1.

Anatomy & Physiology of Kidney

a. Kidney’s functions:
 Maintaining water balance in the body
 Maintaining proper osmolarity of body fluids, to prevent swelling or shrinking of the
cells
 Regulating quantity and concentration of most ECF ions
 Maintaining proper plasma volume, for long-term regulation of arterial blood pressure
 Helping maintain proper acid-base balance, by adjusting urinary output of H+ and
HCO3-
 Excreting end products of bodily metabolism (Urea from protein, Creatinine from
muscle, bilirubin from Hb, and hormone metabolites), which are toxic to the brain
 Excreting many foreign compounds
 Producing renin, erythropoietin
 Converting vitamin D into its active form.

b. Urinary system

Supplied by renal artery & renal vein.

Abdominal aorta  Renal a. Interlobar a. Arcuate a.  Cortical radiate a. (Interlobulary)

a.  afferent arteriole  glomerulus  efferent arteriole  ….  IVC

Located retroperitoneal, T12-L3

Urethra: In MALE  longer, passing through prostate gland and penis.

Might be obstructed by kidney stone or prostate enlargement

In FEMALE  shorter, more susceptible to infection

Nephron: functional unit. 1 millions in each kidney.

Arrangement of nephron  regions of kidney:

 Renal cortex: granular

 Renal medulla: striated triangles  renal pyramids
 Nephron components:

 Vascular component: Glomerulus (capillaries)  filters plasma that’s free of

protein and blood cells
Afferent and efferent arteriole
Peritubular capillaries  exchange with tubular lumen, supply renal tissue

 Tubular component: Bowman’s capsule

Proximal tubule  uncontrolled reabsorption and secretion
Loop of Henle  establish osmotic gradient to vary urine’s concentration
Distal tubule & Collecting duct  controlled reabsorption of Na+ and H2O;
secretion of K+ and H+  the resulting fluid, urine, enters renal pelvis

 Combined component: Juxtaglomerular apparatus: produces regulatory substances

2 types of nephron:

 Cortical nephron (80%): loops of Henle only SLIGHTLY dip into medulla
 Juxtamedullary nephron: Loops PLUNGE through entire depth of medulla
Peritubular capillaries create vascular loops  VASA RECTA

c. 3 basic renal processes: Glomerular Filtration, Tubular Reabsorption, Tubular

Secretion
1) Glomerular Filtration: Only 20% of plasma that enters glomerulus is filtered. That is 125
mL per minute.
2) Tubular reabsorption: of 180 liters of plasma filtered each day, only 1.5 liters pass into
renal pelvis to become urine
3) Tubular secretion:

d. ELABORATION
Glomerular Filtration:

To be filtered, substance must pass through 3 layers

 Pores between and the fenestrations within the endothelial cells of the glomerular
capillary
 An acellular basement membrane
 Filtration slits between the foot processes of podocytes in the inner layer of Bowman’s
capsule

2 important characteristics:

 Glomerular capillaries are more permeable that ANY capillaries, enabling filtration of
more fluid
 Balance of forces across the glomerular membrane is such that filtration occurs
ENTIRE length of the capillaries. (Instead of filtration in the beginning and
reabsorption towards the end, like others)

Driving forces:

1. Glomerular capillary blood pressure:

The reason is the larger diameter of afferent arteriole compared to that of the efferent
arteriole  damming of blood, along with high resistance of efferent vessel 
maintenance of blood pressure along the length. (55 mmHg)

2. Plasma colloid osmotic pressure: Plasma protein, that cannot be filtered, creates
concentration gradient for H2O to move by osmosis. (-30 mmHg)
3. Bowman’s capsule hydrostatic pressure: -15 mmHg.

Net difference: 55 – 30 – 15 = 10 mmHg = NET FILTRATION PRESSURE

Glomerular Filtration Rate (GFR) = Kf x net filtration pressure

Changes in GFR, possible causes:

 Severe burning vs Dehydrating diarrhea

 Urinary tract obstruction
Mechanism of adjustments in GFR:

1. Autoregulation:
o Afferent arteriolar vasoconstriction  decreases the GFR
o Afferent arteriolar vasodilation  increases the GFR

Those are regulated by:

Myogenic mechanism  responds to changes in the stretch accompanying pressure

within the vessels

Tubuloglomerular feedback (TGF)  by macula densa of juxtaglomerular apparatus,

senses changes in salt level in the fluid flowing through the nephron’s tubular
component

2. Extrinsic sympathetic control: affected by fluctuations in arterial blood pressure.

As detected by the arterial carotid sinus and aortic arch baroreceptors.

Tubular Reabsorption

Involves transepithelial transport, so the substance must go across 5 distinct barriers:

a. Leave the tubular fluid by crossing the luminal membrane of tubular cells
b. Pass through the cytosol from one side of the tubular cells to the other
c. Cross the basolateral membrane of the tubular cell to enter the interstitial fluid
d. Diffuse through interstitial fluid
e. Penetrate the capillary wall to enter the plasma

80% of total energy spent by the kidneys is used for Na+ transport.

99.5% filtered sodium ion are reabsorbed throughout most of the tubule

67% in proximal: to reabsorb glucose, amino acids, H2O, Cl-, and urea
 25% in the (ascending limb of) loop of Henle: along with Cl- reabsorption, to enable kidney
to produce urine in varying concentration

8% in the distal and CT: hormonal control, plays a key role in regulating ECF volume.

Hormonal regulation, includes: RAAS system and Natriuretic Peptides*

*Further discussed in “EDEMA”

 Glucose and amino acids are reabsorbed by Na+ - dependent secondary active transport
Dari lumen menuju tubular cells: Sodium and glucose cotransporter (SGLT)
Setelah diffuses melewati basolateral membrane, akan memasuki plasma dengan bantuan
glucose transporter (GLUT)

 Active Na+ reabsorption is responsible for passive reabsorption of Cl-, H2O, and urea

Water reabsorption: 65% in proximal tubule, 15% in loop of Henle.

Those 80% are obligatorily reabsorbed. Remaining 20% are reabsorbed in distal portions
depending on the body’s state of hydration.

H2O passes primarily through aquaporins (AQPs), there are 2 types:

AQP-1, which are always open in proximal tubule

AQP-2, in principal cells of distal parts of nephron, and regulated by Vasopressin

Mechanism:

 Basolateral pump’s extrusion of Na+ Hypertonicity in lateral spaces between tubular

cells, because of increase in sodium concentration
 Osmotic gradient induces PASSIVE net of flow through the cells or through “leaky”
tight junctions.
 Buildup of fluid (water) in lateral spaces  hydrostatic pressure
 Plasma-colloid oncotic pressure is greatest in peritubular capillaries (because of the
extensive filtration of H2O through glomerular capillaries upstream)
  Reabsorption of approx.. 117 L/day of water in the proximal tubule

Urea reabsorption  occurring at the end of the proximal tubule.

Setelah penyerapan air, urea menjadi terkonsentrasi di dalam filtrat dan menimbulkan gradien
konsentrasi

Tubular Secretion

Most important substances secreted are hydrogen ion, potassium ion, and organic anions and
cations.

 Hydrogen ion secretion is important in acid-base balance

, and can be done in proximal, distal, and collecting tubules
 Potassium ion secretion is controlled by aldosterone
 Slight changes in plasma K+ concentration  marked influence on membrane’s
excitability
 Filtered K+ is almost completely reabsorbed in PCT
It is actively secreted by principal cells in distal & CT  During K+’s depletion,
K+ secretion in distal parts of the nephron is reduced to minimum.
Potassium secretion is regulated by Aldosterone

Intercalated cells of distal tubule secretes EITHER H+ Secretion or K+ secretion