Diluting mechanism of the Kidney

Urine dilution is
achieved by:
reabsorbing
solutes to a
greater extent
than water, only
in certain
segments of the
tubular system.
Fluid leaving the ascending loop of Henle and
early distal tubule is always dilute,
regardless of the level of ADH.

Thus, the ascending limb of Henle’s loop and

early distal tubule function as diluting segments.
In the late distal tubule and
collecting ducts, In the
absence of ADH, the urine is
further diluted as the kidneys
continue to reabsorb solutes
while failing to reabsorb
water

The osmolality of the tubular

fluid decreases as little as 100
mosmol or more by the time
it leaves the collecting duct to
enter the urine.
 Concentrating mechanism
Requirements for forming a concentrated
urine

High level of ADH

Development and
maintenance of High
osmolality of the
medullary IF
 Mechanisms responsible for hyperosomolarity
of the medullary interstitial fluid

Thin Collecting Collecting

Thick
ascending Limb
ascending duct duct urea
limb (passive reabsorption reabsorption
(reabsorption of
reabosrption ADH
solutes)
of Na cl)
of (solutes)

Counter
current
multiplier
The Countercurrent multiplier
 Counter-current exchanger mechanism
.
The vasa recta
functions as a counter-
current exchanger that
prevents washout of
solutes from the
medulla.
Renal regulation of sodium
1. Control of GFR:
2. Control of sodium reabsorption:
a. The Renin-angiotensin-aldosterone system

b. Atrial natriuretic peptide (ANP):

1. Control of GFR:
• Reduced total-body sodium   plasma
volume   blood pressure  
sympathetic discharge  reflex
vasoconstriction (including afferent arteriole)
  glomerular capillary hydrostatic
pressure, decrease GFR and accordingly, the
amount of sodium and accompanying fluid
that are filtered decreases. Consequently,
excretion of salt and fluid is diminished.
2. Control of Na reabsorption
a The Renin-angiotensin-aldosterone
system
 b. Atrial natriuretic peptide
• ANP inhibits sodium chloride reabsorption by the
medullary portion of the collecting duct.
• It inhibits the secretion of both renin and
aldosterone.
 Micturition

Definition:

• Micturition is the process of emptying the

urinary bladder. This involves two main
steps:
Mention the different types of Innervation of
the bladder and the function of each

1.Parasympathetic

2. Somatic

3. Sympathetic
Function of parasympathetic innervation
(pelvic nerves)

Motor Sensory

Contraction of Detect the degree of

detrusor stretch of the urinary
bladder wall and
Relaxation of initiate the micturition
sphincter reflex.

The pelvic nerves are the main nerves

of micturition
2. Function of Somatic innervation
(pudendal nerve)

Motor Sensory

Contraction of
Sense of urine
the external
flow
sphincter
3. Function of Sympathetic innervation:
hypogastric nerves

Motor Sensory

Relaxation of the
Pain from the
detrusor muscle and
bladder due to
contraction of the
overstretch
internal sphincter
What it the definition of a cytometrogram ?
mention its phases
and the cause of each phase
Cystometrogram: A plot
of intravesical pressure
against the volume of fluid
in the bladder.
Phases:
I. initial slight rise in
pressure
II. II.Plateau:
III. III. a sudden sharp rise
in pressure
 The micturition reflex
• Micturition a spinal reflex facilitated and inhibited
by higher brain centers

• This reflex is elicited by the stimulation of stretch

receptors situated on the wall of urinary bladder,
especially the bladder neck.
 Voluntary control of micturition

 Inhibitory centers for micturition

Centers in midbrain and cerebral
cortex inhibit micturition by
suppressing spinal micturition centers.

 Facilitatory centers for micturition

Centers in pons facilitate micturition
via spinal centers. Some centers in
cerebral cortex also facilitate
micturition.
Questions
1.
In fluid in the distal part of the proximal convoluted
tubule

a. Urea concentration is higher than in Bowman’s

capsule.
b. PH is less than 6 when the kidneys are excreting an
acid urine.
c. Glucose concentration is similar to that in plasma.
d. Osmolality is about 25 per cent that of glomerular
filtrate.
2. As urine flow increases during osmotic
diuresis

a. the osmolality of urine falls below that of plasma.

b. the osmolality of urine increases because of the

increased amounts of non reabsorbable solute in the
urine.
c. the osmolality of urine approaches that of plasma
because plasma leaks into the tubules

d. the osmolality of urine approaches that of plasma

because an increasingly large fraction of the excreted
urine is isotonic proximal tubular fluid.
3. The cystometrogram shows
a. A plot of bladder pressure on the horizontal axis
against bladder volume on the vertical one.

b. Little rise in pressure with rise in volume at low

bladder volumes.

c. A steep rise in pressure when volume rises above

100 ml.

d. That females generate higher pressures during

micturition than males.
4. Aldosterone secretion tends to
raise the volume of

a. Plasma.

b. Intracellular fluid.

c. Urine.

d. Cerebrospinal fluid.
5. Aldosterone

a. Is a steroid hormone secreted by the adrenal

medulla.

b. Production ceases following removal of the

kidneys and their juxtaglomerular cells.

c. Secretion results in increased potassium

reabsorption by the nephron.

d. Secretion results in a fall in urinary pH.

7. Which of the following changes would you expect
to find in a patient consuming a high-sodium diet
(200mEq/day) compared with the same patient on a
normal sodium diet (100mEq/day) assuming steady
state conditions

a. Increased plasma aldosterone concentration

b.Decreased plasma renin activity
c. Decreased plasma atrial natriuritic peptide
d. An increase in the plasma sodium
concentration
•
8. Which of the following statements is trrue
a. ADH increases water reabsorption from the
ascending loop of Henle.
b. Water reabsorption from the descending loop of
Henle is normally less than that from the
ascending loop of Henle
c. Sodium reabsorption from the ascending loop of
Henle is normally less than that from the
descending loop of Henle
d. Osmolarity of the fluid in the early distal tubule
would be less than 300mOsm/L in a dehydrated
person with normal kidneys and increased ADH
levels.