CHAPTER 15:

Renal

Urinary System Anatomy

Know every diagram on this
pp

Urinary System
Homeostasis
Control of extracellular fluid: interstitial fluid and
plasma
Control both ECF volume and composition
ECF Composition
Electrolytes (Na+, K+, Cl-)
Minerals (PO43-, Mg2+, Ca2+)
Acid-base balance (HCO3, H+)
Toxic products of metabolism (uremic toxins)

ECF Volume

Summary
Homeostasis
Digestive and nervous systems indiscriminate
Cardiovascular systems only controls blood
pressure
The Urinary System (Kidneys) controls composition
of extracellular fluid
Homeostasis is the maintenance of the milieu
interieur, based not on what we ingest but what the
urinary system keeps

Human Kidney - cut section

25% of cardiac output goes into renal artery at rest

Human Kidney - cut section

Key structures to know:
cortex, medulla, pelvis, ureter, artery and vein

25% of cardiac output goes into renal artery at rest

glomerulus
distal tubule

collecting duct

Nephron
1,000,000/human kidney
500,000/dog kidney

proximal tubule

loop of Henle (descending, then ascending limb)

Key structures to know:

cortex, medulla, pelvis, ureter, artery, vein, nephron and its parts

glomerulus
distal tubule

collecting duct

Nephron
1,000,000/human kidney
500,000/dog kidney

proximal tubule

loop of Henle (descending, then ascending limb)

Surrounded by smooth muscle

Proximal tubule

 Important vessels:
Renal artery and vein (1 of each per kidney)
Each nephron has:

Surrounded by smooth muscle

Afferent and Efferent arteriole

Glomerular capillary bed
Peritubular capillary bed (also referred to as Vasa recta capillary bed)
Is more attracted to positive molecules because it holds a negative charge,
seen in the filtration of netrans; carbs with charges

3 key renal processes determine

what is excreted in urine
3

Bowmans
or Glomerular
Capsule
Bowmans
Space

Proximal
Tubule

Filtration

Glomerular structure
(Key: 3 layers of filtration barrier)

Filtration
barrier

Continuous: Limits
macromolecular movement across
wall to molecules <500 gm/mole.
Present in brain and skeletal
muscle. In brain, pericytes are
astroglial cells, and the glial cells
plus continuous capillary are often
called the blood-brain-barrier.

Two types of capillaries

(most small molecules
such as oxygen, glucose,
and electrolytes
readily get across)
Fenestrated: Allows larger
molecules to move across
capillary wall, though usually only
up to 30,000 gm/mole. Present
in liver, endocrine glands, gut,
and kidney. Question: Why would
pores at these sites be useful?

Filtration

Glomerular capillaries
Driven by high hydrostatic pressure (Pc; >50
mmHg) in glomerular capillaries
Highly permeable to water and small
molecules

What gets thru:

Water, small solutes (freely)
Not macromolecules

Water, electrolytes (such as Na, K, Cl), amino acids,

and glucose are freely filtered
Glomerular filtration rate (GFR) = 125 mL/min in
normal person; 4 mL/kg/min in other species)
GFR is large (equivalent to plasma volume every 20
mins in all species)

Highly selective (large molecules such as

proteins >30,000 Daltons, are kept in plasma)
About 1/3 of plasma entering glomerulus is
filtered into Bowmans space (Filtration
Fraction = 33%)
2/3 (67%) of water and small molecules and
100% of large proteins enter peritubular
capillary

Control of GFR
Pressure in the glomerular
capillaries causes filtration (GFR)
Think of afferent arteriole as a spigot
(opening it will increase GFR by
increasing pressure in glomerulr
capillaries)
Angiotensin would increase filtration
rate of GFR
The efferent arteriole is like a
pressure relief valve (opening it will
lower pressure in the glomerular
capillaries and reduce GFR).

Blood pressure

Control of GFR

An increase in systemic arterial blood

pressure might be expected to increase renal
blood flow and GFR
However, if blood pressure increases, there is
an automatic constriction of the afferent
arteriole
Renal blood flow and GFR do not change

Renal autoregulation. Regardless of what

happens to blood pressure, renal blood
pressure remains the same

Reabsorption: Overview

Not filtered solutes

Albumin and other large proteins (>30,000 Daltons)
Filtered solutes
Tubular Reabsorption and Secretion
Subtypes:
Conserved solutes:
important for kidney to save (goal = 100% reabsorption)
examples: glucose and amino acids

Balanced solutes:
kidney balances input with urinary excretion (goal = balance)
examples: Na+, K+, H+

Excreted solutes:
important to eliminate in urine (goal = excretion)
urea, medications (antibiotics)

Water
Regulated by Urine Concentrating Mechanism

Conserved Solute
Reabsorption

Glucose as an example
Sodium-Glucose Linked Transporter (SGLT) in
brush border membrane
Secondary active transport
SGLT2 early in proximal tubule
SGLT1 late in proximal tubule

GLUcose Transporter (GLUT) in basolateral

membrane
Facilitated diffusion

Normally, >99% of glucose reabsorbed before end

of proximal tubule
Amino Acid reabsorption is identical except that
there are different carriers
>99% in proximal tubule

Drug Industry: Developing SGLT inhibitors for

treatment of metabolic syndrome
Metabolic Syndrome (people and cats):
Issue: Obesity, Hyperglycemia (insulin resistance)
Develop: Heart and Kidney Disease

Balanced solutes (sodium)

Renal handling General Scheme

65% reabsorption in proximal tubule
Without regard to body need
Rest of reabsorption is more distal in nephron
Most is with regard to body need

Typically, about 99% of filtered load is reabsorbed but it varies

according to body needs
Hormonal influence on sodium reabsorption
Aldosterone enhances distal tubule reabsorption
Location

Na+

H 2O

Proximal tubule

65%

66%

Loop of Henle

25%

15%

Distal tubule

8%

4%

Total

98%

85%

Overall scheme for Renal Na Handling

Cortical nephrons

Juxtamedullary nephrons

Short loop of Henle

Long loop of Henle

Thin descending limb

Thin descending limb

Thick ascending limb

Thin ascending limb

Thus, the juxtamedullary would be able to filter a larger amount of urine

Overall scheme for Renal Na Handling

Freely filtered
Proximal reabsorption
multiple carriers 65% no regard to body need
Thick Ascending Limb
Distal tubule
Collecting Duct
Note: There is an
accumulation of NaCl
and Urea in the
interstitial fluid in the
medulla of the kidney
Urea is a byproduct of
protein metabolism
produced by liver and
some is mainteined in
medulla but most is
excreted in the urine

Na+ Factoids

Active Transport
Proximal
Distal
Thick segment of ascending limb

Passive Diffusion
Loop of Henle: the Na enters the cells, which then
expel it because of the Na/K pump (think SGLT-1/2
transporters)

Distal tubule and

collecting duct
Na reabsorption (and K/H secretion)
Adjusted in accordance with body needs
Hormone-sensitive:

Aldosterone from adrenal cortex increases Na

reabsorption (and K/H secretion)

Secretion

Secretion is often used for what we called Excreted Solutes

Increases amount of substance that is excreted in urine
Examples:
Urea (waste product of protein metabolism)
Medications, such as antibiotics

pH of extracellular fluid (ECF) is tightly regulated

Enzyme systems function optimally within small pH ranges
ECF pH normally 7.3 7.5
Diet and associated metabolic processes alter H+ production
Meat proteins: increase H+ generation
Plant proteins: herbivores (horses, cows) and vegetarians; less H+

Defense of acid-base homeostasis is achieved by 3 systems

that act in concert
(Immediate):
Buffers act as sponge to bind free H+ in ECF which minimize effects of H+ on pH (only free H
+ contribute to pH)
Kidneys control bicarbonate, while respiratory controls carbon dioxide

(Short-term = minutes):
Ventilation (respiratory system removes or retains CO2)

(Long-term = hours to days):

Renal handling (reabsorption, excretion) of HCO3- and H+

Renal Contribution to Acid-Base Balance

Proximal
Tubular Cell

Distal
Tubular Cell

Proximal tubule
Bicarbonate reabsorption
Carbonic anhydrase
enzyme present in cytosol
and on brush border surface
of tubular cells
Tubular fluid

Tubular fluid

Distal Tubule
Proton secretion
NH3 and Phosphate in
tubular fluid serve as buffers
to absorb the H+

Regardless of hydration, 2/3 of water will

be reabsorbed at proximal tubule
Little Xs are NaK2Cl
Osmolarity of the fluid in interstitial fluid is
600 mo/L
Urea is added as well, which increases
osmolarity
Waters move through aquaporins and
channels

Kidney is responsible for:

Conversion of Vitamin D to its active form
Release of erythropoietin (stimulation of red blood cell production)
Regulates blood pressure
Regulates electrolyte levels
Regulates acid-base balance