Kidneys

2 Important Blood Vessels in Urine Formation

Afferent Arteriole

Bean shaped paired organs

Found at the back of the peritoneum
One is situated lower than the other (Left Kidney
is higher than the Right Kidney)
Retroperitoneal organs
Specifically, it is situated in between the 12
rd
thoracic vertebrae and 3 lumbar vertebrae
Act as major excretory organs (garbage disposal
system in the body)
The kidneys are able to dispose wastes, if and
only, these wastes are water-soluble
Bilirubin is a product of metabolism
When you traverse the kidney longitudinally, you
will be exposed to two major regions:
1) Cortical region (Cortex)
2) Medullary region (Medulla)

Is the one that provides the unfiltered blood

towards the path of capillary
The amount of blood that goes into the kidney
per unit time is the function of the heart also. 20
25% of the cardiac output goes into the kidney
per unit time
Blood: 5 7 L (Ave. is 6 L) 1,200 Ml of blood
into the kidney per unit time
1,200 Ml of blood into the kidney per unit time
represents TRBF (Total Renal Blood Flow)

Efferent Arteriole
-

Output: Urine
Urine is affected by the function of the body. If
there is something wrong with your heart, then
there will be something wrong with your urinary
output.
Arteriole is larger than a capillary
Pressure exerted (10 mmHg) bring changes to
the diameter of a blood vessel
Receives the filtered blood

Glomerulus
-

Renal pyramids pyramidal. Part of medullar

part

Glomerular Filtration Rate (GFR)

Nephrons
-

Functional units
Capable of producing urine
1 1.5 million per kidney
Two types of Nephron:
1) Cortical (85%) Majority of the nephron
2) Juxtamedullary (15%)
The blood vessel that supplies blood towards
the kidney for filtration processes. Urine appears
yellow-like. Plasma is the component of the
blood that makes urine yellow-like.

Renal Anatomy and the Physiology of Urine

Formation
JUSTIN SHAQUILLE C. MANIPON

Is the site for filtration. It is where the blood is

being filtered. In order to facilitate effective
filtration, the pressure in that area should be
around 10 mmHg

3F MT

125 Ml/min (Ultrafiltrate)

The amount is affected greatly by the pressure
happening
This ultrafiltrate is a plasma ultrafiltrate
In the blood, the one that will be filtered out
immediately are the non-cellular components
1,200 Ml of blood per unit time that represents
TRBF (Total Renal Blood Flow), part of that
represents the:
1) Packed Cell Volume (PCV) (45%) = 500
Ml/min
2) Plasma (55%) = 660 Ml/min
This plasma represents the Effective Renal
Plasma Flow (ERPF)
All the remaining blood will flow to the Efferent
Arteriole
540 Ml/min of Packed Cell Volume (PCV)
remained
534 Ml/min of Plasma remained
CLINICAL MICROSCOPY LEC 1ST SHIFTING

Bowmans Capsule
-

The one receiving the newly formed filtrate

(125 Ml/min)
-

Proximal Convoluted Tubule

-

As this 125 Ml/min moves toward the renal

tubule, it will be received by the Bowmans
Capsule then to Proximal Convoluted Tubule
(PCT)
Supposedly blood free because it is a tubule and
not a blood vessel
Plasma should be cell free
If there is cell in the urine there is something
wrong, unless, epithelial cells from urinary tract
lining
125 Ml/min will be decreased as reabsorption
happens in the renal tubules (Tubular
Reabsorption and Secretion)
65% of the filtrate will be reabsorbed back. 15%
will be absorbed by the Loop of Henle
The structure continuing the Loop of Henle is the
Distal Convoluted Tubule (DCT). 19% of the
reabsorption process happens here
Terminally is the collecting duct that receives the
urine
All in all:
99% of that will be reabsorbed 124 Ml
1% become urine 1 Ml urine/min
1,440 Ml/day of Urine
(Normal: 1,200 1,500 Ml/day urine)

Cortical Nephron
-

The Loop of Henle which is part of the nephron

is exclusive for the cortical region

Juxtamedullary Nephron
-

The Loop of Henle which is part of the nephron

traverses the medullary region
As the filtrate passes through the renal tubule,
the filtrate tends to be concentrated. That is with
regards to the concentration of the outside
environment. The area in the medullary region is
an area of concentratedness. The solutes that
are found outside the medullary region are more
concentrated. The filtrate is affected by forcing
water to move out the moment it goes out to an
area where there is concentratedness to dilute
the area, therefore making the filtrate
concentrated. Osmosis is the method by which
water moves out

JUSTIN SHAQUILLE C. MANIPON

3F MT

Three Processes in Urine Filtration

1) Glomerular Filtration
2) Tubular Reabsorption
3) Tubular Secretion
The difference between Reabsorption and
Secretion lies on the direction of the movement
of substances. In Reabsorption, the movement
of the substance is
Efferent Arteriole is continuous with the
Peritubular Capillaries. The moment the
Peritubular Capillaries reached the Loop of
Henle they can be termed as Vasa Recta
Reabsorption means that the filtrate that flows to
the renal tubule goes back to the blood vessel
Secretion is the opposite process. Some
substances that are found in the blood will be
secreted from the blood vessel then outward
Reabsorption from that area to the blood vessel.
Secretion is from the blood vessel towards the
renal tubule
How Does The Filtrate Become Cell Free?
Ultrastructure of the Glomerulus. Glomerulus is
a trilayered filter, and a blood vessel because it
is a capillary
FIRST FILTER/LAYER: Endothelial Fenestration
Endothelial cells that are not tightly packed,
there is space in between
Glomerulus here filter by molecular size
The smaller the molecule, the easier to get
through
Red Blood Cells (6 8 Um) and White Blood
Cells (7 12 microns) cannot pass through
WBCs has the power to undergo diapedesis
(squeeze out in between junctions). These are
abnormal findings originating from
Glomerulonephritis/Pyelonephritis
Proteins are markers of renal damage in the
kidneys. Proteins of interest is Albumin (60,000
70,000 daltons)
SECOND FILTER/LAYER: Basement
Membrane
The primary layer and is thicker in nature
Molecules that are negatively charged will be
repelled back (Like the RBCs)
Urine might be appearing normally yellow, but if
you observe it microscopically it may contain
RBCs
THIRD FILTER/LAYER:
Podocyte are specialized cells with foot
processes and slits.

CLINICAL MICROSCOPY LEC 1ST SHIFTING

Nephron

Urine
-

Ultimately formed 95-97% H20 solvent

3-5% solute (waste products -> organic &
inorganic)
-Urine in solution.

Inorganic solvents in urine: *the following are strong

salts that dissociate in solution.
1. Na+
2. ClOrganic solvents in urine:

1. Creatinine
2. Urea

Hematuria- If with RBC in urine: problem in

glomerulus.
glomerulonephritis

Pure Water
- s.g. 1.000

Pyuria - If with WBC in urine: from glomerulus

also.
termed as Pyuria because WBC synonyms
with pus.
Leukocyturia most commonly found in the
presence of neutrophil.
Some WBCs can pass the glomerulus.

- density: 1.000 g/mL

*Urine sterile from sterile environment
*w/ smell urine: urea was already degraded (this is
the reason why urine has a fishy-like odor) ->
Usually UTI

(NORMAL)- move out; capable of diapedesis.

UTI

Glomerular damage Pyelonephritis.

WBC diapedesis (squeeze themselves out)
UTI

Female> Male
-

TRBF

Hypostenuria

ERPF - 660 mL/min

PCV - 540 mL/min
FF =

x100 =

x100 = 19%

Isothenuria
%1.010- Isosthenuria/Isothenuric
-

Because of closeness of vagina to perianal

opening.

s.g. -> coincides with the color of the urine.

If the urine (light yellow)
Urine colorless : STRAW colored.
Light yellow Straw: More water.
Red cells in hypostenuric urine:
H20 will move -> Swell RBC & after
sometime it will appear as ghost cells->
Bursted RBC

Ex: Physical: light yellow.

Least effect on cellular components of urine.

Plasma ultrafiltrate w/RBC and sp.1.010 ->
seems normal.
RC suspended in medium retain normal forms.
< 1.010 Hypostenuria
Urine becomes dilute sample.
Change in absorption/secretion.
Diluted.

Chem (+) RBC

Microscopic: RBC not found
*The RBCs were not recognized because ghost/burst/no
membrane.
Hyperstenuria

JUSTIN SHAQUILLE C. MANIPON

3F MT

CLINICAL MICROSCOPY LEC 1ST SHIFTING

mucoprotein (basic constituents) ->

Tammhorssfalll protein)

Sp. > 1.010

Appear dark yellow
Concentrated urine, <H2O
Effect in RBC: Shrink
RBC appear crenated
Dysmorphic RBC-> due to glomerular bleeding

Cast
-

WBC Found (Hyposthenuria)

-

H2O found inside will suspense granules inside

glistening the structure -> Glitter Cell.
WBC will become bigger

Form spider-web like

If no structure is formed: Hyaline Cast
*difficult to see in microscope because it is very
refractile.
WBC Cast WBC trapped in cast
RBC & WBC in cast: mixed cellular cast
Granular cast

Protein Free
-

Most commonly found Albumin (69,000 daltons)

Proteins cannot pass through the glomerulus
because they are too big.

Common Constellation of Finding

1.
2.
3.
4.

Hematuria
Pyuria
uria
Etc.

Proteins in Urine -> Proteinuria

Albumin in Urine -> Albuminuria
Cast in Urine: CYLINDRURIA

*White stable foam in urine indicative of earlier

renal damage.

Proteinuria > 30 mg/dL

-

To qualitative CH3COOH in urine:

o White formation in urine/ turbidities
o Protein = Renal damage

Orthostatic
-

P = C = Yellow
SG = 1.035
C = glu = (-)
Pro= (-)
M = Cast

Pain in the lower back, difficulty in urination ->

damage in kidney.
Back pain: Standing for a long time produces
Orthostatic Proteinuria
A.k.a. Cadet Proteinuria
Proteinuria brought by posture.

P = C = Yellow
SG = 1.035
C = glu = (-)
Pro= (++++)
M = Cast (-)

Yellow foam due to bilirubinuria.

Bilirubinuria -> yellow due to jaundice and hepatitis.
-

Cylindrical because theyre formed in DCT

Observe Cast ( have positive protein first)
Ex:
P = C = Yellow
SG = 1.035
C = glu = (-)
Pro= (++++)
M = Cast
result: Okay

Proteins in filtrate move very very slowly -> They

will aggregate & form CAST (main component:

result: Invalid

result: Possible

Filtrate fast moving: No forming of casts.

Castasis: condition w/ cast.

JUSTIN SHAQUILLE C. MANIPON

3F MT

CLINICAL MICROSCOPY LEC 1ST SHIFTING

Clearance
1. Endogenous Substances
*Urea, creatinine, beta-2-microglobulin, cystatinC (for glomerular damage)
2. Exogenous Substances
*Inulin(measure integrity of glomerulus; polymer
of fructose)

Major excretory function of Kidney

1. Excretory : Urine (waste product of

metabolism)
-Urine formed:
a. Glomerular Filtration
- GFR rate
b. Tubular Secretion
- from BV to RT
c. Tubular Reabsoprtion
- from RT to BV

- The main qualifier to be clearance subs: must be

neither reabsorbed/secreted.
Urea Clearance
-

40-50% is reabsorbed.
Disadvantage: filtered out

*b&c: happens simultaneously.

Creatinine Clearance
-

-ability of tubules to secrete well -> thru pH

Submit 24 hour urine sx.

Preserve in ice box.
1 voided urine: Discard
last voided urine: Keep

CC=

Protein in CSF 15-45 mg/dL

Urine: no protein
Clearance test to evaluate glomerulus.

Loop of Henle
-

Site of concentration & dilution of the filtrate.

1.73 (min)
( )

1. U-150 mg/dL
P-1.3 mg/dL
V-1250mL
t-24 hr

CC=

150 /
1.3 /

1250
1440

= 100.16 mL/min

PCT: Major reabsorption about 65%

-

2. U-135 mg/dL
P-1.1 mg/dL
V-900mL
t-24 hr
2
BSA- 1.2 m

CC=

135 /
1.1 /

900
1440

1.73 2
1.2 2

Rate of Reabsorption

= 110.46 mL/min

Cerebrospinal Fluid (CSF)

-

Plasma ultrafiltrate
Choroid plexus: glomerulus
Capillary networks
Endothelial cells in CNS: tightly junctured
together.

JUSTIN SHAQUILLE C. MANIPON

Why site of concentration: (descending),

because water is moving out; because of the
property of being concentrated outside (needs to
be diluted).
(Ascending): NaCl will go out/ solute.
Only part of nephron that is impermeable to
H2O.

Measured by specific gravity.

sg = color
Because of ability of nephron to dilute
everything.

2. Endocrine Gland
- Secrete some hormones and body regulation.
a. Erythropoetin (hormone) (EPO)
3F MT

CLINICAL MICROSCOPY LEC 1ST SHIFTING

- stimulates BM to produce more RBCs

Put oil to prevent dehydration/evaporation

b. alpha-1-hydroxylase, vit-D activation.

c. Renin Angiotensin Aldosterone System

Anuria / Oliguria - regulates blood pressure

(RAAS)
- involvement of kidneys in blood pressure
regulation.

Angiotensin II - potent power (hypogulimia?)

-

TRBF: 20% Total Cardiac Output

Changes in BP:

Release of Antidiuretic Hormone (Vasopressin)

Dehydration
ADH: affect water reabsorption.
ADH hormone: from posterior pituitary gland.
Against diuresis (urination)
Against urination because you are already
dehydrated.
95% of urine water

ADH primarily affects DCT and CD (Collecting duct)

How much urine formed.

- Reabsorb water from filtrate to bring it back to Blood

stream.

bp = filtrate = urine
-

Release of Renin

Hypotensive= urine (MI)

Associated with volume of urine:

1. Polyuria 1000-2500 mL/day
2. Oliguria < 400 mL/day
3. Anuria no urine.
-Minimum amount of urine: 400 mg/dL
2+

Ca

oxalate: tomato foods (CaOx)

urine output = ADH secretion = H2O reabsorption

Multi dosage of drugs / medicine

Oliguria: Summer/ hotdays

Detectors of Blood Pressure
Macula densa - nearest DCT

ADH = H2O reabsorption = urine output

Juxtaglomerular apparatus (JG cells)

-

Urine: more concentrated.

Conc. Soluble
Darker color

Nearest AA.

Color: lighter
True for diabetes insipidus (posterior pituitary
gland)
DI DM (differentiate by specific gravity)
DM-> beta cells of the pancreas
DI: s.g. because it is dilute
DM: s.g. because it is concentrated
bp: H2O in blood & w/ Na+ ions in BS.

JUSTIN SHAQUILLE C. MANIPON

3F MT

CLINICAL MICROSCOPY LEC 1ST SHIFTING