FUNCTIONS OF THE KIDNEY

Excretion of metabolic wastes

Regulation of water & electrolyte balance

Regulation of body fluid osmolality & electrolyte

concentrations

Regulation of arterial pressure

Regulation of acid base balance

Secretion, metabolism & excretion of hormones

Gluconeogenesis
 EXCRETION OF METABOLIC
WASTES
Urea

Creatinine

Uric acid

Products of hemoglobin breakdown

Metabolites of various hormones

Toxins

Pesticides

Food additives
 REGULATION OF WATER &
ELECTROLYTE BALANCES
Maintenance of
homeostasis

Excretion of water &

electrolytes

Maintains balance
between intake &
output
 REGULATION OF ARTERIAL
PRESSURE

Long term control

(altering salt & water excretion)

Short term control

(vasoactive factors e.g., renin)
 REGULATION OF ACID BASE
BALANCE

Third line of
defense
REGULATION OF RBC
PRODUCTION
REGULATION OF 1,25-DIHYRDOXY
VITAMIN D3 PRODUCTION

CALCITRI
OL
 GLUCOSE SYNTHESIS

Gluconeogenesis

Little role as compared to liver (due to

small size)

Active in prolonged fasting

 GENERAL ORGANIZATION OF
KIDNEYS
Paired, extra peritoneal
organs

Weight = 150 gm each

Length = 11 14 cm

Lie on either side of vertebral

column, aorta & IVC

Right kidney slightly lower

than left

Move with respiration!

 BASIC KIDNEY STRUCTURE

Base of renal pyramid

at junction of cortex & medulla
 RENAL BLOOD SUPPLY
Both kidneys get 22% of cardiac output

1100 ml of blood per minute

Two capillary beds, separated by efferent

arterioles:

Glomerular (hydrostatic pressure 60 mmHg)

Peritubular (hydrostatic pressure 13 mmHg)
RENAL BLOOD SUPPLY
 NEPHRON
(FUNCTIONAL UNIT OF KIDNEYS)

One million nephrons in each kidney

No regeneration of nephrons

Decrease with age

Compensatory changes with age

 MICTURITION
Process of emptying the
urine-filled bladder

Autonomic spinal cord reflex

Emptying occurs in two

steps:

1. Progressive filling
(increases tension)

2. Micturition reflex
ANATOMY OF THE BLADDER
 rugae
Detrusor muscle
increases pressure
in bladder
from 40 to 60
mmHg

Smooth musoca
Smooth muscle
(involuntary
control)

Skeletal muscle
(voluntary control)
 ANATOMY OF THE BLADDER

low resistance electrical pathways

Pelvic nerves (2 3 cm)

(motor + sensory)
S2 S3
Stimulate blood vessels
 TRANSPORT OF URINE FROM KIDNEYS
THROUGH THE URETERS INTO THE BLADDER

Fluid in collecting
ducts & bladder has
same composition

Vesicoureteral reflux

Harmful effects of
backflow of urine into
ureters from bladder
PAIN SENSATIONS IN URETERS
& URETERORENAL REFLEX
Ureteral blockage causes pain &
reflex constriction

Sympathetic reflex leading to renal

arteriolar constriction simultaneously

Decreased urinary output

Lithotripsy
 CYSTOMETROGRAM
For empty bladder,
intravesicular pressure = 0 cm
H2 O

For 30 50 ml urine in bladder

, pressure = 5 10 cm H2O

300 ml is cutoff point for rapid

increase in pressure
(intrinsic tone)

Peak pressure = 100 cm H2O

Periodic pressure peaks

(micturition waves)
 MICTURITION REFLEX
Sensory stretch receptors in
bladder & urethra

Sensory signals via pelvic

nerves to S2 S3
Reflex parasympathetic flow
from S2 S3 via pelvic nerves
Causing peristaltic
contractions in detrusor
muscle
More urine, more impulses,
more contraction
Self regenerative
micturition reflex (positive
feedback)
3 phases of micturition
cycle
Voluntary & involuntary
control (cortical & pontine
excitatory/inhibitory
centers)
MICTURITION ABNORMALITIES
1. ATONIC BLADDER

destruction of sensory innervation

Overflow incontinence

Causes: crushing injury of sacrum

& syphilis (tabetic bladder)
MICTURITION ABNORMALITIES
2. AUTOMATIC BLADDER

Spinal cord damage above sacral region

If sacral cord segments are spared,

typical micturition reflex occurs

Reflex control by brain is lost

Reflex suppressed initially (spinal shock)

MICTURITION ABNORMALITIES
3. UNINHIBITED NEUROGENIC
BLADDER

Frequent & uncontrolled micturition

Disrupted inhibitory signals ( brain

stem/cord)

Lack of inhibitory signals from brain

 CLARIFICATION OF TERMS

FILTRATION: the movement of water and plasma solutes from

glomerulus to glomerular capsule.
REABSORPTION: The return of filtered molecules to the
blood.
SECRETION: The active transport of substances from the
peritubular capillaries to the nephron tubules.
EXCRETION: Removal from the body by urination.
EXAMPLE 1
EXAMPLE 2
EXAMPLE 3
EXAMPLE 4
QUESTIONS?
 Simulating Glomerular Filtration
Glomerular
Afferent Glomerulus capsule

Efferent
Collecting
Loop of Henle
Duct

DCT
PCT
 Simulating Glomerular Filtration
Afferent Glomerulus Glomerular capsule

Loop of Henle

Collecting
Efferent
DCT Duct
PCT