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Last Update: 2 November 2017


Part I
Structure of nephron and function of the kidney M - 126
M
Nephrons (Greek nephros=kidney) are
renal or kidney tubules. Each kidney has
over one million nephrons that are
responsible for removing waste products
from blood and maintaining water, salt
and pH balance in the body. This vital
job results in the formation of urine.
1.Afferent Arteriole
The afferent arteriole receives blood
rich in oxygen from the renal artery.
This blood is transported to the
glomerulus of the nephron where it is
pressure filtered.
2.Glomerulus
The glomerulus (Latin glomus=ball) is a
knotted up capillary that contains small
pores. The plasma of the blood and the
small molecules contained in plasma are pressure filtered into the Bowman's capsule. Large blood proteins
and formed elements like blood cells and platlets are too big to be pressure filtered and remain in the
arteriole.
3.Efferent Arteriole
The efferent arteriole is smaller in diameter than the afferent arteriole and increases the pressure in the
glomerulus aiding pressure filtration. The blood entering the efferent arteriole is thicker, as plasma has
entered the tubule, but still contains oxygen that is moved on to the peritubular network to provide for the
metabolic needs of the tubule.
4.Bowman's Capsule
The filtrate produced in the glomerulus is collected in a bulblike start to the nephron called the glomerular
capsule or Bowman's capsule (named for British surgeon Sir William Bowman). The plasma and its'
dissolved molecules are transported from the Bowman's capsule into the lumen or inside of the nephron.
5.Proximal Convoluted Tubule
At this point in the nephron, the filtrate from the blood contains both waste molecules like urea and useful
molecules like amino acids, glucose, and salt. The filtering process in the glomerulus is not selective (except
by size) so the proximal convoluted tubule works to actively transport nutrients (glucose, amino acids, and
salts) back into the blood capillaries so they are not lost in the urine. The tubule has a brush border with
many villi to increase the surface area for this process of selective reabsorption. The cells of the tubule also
contain many mitochondria that produce the ATP required for the large amount of active transport taking
place throughout the length of the tubule.
6.Loop of Henle
The Loop of Henle dips down into the hypertonic environment of the kidney medulla and is responsible for
the reabsorption of water from the filtrate. Water is drawn out of the descending limb of the loop, by
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osmosis, into the hypertonic medulla of the kidney. This water can then move into the capillary network and
back into circulation to maintain blood volume. The ascending limb of the loop is impermeable to water and
removes salt into the medulla of the kidney adding to the hypertonicity.
7.Distal Convoluted Tubule
The Distal Convoluted Tubule is the site of tubular secretion. This process involves the active transport of
materials from the blood directly into the tubule. Examples of molecules that are secreted by the distal
convoluted tubule are creatinine, drugs like penicillin, and hydrogen ions. Tubular secretion of hydrogen
ions along with the reabsorption of bicarbonate ions (a biological buffer) acts as a mechanism to control
blood pH.
8.Peritubular Capillary Network
The Peritubular Capillary Network acts as the blood supply to the nephron. The capillaries provide the
nephron with glucose and oxygen to help with ATP production needed for active transport. The nutrients
and water that are reabsorbed by the nephron are taken up by the capillary network surrounding the tubules
and carried back to the renal vein and the body.
9.Collecting Duct
The collecting duct receives filtrate from several nephrons. The collecting duct will remove varying amount
of additional water from the filtrate depending on the hydration state of the individual. This results in a wide
range of urine, from very dilute (lots of water remains) to very concentrated (most of the water was
reabsorbed). The amount of water reabsorbed is controlled by a hormone called ADH and is the topic of a
future lesson. Once in the pelvis of the kidney the filtrate (now urine) contains substances that were pressure
filtered and never reabsorbed such as urea, excess salt, water and other substances that were secreted from
the blood such as hydrogen ions, drugs, or creatinine.
Formation of urine:
For the production of urine, the kidneys do not simply pick waste products out of the bloodstream and send
them along for final disposal. The kidneys' 2 million or more nephrons (about a million in each kidney) form
urine by three precisely regulated processes: filtration, reabsorption, and secretion.
1.FILTRATION:
Urine formation begins with the process of filtration, which goes on continually in the renal corpuscles . As
blood courses through the glomeruli, much of its fluid, containing both useful chemicals and dissolved waste
materials, soaks out of the blood the blood through the membranes (by osmosis and diffusion) where it is
filtered and then flows into the Bowman's capsule. This process is called glomerular filtration. The water,
waste products, salt, glucose, and other chemicals that have been filtered out of the blood are known
collectively as glomerular filtrate.
2.REABSORPTION:
Reabsorption, by definition, is the movement of substances out of the renal tubules back into the blood
capillaries located around the tubules (called the peritubular copillaries). Substances reabsorbed are water,
glucose and other nutrients, and sodium (Na+) and other ions. Reabsorption begins in the proximal
convoluted tubules and continues in the loop of Henle, distal convoluted tubules, and collecting tubules
3.SECRETION:
Secretion is the process by which substances move into the distal and collecting tubules from blood in the
capillaries around these tubules

Kidney Function
In order to understand the goals of dialysis and why it is so crucial to the health of people with kidney
failure, the function of healthy kidneys must be known.

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What do the kidneys do?

The kidneys are the filtering devices of blood. The kidneys remove waste products from metabolism such as
urea, uric acid, and creatinine by producing and secreting urine. Urine may also contain sulfate and phenol
waste and excess sodium, potassium, and chloride ions. The kidneys help maintain homeostasis by
regulating the concentration and volume of body fluids. For example, the amount of H+ and HCO3 - secreted
by the kidneys controls the body's pH.

Anatomy of the kidneys

The working units of the kidneys are called nephrons. There are approximately 500,000 nephrons in each
kidney. In the diagram above, the nephrons are located in the cortex (cortical nephrons) and medulla
(juxtamedullary nephron). In a given minute, 1200 milliliters of blood flows through the kidneys (Cooney,
270).

How do the kidneys work?

Blood flows into the kidneys through the renal artery and enters the glomerulus in Bowman's capsule. In the
glomerulus, the blood flow is split into fifty capillaries that have very thin walls. The solutes in the blood are
easily filtered through these walls due to the pressure gradient that exists between the blood in the capillaries
and the fluid in the Bowman's capsule. The pressure gradient is controlled by the contraction or dilation of
the arterioles. After passing through the afferent arteriole, the filtered blood enters the vasa recta. Blood
exits the kidneys through the renal vein.

On the other hand, the particles and fluid removed


from the blood, the filtrate, moves from the
Bowman's capsule to the proximal tubule, loops of
Henle, distal tubule, and collecting tubule. Urine is
formed in the collecting duct and then exits through
the ureter and bladder. From the proximal tube to the
collecting tubule, the filtered blood and filtrate pass
very close together. The peritubular capillaries
(containing the filtered blood) are actually
surrounded by the tubules. The nutrients that the
body needs are reabsorbed into the blood at this
point. Along with the nutrients that are reabsorbed
into the blood, the balance of water and other
molecules such as sodium and chloride is established
by the reabsorption from the loop of Henle.

In the kidneys, active, passive, and osmotic transport are used to transfer molecules such as those mentioned
above. The active transport of Na+ out of one side of the tubule membrane and into the peritubular
capillaries creates an electrical potential inside the tubule and a concentration gradient between the tubule
interior and membrane that causes Na+ to move from the interior through the membrane. This passive
tranport causes another Na+ to enter the tubules on the opposite side due to the concentration gradient. Cl-,
HCO3 -, and PO4 2- are also passively transported due to the electrical potential. Unlike those ions, H+ and K+
are actively secreted from the distal tubule and collecting duct. Water is osmotically transported. The
osmotic shifts of water lead to diffusion of solutes between the tubules and capillaries. The amount of
reabsorption of all the molecules depends on the concentrations in the tubules and in the peritubular
capillaries. As well as the amount of the solute present, the amount that can be transported also depends on
the permeabilities of the membranes for the particular solute. In general, wastes are poorly reabsorbed due to
their lower membrane permeability, while the essential nutrients are more readily absorbed as their
permeabilities are higher.

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What is the counter-current mechanism?

Because the human body does


not maintain a constant water
volume, the kidneys have to
compensate for the lack of or
excess of water consumed.
The kidneys use a transport
system called the counter-
current mechanism to
accomplish this (Hoppensteadt
et al, 186). The name is based
on the fact that concentration
first increases in the direction
of flow, then decreases as
flow continues through the
ascending parallel loop. The
mechanism relies on the
adjacent, parallel loops of
Henle and vasa recta.

In the ascending loop, Na+ (or


any solute) is actively pumped out of the tubule. As flow continues up the loop, the tubular concentration
decreases as does the interstitial (the fluid surrounding the loop) concentration. Because water is
impermeable in the ascending loop, the volume at the bottom of the loop is the same as that entering the
distal tubule. At the bottom of the loop, the tubular and interstitial concentrations are equal.

In the descending loop, the concentrations inside and outside the tubule are increasing with the current, with
the maximum concentration being reached at the bottom of the loop. The increased concentration is the
result of the passive diffusion of Na+ into the tubule and water out of the tubule. When the filtrate reaches
the distal tubule, a net loss of Na+ and water has occurred through the loops of Henle.

Inside the distal and collecting tubules, the filtrate is either diluted or concentrated to form urine. The
regulating hormone for this process is ADH (antidiuretic hormone) and is excreted by the pituitary gland.
The absence of ADH makes the membranes of the distal and collecting tubules impermeable to water. In this
case, a larger volume of dilute urine is secreted. With ADH, water passively diffuses out of the tubules and a
smaller volume of more concentrated urine results.

The maximum urine concentration is limited by the interstitial fluid concentration at the bottom of the loops
of Henle. The urine leaving the collecting tubule has the same concentration as the interstitial fluid at that
point. The interstitial concentrations are largely a function of blood flow in the three regions. In the cortex,
the lower concentrations are the result of the large blood flow in the peritubular capillaries. The capillary
blood carries away excess solute and water in the region. In the medulla, the only blood flow is in the vasa
recta, approximately 10% of the cortical blood flow. The loop structure of the vasa recta keeps the entering
and exiting concentration the same. While solute is absorbed in the descending loop, an equal amount of
solute is secreted in the ascending loop.

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