A&P 302 Renal Lecture Notes:

Renal System Function:

Filter blood
o Regulate volume
o Waste excretion
Gluconeogenesis not going to talk about
Produce hormones
o Renin
o Erythropoietin
Metabolize vitamin D important in uptake of calcium
The kidney regulates fluid volume so if youre dehydrated the
kidney does certain things to produce less urine and vice versa
Regardless if youre dehydrated or overhydrated the first steps in
filtration are ALWAYS the same if dehydrated still push lots of fluid
out of blood

The kidney is there to cleanse the blood!! Thats the

overriding consideration
Renal System Anatomy:

Kidney
Ureters
Urinary bladder
Urethra

Renal System Anatomy of the Kidney:

External Anatomy
Internal Anatomy
Blood Supply
Nerve Supply
Nephrons

Renal Physiology

Anatomy of the Kidney External Anatomy:

Retroperitoneal organ
About the size of a bar of soap
Extends from T12 L3
Right kidney is lower than the left because of the liver
Medial aspect contains the hilus
o Hilus where everything goes in (renal artery, vein and ureter)
on our last comprehensive practical, the favorite artery to pick
out is the renal artery. If artery is going in, its the renal artery
(just like the testicular artery)
Hilus contains the renal artery and vein and the ureter
Hilus leads into the kidney by the renal sinus
Atop the kidneys sits the adrenal gland
Kidney is covered by 3 layers of supportive tissue
o Renal capsule
o Adipose capsule
o Renal fascia

Anatomy of the Kidney Supportive Tissue:

Renal capsule - fibrous tissue that covers the kidney

o Renal capsule is a VERY tough membrane
o You cant get rid of gallstones unless you have surgery because
there is NO capsule, but:
o Since there is the Renal capsule on the kidney, you can use
ultrasound waves and water without puncturing the kidney when
you have kidney stones to break them up
Adipose capsule fatty mass protects the posterior wall
Renal fascia anchors kidney to surrounding structures

Anatomy of the Kidney Internal Tissue:

Renal Cortex
Renal Medulla
Renal Pelvis

Anatomy of the Kidney Renal Cortex:

Most superficial region right underneath the capsule

Light in color
Granular appearance

Anatomy of the Kidney Renal Medulla:

Deep to the cortex

Renal pyramids cone shaped masses
Pyramids have a broad base and an apex or papilla
o The triangles (pyramids) are a set of collecting ducts so the
filtrate being changed into urine is traveling through the
pyramids. At the end of the pyramids is a papilla, that is where
urine drips from, into the collecting system
Renal columns tissue between pyramids
o Extremely important in identifying blood vessels is the renal
column
In the cortex is where filtering takes place

Anatomy of the Kidney Renal Pelvis:

Funnel shaped tube which is continuous with the ureter

Major calyx first branching extension of the pelvis
Minor calyx branches off the major calyx
Papilla of the renal pyramids drain into the minor calyx
o Renal pelvis changes to ureter immediately after coming out of
the kidney
o The Papilla looks like a mouses nose
Collecting system has 3 parts ureter from kidney to bladder

Papillae drain into the minor calyx, which forms the major calyx which
then drains into the vast holding chamber called the renal pelvis

Anatomy of the Kidney Blood Supply:

Blood enters the kidney via the renal arteries

As the renal artery enters the kidney it divides into 5 segmental branches
o Renal artery and vein run parallel to each other and throughout
the kidney they continue to run parallel.
o But there is a change in nomenclature (trips people up on test)
renal artery breaks into 5 branches called the segmentals, and
almost immediately breaks off when artery enters the kidney
In the renal sinus, the segmental artery branches into the lobar arteries
Lobar arteries give rise to interlobar arteries that run through the renal columns
o The segmentals the breaks into lobar arteries
o Identifying the renal column is important to identify the
interlobar
Interlobar arteries branch into arcuate arteries that span the base of the renal pyramids
Interlobular arteries (cortical arteries) branch off the arcuates and are in the renal
cortex
o The interlobar artery comes up, arches around the pyramid
known as the arcuate artery.
o To Remember: Arcuate = arch, coming off of that is the
interlobular arteries or cortical arteries, blood then goes into
filtering mechanism
Veins drain starting with the interlobular draining into the arcuates
Arcuates drain into the interlobar
Interlobar veins drain directly into the renal vein
Cortical veins then drain into the arcuate veins, from the vein
they go into interlobar vein (but there is NOT a lobar or
segmental vein, its all called the renal vein)

Blood commit to memory for dissection!!:

You start out at the Renal artery, from the renal artery segmental
artery, segmental artery to lobar artery lobar artery to interlobar
artery interlobar artery to arcuate artery arcuate artery to
cortical artery now from the cortical vein to the arcuate vein
arcuate vein to the interlobar vein interlobar vein to the renal vein

Anatomy of the Kidney Nerve Supply:

Renal plexus network of autonomic nerves that serves the kidney and ureter
Largely sympathetic innervation regulates blood flow by constriction of the arteries
o Sympathetic only!

Anatomy of the Kidney Nephrons:

Structural and functional unit of the kidney

About 1 million per kidney

In addition there are thousands of collecting systems
Multiple nephrons will go into one collecting system
Distinction between cortex and medulla- the arcuate arteries separates
them?
Blood is being filtered out in the cortex

Nephron Components:

Glomerulus

Bowmans or Glomerular Capsule

Renal Corpuscle
Renal Tubule
Nephron Capillary Bed
Juxtaglomerular Apparatus
Filtration Membrane
Types

Nephrons Glomerulus:
Tuft of capillaries

These capillaries are fenestrated

o Fenestrated appear to have holes so plasma can exit the
capillaries
Each glomerulus is associated with a renal tubule
Blood come through the glomerulus and the plasma that leaks out is
known as FILTRATE and it remains filtrate until it gets to the end of the
nephron where its classified as urine

Nephrons Bowmans Capsule:

Cup shaped end of a renal tubule that completely surrounds the glomerulus
o Bowmens capsule surrounds the glomerulus, but theyre two
separate entities.
o The glomerulus is simply the capillaries in there

Nephrons Renal Corpuscle:

Combination of the glomerulus and Bowmans capsule

o If talking about the glomerulus and bowmans capsule = renal

corpuscle

Nephrons Renal Tubule:

Proximal Convoluted Tubule (PCT) goes into the

Loop of Henle and the
Distal Convoluted Tubule (DCT) comes out of the loop of Henle
The proximal and distal convoluted tubules are confined to the cortex
The loop of Henle dips into the medulla
Be able to tell what happens to filtrate as it proceeds through those 3
sections of the nephron (for TEST?)
DO a CHART here, what takes place in each!!

Renal Tubule Proximal Convoluted Tubule:

Exits the glomerulus

Is elaborately coiled
Walls formed by cuboidal epithelium
o Remember: Cuboidal cells do secretion and absorption
Exposed surface has a thick covering of microvilli that reabsorb water and

secretes substances

PCT has a thick covering of microvilli and they are what distinguishes
PCT from DCT. The DCT will NOT have microvilli

Renal Tubule Loop of Henl:

Descending Limb
Ascending Limb

Loop of Henle Descending Limb:

The first portion of the descending limb is continuous with and similar to the proximal
convoluted tubule
The second segment is known as the thin segment wont talk about think and thin
segments

Cells are a simple squamous epithelium that is freely permeable to water

o Water in the filtrate is exiting the descending limb!!
Water is the only thing that escapes

Descending is coming off PCT, ascending is going toward the DCT but
theres a completely different function between the two

Loop of Henle Ascending Limb:

Epithelium becomes more cuboidal to low columnar

Becomes the thick segment

The ascending limb is impermeable to water, it CANNOT

escape.
The omolity of blood will run between 38 millimoolar, when the filtrate is
accumulating the Bowmans Capsule to going through the DCT its the same
osmolity as the blood. What happens to omolairty as its going down the
descending limb? IT INCREASES, at the bottom of loop it will be 1200 mili
osmolar
In the ascending limb its impermeable to water but the electrolytes are
exiting, so filtrate osmolaity is decreased as its leaving the limb

Renal Tubule Distal Convoluted Tubule:

Cuboidal cells that are devoid of microvilli

Play a role in secreting solutes and reabsorbing substances
Goes into the collecting ducts

Nephrons Collecting Ducts:

Receives filtrate from many nephrons

Runs through the renal pyramids
Fuse to form the papillary ducts that delivers urine to the renal papillae
Two types of cells
o Intercalated cells with abundant microvilli
o Principle cells that have no microvilli
Plays an important role in acid-base balance
Remember: The other organ that helps control acid-base balance is the
lungs
o Lungs Alter CO2 levels
o Kidneys Alter bicarb

Nephrons Nephron Capillary Beds:

Glomerulus
Peritubular Capillaries
When looking at the Loop of Henle there is the 2nd point there. The
capillaries in the glomerulus go from artery to the capillary and back to
tje artery.
o The artery brings blood to the glomerulus, the plasma filtered out
becomes filtrate, the Peritubular capillaries has the opposite &
has plasma is going back in.
99% of filtrate that is produced is going back into the blood big
thing: the overriding concern of kidney is to filter blood. Only way it
can is by putting the plasma in the filtrate

Nephron Nephron Capillary Beds:

The glomerulus produces filtrate

The peritubular capillaries reclaim most of the filtrate

Nephron Capillary Beds - Glomerulus:

Specialized for filtration
Run in parallel
Both are fed and drained by arterioles
- Afferent arterioles going toward
- Efferent arterioles going away, exiting
Why are there two different arteries? You can constrict arteries, while
veins can only be moderately constricted.
You can control pressure of the glomerulus by constricting the afferent
or efferent arteries
Afferent arterioles arise from interlobular arteries
Blood pressure in the glomerulus is very high forcing more fluids and solutes out of
the capsule

Nephron Capillary Beds Peritubular Capillaries AKA Vasa Recta

Capillaires:

Arise from the efferent arterioles draining the glomeruli

Cling closely to adjacent renal tubules and empty into venules
Low pressure, porous capillaries
Readily absorb solutes
Why does it absorb both solutes and water? You need solutes to come
because water follows sodium.
If there is a water imbalance, look at where the sodium is.

Nephrons Juxtaglomerular Apparatus:

Region where the distal convoluting tubule comes in contact with the afferent arteriole
feeding the glomerulus
Both structures are modified at the point of contact
The Apparatus monitors whats going on w/ the kidneys so it can alter
the function appropriately
Easy to the DCT and afferent arterioles are involved because, it needs
to monitor the blood coming in (afferent arteriole) and whats going out
(DCT)

The arteriole wall has juxtaglomerular (JG) cells which are smooth muscle
cells with prominent secretory granules that contain renin FAV TEST Q

JG cells act as mechanoreceptors that gauge the blood pressure in afferent arterioles
o Mechanoreceptors gauging stretch

The distal convoluting tubules contain a group of cells known as the macula
densa
The macula densa are chemoreceptors that monitor the solute content of the
filtrate
o Chemoreceptors monitors filtrate that is exiting

o Keep the JG and macula densa straight!

These two different types of cells help regulate the rate of filtration and systemic blood
pressure
Mesangial cells surrounding the juxtaglomerular apparatus are phagocytes
(macrophages)

Nephrons Filtration Membrane:

Lies between the blood and the interior of the glomerular capsule
Porous membrane that allows free passage of water and solutes smaller than plasma
proteins very thin membrane

Consists of 3 layers
o Fenestrated endothelium of the glomerular capillaries
o Visceral membrane
o Intervening basement membrane

o W/ filtration membrane you have small proteins that pass

through,
large proteins dont.
RBCs DONT either.
o When looking at the final product in urine, shouldnt see blood. If
you do, it can come from any portion of the renal system, usually
from bladder w/ infection.
o GLUCOSE DOES pass through but you shouldnt see glucose in
the urine either.
Capillary pores allow the passage of (small) plasma proteins but not blood cells

The basement membrane confers electrical selectivity to the filtration

process (plasma proteins are repelled) FAV TEST Q!

The Renal System Renal Physiology:

Function of the Kidney

Filtration
Tubular Reabsorption
Tubular Secretion
Countercurrent Mechanism

Renal Physiology Function of the Kidney:

Determination of renal function has several important applications

Diagnosis of renal failure Renal failure means that the kidney isnt
functioning properly (& not producing urine) if youre
dehydrated may not be able to concentrate the urine (producing
a lot of urine usually the first stage of kidney failure)
Monitor the progression of renal failure you can lose a large % of
kidneys and still have normal function, but if the toxins build up
you have to go on dialysis
Determine drug dosage meds: many exit the body through the
kidneys

The formation of urine is dependent on three processes FAV TEST Q

Filtration takes place exclusively in the
glomerulus
Reabsorption takes place in PCT & Loop of Henle
Secretion takes place in PCT & Loop of Henle

When talking kidney function BUN and creatinine (chemical given off
by muscles)

Renal Physiology Filtration: MAKE A CHART ON FILTRATION

Filtration is the movement of fluid across a membrane

Will be on TEST! 5-6 terms to know what they mean, their significance,
cant use logic to get through it just route memory

The portion of the cardiac output that is filtered by the kidneys is known as the renal
fraction

The renal fraction can vary from 12 to 30%

Averages 21%

The renal blood flow rate is 1176 mL/min

Based on renal fraction

The renal plasma flow rate is the plasma filtered by the kidney
Renal blood flow rate times the portion of blood made up from plasma
Approximately 650 mL plasma/minute

The plasma that is filtered through the glomerulus into Bowmans capsule and becomes
filtrate is the filtration factor
The filtration factor is about 19%
o Normally we produce about 125 mL of filtrate per minute
o At 125 mL/min think how much filtrate/fluid youd lose if we
didnt take back 99% of this
The amount of filtrate produced by the kidneys each day is the glomerular filtration
rate
o Approximately 180 liters/day
o This is the important one to remember 180 liters is why youre
in trouble if you arent concentrating urine
o GFR one of the things that helps with med dosage

Renal Physiology Creatinine Clearance: DO CHART, FUNCTION TESTS

Volume of plasma that is cleared of a particular substance in a given time (usually 1

minute)
Used to follow the progress of renal disease
BUN & creatinine both rise w/ renal failure
Creatinine clearance is the way to monitor progress
2 ways to do CC just use creatinine not a particular substance
Creatinine is given off by muscles, and the rate that is given off is
standard (same each day) - based on how much muscle you have
athlete is a lot.
You see how much the creatinine is and then collect for 24 hours and
see where you are
RC = renal clearance (ml/min)
U = concentration of the substance in urine
V = flow rate of urine formation (ml/min)
P = concentration of substance in plasma (mg/ml)

ON TEST: RC= UV/P

Renal Physiology Filtration:
The filtration membrane allows plasma to enter Bowmans capsule but
stops blood cells and proteins from entering Bowmans capsule
Small proteins are being absorbed back by the PCT why they arent in

the urine
If something is being absorbed, its in the filtrate and it is returning to
the body
If something is being secreted, its going into the filtrate (primarily in
the PCT)
GLUCOSE passes, but it is also taken up by the PCT

Water and solutes of small diameter pass through the filtration membrane and into
Bowmans capsule

Molecules of greater than 7nm in diameter or with a molecular mass of 40,000 daltons do
not pass through the glomerular capillaries

Proteins that do pass through the filtration membrane are absorbed by the cells in the
proximal convoluted tubule and metabolized there

Therefore in the healthy kidney very little protein is released in the urine

Why is glucose in the urine w/ diabetes? If your sugar

is over *300* there is too much sugar in the filtrate to
be reabsorbed.

The formation of filtrate is dependent on the filtration pressure

o What is filtration pressure? When talking about vascular there is
hydrostatic pressure. Thats what this is, its going to be based
on BP. There has to be pressure on the outside the capsule and
inside the glomerulus, just like capillaries that have pressure
inside and outside
o Why are there the two arteries like he mentioned previously? To
monitor filtration pressure

The filtration pressure is a function of the forces that push the plasma out of the
glomerular capillaries and the forces that push plasma back in the glomerular capillaries
The glomerular capillary pressure is the blood pressure inside the capillary
Pushes plasma out of the glomerular capillary into Bowmans capsule
The capsule pressure is the physical pressure generated inside Bowmans capsule by the
accumulation of filtrate
Pushes filtrate from Bowmans capsule back into the glomerular capillaries
The colloid osmotic pressure is the pressure generated inside the glomerular capsule
because of the relative increase in solute with the loss of plasma into Bowmans capsule

o See the same thing here, but a littler different from vascular. In
the glomerulus/renal capsule the colloid osmotic pressure in the
bowmans capsule doesnt count!! Just looking at the pressure
inside the glomerulus.
o What happens to the colloid osmotic pressure? Its increasing as it
goes through? Thing is the colloid osmotic pressure as sucking
the fluid back in

Filtration pressure is then:

o Glomerular capillary pressure (capsule pressure + colloid osmotic pressure)
BP is the driving force pushing plasma out.
3 factors are BP, COP (colloid osmotic pressure), and CP (capsule
pressure)
Efferent artery is on the bottom in the picture below.
What size does the Afferent artery have to be in relation to the Efferent
artery in order for the pressure to build? How can it increase the
pressure?
o Efferent would be smaller, afferent would be larger
essential to understand what is happening!
Its like blood backing into the aorta, you want to open up
the afferent and clamp the efferent.
If there is too much blood, you do the opposite to relieve
pressure

Hydrostatic pressure is BP through the glomerulus

Osmotic pressure is sucking fluid back in
But the driving force pushing blood out is BP

Only thing the kidney can control is the pressure inside the glomerulus
(why there are those two arteries), it has NO control of the pressure in
the bowmans capsule

Glomerular capillary pressure can be raised by dilation of the afferent arteriole and
constriction of the efferent arteriole
Past the efferent arteriole, pressure is diminished
Afferent blood to glomerulus
Efferent blood away from the glomerulus

Want to alter/increase pressure afferent should be bigger

than efferent, that is all this is saying

Pressure in the peritubular capillaries are low allowing for absorption of fluids in the
interstitium
Vasa recta = peritubular capillaries
Low pressure so fluids can be reabsorbed
Glucose:
o Diabetes means - over-production of urine
o Blood sugar diabetes diabetes mellitus
o Problem w ADH (releasing lots of urine) diabetes insipidus
o Why do you produce more urine? Polyuria (going to bathroom)
polydipsia (drinking too much), and polyphagia (eating too
much). Youre drinking too much because youre urinating too
much.
But why does a pt w/ high blood sugar pee too much? When in the PCT,
as long as its under 300 it gets absorbed. Glucose has osmotic
pressure, so water follows glucose just like sodium. All the extra
glucose is taking water with it.
Same thing applies to the cells, not only are you losing more water in
the urine, the high glucose in the blood is sucking water out of the
cells.

In a pt with high blood sugar they will be dehydrated no matter how

much fluid you give them until their blood sugar is normal again.
But first thing you do is dilute the blood with IV fluids. Very little insulin
is needed

Renal Physiology Tubular Resorption:

Filtrate leaving Bowmans capsule travels through the proximal convoluted tubule, loop
of Henl, and the distal convoluted tubule before draining into the collecting system

Filtrate undergoes tubular resorption along the way while being transformed into urine
Tubular resorption involves osmosis, diffusion, facilitated diffusion, active transport, and
co-transport
If theres a way to transport a molecule it will be used in the nephron
Consider the nephron like the GI, first portion (PCT) does most of the
absorption

 Of the filtrate that leaves Bowmans capsule 99% is returned to the

circulation KNOW that number (for TEST?)
o

You can ONLY Cleanse the blood IF you produce filtrate!!

Fluid
Organic salts
Inorganic salts

Water follows the solutes that are reabsorbed

Water follows sodium the kidney COULDNT function without
sodium

Resorption is dependent on the various transport and the permeability characteristics of

each segment
Do CHART on the 3 components of the nephron and what takes place in
each component

Cells in the tubules have apical, basal, and lateral surfaces

Has apex and base, its epithelial tissue

In the picture: One on the right is PCT, the fuzziness is the villi found on
the PCT (where absorption takes place)
Resorption in the Proximal Convoluted Tubule
Resorption in the Loop of Henle
Resorption in the Distal Convoluted Tubule

Tubular Resorption Proximal Convoluted Tubule:

The PCT is permeable to water and extensive reabsorption of solutes take place

o The water leaving the filtrate is being absorbed by the blood

Reabsorption of most solutes are linked to active transport of Na+ across the basal
membrane into the interstitium creating a low concentration of Na+ in the cell DONT
have to know the specifics here!!
At the basal membrane ATP provides the energy to transport Na+ in exchange for K+ by
countertransport
The sodium concentration in filtrate being high, a large concentration gradient in between
the filtrate in the lumen and tubule cell
Concentration gradient is source of energy to co-transport many of the other
solutes
The carrier molecules are present in the in the apical membrane that transport amino
acids, glucose, and other solutes
Carrier molecules are specific to the solute
When the solute arrives in the cytoplasm, they cross the basal membrane
Some solutes also diffuse between the cells, entering the interstitial fluid
Happens when the concentration gradient for these solutes increase above the
concentration of the interstitial fluid END of dont have to know!!

By the time the filtrate has cleared the PCT:

Volume is reduced by 65%

 Concentrate of filtrate remains about the same as the concentration

of the interstitial fluid 300 mOsm/kg

Interstitial fluid fluid surrounding tubules

Boxes in picture (below) concentration of interstitial fluid
The renal pyramids have the blue things running through it
Filtrate (in the tunnels) will carry the same osmolality as the interstitial fluid around it

Tubular Resorption Loop of Henl:

The loop of Henl dips into the medulla where the concentration of solutes in the
interstitial fluid is high
The thin segment of the descending Loop of Henl (portion closest to the PCT) is highly
permeable to water and mildly permeable to solutes
o Water passes (by osmosis) much more rapidly than solutes
o X dont have to know thin from thick segment
o As you go down the descending, water is being sucked OUT. The
high concentration interstitial fluid is pulling it out, leaving the
solutes (and therefore increase the concentration of the solutes)
o As you go back up the ascending loop the filtrate will mirror the
outside interstitial fluid.
o But is you concentrate it by getting fluid out, you drop the
osmolity by not getting fluid in.
o There are two ways you can drop osmolity: by putting water in or
pulling the salt out,
o Whats happening here, is when its going up, the salt is being
pulled out and the filtrate osmolity is going down

DIDNT go over --

When the filtrate has reached the end of the thin segment of the loop of Henl the volume
has been reduced another 15% and the concentration of the filtrate is equal to that of the
interstitial fluid (1200 mOsm/kg)
Both the thin and thick portions of the ascending limb of the loop are impermeable to
water
The fluid that surrounds the ascending limb is less concentrated as the tubule ascends
END
As the filtrate passes through the thin segment of the ascending limb, solute diffuses
Filtrate becomes less concentrated
As we go up, the sodium is pulled out. Once in the cortex, the
filtrate is diluted by the time you reach the end of the ascending
loop of Henle

Start at 300 end at 100 that is CONSTANT: 200

miliosmolar drop is CONSTANT, if its 280, the
filtrate would be 80, etc.

The thick segment is not permeable to water or solute

Na+, K+, and Cl- are transported from the thick segment into the interstitial fluid by
cotransportation of K+ and Cl- with Na+
Just know what Na, K, and Cl are transported OUT!

Cl- and K+ cross the basal membrane into the interstitial fluid ---X
The concentration gradient for Na+ is created by active transport ---X
Since the ascending limb is impermeable to water but solutes are actively transported out,
the concentration of solutes in the nephron goes down to 100mOsm/kg just saying
that as you reach the end of the ascending loop, it drops to 100 milliosmolar like we said

The interstitial fluid has a concentration of about 300 mOsm/kg

The filtrate entering the distal convoluted tubule is more dilute than the surrounding
interstitial fluid

Tubular Resorption Distal Convoluted Tubule:

The DCT is only permeable to water under the influence of antidiuretic hormone (ADH)
Cl- is transported across apical membrane with Na+

The concentration gradient for Na+ is set up by the active transport of Na+ across the basal
cell membrane

Water moves by osmosis out of the DCT and into the interstitial fluid

Water moves nowhere when the DCT is impermeable to water

Renal Physiology Tubular Secretions:

Involves the movement of some substances that are either by-products of metabolism or
substances not produced by the body such as drugs into the nephron
Can be passive or active
In a counter transport process, H+ is moved into the nephrons lumen
H+ bind to carrier molecules on the inside of the plasma membrane and Na+ binds
to carrier molecules on the outside of the plasma membrane
As Na+ moves into the cell, H+ moves out of the cell
The secreted H+ are produced as a result of carbon dioxide and water reacting to form H+
and HCO3The counter transport molecule secretes H+ into the nephrons lumen and Na+ enters the
nephron cell
Na+ and HCO3- are cotransported across the basal membrane of the cell and enter the
peritubular capillaries
H+ ions are secreted into the proximal and distal convoluted tubules, and K+ ions are
actively secreted in the distal convoluted tubule

Renal Physiology The Countercurrent Mechanism:

The Countercurrent Multiplier

The Countercurrent Exchanger

The Countercurrent Mechanism The Countercurrent Multiplier:

The descending limb of the loop of Henl is relatively impermeable to solutes and freely
permeable to water.
The ascending limb is permeable to solutes, but not water.

The collecting ducts in the deep medullary regions are permeable to urea.

The Countercurrent Multiplier Descending Limb:

Osmolality of the medullary interstitial fluid increases along the descending limb, water
passes osmotically out of the filtrate along this course
The filtrate osmolality reaches its highest point of 1200 mOsm at the elbow of the loop

The Countercurrent Mechanism Ascending Limb:

In the ascending limb tubule permeability changes becoming impermeable to water and
selectively permeable to salt

Na+ and Cl- concentrations in the filtrate entering the ascending limb is very high
Most NaCl reabsorption takes place in the thick segment

o Are transferred from the infiltrate to the medullary interstitium where it

contributes to the high osmolality there
With the loss of salt and not water, the filtrate is becoming more and more dilute at 100
mOsm
Hypotonic to blood
There is a constant difference in filtrate concentration between the two limbs of the loop
of Henl
The solute in the ascending limb filtrate is always 200 mOsm lower than the
descending limb

Because of the countercurrent flow, the loop of Henl is able to multiply these small
changes into gradient changes along the vertical length of the loop
The two loops are not in direct contact but are close enough to share the same interstitial
area

Water diffusing out of the descending limb produces the increasingly salty filtrate that
the ascending limb uses to raise the osmolality of the medullary interstitial fluid
The more NaCl the ascending limb extrudes the more water diffuses out of the
descending limb and the saltier the filtrate in the descending limb becomes

This establishes a positive feedback mechanism that produces the high osmolality of the
fluids in the descending limb and the interstitial fluid

The Countercurrent Multiplier Collecting Ducts:

The amount of urea in the filtrate remains high because most nephrons segments beyond
the PCT are impermeable to it
When urine passes through the collecting duct where the duct is highly permeable to
urea, urea diffuses out of the duct into the medullary interstitial fluid
Contributes to the high osmolality in that region
Urea continues to move out of the duct passively until its concentration inside and outside
the duct is equal

Even though the ascending limb of the loop of Henl is poorly permeable to urea, when
urea concentration in the medullary interstitial space is high, some urea does enter the
limb

Urea's cycling simply equalizes its concentration inside and outside the renal tubules

The Countercurrent Mechanism The Countercurrent Exchanger:

The vasa recta function as a countercurrent exchanger maintaining the osmotic gradient
established by the cycling of salt while delivering blood to cells in the area
These blood vessels receive only about 10% of the renal blood supply
o The flow is sluggish

The vasa recta are freely permeable to water and NaCl, allowing blood to make passive
exchanges with the surrounding interstitial fluid and achieve equilibrium
As blood flows into the medullary depths, it loses water and gains salts and as it emerges
from the medulla the process is reversed and the blood picks up water and loses salt
Because blood leaving and reentering the cortex via the vasa recta has the same solute
concentration the vessels of the vasa recta this act as a countercurrent exchanger
This system does not create the medullary gradient but it protects it by preventing
removal of salt from the medullary interstitial space

Renal Physiology Regulation of Urine Formation:

Introduction
Hormonal Mechanism
Autoregulation
Sympathetic Innervation

Regulation of Urine Formation Introduction:

Urine concentration and volume are regulated by mechanisms that maintain the
extracellular fluid osmolality and volume within narrow limits

The process taking place in the proximal convoluted tubule and descending limbs of the
loop of Henl is obligatory and therefore is constant

In the distal convoluted tubule and collecting duct, filtrate reabsorption is regulated and
can change drastically
Depending on the needs of the body

Regulation of Urine Formation Hormonal Mechanism:

Antidiuretic Hormone
Renin-Angiotensin
Aldosterone
Atrial Natriuretic Hormone
Prostaglandins and Kinins

Hormonal Mechanism Antidiuretic Hormone:

ADH is secreted from the posterior pituitary

Released into the circulatory system from neuron transmitter

Changes in serum osmolality are detected by osmoreceptor cells

Increases in osmolality triggers the release of ADH
Decreases in osmolality inhibit the release of ADH

Baroreceptors in the heart, large veins, carotid sinuses, and aorta influence ADH release
With increases or decreases of 5 10%
Both an increase in blood osmolality or a significant decrease in blood pressure cause an
increase in ADH release
The increase in water reabsorption decreases osmolality and increase blood
volume
When blood pressure increases or blood osmolality decreases, ADH secretion is inhibited

Less water is reabsorbed increasing osmolality and decreasing blood volume

decreasing blood pressure
The secretion of ADH is affected by small changes in osmolality but it requires large
changes in blood pressure to affect ADH secretion

Hormonal Mechanism Renin-Angiotensin:

Renin is an enzyme secreted by cells of the juxtaglomerular apparatus whose rate of

secretion increases when
Blood pressure in the afferent arteriole decreases
Na+ concentration of the filtrate decreases

Renin enters the circulation and converts angiotensinogen to angiotensin I

Angiotensin I is converted to angiotensin II by angiotensin converting enzyme
Angiotensin II has the following effects:
Potent vasoconstrictor
Stimulates secretion of aldosterone
Increases the sensation of thirst
Increases the salt appetite
Stimulates ADH secretion
A large decrease in the concentration in the Na+ of the interstitial fluids acts directly on
the aldosterone-secreting cells of the adrenal cortex to increase the rate of aldosterone
secretion

Hormonal Mechanism Aldosterone:

Aldosterone is a steroid hormone secreted by cortical cells of the adrenal gland

Distributed through the blood to the distal convoluted tubule and collecting ducts

Aldosterone binds to receptors that increase the synthesis of transport protein molecules
that increase the transport of Na+ across the basal and apical membrane of the nephron
cells

Reduced secretion of aldosterone decreases the rate of Na+ transport

The concentration of Na+ in the distal tubules and the collecting ducts remain high

If the concentration of Na+ in the filtrate remains high it is difficult for water to leave the
distal convoluted tubule and collecting duct by osmosis

Hormonal Mechanism Atrial Natriuretic Protein:

ANP is secreted by cardiac muscle in response when the blood volume in the right atrium
increases and stretches the cardiac muscle

ANP inhibits ADH secretion and inhibits Na+ reabsorption in the kidney
Leads to production of a large volume of dilute urine
ANP dilates arteries and veins and reduces peripheral resistance and lowers blood
pressure
Decrease occurs in venous return and blood volume in the right atrium

Hormonal Mechanism Prostaglandins and Kinins:

Both are formed in the kidney and affect kidney function

Influence the rate of filtrate formation and Na+ reabsorption

Regulation of Urine Formation Autoregulation:

Autoregulation is the maintenance of a stable glomerular filtration rate (GFR) over a

wide range of systemic blood pressure

Autoregulation involves changes in the degree of constriction in the afferent arterioles

As systemic blood pressure increases, the afferent arterioles constrict and prevent an
increase in renal blood flow and filtration pressure across the filtration membrane of the
renal corpuscle
A decrease in systemic blood pressure results in dilation of the afferent arterioles
preventing a decrease in renal blood flow and filtration pressure across the filtration
membrane

It is influenced by the rate of flow of filtrate

An increased flow rate is detected by the macula densa which signals the
juxtaglomerular apparatus to constrict the afferent arteriole resulting in a decrease
in filtration pressure

Regulation of Urine Formation Sympathetic Stimulation:

The afferent arteriole constricts under the influence of the neurotransmitter

norepinephrine
Constriction of the afferent arteriole by norepinephrine causes a decrease in renal blood
flow and filtrate formation
Intense sympathetic stimulation can decrease the rate of filtrate formation to a few
milliliters per minute

Renal Physiology Formation of Dilute Urine:

Since tubular filtrate is diluted as it travels through the ascending limb of the loop of
Henl, to produce dilate urine the filtrate is allowed to travel through the nephron
unchanged
o happens in the absence of ADH

The collecting ducts remain impermeable to water due to the absence of aquaporins at the
luminal cell membrane

No further water reabsorption occurs

Na and other ions can still be removed from the filtrate by the distal convoluting tubule
making the urine even more dilute
Dilute urine can have an osmolality as low as 50 mOsm
About 1/6th the concentration of plasma
+

Renal Physiology Formation of Concentrated Urine:

Antidiuretic hormone inhibits diuresis

Via a secondary messenger using cyclic AMP that increases the number of water
pores known as aquaporins
Water passes through the aquaporins into the interstitial space
Osmolality of the urine becomes the same as the osmolality of the interstitial
space

There are two types of nephrons

Cortical nephrons
Juxtamedullary nephron
Juxtamedullary nephrons can concentrate urine better than cortical nephrons given the
osmolality of the medulla

The collecting ducts pass through the medulla where the filtrate is subjected to
hyperosmolar conditions

The degree to which filtrate can be is dependent on the amount of ADH released and the
conditions found in the interstitial space
Filtrate can be concentrated up to 1200 mOsm/kg
With maximal ADH secretions up to 99% of water in the filtrate can be reabsorbed
Less than 1 L/day of urine can be produced

Water reabsorption that depends on ADH is known as facultative water reabsorption

ADH is release continuously in small amounts unless blood solute concentration drops
too low
Release of ADH is enhanced by any event that raises plasma osmolality above 300
mOsm/kg

The Renal System Urine:

Physical characteristics
o Color
o Odor
o pH
o Specific gravity
Chemical composition

Urine Color:

Urochrome a pigment from the destruction of red blood cells that gives urine its yellow
color
The more concentrated the urine the deeper the color
Abnormal colors can come from food or blood

Urine Odor:

Fresh urine is slightly aromatic

Old urine develops a stronger smell because of bacteria
Some drugs and vegetables change the odor of the urine

Urine pH:

Varies from 4.5 to 8.0

Acidic
o High protein diet
o Whole wheat products
Basic
o Vegetarian diet
o Prolonged vomiting
o Urinary tract infection

Urine Specific Gravity:

Compares the mass of a substance to the mass of an equal volume of distilled water
Distilled water specific gravity = 1.0
Urine specific gravity 1.001 to 1.035 depending on the state of hydration

Urine Chemical Composition:

95% water
Solutes
- Urea breakdown of amino acids
- Nitrogenous wastes
* Uric acid nucleic acid metabolism
* Creatinine from the muscles
* Electrolytes

Renal The Ureters:

Slender tubes that connect kidney to the bladder

Continuation of the renal pelvis
Is retroperitoneal
Runs obliquely to the posterior bladder wall

Trilayered
o Lining mucosa
o Muscularis consists of two layers of smooth muscle
o Adventitia of fibrous connective tissue

Innervated by sympathetic and parasympathetic fibers

Pain fiber innervation
Peristaltic waves more a function of muscle stretch than nervous innervation

The Renal System Urinary Bladder:

Smooth, collapsible, muscular sac

Located retroperitoneal on the pelvis floor
Sits on top of the prostate or anterior to the uterus and vagina
Trigone - triangular region of the bladder outlined by the openings of the ureters and
urethra
Transitional epithelium
Fibrous adventitia
Detrusor muscle smooth muscle arranged in inner and outer longitudinal fibers and a
circular middle layer

Moderately full bladder contains about 500ml (one pint)

Maximum capacity is 800 1000 ml

The Renal System Urethra:

Lining
Sphincters
Female
Male

Urethra Lining:

Thin-walled muscular tube with a pseudostratified columnar epithelial lining

Transitional epithelium at the junction of the bladder

Urethra Sphincters:

Internal urethral sphincter formed by the detrusor muscle is involuntary and prevents
leakage between voidings
External urethral sphincter surrounds the urethra at the urogenital diaphragm
Also has a component from the levator ani muscle

Urethra Female:

Short
Tightly bound to the anterior vaginal wall
External urethral orifice lies anterior to the vaginal opening and posterior to the clitoris

Urethral Male:
Three regions
- Prostatic urethra through the prostate
- Membranous urethra through the urogenital diaphragm
- Spongy or penile urethra through the penis

The Renal System Micturition:

Stretching of the bladder activates visceral afferent receptors that activate a spinal reflex
Increase sympathetic inhibition of the bladder detrusor muscle
Stimulate contraction of the external urethral sphincter by activating pudendal motor
fiber
Afferent impulses are transmitted beginning at 200 ml
Visceral afferent impulses activate the micturition center in the dorsolateral pons
Parasympathetic neurons stimulate contraction of the detrusor muscle and relaxes both
sphincters
If voiding is postponed the reflex bladder contractions subside within a minute
The voiding reflex is repeated after another 200 300ml has accumulated
The second time the reflex can be dampened again
After the bladder volume exceeds 500 600mls the urge to void becomes irresistible
After voiding the residual is about 10ml