1.

Major Functions of The Kidney

• Regulation of osmolality of the body fluid
• Regulating the volume of the extracellular fluid
• Regulating concentrations of electrolytes of the
extracellular fluid
• Regulation of acid-base balance
• Clearance of metabolic waste products (urea, uric
acid, creatinine)
• Production of special substances (erythropoietin,
renin, prostaglandins, and thromboxane)
2. Functional Anatomy
Overview of the kidney
• Cortex
• Medulla
• outer medulla
• inner medulla
• Papilla
• Minor calyx
• Major calyx
• Renal pelvis
• The nephron is the basic unit of kidney structure and
function
 Renal corpuscle
glomerulus
Bowman's capsule
  Renal tubule
•  Cortical nephron (80%)
•  Juxtamedullary nephron (20%)
•  Structures of the renal tubule
The juxtaglomerular apparatus
• Macula densa (tubular epithelium)
• Granular cells (smooth muscle cells of afferent arterioles)
 renin

• extraglomerular mesangial cells

• Tubuloglomerular feedback hypothesis
3. Urine Formation
3. Urine Formation
Glomerular filtration
• The glomerular filtration barrier
 capillary endothelium
 glomerular basement membrane
 podocyte cell layer
 passage of macromolecules through the barrier are affected by pore size and
electrical charge
• Glomerular filtration rate (GFR)
 GFR=Kf(PGC - PBS - pGC)
 Kf =filtration coefficient - dependent upon fluid
permeability and surface area
• The renal plasma clearance
 Cx = Ux x V / Px (ml plasma/minute)
 Inulin clearance as a way to measure GFR
Inulin clearance
Renal blood flow

– very high (20-25% CO = ~4ml/min/g)

– relatively constant (BP 80-180 mmHg)

• Autoregulation
Myogenic
Tubuloglomerular feedback

• Sympathetic activity

• Vasomediators
Constrictors: endothelin, angiotensin II, NEP, EP,
Thromboxane A2, adenosine.
 Dilators: Nitric oxide, Ach, PGE2, PGI2, kinin.
Paracrine signal: NaCl, NO,
adenosine etc. ?
Tubular reabsorption
• Active reabsorption (active transport)
 sodium, glucose, phosphate
• Passive reabsorption (passive transport)
 urea, chloride, water
• Reabsorption of glucose
• Reabsorption of amino acids
• Reabsorption of uric acid
• Reabsorption of urea
• Reabsorption of proteins
Glucose moves in couple with Na+
Passive reabsorption
of urea in proximal
tubule
Tubular Transport of Electrolytes
• Na+ reabsorption (actively transport by Na+/K+ -
ATPase)
 Na+ reabsorption in the proximal convoluted tubule
70% of Na+ transported in this segment
cotransported with sodium are glucose, amino acid,
phosphate, Cl- and water

 Sodium reabsorption in the loop of Henle

20% sodium transported in the loop of Henle
cotransporter: Na+/K+/2Cl-
  Sodium reabsorption in the distal convoluted tubule and
collecting duct
- 9% sodium transported in these segments
- aldosterone stimulates sodium reabsorption by the collecting
ducts

• Potassium is filtered, reabsorbed, and secreted in the

kidney
 The Principal cells of the collecting ducts secret K+
 factors that facilitate secretion of K+
- Na+/K+ - ATPase in the basolateral membrane
- negative electrical potential (-50mV) in the lumen of collective
ducts than the basolateral side (0 mV)
- aldosterone increases uptake of K and the luminal membrane
permeability to K+

• Reabsorption of calcium, magnesium, and phosphate

Principal cells & aldosterone
Tubular reabsorption of water
• Tubular reabsorption of water determines the urine flow
rate and osmolality of urine
• Mechanisms of tubular reabsorption of water
 the loops of Henle act as countercurrent
multipliers (countercurrent theory)
 countercurrent exchange in the vasa recta

• Factors that influence the ability to form an osmotically

concentrated urine
 ADH
 delivery of NaCl to ascending limb of LOH
 reabsorption of NaCl by ascending limb
 delivery of fluid to medullary collecting ducts
 medullary blood flow
 urea
 length of LOH
4. Other Organs of the Urinary System
• Ureters
• Urinary bladder
• Urethra
• Micturition (urination)
 stretch receptors initiate visceral reflex arc causing
relaxation of internal sphincter
 external sphincter is voluntarily controlled except in
infants