FORMATION OF URINE

GFR: Glomerular filtrate formed by both kidneys per minute.

125 ml/min.

FACTORS EFFECTING GFR

Hydrostatic pressure gradient across the capillary wall

Osmotic pressure gradient across the capillary wall
Capillary permeability.
Size of the capillary bed.

1. GFR decreases with increased age.

2. GFR is directly proportional to renal blood flow.
3. Changes in concentration of plasma proteins.
4. Hypoproteinemia- decreased colloid osmotic pressure – increased GFR.
5. GFR decreases with decrease in size of capillary bed.

CLEARANCE
It is the volume of plasma required to contain that much amount of the
substance which is excreted in one minute in the urine.

FORMULA:
C = UV/ P.
Where
C is Clearance,
U is concentration of substance in the urine,
V is urine flow,
P is the concentration of the substance in the plasma.

Uses
1. Clearance of Inulin gives GFR.
2. Clearance of para-ammino-hippuric acid( PAH) gives renal plasma
flow.(RPF)
Transport of various substances across renal tubules

Tips to remember:

% of water absorption in various segments of renal tubules.

PCT 70-80 %
Loop of henle 15%
DCT 5%
CT 15%

Renal threshold of glucose is 180mg%, it means glucose begin to appear in

urine, when blood glucose is >200mg/dl.

GLUCOSE REABSORPTION

Almost 100% glucose is actively reabsorbed in PCT.

Mechanism of glucose reabsorption (secondary active transport):

1. Glucose is reabsorbed along with sodium.

2. Glucose and sodium bind to common carrier (SGLT-2 ) in the
luminal membrane.
3. Both are carried into the cell.
4. Glucose moves into peritubular capillaries (via GLUT-2 ).
SODIUM REABSORPTION

1. PCT: 70- 80 %
2. DCT 15 %
3. CT 2-5%

MECHANISM OF ABSORPTION IN PCT

Passively transported down chemical gradient by simple diffusion through

apical membrane

Sodium is actively pumped out of cell into lateral intracellular space.

Loop of Henle

1. Thin segment – passively reabsorbed

2. Thick segment – active transport – Na K ATPase pump.

DCT AND CT
1. Passive transport along with sodium chloride.
2. Na- H, or Na –K exchange pump.

FACTORS EFFECTING SODIUM REABSORPTION

a) Increased GFR
b) Increased solute reabsorption from PCT
c) Increased water reabsorption from PCT
d) Increased fluid delivery to loop of Henle and DCT
e) Increased solute reabsorption loop of Henle ( ascending limb)

POTASSIUM TRANSPORT

1. Completely filtered.
2. Reabsorbed as wall as secreted.
3. Reabsorption occurs in PCT
4. Secretion occurs in DCT, regulated by Aldosterone.
5. Active transport by Na+ –K- ATPase pump.
6. H+ K- pump compete with each other for Na+ exchange in DCT
 \\

FACTORS AFFECTING K TRANSPORT

1. ALDOSTERONE.
2. METABOLIC ACIDOSIS.
3. ALKALOSIS.
4. K- H exchange for Na.

HCO3 REABSORPTION:

1. 90% reabsorbed PCT. Secondary active transport via Na H exchange.

2. Secreted H combines with bicarbonate in tubular lumen. To form
H2CO3 that is catalysed by carbonic anhydrase to form H2O and CO2
 3. H2O and CO2 differ in PCT cells and again hydrolysed to form H2CO3

H2CO3--------.> H SECRETED INTO LUMEN.

BUFFER HCO3

H+ SECRETION

85% PCT.
EXCEPT IN LOOP OF HENLE.

Factors affecting
1. Increased CO2, hyperventilation. More H , more HCO3, increased
secretion.
2. Carbonic anhydrase inhibitor.
3. K+ and HCO3 inversely related.
4. Aldosterone
5. Extracellular fluid volume.
Cl- TRANSPORT

INVERSE RELATION TO HCO3

Na K Cl COTRANSPORT.
PASSIVE TRANSPORT - PCT.
PASSIVE TRANSPORT -THICK ASCENDING LIMB LOOP OF HENLE.
WATER REABSORPTION

PASSIVE DIFFUSION

PCT
70- 80 % of water reabsorption along osmotic gradient

LOOP OF HENLE
5- 10 %water is reabsorbed

Descending limb highly permeable to water (fluid is hypertonic)

Ascending limb impermeable to water (hypotonic)

DCT

Early part is less impermeable to water 5-7%water reabsorbed (hypotonic

solute

Terminal DCT and CT

Water permeable ADH acts here and aids water reabsorption 10% water
reabsorbed

ADH can reabsorb 99 % of water by its maximal effect