Outline

Renal functions Structure of the kidneys and urinary system Structure of a nephron Basic renal processes Renal clearance Renal blood flow Glomerular filtration

Urinary system

Posterior vena cava Renal artery and vein Aorta Ureter Urinary bladder Urethra Kidney

The kidney

Nephron

Types of Nephron

Juxtamedullary nephron

Cortical nephron

Renal cortex

Collecting duct Renal medulla

To renal pelvis

Types of nephron

A Tour of the Nephron (A)

A Tour of the Nephron (C)

Filtration membrane

Renal blood vessels

Summary of the mammalian urinary system

Posterior vena cava Renal artery and vein Aorta Ureter Urinary bladder Urethra (a) Excretory organs and major associated blood vessels Kidney Renal medulla Renal cortex Renal pelvis

Ureter Section of kidney from a rat

(b) Kidney structure

4 mm

Juxtamedullary nephron

Cortical nephron

10 m

Afferent arteriole Glomerulus from renal artery Bowmans capsule SEM Proximal tubule Peritubular capillaries

Renal cortex

Collecting duct

Efferent arteriole from glomerulus Branch of renal vein

Distal tubule Collecting duct

Renal medulla To renal pelvis

Descending limb

Loop of Henle

(c) Nephron types

Ascending limb

Vasa recta

(d) Filtrate and blood flow

Substance X is filtered and secreted but not reabsorbed. Substance Y is filtered and some of it is reabsorbed Substance Z is filtered and completely reabsorbed.

Excretion of a substance
A substance can gain entry to the tubule and be excreted in the urine by glomerular filtration or tubular secretion or both. Amount excreted = amount filtered + amount secreted- amount reabsorbed Excretion rate = V x Ux Excretion rate: amount of X excreted per minute (mg/min) V: urine flow rate (mL/min) Ux : urine concentration of X ( mg/mL)

Renal clearance
Clearance: a general concept that describes the rate at which substances are removed or cleared from plasma. Renal clearance: the volume of plasma completely cleared of a substance by the kidneys per unit time. (mL/min) Renal plasma clearance C = V x [U]x [P ]x
V = urine flow rate per min (mL/min) U = concentration of substance X in urine (mg/mL) P = concentration of substance X in plasma (mg/mL)

Substances with the highest renal clearances may be completely removed on a single pass of blood through the kidneys. Substance with the lowest renal clearances are not removed at all.

Renal clearance of Para-aminohippuric acid

(PAH)

Para-aminohippuric acid (PAH) are both filtered and secreted therefore it has the highest clearance

Renal clearance of glucose

Glucose is filtered and completely reabsorbed. Renal clearance of glucose is zero. (Substance Z)

Renal clearance of inulin

Renal clearance of inulin

If a substance is not reabsorbed or secreted, then the amount excreted = amount filtered. Amount excreted = V x [U]inulin
Amount excreted = mg/min. V = rate of urine formation. [U] = inulin concentration in urine.

Clearance of Urea
Urea is secreted into blood and filtered into glomerular capsule. Urea clearance is 75 ml/min., compared to clearance of inulin (120 ml/min.). 40-60% of filtered urea is always reabsorbed. Passive process because of the presence of carriers for facilitative diffusion of urea.

Clearance ratios
Cx/Cinulin=1.0 the clearance of x equals the clearance of inulin. The substance also must be a glomerular marker (filtered, but neither reabsorbed nor secreted) Cx/C inulin <1.0 the clearance of x is lower than the clearance of inulin, either the substance is not filtered or it is filtered and reabsorbed. (Glucose) Cx/Cinulin> 1.0 The clearance of X is higher than the clearance of inulin. The substance is filtered and secreted. (PAH)

Sample problem
In a 24 hour period, 1.44 L of urine is collected from a man receiving an infusion of inulin. In his urine, the [inulin] is 150 mg/mL, the [Na+] is 200 mEg/mL. In his plasma, the [inulin] is 1mg/mL, and the [ Na+] is 140 mEg/L. What is the clearance ratio for Na+, and what is the significance of its value?

Renal blood flow (RBF)

The kidney receive about 20 to 25% of the cardiac output, which is among the highest of all the organ systems. In a person whose cardiac putput is 5L/min, renal blood flow (RBF) is 1.25L/min or 1800L/day.

Measure Renal plasma flow (RPF)

Not all blood delivered to glomeruli is filtered in the glomerular capsules. Most of glomerular blood passes to the efferent arterioles. 20% renal plasma flow filtered.
Substances are returned back to blood.

Substances in unfiltered blood must be secreted into tubules to be cleared by active transport (PAH is an example). PAH can be used to measure renal plasma flow.

Filtration and secretion clear only the molecules dissolved in plasma. PAH clearance actually measures renal plasma flow.

Renal handling of PAH

Para-aminohippuric acid (PAH) are both filtered and secreted.

Measure glomerular filtration rate (GFR)

If a substance is neither reabsorbed nor secreted by tubule: The amount excreted in urine/min will be equal to the amount filtered out of the glomeruli/min. Rate at which a substance is filtered by the glomeruli can be calculated: Quantity filtered = GFR x [P]inulin
[P] = inulin concentration in plasma.

Amount filtered = amount excreted GFR = V x[U]inulin [P]inulin [U]inulin: urine concentration of inulin (mL/min) [P]inulin: plasma concentration of inulin (mL/min) V: urine flow rate (mL/min)

Filtration fraction and filtered load

Filtration fraction = GFR/RPF Filtered load= GFR x Px Filtered load= amount of X filtered per minute (mg.min) GFR (glomerular filtration rate (mL/min) Px= plasma concentration of X (mg/mL) Excretion rate = V x Ux

Sample problem
A woman who consents to renal studies in the clinical research center is infused with inulin to measure her GFR. Over the course of the measurement, her urine flow rate is intentionally varied by having her drink large amounts of water. The [P]inulin is kept constant at 1mg/mL with an infusion. The urine flow rate and [U] inulin before and after she drinks water are as follows: Before drinking water After drinking water [U]inulin =100mg/mL [U]inulin = 20 mg/mL V= mL/min V= 5mL/min What is the effect of the increase in urine flow (produced by drinking water) on the womans GFR?

Glomerular filtration

Structure of the glomerular capillary wall

Regulation of filtration

Effects of constricting afferent and efferent arterioles on renal plasma flow and glomerular filtration rate