Renal Anatomy

and Physiology

SRSibal
OBJECTIVES
• To review the gross anatomy and histology of the kidneys
• To enumerate the functions of the urinary system
• To discuss the renal blood flow and its circulation
• To discuss the processes of urine formation
RENAL ANATOMY
Genitourinary Tract Anatomy

Major components
of the urinary system
• Kidney
• Ureters
• Urinary bladder
• Urethra
Major Functions of the Urinary System
• Removes metabolic waste products from the circulatory
system (eg. Urea, ammonia)
• Regulates blood, pH, ion balance and fluid balance
• Assists in regulating BP
Primary Functions: KIDNEY
• Regulation of the plasma concentration of sodium,
potassium, chloride, calcium and other ions
• Long term regulation of blood volume and pressure
• Long term regulation of plasma pH
• Excretion of organic wastes
• Assists the liver in detoxification of toxins and
gluconeogenesis
Gross Anatomy: Kidneys
• Bean shaped
• Lie between the dorsal body
cavity and the parietal
peritoneum
• Weight: 150 gms
• Size: 12.5 cm x 7.5 cm x 2.5 cm
• Extend from the level of the
T12 vertebra to the L3
vertebra
Gross Anatomy: Kidneys
• Right kidney is lower than the
left
• Lateral surface is convex
• Medial surface is concave
• Medial surface has a vertical
cleft called “hilus” that leads to
a space called the “renal sinus”
3 Regions of the Kidney
1. Outer cortex
• Light color
• Has granular appearance

2. Inner medulla
• Darker red, reddish brown
• Exhibits a cone-shaped tissue
masses called “medullary of
renal pyramids”
3 Regions of the Kidney
Renal pyramids
• Apices point towards the
hilum
• Appear striped because they
are formed by bundles of
parallel tubules
3. Renal pelvis
• Funnel-shaped
• Continuous with the ureter
EXTENSIONS OF PELVIS
• Major calyces
• Further branch into “minor
calyces” enclose the
papillae of the pyramids;
collects the urine that
drains continuously from
the papillae
RENAL BLOOD FLOW
Blood supply: Kidneys
Renal Circulation
Renal Artery Renal Vein
Segmental arteries Segemental veins
Interlobar arteries Interlobar veins
Arcuate arteries Arcuate veins
Interlobular arteries Interlobular veins
Afferent arterioles Venules
Glomerulus
Efferent arterioles
Peritubular capillaries
Renal Circulation
• 2 capillary beds
• Glomerular capillaries
• Peritubular capillaries
• Arranged in series and separated by efferent arterioles that
help regulate hydrostatic pressure in both sets of capillaries
Renal Circulation
Renal Circulation
• By adjusting the resistance of the afferent and efferent
arterioles, the kidneys can regulate the hydrostatic pressures
in both the glomerular and peritubular capillaries, changing
the rate of glomerular filtration and/or tubular reabsorption
in response to body’s homeostatic demands
Renal Blood Flow (RBF)
• Supplied by the renal artery from the abdominal aorta
• 21% of the total cardiac output
• Directly proportional to the pressure difference between the
renal artery and renal vein
• Inversely proportional to the resistance of the renal
vasculature
• Exhibit autoregulation (RBF remains constant over a range of
pressure form 100 – 200 mmHg)
THE NEPHRON
• Functional unit of kidney
• Each kidney contains over 1 – 1.5 million nephrons
• Has 2 major components:
• Glomerulus
• Tubules
Parts of the Nephron
Structure of a nephron
1. Glomerulus
• Coil of 8 capillary lobes, collectively as “capillary tuft”
• Nonselective filter (MW <70,000 subs)
• Receives blood from the afferent arterioles
• Empties blood into the efferent arterioles
• Function: filtration
 3 Major Layers of Glomerular Capillary Membrane
(Filtration Barrier)
1. Endothelium
• Perforated by small holes (fenestrae)
• Pores increase capillary permeability but do not allow passage of large
molecules and blood cells
2. Basement membrane
• Meshwork of collagen
• Proteoglycan fibrillae
• Strong negative charges repel the negatively charged albumin
3. Epithelial cells (podocytes)
• Foot processes are separated by gaps called slit – pores thru which glomerular
filtrate moves
• Therefore, primary restriction point for plasma proteins is the basement
membrane
Factors influencing glomerular filtration
• Cellular structure of the capillary wall membrane and
Bowman’s capsule
• Basement membrane (basal lamina)
• Visceral epithelium of Bowman’s capsule
Structure of a Nephron
2. Bowman’s Capsule
• Surrounds the glomerulus
• Forms a double – walled chamber
• Its cavity opens into the proximal convoluted tubule
• Bowman’s capsule + Glomerulus = Renal corpuscle
Structure of a Nephron
3. Tubular system
• Function: reabsorption and secretion
a. Proximal convoluted tubule (PCT)
• Lined by cuboidal epithelium
b. Loop of Henle
• Thin segment – lined by squamous epithelium
• Thick segment – lined by cuboidal epithelium
c. Distal convoluted tubule (DCT)
• Lined by cuboidal epithelium
d. Collecting duct
a. Fuse with the other collecting tubules to form the papillary ducts that
empty into the renal papillae renal pelvis
 2 types of Nephron

1. Cortical Nephron
• Mainly found in the cortex

2. Juxtamedullary Nephron
• Located near the cortex
medullary junction
Peritubular Capillaries
• Arise from the efferent arteriole that drain the glomerulus
• Closely associated with the renal tubules
• Adapted for absorption
• Readily absorbs solute and water from the tubule cells
Juxtaglomerular apparatus
• Region of the nephron where the DCT comes in contact with
the afferent arteriole
• At the point of contact, both the afferent arteriole and DCT are
modified
• Afferent arteriole has juxtaglomerular cells which are
mechanoreceptors/pressoreceptors that sense changes in
pressure in the afferent arteriole
• JG cells secrete renin in response to hypoperfusion
• DCT contain macula densa which are
chemoreceptors/osmoreceptors that detect changes in solute
concentration of the filtrate
MECHANISMS OF URINE
FORMATION
Glomerular Filtration Rate
Processes of Urine Formation
1. Glomerular filtration
2. Reabsorption of substances from renal tubules into
peritubular capillary blood
3. Secretion of substances from peritubular capillary blood
into renal tubules
4. Urinary excretion
Processes of Urine Formation
Steps in Urine Formation
1. Glomerular Filtration
• Urine formation begins with filtration from the glomerular
capillaries into the Bowman’s capsule of a large amount of
fluid that is virtually free of protein

• Most substances in the plasma, except for proteins, are

freely filtered so that their concentrations in the
glomerular filtrate in the Bowman’s capsule are almost
the same as in plasma.
Glomerular Filtration
• Glomerular HP created by the smaller size of the efferent
arteriole and glomerular capillaries
• To overcome the opposition of pressures from the fluid
w/in Bowman’s capsule and colloidal pressure of
unfiltered plasma proteins in the glomerular capillaries

• Increasing or decreasing the size of the afferent arteriole to

maintain the glomerular blood pressure at a constant rate
regardless of fluctuations in the systemic blood pressure
 FR, RR and UERS of Different Substances in
the Kidneys
Filtered
Amt Amt Amt load
Substance Unit
Filtered Reabsorbed Excreted reabsorbed
(1%)
GLUCOSE gm/day 180 180 0 100
BICARBONATE mEq/day 4,320 4,318 2 >99.9
SODIUM mEq/day 25,560 25,410 150 99.4
CHLORIDE mEq/day 19,440 19,260 180 99.1
UREA gm/day 47 24 24 50
CREATININE gm/day 1.8 0 1.8 0
Filterability of Substances by Glomerular
Capillaries based on Molecular Weight
Substance Molecular Weight Filterability
Water 18 1.0
Sodium 23 1.0
Glucose 180 1.0
Inulin 5,500 1.0
Myoglobin 17,000 0.75
Albumin 69,000 0.005
Steps in Urine Formation
2. Tubular Processing of the Glomerular Filtrate
• Unlike glomerular filtration which is relatively
nonselective, tubular reabsorption Is highly selective
• Reabsorption of water and solutes include active and
passive transport mechanisms as in other cell membranes
• Eventually, urine that is formed and all the substances in
the urine represent the sum of the 3 processes
• Glomerular filtration
• Tubular reabsorption
• Tubular secretion
 Cellular mechanisms involved in tubular
reabsorption
Active transport Passive transport
• Subs to be transported should • Movt of molecules across a
combine with a carrier protein membrane caused by
• The energy created transfers the differences in their conc on
subs across the cell membranes opposite sides of the
and back into the blood membrane
• E.g. Reabsorption of Glucose, • E.g. Water reabsorption in all
Amino acids and salts in PCT, Cl in parts of the nephron except
Loop of Henle and Na in DCT ascending loop of Henle
(impermeable to water)
Tubular Secretion
• Involves passage of substances from the blood in the
peritubular capillaries to the tubular filtrate
• 2 Major Functions
1. Elimination of waste products not filtered by the glomerulus
2. Regulation of acid – base balance in the body through the
secretion of H ion
BASIC FACTS TO REMEMBER
• GFR is 180 L/day & Tubular reabsorption is 178.5 L/day,
leaving 1.5 L/day of fluid to be excreted in the urine
• Relatively constant and normally not affected by changes in
arterial pressure because of 2 reasons:
• Renal autoregulation
• Adaptive mechanisms in the renal tubules that allows them to ↑
their reabsorption rate when GFR rises:
• Glomerulotubular balance
• Pressure diuresis or pressure natriuresis
Juxtaglomerular Apparatus
• Renin released form these cells increase formation of
angiotensin I which is converted to angiotensin II
• Angiotensin II – constricts the efferent arterioles thereby
increasing the glomerular HP and returning GFR to normal