STRUCTURE AND FUNCTION OF

THE KIDNEYS AND THE LOWER

URINARY TRACT
OBYECTIVES
1.Describe the location of the kidneys and their gross anatomical
feature.
2.Describe the defferent parts of the nephron and their location
within the cortex and medulla.
3.Identify the components of the glomerulus and the cell types
located in each component.
4.Describe the structur of glomerular capillaries and identify
which structures are filtration barriers to plasma proteins.

OBYECTIVE
5.Describe the components of the yuxtaglomerular
apparatus and the cells located in each component
6.Describe the bood supply to the kidneys.
7.Describe the innervation of the kidneys.
8.Describe the anatomy and physiology of the
lower urinary tract.

STRUCTURE OF THE KIDNEYS

Yuxtaglom: is one component of an important feedback mechanism

that is involved in the autoregulation of RBF and GFR

INNERVATION OF THE KIDNEY

SYMPHATIS ------CELIAC PLEXUS

THER IS NO PARASYMPHATIC
ADRENERGIC FIBER ----- RELEASE
NOREPINEPHRIN AND DOPAMIN

INNERVATION OF THE BLADDER

Is important in controling urination

Sympathetic hypogastric nerves

Alfa adrenergic receptor primarily in the bladder

neck and urethra.
Parasympathetic fiber via pelvic nerves (muscarinic)
innervated the bladder body bladder contraction
Pudendal nerves skeletal muscle fiber external
sphincter contraction

MICTURATION
IS THE ACT OF EMPTYING THE URINARY
BLADDER : TWO PROCESS

PROGRESSING FILLING OF THE BLADDER

MICTURATION REFLEX TO EMPTIES THE

BLADDER

GLOMERULAR FILTRATION
AND RENAL BLOOD FLOW
OBJECTIVES
1. Describe the concepts of mass balance and clearence
and explain how they are used to analyze renal trnsport
2. Define the three general process by which substances are
handled by the kidneys:glom. Filtration, tub.reabsorb and
tub. Secretion.
3. Explain the use of inulin and creatinine clearence to measure the GFR.
4. Explain the use of p-aminohippuric acid (PAH) clearence
to measure renal plasma flow(RPF)
5. Describe the composition of theglom.ultrafiltrate, and
identify which molecule are not filtered by the glomerulus.

OBJECTIVES (cont.)
6. Explain how the los of negative charges on the glom.
capillaries results in proteinuri.
7.Describe starling forces involved in the formation of
the glom. Ultrafiltrate , and explain how charges in each
force affect the glom.filtration rate.
8.Explain how the starling force change along the length
of the glom. Capillaries.
9.Describe how changes in the renal plasma flow rate
influence the GFR.
10.Explain autoregulation pf renal blood flow and the GFR
and identify the factors responsible for autoregulation
11.Identify the major hormones that influence RBF.
12.Explain how and why hormones influence RBF despite
autoregulation.

RENAL CLEARENCE

GLOMERULAR FILTRATION

REABSORBTION

SECRETION

C x= Ux X V
Px

Cx=clearence x
Ux=conc. x in
urine
V= urine flow
rate/minute
P= conc. x in
plasma

MEASUREMENT OF GFR
CLEARENCE OF INULIN
Amount filtered = amount excreted
GFR X Pin

= Uin X V

GFR

= Uin X V
Pin

MEASUREMENT OF RENAL PLASMA FLOW

AND RENAL BLOOD FLOW.

RPF= CLEARENCE OF PAH

RPF

= Upah X V
P pah

RBF =

RPF
1 - HCT

PAH LOW 0,12mg/ml

REQUIREMENTS FOR USE OF A SUBSTANCE

TO MEASURE GFR

1. The substance must be freely filtered by the

glomerulus.
2. The substance must not be reabsorbed or
secreted by the nephron .
3. The substance must not be metabolized or
produce by the kidney.
4. The substance must not alter GFR

FILTRATION PLUS TUBULAR REABSORPTION

CLEARENCE OF GLUCOSE

FILTERED LOAD(GLUCOSE)= GFR X Pg

GLUCOSE IS REABSORBED BY CELL OF
PROXIMAL TUBULE.
TUB. TRANSPORT MAX.(Tm) = 375 mg/min

FILTRATION PLUS TUBULAR SECRETION

CLEARENCE OF PAH

PARA AMINO HIPURIC ACID (PAH) IS EXCREATED

INTO THE URINE BY GF AND TUB. SECRETION
Tm PAH VARIES , BUT AVERAGE VALUE OF 80 mg/
Min.

USING CLEARENCE TO ESTIMATE

TRANSPORT MECHANISM
EXCRETION RATE = FILTERED LOAD
REABSORPTION RATE +
SECRETION RATE

Ux X V

GFR X Px R+S

Note : - if its clearence is less than the inulin clearence , the

substance is reabsorbed by the nephron ( glucose)
- if its clearence is greater than the inulin clearence,
the substance is secreted ( e.g. PAH)
- if its clearence equals the inulin clearence , the
substance is only filtered.

GLOMELURALFILTRATION AND
RENAL BLOD FLOW
ULTRFILTRATION ----- STARLING FORCES
ACROSS GLOM. CAP.
GFR (Puf) = Kf ( Pgc Pbs ) ( II gc IIbs )
AFFERENT END
45 mmHg
0 mmHg
-10 mmHg
-25 mmHg
10 mmHg

Pgc
IIbs
Pbs
IIgc
Puf

EFFERENT END
44 mmHg
0 mmHg
-10 mmHg
- 34 mmHg
0 mmHg

RENAL BLOOD FLOW

RBF = 25% CARDIAC OUT PUT (1.25 L/min)
THE IMPORTANT FUCTION OF RBF INCLUDING :
1. Determining the GFR
2. Modifying the rate of solute and water reabsorption by
the proximal tubule.
3. Participating in the concentration and dilution of urine.
4. Delivering oxygen, nutrients and hormones to the nephron
cell and returning CO2 and reabsorbed fluid and solute to
general circulation.

REGULATION OF RENAL BLOOD FLOW

hemorrhage
Arterial blood pressure

Intra renal receptors

Carotic sinus and
Aortic arch reflexs
Activity of renal
Symphatic nerves

Renin secretion

Plasma renin
Plasma angiotensin

Constriction of
Renal arterioles
RBF and GFR

RENAL TRANSPORT MECHANISM

NaCL AND WATER REABSORPTION ALONG
THE NEPHRON
OBJETIVE
1.Explain the three processes involved in the production of urine
a. filtration b. reabsorption c. secretion.
2.Describe the magnitude of the processes of filtration and reabsorption by the nephron.
3.Describe the composition of normal urine.
4.explain the basic transport mechanisms present in each nephron
segment.
5.Describe how water reabsorption is coupled to Na+ reabsorp
tion in the proximal tubule.
6.Explain how solutes, but not water , are reabsorbed by the thick
ascending limb of Henles loop.

OBJECTIVE - CONT.
7. Describe how Starling forces regulate solute and
water reabsorption across the proximal tubule.
8. Explain glomerulotubular balance and its physiological significance .
9. Identify the major hormones that regulate NaCl
and water reabsorption by its nephron segment

COMPOSITION OF URINE
SUBSTANCE

Na+
K+
NH4Ca++
Mg++
Cl PO4
Urea
Kreatinin
pH
Osmolality
others

CONCENTRATION

50 - 150 meq/l
20 - 70 meq/l
30 - 50 meq/l
5 - 12 meq/l
2 - 18 meq/l
50 - 130 meq/l
20 - 40 meq/l
200 400 mM
6 - 20 mM
5 - 7
500 - 800 mOsm/Kg H2O
0

MECHANISMS OF SOLUTETRANSPORT

PASSIVE
Spontaneous , down an electrochemical
gradient
no energy requirement.
Diffusion
Facilitated diffusion
ion channel
Uniport
Coupled transport
Antiport
Symport

MECHANISMS OF SOLUTETRANSPORT (Cont)

ACTIVE
Against an electrochemical gradient, requires
direct input of energy
Active transport
Endocytosis.

Tubuler fluid
Paracelluler
pathway

blood
Lateral intercellular space

Transcelluler
pathway

Tight
junction

Na+
ATP

Na+
K+

ATP

ATP
Apical cell
membrane

Na+
Basolateral
membrane

Capillary
Basement
membrane

Tubular fluid

blood

Na+
X

ATP

Na+

K+
X

Na+
H+

CA

HCO3

CO2 + H2O

First half of proximal tubule

Tubular fluid

0rganics

Na+ Clblood

NaCl
H2O

Na+

org
anic

Cl-

Na+ ClH2O

orga
nics
organics

H2O

Na+ Cl-

Tubular fluid

Second half of proximal tubule

blood

CLNa+
Na+

H+
Hbase
Base
Cl-

ClNa+

Na+

Na+

H base
Cl-

K+
Cl-

ATP

K+

Some organic secreted by the proximal tubule

Endogenous anions
cAMP
Bile salts
Hippurate(PAH)
Oxalate
Prostaglandins
Urate

Drug
acetazolamide
chlorothiazide
furosemide
penicillin
probenecid
salicylate(aspirin)
hidrochlorthiazide
bumetanide

Some organic cations secreted by the

proximal tubule

Endogenous cations
Creatinine
Dopamine
Epinephrine
Norepinephrine

Drugs
atropine
isoproterenol
cimetidine
morphine
quinine
amiloride

Tubular
fluid

BLOOD

Na+
APAH
(OA-)

K+

ATP

Na+
Di/tri carboxylase

PAH(OA-)

Di/tri carboxylase