FUNCTIONS of the KIDNEY

WABeresford

1 Remove waste and foreign materials, at the

least cost in useful materials and energy
2 Regulate (homeostasis) bodys water and
electrolyte levels, and the acid-base balance
3 To do 1 & 2 over a wide range of water, salt, &
protein dietary intakes, and degrees of muscular
activity
4 Allow cells to act on blood and an ultrafiltrate
of blood
5 Otherwise assist bodys functions - other
metabolic and controlling roles

KIDNEY: Overall architecture 1

Capsule
Cortex
Cortico-medullary
junction

Renal vein

URETER
Renal artery

Medulla

KIDNEY: Overall architecture 2

Capsule
Cortex
Corticomedullary
junction

Renal vein

Ureter
Renal artery

Medulla

The indentation where the ureter, and

renal vein & artery attach is the
HILUS. The lung and lymph node
also have a hilus, with distinctive
hilar structures

KIDNEY: Overall architecture 3

Cortex - round renal corpuscles

(glomeruli), convoluted
tubules & capillaries

Ureter

Medulla -

parallel tubules,
ducts, & capillaries

KIDNEY: Overall architecture 4

Blunt tip of pyramid is the

PAPILLA dripping urine into

}
Pyramid

Minor calyx
urine
Pelvis

to collect

Ureter

Major calyces omitted

Imagine three tiers of truncated
funnels: minor calyces, major
calyces, & renal pelvis

KIDNEY: Overall architecture 5

LOBULE = the
sector centered on
one medullary ray

LOBULE

-- an extension of

Medullary
ray

medullary tissue into the

cortex, & itself centered
on a collecting duct

Pyramid

Pyramid

LOBE

LOBE = a pyramid +
the overlying cortex

MORE RENAL STRUCTURES

Cortical labyrinth =

Medullary ray

Corpuscles &
convoluted tubules

Medullary ray

Medulla - straight
tubules & no
corpuscles

Papilla with surface

columnar epithelium

Minor calyx lined with

transitional epithelium

Centered on
collecting tubule;
mostly straight
proximals & distals

Collecting duct
Papillary duct

KIDNEY: Blood flow 1

Inter-lobar artery
2

Arcuate artery
3

Inter-lobular artery
4

Renal
artery
1

KIDNEY: Blood flow 2

Inter-lobular artery
4

6
Glomerulus
Afferent arteriole
5
7
Efferent arteriole feeding

Cortico-medullary
junction is the site
of both arcuate
arteries & veins

tortuous
(cortex) or straight capillaries (medulla)

capillaries

KIDNEY: Blood flow 3

Efferent arteriole

Afferent arteriole
Glomerular
capillary tuft

Straight medullary
8
vessels (Vasa recta)

Veins

Contorted capillary plexus

KIDNEY: Blood flow 4 Venous drainage

Inter-lobar vein
11

Arcuate vein
10

Inter-lobular vein
9

Renal
vein
12

RENAL CORPUSCLE
Afferent
arteriole

Efferent arteriole
Mesangial cells & matrix
between roots of
capillaries

Glomerular
capillary tuft
Capsular
space

Start of Proximal tubule

Visceral epithelium
of podocytes
Bowmans capsule
with simple
squamous parietal
epithelium

RENAL CORPUSCLE 2
Afferent
arteriole

VASCULAR
POLE

Efferent arteriole
Mesangial cells & matrix
between roots of
capillaries

Glomerular
capillary tuft
Capsular
space

Bowmans capsule

URINARY POLE
Start of Proximal tubule

RENAL CORPUSCLE 3
Efferent arteriole

Afferent
Blood
arteriole
pressure
drives the
ultrafiltration

Mesangial cells & matrix

between roots of
capillaries
Glomerular
capillary tuft

Capsular
space

Visceral epithelium
of podocytes
Bowmans capsule
with simple squamous
parietal epithelium

Start of Proximal tubule

The process puts at risk of loss from the body large

quantities of water and valuable materials, so that the
priority of the proximal tubule is to recover most of these

FILTRATION BARRIER
Fenestrated endothelium

Basal lamina
The charged proteoglycans of
the BL help control what
passes through

Podocytes with
Capsular
space

Capillary
lumen

Filtration
slits
between
feet
Capsular space

Fenestration

Basal lamina

Filtration slit closed by a diaphragm

FILTRATION BARRIER Detail

Filtration diaphragm

comprising nephrin molecules

interlocked, but spaced, in a
zipper-like array, determining
the size of the molecules that
can pass

}
BL
Foot/pedicel of
PODOCYTE

Podocytes foot can be more or less

spread on the basal lamina by actinbased mechanisms to regulate flow

PODOCYTES ROLES
Interact with endothelial
cells
Create charge barrier to protein passage
Counterbalance pressure
Help keep capillary-loop shape
Produce & maintain basal lamina

Create size barrier to protein passage

As listed by Shankland SJ. The podocytes response to injury: role in

proteinuria and glomerulosclerosis. Kidney Int 2006;69:2131-2147

Fenestrated
endothelium

Basal lamina

Podocytes with
Capillary
lumen

Filtration
slits
between
feet
Capsular space

Renal
corpuscle

Arched
collecting
tubule

Distal
tubule

Proximal
tubule

*
Interstitium

~
~

NEPRON & ITS

COLLEAGUES

~
~

*~

~
~

*
Collecting
duct
~

Thin segment

~
~

*
Vasa
recta

Generation & collection

of ultrafiltrate

NEPRON & ITS COLLEAGUES - Actions

Renal
corpuscle

Distal
tubule

Proximal
tubule

Fine
electrolyte
adjustment

2 Major
reabsorption

~
Interstitium

4
*

Arched
collecting
tubule

Adjustment of
urines
~
water content
& final pH

~
~

~
~

Thin
segment

Collecting
duct

~
~

~
~

~
Vasa
recta

PROXIMAL TUBULE
High cuboidal epithelium
Eosinophilic cytoplasm
Brush border - microvilli

PAS+

Basal striation - membrane

infoldings & mitochondria
Few nuclei
DISTAL TUBULE

Lower cuboidal epithelium

= wider lumen
Less eosinophilic cytoplasm
No brush border - few microvilli
Still has Basal striation

More
nuclei

COLLECTING DUCT

Pale cuboidal cells

Cell walls visible
Luminal bulging
No Basal striation
An aquaporin is the membrane molecule used by the CD
cells, under antidiuretic hormonal control , to allow water to
return to the interstitium and thence to vascular retrieval

JUXTAGLOMERULAR APPARATUS
Renal
corpuscle

Reninsecreting
JG cells

Afferent
arteriole

Arched
collecting
tubule

Distal
tubule

Proxima
l tubule

~
~

Interstitium

Distal
tubule

~
~

~
~

Thin
segment

Collecting
duct

~
~

~
~

~
Vasa
recta

Mesangium

Renal
corpuscle

Flow & NaCl-sensing Macula densa

Efferent
arteriole

JUXTAGLOMERULAR APPARATUS 2

Reninsecreting
JG cells

Afferent
arteriole

High luminal flow results in

VSMC Vasoconstriction

Vascular smooth
muscle cells
Distal
tubule

for single-nephron tubuloglomerular feedback to relate

glomerular flow to distal flow rate

NaCl

Mesangium

Renal
corpuscle

Flow & NaCl-sensing

Macula densa
Efferent arteriole

JUXTAGLOMERULAR APPARATUS 3
Afferent
arteriole

The renin-secreting JG cells

are modified arteriolar smooth
muscle cells. More can be
recruited as needed.

Reninsecreting
JG cells

Vascular smooth muscle cells

NaCl

Distal
tubule

Mesangium
Renal
corpuscle

Efferent arteriole

JUXTAGLOMERULAR APPARATUS 4

Reninsecreting
JG cells

Afferent
arteriole

Vascular smooth
muscle cells
Low distal NaCl causes JGDistal mediated renin release &
tubule subsequent effects via
angiotensin and aldosterone
NaCl

Mesangium

Renal
corpuscle

Flow & NaCl-sensing

Macula densa
Efferent arteriole

JUXTAGLOMERULAR APPARATUS 5
Vascular smooth
muscle cells

Reninsecreting
JG cells

Afferent
arteriole

Low distal NaCl causes JG-mediated

renin release & subsequent effects
via angiotensin and aldosterone
Angiotensinogen

Renin
Angiotensin I
Angiotensin II

NaCl

Renal
corpuscle

Aldosterone
Efferent arteriole

Converting
enzyme

JUXTAGLOMERULAR APPARATUS 6
JG cells

Angiotensinogen
Renin
Angiotensin I
Angiotensin II

Zona glomerulosa

Converting
enzyme
Vasoconstriction

]
Aldosterone

Sodium + water
reabsorption

DISTAL
TUBULE

(so blood pressure up)

SOME RENAL DISEASES

GLOMERULONEPHRITIS
e.g., mesangial-cell
reaction

RENAL ISCHEMIA
Renal
corpuscle

TUBULAR epithelial
NEPHROTOXICITY
from
aminoglycosides &
heavy metals

Arched
collecting
tubule

Distal
tubule

Proximal
tubule

~
~

Interstitium

FIBROSIS

~
~

~
~

Thin
segment

Collecting
duct

~
~

~
~

~
Vasa
recta

DIABETES INSIPIDUS
pituitary or nephrogenic