Chapter 19: The Kidneys

I. Gross Anatomy of the Urinary System

A. Six Principle Organs: (Figure 19.1)
2 kidneys:

2 ureters:

Urinary bladder:

Urethra:

B. Renal parenchyma (c-shaped glandular tissue that makes urine) is divided

into 2 regions: Renal cortex and Renal medulla.

II. Microscopic Anatomy of the Kidney (Figure 19.1)

A. Functional unit of the kidney = NEPHRON

B. Vasculature
Renal arteries -> Arcuate artery -> Afferent Arterioles -> enters a
portal system -> system of venules -> Renal vein

Portal system:
Cortical Nephrons Juxtamedullary Nephrons
Afferent Arteriole Afferent Arteriole

Glomerulus Glomerulus
(capillary bed #1) (capillary bed #1)

Efferent Arteriole Efferent Arteriole

Peritubular capillaries Specialized peritubular capillaries: Vasa
(capillary bed #2) Recta
(capillary bed #2)

C. Function of Cortical & Juxtamedullary Nephrons is related to

vasculature
Glomerulus:
Peritubular capillaries:
Vasa recta:

D. 2 parts of the Nephron: Renal Corpuscle & Renal Tubule

Renal Corpuscle filters blood plasma
o Bowmans Capsule:
 o Juxtaglomerular Apparatus:

Renal Tubule converts the filtrate to urine

o Proximal tubule:

o Loop of Henle: a hairpin-shaped segment that dips down toward the

medulla and then back up. The loop of Henle is divided into two limbs:
- Descending Limb:
- Ascending Limb:
Thick segments

Thin segments

o Distal tubule:

o Collecting Duct:

E. Summary of the flow of urine

III. 4 Processes of Urine Formation: Overview (Figure 19.2)

A. Filtration: movement of solutes and fluid from blood to lumen of the
nephron

B. Reabsorption: movement from lumen of the tubule back into the blood
flowing through peritubular capillaries
Proximal Tubule:

Loop of Henle: primary site for creating dilute urine

Distal Tubule:

Collecting Duct:

C. Secretion: movement from blood to lumen

D. Excretion: movement from lumen to outside the body

E. Summary of 4 processes (Figure 19.3):

Amount filtered Amount reabsorbed + Amount secreted = Amount

 excreted

IV. Process #1: Filtration

A. Blood within the glomerulus filters into the glomerular capsule

through 3 layers (Figure 19.5)
Glomerular (fenestrated) capillary endothelium:

Basal lamina (basement membrane):

Epithelium of Bowmans capsule (filtration slits of podocytes):

B. What is the driving force for filtration? (Figure 19.6)

2 pressures:
o Hydrostatic pressure
- Pfluid: fluid pressure created by fluid in Bowmans capsule
- PH: hydrostatic pressure (blood pressure)

o Colloid osmotic pressure : colloid osmotic pressure gradient due to

proteins in plasma but not in Bowmans capsule

Net filtration pressure: PH pi = Pfluid

C. Glomerular Filtration Rate (GFR): the volume of GF formed perminute

(110-125 mL/min)
GFR = NFP * Kf

Kf = filtration coefficient (12.5 ml/min for men, ~10% lower for women)
o Example: 10 mm Hg * 12.5 = 125 ml/min (for men)
GFR is influenced by 2 factors:
o Net Filtration Pressure (just described):

o Filtration coefficient: Kf

- Surface area of glomerular capillaries available for filtration

- Permeatbility of filtration layers

D. Autoregulation maintains a nearly constant GFR (Figure 19.6b)

Autoregulation maintains a nearly constant GFT when mean arterial blood
pressure is between 80 and 180 mm Hg
A lot of pressure on capillaries, the greater chance of damage to them
Allowing nephrons
Decrease amount of solutes and fluids

E. GFR is controlled by resistance through renal arterioles (Figure

19.6d,e)
 The effect of increased resistance on GFR, however, depends on where the resistance
change takes place.
Afferent Arteriole:

Efferent Arteriole:

F. Adjusting Glomerular blood pressure occurs via 3 mechanisms:

Autoregulation (local control mechanisms that help kidney maintain a
constant GFR. Main function is to protect filtration barriers from high blood
pressure that might damage them). Autoregulation mechanisms can be
overridden by other mechanisms under special conditions.
o Myogenic response: Intrinsic ability of vascular smooth muscle to
respond to pressure changes

With an in MAP With an in

MAP MAP
stretch of afferent arteriolar walls stretch of afferent arteriol
smooth muscle contraction smooth muscle relaxes
vasoconstriction vasodilation
blood flow to glomerulus blood flow to glomerulus
PH PH
NFP NFP
GFR GFR

o Tubuloglomerular feedback (Figure 19.7a,b): is a local control pathway in

which fluid flow through the tubule influences GFR.
Juxtaglomerular apparatus:

o Macula densa:

o Juxtaglomerular cells (JG cells):

Summary of effects (Figure 19.7c):
o GFR increases flow through tubule increases
flow past macula densa increases

Sympathetic Control
o Sympathetic nerve fibers vasoconstrict the afferent arteries in
emergency situations (e.g. accident, hemorrhage, severe
dehydration)

Hormone Control (Renin-Angiotensin II system)

o

II. Process #2: Reabsorption of Solutes and Water

A. Summary of Reabsorption in Nephron:
Proximal Tubule Loop of Henle Distal Tubule Collecting Duct
Reabsorb Reabsorb Variable Variable
solutes (H2O water via salinity reabsorption of reabsorption of
follows by osmosis) gradient salts & water salts & water
70% volume 90% volume
reabsorbed reabsorbed
B. Principles governing reabsorption of solutes and water (Figure 19.8)
o Reabsorption involves both epithelial transport and paracellular
transport.
o Na+ dependent co-trasport causes reabsorption of glucose, amino
acid, organic metabolites, and ions

o Reabsorption of water and solutes from the tubule lumen to the

extracellular fluid depends on active transport of sodium.

o Overview: Figure 19.8a:

o Step 1:
o Step 2:
o Step 3:
o Step 4:

C. Reabsorption of Solutes
o Active transport of Sodium (Figure 19.8b)
- Apical side of tubule cells are close to tubule lumen.
- Basolateral side of tubule cells are close to interstitial fluid
o Step 1:

o Step 2:

o Sodium-dependent co-transport causes reabsorption of

glucose, amino acids, organic metabolites and ions (Figure
19.8c)
o Step 1:

o Step 2:

o Step 3:

o Renal transport can reach saturation (Figure 19.9, 19.10)

o Figure 19.9:
- Saturation =

- Renal Threshold:

- Transport maximum (Tm) =

o Example of saturation: Glucose (Figure 19.10)

- Figure 19.10a:

- Figure 19.10b:

- Figure 19.10c:

- Figure 19.10d:
 D. Reabsorption of Water
o Lower hydrostatic pressure in peritubular capillaries results
in net reabsorption in interstitial fluid (Figure 19.11)

o Mechanisms of water reabsorption vary by nephron region

Proximal Loop of Henle Distal Tubule Collecting Duct
Tubule
H2O follows Creates a salinity gradient Variable Contributes to salinity
solute (Countercurrent reabsorption of gradient (Countercurrent
reabsorption Multiplier) that helps with Na+ (H2O Multiplier)
H2O reabsorption follows)
Variable reabsorption of
(Countercurrent
(ALDOSTERON H2O (VASOPRESSIN)
Exchange)
E)

III. Process #3: Secretion (not covered)

IV. Process #4: Excretion

A. Excretion = filtration - reabsorption + secretion

B. Clearance = the rate at which that solute disappears from the body by
excretion or by metabolism

o Figure 19.13a: inulin clearance

o Step 1:

o Step 2:

o Step 3:

o Step 4:

o Now lets show mathematically that inulin clearance is equal to GFR.

Mathematical expression of GFR Mathematical expression of Inulin clearance

We already know that The right side of Eqn #4 is identical to the clearance
equation for inulin. Thus the general equation for the
Filtered load of X = [ X] plasma * GFR (Eqn 1) clearance of any substance X (mL plasma cleared/min)
is:
We also know that 100% of the inulin that filters
into the tubule is excreted. In other words: Clearance of X = excretion rate of X (mg/min)/
 [X]plasma (mg/ml plasma) (Eqn 5)
Filtered load of inulin = Excretion rate of
inulin (Eqn 2)

Because of this equality, we can substitute

excretion rate for filtered load in equation (1) by
using algebra (if A = B and A = C, then B = C):

Excretion rate of inulin = [ inulin] plasma *

GFR (Eqn 3)

For inulin:
This equation can be rearranged to read
Inulin clearance = excretion rate of inulin /
GFR = excretion rate of inulin/ [inulin] plasma [inulin] plasma (Eqn 6)
(Eqn 4)

The right sides of equations (4) and (6) are identical, so by using algebra again, we can say that:

GFR = inulin clearance (Eqn 7)

For any substance that is freely filtered but neither reabsorbed nor secreted, its clearance is equal to
GFR

o Useful equations in Renal Physiology (Table 19.1)

o Figure 19.13b: Glucose clearance (normally all glucose that

filters is reabsorbed)
o Step #1:
o Step #2:
o Step #3:
o Step #4:
o Excretion rate:

o Figure 19.13c: Urea clearance is an example of net

reabsorption (filtration is greater than excretion)
o Step #1:
o Step #2:
o Step #3:
o Step #4:
o Excretion rate:

o Figure 19.13d: Penicillin clearance is an example of net

secretion (excretion is greater than filtration)
o Step #1:
o Step #2:
o Step #3:
o Step #4:
o Excretion rate:

VIII. Clinical Concepts

A. Renal Calculus (Kidney Stones): granules of calcium phosphate or other
mineral salts in the urine
Form in the renal pelvis
 Usually small enough to pass unnoticed in the urine flow
Large stones might block renal pelvis or ureter, causing pressure buildup in kidney
Passage of large jagged stones may damage ureter causing hematuria (blood in urine)
Causes: hypercalcemia, dehydration, pH imbalances, frequent urinary tract infections, or
enlarged prostate gland causing urine retention
Treatment: stone-dissolving drugs, often surgery, or lithotripsy (nonsurgical technique
that pulverizes stones with ultrasound)

B. Renal Insufficiency: a state in which the kidneys cannot maintain

homeostasis due to extensive destruction of their nephrons
Causes of nephron destruction: Hypertension, chronic kidney infections, trauma,
prolonged ischemia and hypoxia, poisoning by heavy metals or solvents, blockage of renal
tubules in transfusion reaction, atherosclerosis, or glomerulonephritis
Nephrons can regenerate and restore kidney function after short-term injuries (Other
nephrons hypertrophy to compensate for lost kidney function)
Can survive with one-third of one kidney
When 75% of nephrons are lost and urine output of 30 mL/hr is insufficient (normal 50 to
60 mL/hr) to maintain homeostasis
o Causes azotemia, acidosis, and uremia develops, also anemia

C. Hemodialysis {Hemo=blood; Dialyzer=filter}: artificial kidney that

clears wastes and excess water from the blood
The blood circulates outside the body of the patient - it goes through a machine that has
special filters. The blood comes out of the patient through a catheter (a flexible tube) that
is inserted into the vein. The filters do what the kidney's do; they filter out the waste
products from the blood. The filtered blood then returns to the patient via another
catheter.
Hemodialysis usually lasts about 3 to 4 hours each week. The duration of each session
depends on how well the patient's kidneys work, and how much fluid weight the patient
has gained between treatments.