net filtration pressure

How much glomerular surface area is available for penetration

How permeable the glomerular membrane is

 Glomerular Filtration Rate

Pathologically, plasma-colloid osmotic pressure and

Bowmans capsule hydrostatic pressure can change

Plasma-colloid osmotic pressure

- Dehydrating diarrhea
- Relative increase in colloid pressure in glomerulus
- increase in pressure opposing filtration
GFR

Bowmans capsule hydrostatic pressure

-kidney stone/obstruction of tubule with enlarged prostate
- increase in capsular hydrostatic pressure
- GFR
 RENAL BLOOD FLOW (RBF)

Renal blood flow is approx 25% of the cardiac output (1.1 l/min )

Flow l/min
- RBF determines GFR 1.5

Renal blood flow

- Renal blood flow is 1.0
autoregulated between 90
and 180 mm Hg 0.5
GFR

0
0 100 200
Arterial blood pressure, mm Hg
How is GFR maintained at 125ml/min?????

1. Myogenic response
2. Tubuloglomerular feedback
 RENAL BLOOD FLOW - AUTOREGULATION
Autoregulation uncouples renal function from arterial blood pressure
and ensures that fluid and solute excretion is constant.

1. Myogenic hypothesis
When arterial pressure increases the renal afferent arteriole is stretched

Increase of Flow
arterial pressure increases

Vascular smooth muscle contracts to increase resistance

Flow
Increase of
returns to
vascular tone
normal
 RENAL BLOOD FLOW - AUTOREGULATION

2. Tubuloglomerular feedback

Alteration of tubular flow is sensed by the macula densa of the

juxtaglomerular apparatus (JGA) and produces a signal that alters
GFR.
 Juxtaglomerular
(granular) cells capillaries
Efferent
Arteriole

Macula
Densa

Afferent Distal
Arteriole tubule
Endothelin
 Mesangial Cell Contraction
Mesangial cells are modified
smooth muscle cells located on
glomerular capillaries.

Large Surface
Area for Filtration Filtration
slits
They contract in response
to an increase in MAP
resulting in a decrease in
surface area available for
filtration.
Capillary Bowmans
lumen capsule
Relaxation of afferent
arteriole

Bradykinin