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Functions of kidney
• The main function of the kidneys is to regulate
the volume and composition of the extracellular
fluid
• Excrete metabolic waste products including
creatinine, urea, uric acid and some end
products of haemoglobin breakdown
• Excrete foreign substances and their derivatives,
including drugs, and food additives
• Function as endocrine organs, producing the
hormones renin, erythropoietin and calcitriol, the
active form of vitamin D.
Kidney Location and External
Anatomy
• The bean-shaped
kidneys lie in a
retroperitoneal
position in the
superior lumbar
region and extend
from the twelfth
thoracic to the third
lumbar vertebrae
• Renal capsule –
fibrous capsule that
prevents kidney
infection
• Adipose capsule –
fatty mass that
cushions the kidney
and helps attach it to
the body wall
• Renal fascia – outer
layer of dense fibrous
connective tissue that
anchors the kidney
• The lateral surface is
convex and the
medial surface is
concave, with a
vertical cleft called the
renal hilus leading to
the renal sinus
• Ureters, renal blood
vessels, lymphatics,
and nerves enter and
exit at the hilus
– Renal Hilum
• Opening to Kidney
– Renal Sinus
• Space within hilus
• Kidneys receive
blood vessels and
nerves.
Internal anatomy
• Medulla divided in to
multiple cone shaped
masses called as
renal pyramid.
• It terminates in to
renal papilla which
projects in to the
space of renal pelvis
which continues as
ureter
Major calyx and minor calyx
Blood supply
Nephron
• Each kidney is made up of 1 million
nephrons.
• It is a functional unit of kidney
• Kidney cannot regenerate nephrons
• After age of 40 nephron usually decreases
about 10 percent every 10 years
• At the age of 80 many people have 40
percent less nephrons
The glomerulus and
juxtaglomerular apparatus
Regional differences in structure
Urine formation
• A. Glomerular Filtration
• B. Tubular Reabsorption
• C. Tubular Secretion
angiotensin
converting enzyme
(ACE)
angiotensin II
• It stimulates sodium reabsorption by the
proximal tubule, and chloride and water
follow passively.
• It stimulates aldosterone secretion by
the adrenal cortex.
• It stimulates antidiuretic hormone (ADH)
secretion from the posterior pituitary
gland.
• It stimulates thirst
Aldosterone
• Aldosterone released by the adrenal cortex.
• stimuli
3. Increase in the concentration of angiotensin II
4. increase in plasma K+ concentration.
• Aldosterone acts to stimulate Na+ absorption
and K+ secretion by the principal cells of
• the distal tubule and collecting duct
• increasing the number of Na+ and K+
channels in the luminal membrane and in
increasing the activity of Na+/K+ ATPase
• Atrial natriuretic peptide – secreted by
cells of atria when distended by excess
volume
• Inhibits sodium and water reabsorption
• Parathyroid – calcium regulating hamone
• Increases reabsorption of calcium from
DCT and loop of henle
Role of ADH
Regulation of body fluid volume
Production
of calcitriol.
• Vitamin D3 is present in diet and that can be
synthesized in the skin in the presence of ultraviolet light.
• Converted to 25-hydroxycholecalciferol in the liver
• Then to the active metabolite calcitriol in the kidney
(mainly in the proximal tubule).
• The conversion to calcitriol is stimulated by PTH and
is therefore indirectly stimulated by a reduction in
Ca2+.
• Calcitriol increases Ca2+ and phosphate absorption by
the gut and it enhances bone resorption
Applied physiology
• Acute renal failure:
• Ability of kidneys to excrete wastes and regulate
homeostasis of blood volume, pH, and electrolytes
impaired.
• Types
4. Prerenal renal failure - due to a failure of renal
perfusion.
5. Renal’ renal failure - the cause of the renal failure lies
within the kidneys
6. Postrenal renal failure problem lies distal to the
kidneys. Obstruction to the renal tract can occur in one
ureter and lead to loss of function of the corresponding
kidney
• Effects
• (a) fluid and electrolyte balance;
• (b)excretion
• (c) endocrine functions
• Glomerulonephritis:
• Inflammation of the glomeruli.
• Autoimmune disease by which antibodies have
been raised against the glomerulus basement
membrane.
• Leakage of protein into the urine.
• Renal insufficiency:
• Nephrons are destroyed.
• Clinical manifestations:
• Salt and H20 retention.
• Uremia.
• Elevated plasma [H+] and [K+].
Diuretics
• Increase urine volume excreted.
– Increase the proportion of glomerular filtrate that is
excreted as urine.
• Loop diuretics:
– Inhibit NaCl transport out of the ascending limb of the
LH.
• Thiazide diuretics:
– Inhibit NaCl reabsorption in the 1st segment of the
DCT.
• ACE inhibitors
• Osmotic diuretics:
– Increase osmotic pressure of filtrate