RENAL ANATOMY AND PHYSIOLOGY

What is Kidney? A bean-shaped organ that is responsible for filtering of blood to remove its waste thru urine formation then excretion. Situated on the posterior wall of the abdominal cavity. THE GENERAL FUNCTIONS OF THE KIDNEYS Elimination of metabolic waste products through the formation of urine. Regulation of the plasma & water volume. Regulation of Ionic Equilibrium Maintenance of acid-base balance Endocrine function ANATOMY Nephron Kinds 1. Cortical 2. Juxtamedullary Compose of glomerulus and renal tubules Glomerulus Non- selective filter Filtrate rate Renal Tubules Proximal Convoluted Tubules Descending Loop Of Henle Ascending Loop of Henle Distal Convoluted Tubule URINE FORMATION Occurs in the kidneys A kidney is made up of one to one and a half (1 1.5) million nephrons Each of these nephrons is capable of producing urine independently The urine formation in the nephrons may be simply traced as follows: Circulated and used bloods are sent through the different arteriole to the glomerulus (composed of about 50 capillaries) for filtration Blood which has been filtered are sent back to the body circulation through the efferent arteriole. The filtrate goes through the Bowmans capsule or renal capsule Then to the proximal convoluted tubule where the re-absorption process occurs RENAL PHYSIOLOGY RENAL BLOOD FLOW Proximal Convoluted Tubules Reabsorbs necessary substances back into the bloodstream Glucose threshold Secretes sulfates, glucoronides, hydrogen ions, & drugs Descending Loop Of Henle Does not reabsorb solutes Ascending Loop of Henle Does not reabsorb water Distal Convoluted Tubule Reabsorbs sodium Secretes Potassium, Ammonia and hydrogen

GLOMERULAR FILTRATION Factors that influence the filtration Cellular structure of the capillary walls and Bowmans Capsule Hydrostatic and oncotic pressure Feedback mechanism of RAA Action 1. 2. 3. of Angiotensin II Vasoconstriction of Renal Artrioles Stimulates reabsorption of sodium at the PCT Release of aldosterone

Glomerular Filtration Test CLEARANCE TEST- measures the rate at which kidneys are able to remove filterable substances from blood. Factors to consider in selecting a clearance test substance: 1. Neither reabsorbed nor secreted. 2. Stability in urine on 24 hours collection. 3. Consistency of the plasma level. 4. Substance availability in the body. 5. Availability of test for chemical assay. 1. Urea Clearance Test Urea is freely filtered by the glomeruli but variably reasbsorbed in the tubules depending upon the transit time (rate of urine flow along the course of nephric tubules) of urea filtrate Creatinine Clearance Test Creatinine occurring through metabolic production is eliminated from the plasma by glomerular filtration and therefore a measurement of its rate of clearance affords a measure of the process. Disadvantages: Some creatinine are secreted Chromogens affect the chemical analysis Affected by high meat diet Not reliable in muscle wasting diseases Inulin Clearance Test Inulin freely passes the glomeruli but is neither secreted nor reabsorbed by the nephric tubules. Considered to be the most accurate measure of GFR. Gold standard for clearance test Polymer of fructose Extremely stable substance Exongenous method Only used in research Normal value: 250 ml/min. - men (due to larger renal mass) ; 110 mi/min - women 2 Microglobulin Clearance Test Dissociates from HLA at constant rate Rapidly removed from the plasma More sensitive than creatinine Measured by RIA or EIA Not reliable for patients with immunologic disorders of malignancies

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Radioisotopes Measures rate of disappearance in the plasma of infused substances. Has the greatest source of error.

General Formula for Clearance Test: C (mL/min)= U/P * volume (mL/min) * 1.75/A Where: C - Clearance of the substance expressed in ml/min. U - Concentration of substance in urine P - Concentration of substance in plasma (blood) Volume (ml/min) - total volume of urine excreted in 24 hours converted to ml/min.

1.73 - generally accepted body surface area of an individual in square meters A - Body surface area of patient where value is obtained from a nomogram (height and weight are needed)

a. ADH production (3:1) b. Renal ADH receptor problem (1:1)

TUBULAR REABSORPTION All substances necessary for body function are being reabsorbed: Glucose Amino acid Creatine Pyruvate Lactate Ascorbic acid Almost all amino acids Other substances re-absorbed: Sodium, chlorides, potassium, calcium, urea, bicarbonate, phosphates, electrolytes and water This process also takes place in the loop of Henle and the distal convoluted tubule. Active Reabsorption - combined with a carrier protein in the membrane of tubular cell. Glucose, amino acids, salts Chloride Sodium Passive Reabsorption - movement of molecules across a membrane as a result of difference in their concentration. Water Urea Sodium Renal Threshold - plasma concentration at which active transport stops Tubular Reabsorption Test Test to determine the ability of the tubules to reabsorb essential salts and water that have been nonselectively filtered by the glomerulus. 1. Fishberg - determination of the ability of the kidneys to maintain excretion of solids under conditions of reduced water intake plus a high protein diet. Mosenthal - this method determines the ability of the kidney to respond to the water intake variation of normal dietary urine output and specific gravity charges. Specific Gravity - depends on the number of particles present and its density Osmolarity - affected only by the number of particles present. It is also used for the differential diagnosis of hypo/hypernatremia & evaluating renal response and secretion to ADH.

Free-Water Clearance Used to determine the ability of the kidney to respond to the state of body hydration. CH2O= V Cosm Cosm= (Uosm/ Posm) * V ** (-) less than the necessary amount of water is being excreted no renal concentration or dilution (+) excess water have been excreted

TUBULAR SECRETION elimination of waste products Acid-base balance through secretion of Hydrogen ions. Two ways to excrete Hydrogen: 1. HPO4 2. NH3 Whatever substances not re-absorbed becomes a component of urine: Urea, creatinine, uric acid, sulfates, glycuronides, phenol, phosphates, hippurrates, (and Diodrast) Other substances are carried to the collection tubules whereby through a minor mechanism of secretion, these are excreted in micturation or urination.

Tubular Secretion Test PAH Test test that is most commonly associated with tubular secretion and renal blood flow. measures the exact amount of blood flowing through the kidney uses an exogenous dye like PSP Phenolsulfonphthalein (PSP) Not commonly/currently used in the laboratory. Interfered by medication and elevated waste products by patients Indigo Carmine Test Used by Urologists Inject intravenously 100 mg. of the indigo carmine dye. Surgeon observes the ureteric orifices in urinary bladder with a cystoscope. Normally blue dye is excreted in equal concentrations by both kidneys starting 15 minutes after injections. Inefficient kidney will secrete urine containing little or no dye, and the dye will upper later in the urine of the affected part. This is confirmatory diagnosis of unilateral kidney disease. Titratable Acidity and Urinary Ammonia Test test that measures the ability of kidneys to produce an acidic urine (presence of H+) Renal tubular acidosis inability to produce an acid urine in the presence of metabolic acidosis. result from: Impaired tubular secretion of H+ Defects in ammonia secretion

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Colligative properties Boiling point Osmotic pressure Freezing point Vapor pressure Freezing point osmometers - measures the heat of fusion Vapor pressure osmometers - measures the dew point Diabetes Insipidus Random condition Urine : Serum osmolarity 1:1 After controlled fluid intake (3:1) Use to assess the cause of DI