Medical Physiology

Introduction to the Renal System

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Introduction to the Renal System

Lecturer: Dr Mike White
E-mail: mwhite@drexelmed.edu

References: Rhoades and Bell Medical Physiology, 4th ed, pp. 399-402
Preston and Wilson, Lippincott's Illustrated Reviews: Physiology pp.313-317
Eaton & Pooler Vander's Renal Physiology, 8th ed Ch. 1

Learning Objectives:

1.) Be able to identify the renal cortex, renal medulla, renal calyces, medullary pyramids,
renal pelvic space, renal artery, renal vein on a cross-section of the kidney

2.) Describe in sequence the tubular segments through which the filtrate flows from
Bowman’s capsule to the renal pelvis.

3.) Describe in sequence the blood vessels through which blood flows from the renal artery to
the renal vein.

4.) Describe the functional processes that take place in each region of the tubule.

Overview of Kidney Function

The kidney performs a number of important functions:

1.) Excretion: Plasma is filtered by the kidney and metabolic wastes and other compounds
that may have an adverse effect on cell function are excreted in the urine

2.) Homeostasis: Regulation of water and electrolyte balance, extracellular fluid volume, and
plasma osmolarity

3.) Red blood cell production: The kidney secretes erythropoietin, which stimulates red blood
cell production by bone marrow.

4.) Regulation of vascular resistance: Renin is secreted by cells in the juxtaglomerular

apparatus to initiate the renin-angiotensin-aldosterone system (RAAS), which (among other
things) controls vascular resistance.

5.) Regulation of Acid-Base balance: Through its ability to secrete or absorb bases and acids,
the kidney helps to regulate pH.

6.) Vitamin D production: The active form of vitamin D (calcitriol) is produced by the kidney.

7.) Gluconeogenesis: Although most gluconeogenesis takes place in the liver, the kidney also
contributes to the glucose pool, especially during prolonged fasting.

The kidneys perform these functions by filtering plasma, reabsorbing most of what is required,
and secreting/excreting what is not needed or is harmful. In doing these functions, the
 Medical Physiology
Introduction to the Renal System
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kidneys process ~180 liters of plasma per day (remember, total plasma volume is on the
order of 5 liters), and reabsorbs ~99% of the water that is filtered.

Functional Anatomy of the Kidney

There several defined anatomic regions of the kidney:

Cortex

The cortex, located in the outer part of the kidney, contains Bowman’s capsules, which
contain the glomeruli, the proximal convoluted tubules, cortical portions of the loop of Henle,
distal convoluted tubules, and cortical collecting tubules. In addition, microvasculature
needed for renal function for this region are also here.

Medulla

The medulla contains cone-shaped tissue termed pyramids. These contain the medullary
portions of the loop of Henle medullary collecting tubules and the collecting ducts, along with
the associated microvasculature.
hapter 1. Renal Functions, Basic Processes, and Anatomy
Renal Physiology,
Calyces 8e, 2013
These drain into the renal pelvis, which forms the head of the ureter, which sends urine to the
urinary bladder.

Eaton and Pooler Fig 1-2

nd:
The vasculature
structural components of kidney.
of the the cortex and the medulla
(Reproduced have a different
with permission from arrangement. In the
Kibble J, Halsey cortex,
CR. The Big Picture: M
the tubules
logy. New York: and blood
McGraw-Hill; vessels are intertwined in a more or less random fashion while in the
2009.)
medulla they are in a parallel arrangement.

download: 2/5/2015 Copyright © 2015 McGraw-Hill Education. All rights reserved.

 Medical Physiology
Introduction to the Renal System
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The Nephron

The nephron is the functional unit of the kidney and is a tubular structure comprised of
epithelial cells. Each kidney contains on the order of 1 million nephrons. The top of the
nephron is at the glomerular capsule (aka Bowman's capsule) in the cortex. Blood enters
from the afferent arteriole into the glomerular capillaries and out via the efferent arteriole. The
glomerular capillaries filter the blood and the filtrate (water, low molecular weight compounds,
and ions) enters Bowman’s' space and then the proximal tubule. The proximal tubule has two
parts- the proximal convoluted tubule (PCT) in the cortex and the proximal straight tubule
(PST) in the medulla. The tubule forms a long loop that descends into the inner medulla and
then returns back to the cortex. This is the Loop of Henle, and is divided into the descending
thin limb (DTL), the ascending thin limb (ATL), and the thick ascending limb (TAL). Fluid then
passes through the distal convoluted tubule (DCT) to the connecting tubule and then empty
into the cortical and medullary collecting ducts before going to the calyx.

Preston & Wilson Fig 25.5

Peritubular capillaries surround the nephron tubule. These capillaries provide O2 and
nutrients to the tubule and carry away the fluids and electrolytes that have been reabsorbed
by the tubules.
 Medical Physiology
Introduction to the Renal System
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Preston & Wilson Fig 25.4

There are two main classes of nephrons: superficial and juxtamedullary. The superficial
nephrons receive ~90% of the renal blood supply and are the major site of fluid and
electrolyte reabsorption. They have relatively short loops of Henle that do not reach down to
the inner medulla. The juxtamedullary nephrons receive the remaining 10% of the blood
supply and have very long loops of Henle that go deep into the inner medulla. The peritubular
capillaries associated with the juxtaglomerular nephrons form a long, looping vascular
network known as the vasa recta. The juxtamedullary nephrons serve to create osmotic
gradients that concentrate the urine.

Renal Processes

The role of the kidney is to filter blood, reabsorb water, solutes, and electrolytes, and to
eliminate the rest. Filtration is the process by which water and solutes leave the glomerular
capillaries and enter Bowman's space. Secretion is the process whereby substances are
transported from the tubular epithelial cells into the nephron lumen. Secreted substances can
 Medical Physiology
Introduction to the Renal System
l Functions, Basic Processes, and Anatomy Page 5 of 6
gy, 8e, 2013
either be synthesized in the epithelial cells or from the surrounding interstitial space.
Reabsorption is the process by which substances in the lumen cross the epithelial barrier and
into the interstitial space, where they can be absorbed by the peritubular capillaries. Excretion
is the exit of substances from the body via the urine.

Eaton and Pooler Fig 1-7

The renal system is extremely efficient of absorbing water, ions, and substrates form the
s of renalblood.
function—glomerular filtration,
The table below shows some tubular
examples secretion
of the efficiency and
of these tubular reabsorption—
processes:
nd vasculature in the cortex.
Substance Amount filtered per Amount excreted %Reabsorbed
day
water, L 180 1.8 99.0
Na+, g 630 3.2 99.5
Glucose, g 180 0 100
Urea, g 56 28 50
2015 Copyright © 2015 McGraw-Hill Education. All rights reserved.
Data from Eaton and Pooler, Table 1-2.
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Each tubular region serves different functions in the reabsorption and secretion process:

Proximal Convoluted Tubule (PCT)

• Isosmolar reabsorption of about 70% of filtered water and solute.
• Major role in reclaiming salt and water need to maintain ECF.
• Carrier-mediated Na+ transport.

Loops of Henle (LoH)

• Carrier-mediated NaCl reabsorption by the water impermeable thick ascending limb.
• Generation of corticomedullary concentration gradient.

Distal Convoluted Tubule

• Carrier-mediated reabsorption of NaCl.
• Water impermeable.
• Hormone- modulated Ca++ reabsorption.

Connecting Tubule (CNT)

• Both carrier-mediated and ion channel (hormone-regulated) Na+ reabsorption.
• Hormone-regulated Ca++ reabsorption.
• Arginine vasopressin (AVP)-responsive water permeability.

Collecting Tubules and Collecting Ducts

• Different cell types for Na+ reabsorption and H+ secretion.
• Hormone regulated ion channel Na+ reabsorption.
• K+ secretion – hormone modulated.
• H+ secretion – hormone modulated.
• Arginine vasopressin (AVP)-responsive water permeability.
• Urea transport.

As we go through the lectures in this module we will focus on the processes that take place in
each region to allow the renal system to serve its function in homeostasis.