RENAL PHYSIOLOGY PART 2

MEDICAL PHYSIOLOGY
MAM TINE

If the components or cellular components, that is indicated none in

table, suddenly occur with a value is a sign of pathology.
Urine Formation
Processes of Urine Formation:
1. Filtration
2. Reabsorption
3. Secretion
Reabsorption it determines the final urinary excretion rate

Because this is like a screening process. They screen

substances, those can still be use by the body and those are
unwanted.

This is the process which dictates the components of your

urine.

It is the movement of your substances back to the blood

or to systemic circulation.

Ex:

Glucose, HCO3, Na, Cl, K

Secretion it is the movement of substance towards the renal tubule

Color of your urine talks a lot about your bodys function,
especially with hydration.

Ex: (unwanted or waste substances of the body)

o Urea, Creatinine, Excess Electrolyes

1 to 8 in the Urine Color Chart indicates the dehydration of

the patient.
As urine goes down or goes deeper in color, it is an
indication that you are dehydrated or in lack of water.
Physical Characteristics of a Normal Urine
URINE ANALYSIS (URINALYSIS)

General
Measurements

Other Components

Sediment

Test

Normal Result

Color

Yellow-Amber

Turbidity/Clarity

Clear to faintly hazy

4.5-8.0
(average 5.5-6.0)

pH
Specific gravity

1.030

Glucose

None

Ketones

None

Blood

None

Protein

2-8 mg/dl

Billirubin

None

RBCs

0-2 per high power

WBCs

0-1 per high power

Casts

Occasional

Mucous threads

Occasional

Crystals

Occasional

Urine Formation
I.

First, you need to have your filtration. All of your blood

should go back to your systemic circulation.

II.

All filtered substances are called filtrate. It goes to your

Bowmans capsule.

III. It goes to your renal tubules where reabsorption and

secretion happens.
IV. Then, it goes outside your body.

Tubular Reabsorption it is the movement from tubules going

back to your blood.
It is the transport of substance occurs across the following
substances below.
These are the structures or layers that your substances are passing
through in order to be reabsorbed:
1. Tubular epithelial membrane
2. Renal interstitial fluid
3. Peritubular capillary membrane
4. Back in to the blood

ACTIVE TRANSPORT VS PASSIVE TRANSPORT

Movement of
Substance
Other name
Requires Energy
(it is the form of ATP)

ACTIVE

PASSIVE

Lower to higher
concentration

Higher to lower
concentration

Uphill

Downhill

Yes

No

1. Primary
2. Secondary
Types

1. Diffusion
2. Osmosis
3. Bulk flow
(ultrafiltration)

Types of Active Transport:

Primary Active Transport it is coupled directly to an

energy source.
o It uses direct energy source.

Secondary Active Transport it is coupled indirectly to

an energy source.
o It uses indirect energy source

Types of Passive Transport:

Diffusion it is a passive transport for substances aside

from water.

2 ROUTES of substances so that they can go into your blood or can

back into your circulation.
1.

2.

Transcellular route (active and passive transport)

o It is the movement of substances through cell
membrane.
o Substances that use this route shall undergo both
active and passive transport mechanism

Osmosis it is a passive transport specifically for water.

Bulk flow or Ultrafiltration

PASSIVE TRANSPORT it is the movement of substances from

higher to lower concentration.
it used by Paracellular Route and Transcellular Route

Ex: Water it is a substance that uses passive transport

Paracellular route (passive transport)

o It is the movement of substances in between the
spaces of cell membrane.
o

Substances that use this route shall undergo

passive transport mechanism

TRANSCELLULAR ROUTE vs PARACELLULAR ROUTE

PRIMARY ACTIVE TRANSPORT
It is a transport that is coupled directly to an energy source
It can move solutes against an electrochemical gradient,
from lower to higher concentration since it uses energy.

Energy source?
o It is in the form of ATP or Adenosine
Triphosphate

Example of primary active transport:

o Na-K pump

(For sodium and potassium to go to their destination, they will the Na-K
pump. It tends to pump sodium outside, and potassium inside the cell)

3 Na out; 2 K in

Substance that uses primary active transport is the sodium,

especially at the level across the PCT.

Proximal Convoluted Tubule (PCT) it is the level of the

renal tubule where most reabsorption happen.

SECONDARY ACTIVE CO-TRANSPORT MECHANISM

PRIMARY ACTIVE TRANSPORT OF SODIUM IONS

SECONDARY ACTIVE COUNTER TRANSPORT

MECHANISM
For your Sodium to go back into your blood, it uses primary active transport.
Again, for sodium to go back in to your systemic circulation, we need to use
the Na-K pump.

SECONDARY ACTIVE TRANSPORT

It is a transport mechanism wherein substances are coupled
indirectly to an energy source.

Two or more substances interact, share, or hitch with a

specific carrier molecule so that they can be transported
together across the membrane or one substance in an
opposite direction.

Types of Secondary Active Transport:

1.

Co-transport
substances are transported together across the
membrane. (same direction)

2.

it is used during reabsorption

Counter transport
movement of one substance enables movement of
another substance in an opposite direction.

it is used during secretion

SECONDARY ACTIVE CO-TRANSPORT MECHANISM

Glucose it is the substance that uses secondary active cotransport mechanism.

Glucose interacts and shares energy with Sodium so that

from your renal tubule, Glucose and Sodium can go back to
your circulation. And so that glucose can go reabsorption.

Hydrogen ion it is a substance that uses secondary active

counter transport mechanism.

Hydrogen ion to go inside the renal tubule, it will need the

energy of the sodium.
o Sodium should be reabsorbed (goes out the renal
tubule) or go back to the systemic circulation
while hydrogen ions destination is going inside
the renal tubule, and to be secreted outside the
body.
o

They have an opposite direction.

Co-transport it is used for reabsorption

o Substances that uses the mechanism:

Glucose

Amino acids
Counter-transport it is used in secretion
o Substances that uses the mechanism:

Hydrogen ions

TRANSPORT MAXIMUM

This is where substances that are actively reabsorbed or

secreted have a limited rate at which they can be
transported.

It happens when amount of solute exceeds the capacity

of carrier proteins and enzymes involved in the
transport process.

This is only seen in substances that are actively

transported.

Examples:
o Glucose reabsorption in the proximal tubule
o Sodium ion reabsorption in the distal parts of
nephron.

Why is it important for glucose to be reabsorbed back to your

systemic circulation?
o Because if it is not reabsorbed, it will go out of our body
and mixed with urine, and is a sign of pathology.

Glucosoria there is high level of glucose in urine

o It is a sign of Diabetes Mellitus

GRADIENT TIME TRANSPORT

This is applicable to substances that are passively

reabsorbed

Factors that affect rate of reabsorption

1.

2.

3.

Electrochemical or concentration
gradient of diffusion

EFFECT RATE OF REABSORPTION IN GRADIENT TIME

TRANSPORT IF FACTORS ARE INCREASED
Factors

Rate of Reabsorption

Electrochemical gradient

Increased

Permeability of the membrane to

the substance
Time that the substance is in the
tubule

Increased
Decreased

TRANSPORT MECHANISM AND ITS LIMITATION

Transport
Mechanism

Reabsorption is
Limited by:
(TM or GT)

Example of Ions

-Gradient time
transport (proximal
convoluted tubule)

Active Transport
(Primary)

Na Ions

Active Transport
(Secondary)

Glucose, amino
acids

Passive Transport

Water

-Transport
maximum (other
segments of
nephron)
Transport
maximum
Gradient time
transport

The higher the concentration gradient

is, the greater would be the rate of
reabsorption. (passive)

ABSORPTION AND SECRETION ALONG DIFFERENT

PARTS OF NEPHRON

Relationship: Direct to reabsorption

Reabsorption and Secretion:

Permeability of the membrane to the

substance

The more permeable the membrane is

to that substance, the greater also would
be the rate of reabsorption.

Relationship: Direct to reabsorption

Time that the substance is in the renal

tubule

The longer the substance is in the renal

tubule; there will be enough time for
that substance to go back in the
circulation, and therefore increases the
rate of reabsorption.

Relationship: Inverse to reabsorption

Structure responsible: Renal Tubules

Different segments of Renal Tubules:
o Proximal Convoluted Tubule
o Loop of Henle

Ascending Loop of Henle

Descending Loop of Henle

o Distal Convoluted Tubule
o Collecting ducts

Remember: Fluid inside renal tubule is excreted as urine

Fluid in renal tubule contains:

o Solute or cellular components
o Water

Osmolarity it is the number of solute in 1 kg of water

Urine Osmolarity (Urine can be)

Example of gradient time transport:

Sodium ion reabsorption at the
Proximal Convoluted Tubule

Water

1.

Hypoosmotic or Diluted urine there is more water

that solute.
(increase H2O; decrease solute)

2.

Isoosmotic urine water is equal to the value of your

solute.
(H2O = solute)

3.

Hyperosmotic or Concentrated urine there is more

solute than water.

(decrease H2O; increase solute)

o
o

Urine osmolarity varies in different segments of renal

tubules.
o Because the different segments of your renal
tubules have different characteristics in terms of
reabsorption of your solute and of your water.

Proximal Convoluted Tubule (PCT) it is the segment of

the renal tubule does most reabsorption occurs.

It actively reabsorbs sodium and secrete

hydrogen
Theres a reabsorption of water controlled by
ADH
Urea is permeable.

REABSORPTION OF RENAL TUBULES

Renal Tubule

Reabsorption

Proximal Tubule
Descending Loop of Henle

Solute

Water

65%

65%

Moderate to high

High

25%

None
(water is impermeable)

Ascending Loop of Henle

Early Distal Tubule
Late Distal Tubule

Na and K ion are controlled by

Aldosterone; Urea is
impermeable

Collecting Tubule

Urine Osmolarity

Take note:
o Urine is most diluted in Early Distal Tubule
o

Urine is most concentrated at the level of Collecting

Tubule or Collecting Duct.

Antidiuretic hormone (ADH) or Vasopressin it is a

hormone that increases water reabsorption. It dictates the
urine osmolarity.

Controlled by Antidiuretic
Hormone/ Vasopressin
(For water to be reabsorbed this
hormone is needed)

Isosmotic
Isosmotic
Hypoosmotic/Diluted
-ADH is high;
hyperosmotic/concentrated
-ADH is low;
hypoosmotic/diluted

PRINCIPAL CELLS AND INTERCALATED CELLS (Cortical

collecting duct)

CORTICAL COLLECTING DUCT, DISTAL TUBULE,

MEDULLARY COLLECTING DUCT
In here for reabsorption to happen, you will need your hormones.

Cortical collecting duct and Late distal tubule

o Reabsorption are hormonally controlled

Aldosterone is for solute, ADH is for

water
o

Urea is impermeable. It adds up to the

concentration of the urine.

2 types of cells of Collecting Duct

(these cells are important in acid-base balance
regulation of urine)

Intercalated cells

Reabsorbs K (potassium),
HCO3 (bicarbonate);

secretes H (hydrogen)

Principal cells

Reabsorbs K (potassium), Cl
(chloride ion);

secretes Na (sodium)

Medullary Collecting Duct

CORTICAL AND MEDULLARY COLLECTING DUCT

2.

Countercurrent mechanism

COUNTERCURRENT MECHANISM
It occurs when fluid flows in opposite directions in two
adjacent segments of the same tube
2 Components of Countercurrent mechanism (these two
components dictate the osmolarity of the urine)
a. Countercurrent multiplier
b. Countercurrent exchanger
Countercurrent multiplier it represents the
Loop of Henle
Its up to Loop of Henle, if he wants to
multiply the characteristic to
reabsorbed a substance.

TUBULAR SECRETION it is the movement of substances from

your blood vessel or capillary going back in your renal tubules.

More solute reabsorbed than water;

Urine becomes hyperosmotic.

Countercurrent exchanger it represents the

the vasa recta

Countercurrent mechanism is important because it

establish and maintain an osmotic gradient system from
renal cortex to medulla (300 to 1200 mOsm)

Countercurrent mechanism allows kidneys to vary urine

concentration

TUBULAR SECRETION
RENAL TUBULE

SUBSTANCE SECRETED

Proximal Tubule

H ions, organic acids, bases

Descending Loop of Henle

None

Ascending Loop of Henle

H ions

Late Distal Tubule and Cortical

Collecting Tubule

K ions (via principal cells)

H ions (via intercalated cells)

Medullary Collecting Tubule

H ions

REGULATION OF URINE OSMOLARITY

Diluted urine
o It is excreted if there is excess water in the body
Our renal tubule makes our urine diluted, if the renal tubule
detected that theres an excess of water. And to get rid of that
excess water in the body, our renal tubules makes our urine diluted.

Concentrated urine
o It is excreted if there is limited fluid intake
If our body detected that theres a limited content of water in
our body, it makes our urine concentrated. And so that water would
be not secreted and would not lead to dehydration.

Factors that regulate concentration/dilution of urine:

1. Antidiuretic Hormone (ADH)

GLOMERULOTUBULAR BALANCE

It is the intrinsic ability of the tubules to increase their

reabsorption rate in response to increase tubular
inflow.

It is Directly proportional to tubular inflow

o The greater the amount of fluid that goes to your
renal tubule; the greater will be the reabsorption.

Importance (why we need glomerulotubular balance):

o It prevents overloading of the distal segments
when Glomerular Filtration Rate increases
o

It acts a Second line of defense to buffer the

effects of spontaneous changes in GFR on urine
output.

Autoregulation it is the first line of defense to prevent the

overflowing of fluid.

Factors that affect rate of Tubular Reabsorption

1. Physical Forces
2. Hormones
3. Sympathetic Nervous System

Peritubular Capillaries is affected by:

1. Arterial Pressure
2. Constriction of Efferent and Afferent Arteriole

Arterial Pressure and Constriction of Efferent and Afferent Arteriole

PHYSICAL FORCES

Hydrostatic Pressure
o it promotes reabsorption in terms of interstitial
fluid
o It tends to move your substances from your renal
tubule going back to your circulation)
o

Peritubular Capillary Hydrostatic Pressure it

moves your fluid or substances away from the
capillary or circulation.

b.

Renal Interstitial Hydrostatic Pressure

Osmotic Pressure
o It opposes reabsorption in terms of interstitial
fluid.
o It tends to drives fluid away

a.

Movement of substances goes back to your renal

tubules.

Peritubular Capillary Osmotic Pressure - it moves

your substances of fluid towards the capillary or
circulation.

b.

It promotes reabsorption in terms of

peritubular capillary.

Renal Interstitial Osmotic Pressure

Take note:

Arterial pressure tends to raise or increases your peritubular

hydrostatic pressure
o Therefore, a decrease rate of reabsorption.

Constriction of Efferent and Afferent Arteriole decreases

peritubular hydrostatic pressure
o

it has a suction effect

a.

Therefore, a increase rate of reabsorption

FILTRATION COEFFICIENT
This is due to large surface area of capillaries.
It adds up to the reabsorption rate
Filtration Coefficient Value: 12.4 mL/min/mmHg

EFFECT OF PHYSICAL FORCES TO REABSORPTION IF

INCREASED
RATE OF REABSORPTION
Renal Interstitial Hydrostatic
Pressure

Increased

Renal Interstitial Osmotic

Pressure

Decreased

Peritubular Hydrostatic
Pressure

Decreased

Arterial Blood Pressure

Decreased

Efferent/Afferent Arteriole
Constriction

Increased

Peritubular Osmotic Pressure

Increased

When it comes to peritubular capillaries, we

have an opposite effect of hydrostatic pressure
and osmotic pressure.

Peritubular
Capillary

Interstitial Fluid

Hydrostatic Pressure

Hydrostatic Pressure

Osmotic Pressure

Osmotic Pressure

Renal Interstitial

PHYSICAL FORCES

Forces that promotes reabsorption

o Interstitial fluid hydrostatic pressure

6 mmHg
o

Peritubular capillary osmotic pressure

32 mmHg

Forces that opposes reabsorption

o

Interstitial fluid osmotic pressure

15 mmHg

Peritubular capillary hydrostatic pressure

13 mmHg

If sympathetic nervous system is stimulated, there will be a

decreased urine output.

Net reabsorption rate = 10 mmHg

o This is the needed pressure to reabsorption to
happen.

Effects on reabsorption

Increases reabsorption of sodium and water

Decrease sodium and water excretion

Decrease urine output

HORMONES which can also affect the reabsorption rate

(please FOCUS here)
HORMONE

SITE OF ACTION

EFFECTS

BLOOD VOLUME

URINE OUTPUT

Increase

Decrease

Increase

Decrease

Increase sodium and

water reabsorption;

Aldosterone

Collecting duct

(where sodium goes, water

follows)

Increase potassium
secretion

All segments of renal

tubule except
descending loop of
Henle

Increase sodium and

water reabsorption;

Antidiuretic

Distal Tubule,
Collecting Duct

Increase water
reabsorption

Increase

Decrease

Atrial Natriuretic
Peptide (ANP)

Distal Tubule,
Collecting Duct

Decrease NaCl
reabsorption

Decrease

Increase

All segments of renal

tubule except
descending loop of
Henle

Increase calcium
reabsorption

N/A
It has not have any
effect.

N/A
It has not have any
effect.

Angiotensin II

Parathyroid
Hormone

Increase hydrogen
secretion

<3 (ANP) increases urine output

SUMMARY
urine

BP/ Blood Volume

AVALDR decreases urine output

AVALDAR stands for:
AV antidiuretic hormone, Vasopressin (other term for ADH)
ALDA aldosterone
R Renin

FACTORS

TUBULAR
REABSORPTION

URINE OUTPUT

Increase

Decrease

Decrease

Increase

-Interstitial fluid
hydrostatic
pressure
-Peritubular
capillary osmotic
pressure

<3 heart stands for Atrial Natriuretic Peptide, secreted from right atrium.

Take note:
Urine is inversely proportional to your Blood Volume.
Sympathetic Nervous System
Functions to:

Vasoconstriction of renal arterioles

Stimulate increase renin release

Stimulate formation of angiotensin II

-Interstitial fluid
osmotic pressure
-Peritubular
capillary
hydrostatic
pressure

Atrial Natriuretic
Peptide (ANP)

Aldosterone
Angiotensin II
Antidiuretic
Hormone

Increase

Decrease

Decrease

Increase

Sympathetic
Nervous System

Increase

Decrease