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Kidneys
o Part of the urinary system
o Formation of urine
o Excretion of waste products, specifically
water-soluble waste products
o A small portion of water-soluble waste
products is excreted via the skin as sweat,
but majority is excreted by the kidneys as
urine
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Blood Supply: Renal Blood Flow:
o About 22% of the cardiac output
(1100mL/min)
Nephron:
o 1 million per kidney
o After 40 years old, there will be a
decrement of 10% per 10 years
Starlings forces:
1. Capillary Hydrostatic Pressure
2. Capillary Osmotic Pressure of Plasma
Protein Pressure Types of nephron:
3. Interstitium/tissue HP 1. Cortical outer-cortex and mid-cortex
4. Interstitium/ tissue OPPP o Shorter loop of Henle
o More numerous
o Hydrostatic Pressure drive away fluid o Supplied by peritubular capillary
o Osmotic Pressure of Plasma Proteins 2. Juxtamedullary
attracts fluid (contributed largely by o Longer and straighter loop of Henle
proteins) o Supplied by vasa recta
o Concentrates urine
Forces favoring filtration:
o cHP & iOPP Nephron from renal corpuscle (glomerulus +
Bowmans capsule) to distal tubule
Forces favoring reabsorption:
o cOPP & iHP Urineferous tubule connecting tubules and
collecting tubuless
Glomerular capillary:
o High pressure capillary bed Urge to urinate: 150mL (for a normal 70kg person)
o 60mmHg Urinary/micturition reflex: 700mL or 1L
o Favors filtration
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Filtration barrier:
1. Basement membrane
o Lamina densa: central dense layer
o Lamina rara interna and externa
proteoglycans which contribute to
the membranes negative charge
Reabsorption = cOPPP + iHP
2. Glomerular endothelium = 13mmHg + 37mmHg
o fenestrated, with fixed negative = 50mmHg
charges that inhibit passage of
plasma proteins Filtration = cHP + iOPPP
=60mmHg + 0mmHg (zero pressure
3. Layer of epithelial cells (podocytes) because no proteins were filtered)
surrounding the glomerulus = 60mmHg
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JG Apparatus: Urine Formation:
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A. Substance is freely filtered by glomerular
capillaries, neither reabsorbed nor
secreted. Excretion rate = Filtration rate
(Ex: Waste products like creatinine)
B. Subtance is freely filtered, and partially
reabsorbed.
Excretion= Filtration Reabsorption
(Ex: electrolytes like Na and Cl)
C. Substance is freely filtered and completely
reabsorbed. Therefore, no substance is
excreted. (Ex: Glucose and amino acids)
D. Substance is freely filtered, not reabsorbed
and partially secretion. (Ex: Organic acids
o Principle of clearance: What is taken in and bases)
should be equal to what is given out.
Glomerular Filtration Rate (GFR)
o Source of input for the kidney: Renal artery
=
o Output: May go into the urine or it may GFR = 125mL/min
remain the plasma. Why? 7500mL/hour
Not all substances are filtered so it goes to 180L/day
the efferent arterioles and peritubular
capillaries or into the urine.
= =
Filtration Fraction = , where RPF = Renal Plasma Flow
Although, nearly all the plasma that enters the
kidneys passes through the glomerulus,
approximately 10% does not. The portion of filtered
plasma is termed filtration fraction.
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Factors affecting GFR: BOTH afferent and efferent arterioles VASODILATE:
o More flow
o SAME GFR
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o The increase in resistance of the arteriole
Autoregulation: offsets the increase in pressure, therfore
o Inherent mechanism of kidney in making the RBF and GFR constant, provided
maintaining RBF and GFR at a relatively that P and R remain constant.
constant level over an arterial pressure o Based on Ficks Principle:
range between 80 170mmHg
=
o Also influenced by nervous mechanism,
hormones, autocoids and others.
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o This will lead the macula densa to degrade Nerve Innervation
ATP to adenosine o Sympathetic NS
o Adenosine will cause vasoconstriction of o Act via beta receptors present in JG cells
the AFFERENT arteriole due to the presence o JG cells secrete renin
Adenosine 1 receptors o Renin will cause Na reabsorption
o Vasoconstriction will then decrease the GFR particularly in the proximal tubules
back to normal o Increase Na Increase fluid intake
o When GFR decreases, there is low Na increase BV increase VR increase EDV
concentration, which is detected by the increase SV increase CO increase
macula densa BP
o Macula densa will then cause the JG cells to
secrete renin Obligatory reabsorption is seen in the proximal
o Renin will then activate angiotensinogen to tubules due to the presence of brush borders.
angiotensin I
o Angiotensin I will then be converted to Tubular Reabsorption
angiotensin II by ACE in the lungs
o Angiotensin II will then cause
vasoconstriction of the EFFERENT arteriole,
causing an increase of GFR back to normal
4. Nervous mechanism
o Exclusively Sympathetic NS
o Strong activation of renal sympa:
o Vasoconstrict renal arterioles
o Decrease RBF and GFR
o Moderate or mild activation:
o Little influence on RBF and GFR
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o Gradient-time Limited
o Na, Cl and HCO3
o Mostly passive, but can also be
active transport
o The greater the concentration
gradient, more substances are
transported
o The longer the time, more
substances are transported
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