Renal Physiology

D. C. Mikulecky Faculty Mentoring Program Virginia Commonwealth Univ.

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FUNCTIONS OF THE KIDNEY

Water balance Electrolyte balance Plasma volume Acid-base balance Osmolarity balance Excretion Hormone secretion
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THE URINARY SYSTEM

Kidneys Blood supply: Renal arteries and veins Ureter Urinary bladder Urethra

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THE NEPHRON IS THE FUNCTIONAL UNIT OF THE KIDNEY

Bowmans Capsule Proximal Convoluted Tubule

Distal Convoluted Tubule Peritubular Capillaries

Glomerulus Artery Loop of Henle Vein

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Cortex Medulla

Collecting Duct

THREE BASIC RENAL PROCESSES

Glomerular Filtration: Filtering of blood into tubule forming the primitive urine Tubular Reabsorption: Absorption of substances needed by body from tubule to blood Tubular Secretion: Secretion of substances to be eliminated from the body into the tubule from the blood
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BASIC RENAL PROCESSES

Efferent Arteriole
Afferent Arteriole Glomerulus

GF

Kidney Tubule

TR
Peritubular Capillary

TA

Urine Excreted
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Glomerular Filtration
First step in urine formation 180 liters/day filtered Entire plasma volume filtered 65 times/day Proteins not filtered

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Forces Involved in Glomerular Filtration

Glomerular Capillary Blood Pressure

Plasma Colloid Osmotic Pressure

+ -

55

30 Bowmans Capsule Hydrostatic Pressure

15

Net Filtration Pressure

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10

Tubular Reabsorption
Water: 99% reabsorbed Sodium: 99.5% reabsorbed

Urea: 50% reabsobed

Phenol: 0% reabsorbed
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Tubular Reabsorption
By passive diffusion By primary active transport: Sodium

By secondary active transport: Sugars and Amino Acids

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Tubular Reabsorption is a Function of the Epithelial Cells Making up the Tubule

Lumen

Cells

Plasma

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Sodium Reabsorption
PUMP: Na/K ATPase Lumen Sodium

Cells
Potassium Plasma Chloride Water

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Rennin-AngiotensinAldosterone System
Stimulates Sodium Reabsorption in distal and collecting tubules Naturetic peptide inhibits In absence of Aldosterone, 20mg of sodium/day may be excreted Aldosterone can cause 99.5% retention

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Rennin-AngiotensinAldosterone System
Fall in NaCl, extracellular fluid volume, arterial blood pressure
Juxtaglomerular Apparatus Adrenal Cortex Lungs Helps Correct

Liver

Renin

+
Angiotensin Angiotensin

Converting Enzyme

Angiotensin

Aldosterone

Increased Sodium Reabsorption

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DIURETICS
ACE Inhibitors (Angiotensin Converting Enzyme): Cause loss of salt---> water follows Atrial Naturetic Peptide (ANP) also inhibits sodium reabsorption Osmotic diuretics: Are not reabsorbed

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Glucose and Amino Acids are reabsorbed by secondary active transport

They are actively transported across the apical cell membranes of the epithelial cells Their active transport depends on the sodium gradient across this membrane All other steps are passive

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GLUCOSE REABSORPTION HAS A TUBULAR MAXIMUM

Glucose Reabsorbed mg/min

Filtered

Excreted

Reabsorbed

Renal threshold (300mg/100 ml)

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Plasma Concentration of Glucose

Tubular Secretion
Protons (acid/base balance) Potassium

Organic ions

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Potassium Secretion
PUMP: Na/K ATPase Lumen Sodium

Cells
Potassium Plasma Chloride Water

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DUAL CONTROL OF ALDOSTERONE SECRETION

Increased Plasma Potassium Fall in sodium

ECF Volume
Blood Pressure

Increased Aldosterone secretion

Increased Tubular Potassium Secretion Increased Urinary Potassium Secretion
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Increased Tubular Sodium Reabsorption

Fall in Urinary Sodium Excretion

Reabsorption in Proximal Tubule (Summary)

Glucose and Amino Acids 67% of Filtered Sodium Other Electrolytes 65% of Filtered Water 50% of Filtered Urea All Filtered Potassium

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Secretion in Proximal Tubule (Summary)

Variable Proton secretion for acid/base regulation Organic Ion secretion

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Reabsorption in Distal Tubule (Summary)

Variable Sodium controlled by Aldosterone Chloride follows passively

Variable water controlled by vasopressin

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Secretion in Distal Tubule (Summary)

Variable Proton for acid/base regulation Variable Potassium controlled by aldosterone

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Collecting Duct (Summary)

Variable water reabsorption controlled by vasopressin Variable Proton secretion for acid/base balance

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REGULATION OF URINE CONCENTRATION

Medullary countercurrent system Vasopressin

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Medullary countercurrent system

Osmotic gradient established by long loops of Henle Descending limb Ascending limb

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Descending limb
Highly permeable to water No active sodium transport

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Ascending limb
Actively pumps sodium out of tubule to surrounding interstitial fluid Impermeable to water

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COUNTERCURRENT MAKES THE OSMOTIC GRADIENT

From Proximal Tubule
Active Sodium Transport Passive Water Transport

300
450 600 750 900 1050 1200 1200

300
450 600 750

100
250 400 550

To Distal Cortex Tubule Medulla

900
1050 1200 1200

700
850 1000 1000

Long Loop of Henle

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THE OSMOTIC GRADIENT CONCENTRATES THE URINE WHEN VASOPRESSIN (ANTI DIURETIC HORMONE [ADH]) IS PRESENT Interstitial Fluid
300
450 600 750 900 1050 1200 1200 From Distal Tubule

Cortex

300

Collecting Duct

400 550 700

Medulla

850
1000

Pores Open

1100 1200

Passive Water Flow

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WHEN VASOPRESSIN (ANTI DIURETIC HORMONE [ADH]) IS ABSENT A DILUTE URINE IS PRODUCE Interstitial Fluid
300
450 600 750 900 1050 1200 1200 From Distal Tubule

Cortex

100

Collecting Duct

100 100 100

Medulla

100
100

Pores Closed

100 100

No Water Flow Out of Duct

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Renal Failure
Acute: Sudden onset, rapid reduction in urine output - usually reversible Chronic: Progressive, not reversible Up to 75% function can be lost before it is noticeable
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THE URINARY BLADDER STORES THE URINE

Gravity and peristaltic contractions propel the urine along the ureter Parasympathetic stimulation contracts the bladder and micturition results if the sphincters (internal and external urethral sphincters) relax The external sphincter is under voluntary control
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Reflex and Voluntary Control of Micturition

Bladder filling reflexively contracts the bladder Internal Sphincter mechanically opens Stretch receptors in bladder send inhibitory impulses to external sphincter Voluntary signals from cortex can override the reflex or allow it to take place

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