{I have just written what the doctor said but in organized way and

delete many repeating sentence in his talk .. so u can get more benefit
and good luck }

Today we will take the last lecture in urinal system
In the last lecture , We started to talk about absorption or reobsorption
in the tubular system , sodium in details and also we discuss the glucose
reobsorption , amino acid which is almost same as glucose ( its a co-
transporter active with the sodium co-transporter) , vitamins and finally
hydrogen which works in the opposite way which is secretion
We also talk about the Tmax and the renal threshold
threshold: its a term that retain to the plasma concentration
Tmax: its the amount of substance in the tubular system or the
filtered load

* Phosphate and calcium
-They both are reabsorbed actively
- They are regulated by the renal reabsorption (kidneys )
As we know the renal threshold for an element means : the normal
concentration of this element in the blood
And we also know that the renal system has specific T max for each
element ..
So in the normal concentration of phosphate or calcium ( Tmax = renal
threshold) the absorption of renal system will works probably .

Now if the calcium concentration is higher than the normal thats mean
the calcium that would be filtered in the tubule is extra than of Tmax (
on the top of Tmax ) in this case the extra calcium wont be absorbed
because the capacity of the absorpty system is the Tmax , after Tmax no
absorption.

Conclusion:
The renal reabsorption of phosphate and calcium occur only if the Tmax
of the renal system for them equal the threshold otherwise no
absorption will occur
Extra amount of phosphate and calcium will be excreted

As we know
-the sodium absorption mainly occur in the proximal tubule by different
ways {many means} but mainly active reabsorption.
,
-67% of sodium will be reabsorbed in the proximal tubule and about
20% in the tube of henle , So about 8- 10 % remaining in the collecting
duct .
-In the basoretinal side {dont know what does it mean} , the
absorption of the sodium occur by the sodium potassium pump


Now lets talk about the reaming percent = 13% in the distal and
collecting tubules .
In the distal and collecting tubules, sodium is absorbed by the sodium
potassium pump but with a control , This control is the ALDASTERONE
LEVEL .


So present aldosterone secretion in our body is responsible for the
sodium reabsorption in collecting and distal duct , and the absent of it,
causes the closure in tubules from sodium reabsorption ( in other word ,
no absorption occur )


Now what affects the aldosterone secretion??
sodium concentration >> if we have normal sodium concentration in
the blood , aldosterone wont be secreted ( the blood dont need any
more sodium ) , and if the sodium concentration decreases , it will be
secreted , so that sodium will be conserved { or reserved back }
The doctor said that he wont ask about the details of the mechanism

How is aldosterone secreted ?
By :

Renin angiotensin system (Renin angiotensin aldosterone system)
Renin is the substance that it is secreted in Costa apparatus glomerulus
in the kidney controlling GFR
Mechanism of Renin angiotensin system .

- When we have low concentration of sodium in blood so low conc. In
distal tubules and filtrate , The kidney releases Renin , which activate the
angiotensin in liver . -The angiotensin will converted into angiotensin1 .

-The angiotensin1 will flow in the blood until it reaches the capillaries
and blood circulation of the lung
- There the angiotensin1 will converted to angiotensin2
- At last angiotensin2 will release the aldosterone.

The affect of aldosterone :
1- constriction of efferent arterioles so increase the GFR
2- increase sodium reabsorption in the kidney
3-increase chloride and water reabsorption ( NACL will follow the
sodium , when NACL is absorbed , water will follow the Salt , the water
will be reabsorb )

The RESULT:
1- return back to the normal sodium reabsorption in the blood
2- increase the water volume in the blood so increase the blood
pressure ( when we constrict the arteriole)


SO THIS IS HOW THE RNEN SYSTEM CONTROL BLOOD PRESURE
&SODUIM CONCENTRATIN IN THE BLOOD .
atrial natriuretic peptide (ANP)
Its a peptide but its a hormone like substance
and it is released from the heart muscle . it has the opposite effect of
aldosterone
when it releases?
When there is a stretch in the heart muscles .
-that means the blood volume is huge , so the blood pressure high so
ANP will be released
The Affect of ANP:
It will inhibit the sodium and water reabsorption >> (less sodium and
water in the blood) >> (so more sodium excreted and water ) , no
chloride reabsorption and Less blood volume , so the blood pressure
will go down .
Chloride reabsorption is a passive process in whole way

Water reabsorption

-Water is absorbed passively in the whole tubular system
- 65% of water will be free reabsorbed
- 60% of water will be reabsorbed in
in the proximal tubule ( means
no control no inhibition no stimulation ) just be osmosis

loop of henle
Loop of henle

The ascending limb The descending limb
No absorption happens free water reabsorption
( never )


- 20% reaming in the distal and collecting duct .
In the first part of distal tubule , there is no water reabsorption (never )
>>> after that , in the late part
of distal tubule and collecting duct , water reabsorption happened
depending on hormone called antidiuretic hormone )
( which opens their channel for water reabsorption
If we have it >> there is water reabsorption,
If we dont have >> No water reabsorption

So we can say that absent of antidiuretic hormone
Makes the distal tubules and collecting ducts works as ascending limb of
loop of henle ( no water reabsorption ) , and it is the different .

metabolic waste
Urea creatinine phenol - drugs and toxic material
All of them metabolic waste that shouldnt have full capacity for
reabsorption .

LETS TALK ABOUT EACH OF THEM :
-Urea : when its inside the tubular system it is absorbed about 50% ,
(not as water = 99% - sodium = 99 % - glucose = 100% )
Urea is absorbed because it have a physiological benefit.

-Toxic material : they shouldnt be reabsorb
- creatinine : we dont absorb it
- phenol : we dont at all ( whatever filter is goes for the Uren )

NOW WE HAVE TO DEFRENCIATE BETWEEN TWO CONCEPTS :

- IN REABSOBTION : we divided the material into :
Very good nutrition (we take it back 100% )
Partially back material
Toxic material ( we dont take them back )
- tubular secretion : it is related to the very very toxic material so
we dont want them to circulate back in our body .

-Examples of those: hydrogen potassium ( has a special case, not as
toxic and very toxic ) - organic material like : penicillin drugs food
additive histamine and nor-epinephrine

- We filter them , but we dont reabsorb them
-They are secreted from the peritubular capillary to the tubular system

percentage of secretion in each cycle of blood circulation :
Percentage of secretion =
20% (which is the filtrated from glomerulus) + percentage of secreted
material from peritubular capillary to the tubular system. (Depends on
the material )

Examples:

-If the material (x) will be secreted extra 10 % and we will lose 20% by
filtration SO total secretion will be 30 %

-If the secretion rate is 50% for material (y) , and we will lose 20%
filtration SO we will lose 70% in each cycle of blood flow

But if we lose 80% in secretion that means : this material will be lost
from ur body from the first cycle of blood flow


Explanation:
when the blood coming to the kidney , 20% of that material will be
filtered not reabsorbed because its toxic material , and 80% will follow
from peritubular capillary to the tubule , So the sum is 100%

there is only one substance can follow this way : paraaminoheporic
acid ( freely filtered not reabsorbed completely secreted ) and we can
call this : plasma clearness
[ [` `Plasma clearance of any substance is the volume of plasma
completely cleared (or cleaned) of that substance by the kidneys
per minute
The major function of the kidneys is to clean our plasma, Each minute
plasma goes to the kidney ,each minute some plasma will be cleaned how
much of volume of that plasma cleaned from x material is the plasma
clearance of x
each substance has its own plasma clearance which means if there is a
toxic material and this toxic material freely filtered; when we call that
substance is freely filtered thats mean 20% of it will be in the Bowmans
Capsule .
Lets see if we have one hundred particles of that material 20
particles will inter to bowmans capsule (then they will go through
tubular system and finally in urine ) and the remaining 80 particle in
blood they will go through peritubular capillary




Now, if that x material is not secreted(it couldnt pass by secretion) and
not reabsorbed(the material not go back in tubular system) it will
secreted out.
Q: how many miles of plasma were cleaned from that material?
Answer: glomeral filtration rate (125ml/min)
In another word the definition of Plasma clearance for x not related to
the x but to the volume of the plasma.
If a substance freely filtered not reabsorbed and not secreted the
plasma clearance of it equal to glomerus filtration rate GFR; eg(inulin,
kreatinin)

If we want to calculate the plasma clearance of any substance we must
know:
The concentration of that substance in the urine Us- .
The flow rate of the urine-V- .
The Plasma con. Of substance-Ps- .
Cs= (Us x V)/ps
Simple Q; whats the plasma clearance of glucose, amino acid, vitamin
and fatty acid?
-zero; there is no mile of plasma was cleaned from glucose by the
kidneys because the glucose is freely filtered completely reabsorbed and
not secreted. and the other like it.

+The paraaminohippuric acid is completely secreted, freely filtered
and not reabsorbed so the plasma clearance of it equals to plasma renal
flow.
What is that mean?
The plasma coming to the kidneys 700ml/min, they contain x amount of
paraaminoheppuric acid they went to the glomerulus,
in the glomerulus they lost 20% of the paraaminoheppuric acid As
filtration, the 20% remaining in the glomerulus
went to peritubular capillaries but there they secreted everything SO
the amount of the paraaminoheppuric acid in all volume of plasma
coming to the kidneys each minuet was cleaned completely so



so if the plasma renal flow was 700ml/min they will be all cleaned from
paraaminoheppuric acid,if the plasma renal flow was 1000ml/min(which
is possible)all will be cleaned.

NOW; lets classified all concepts in:
` Materials which are freely filtered not reabsorbed and not secreted
there plasma clearance will equal to 125ml/min.
Materials which are freely filtered not reabsorbed and completely
secreted there plasma clearance equal to plasma renal flow
(~620ml/min).
`In between; Materials which are freely filtered not reabsorbed
partially secreted there plasma clearance is between (125-620) ml/min
depending on secretion rate.
``Materials which are freely filtered partially reabsorbed not secreted
there plasma clearance will be less than GFR.

The plasma clearance for paraaminoheppuric acid
equal to plasma renal flow






Introduction :
URINE EXCRETION OF VARYING CONCENTRATIONS
Now the last concept the most important
concept not for the exam put in medicine
and I am not going to ask you in details
about it in the last 3 min I will tell you
what to I am going to ask you in the exam.
this is the target this is the most
important of the physiology of renal because up to now we studied the
nephron which if you take outside the kidney and leave it works it will
do its job normally if u start to add plasma in the glamorous by the end
of the day the nephron will get out the diluted urine so its not a human
physiology its biophysics But how we concentrate the urine?? is the story
if you want to get the concentrated urine outside the body you cant do it so it
should be in the kidneys by building hypertonic medulla, (look to the pic.above)
this is the cortex u see the cortex the lighter one the osmolarity of that cortex is
isotonic normatonic like plasma but if you go down to the medulla you start to
going hypertonicity 600 900 1200 and the 1200 mOsm/L is the maximum
level by which the human being can concentrate its urine.
Every day of our life we will have metabolic waste equivalent to 600 mOsm/day
if you have

particals of toxic materials which should be excreted out in order to survive,
which will not happen unless they are diluted in a volume of water, as I told u
even what is the external environment you should to secrete daily 0.5 L
of urine so its the minimum amount of urine should be secreted daily
when u put in that volume 600 mOsm u will get a solution whats the con.
of that solution? 1200 mosm/L (con. = num. of mosm/ volume of the
solution) and this is the maximum human osmolarity can be excreted.
1200mosm/day so the kidney should excrete 1 letter of
water with them to keep within this con. if u have 2400 mosm/day
as an example whats going on when you drink the sea water its a salty water when u drink it which are
particles if u take 1 L of it which double amount of osmoles and add to them the 600 mosm from your
body you excrete 2 L by the kidneys to get rid of the extra particles so you drink more you excrete double
thats why they die of dehydration How is that happen ???

toxic material in order to get rid of them u have to excrete 2 letter of
water


1- Cortical nephrons 80% they have nothing to do with this mechanism . only the
j m n work that way
in the kidney There are:
2- Juxtamedullary nephrons 20% its the responsible for counter current
mechanism building that mechanism called counter current multiplayer , keeping
that gradient called counter current exchanger
In the loop of henle:

1-descending limb: -high water permeability
-no sodium reabsorption
2-ascending limb: -actively reabsorbed NaCl no matter is going out It will expel the Na out so
its a power or an energy which equal 200 mosm/L -impermeable for water
Mechanism of CCM
Initial scene : interstitial fluid is 300mOsm/L
STEP 1
NaCl actively pumped from ascending with
the force of 200mOsm/L difference , which means if the
Na out =300 mOsm/L and in = 300 mOsm/L the pump is able to expel Na
out until it causes a difference which equal 200 mOsm/L between out and
in when there is difference 200 the pump stops
water will be reabsorbed from descending
to equilibrate with the outside until both have 400mOsm/L , the descending
limb have normatonic 300 but because of the water permeability of it we will get to the equilibrium with
outside which is hypertonic 400 mOsm/L So by the end of the day the equilibrium will get 400 mOsm/L in
and out
So by the end of the first step : the descending limb we have hyper tonic in the ascending limb we
have hypotonic
STEP 2
movement of luminal filtrate so from
ascending 200mOsm/L fluid to the distal tubules,
& 300mOsm/L fluid from proximal tubules gets
in the descending limb & in between
400mOsm/L is moved around the tip , When we have
EXTRA FLOW going on the new filtrate coming here (the beginning of
descending limb) as normatonic this was the filtrate which was 400 because of the equilibrium and this is the
hypotonic which was in the ascending limb which will go up y3ne bs t7rrak kol $y l8dam l2nno 2ja
kmmeya jdede :P !!

STEP 3
ascending limb pumps NaCl while water is
reabsorbed the descending limb until 200mOsm/L
dif. Is established between the ascending, the
interstitial fluid & the descending , there is another pump
to get out the Na so when the Na goes out and water goes in that remain
to change this to hypotonic when you lose the salt and you dont lose
the water u will transfer the solution from normal or hyper to hypo 400
300 200150
STEP 4
movement of filtrate will again disrupt the
200mOsm/L at the horizontal level , like what happen in
step 2 put with higher Osmolarity notes !! and we repeat the cycle again
and again until we reach this point STEP 5
STEP 5
active NaCl pump in the ascending limb
with water diffusion in the descending one
the 200mOsm/L is reestablished
will have 600 here and 600 here 400 here 225 the (here) is going up with the
ascending limb so the same as step 1 with more hypo and hyper values
STEP 6
filtrate movement again will change the
gradient so that it will lead to a progressive
increment in the tonicity of the fluid in the
descending limb & decrement in the ascending one , by
the end of these cycles together with the help of urea I
remember I told u the urea is reabsorbed urea play a big role
in creating that gradient so this is the benefit give the
kidneys reabsorb this toxic material to help in other way by
the end of the day u will have 1200 mOsm concentrated in the
down of medulla 1050 a little bit up 900 700 600
and so on so we will get that gradient from normatonic to hyper tonic
Those cycles infront of you which create 1200 mOsm/L depends on the loop of henle if we
hane longer loop of henle we will make more than 1200 if u double the loop of henle down
and up u will have up to 2400 mOsm/L urine capacity




Thats why when u examine the loop of henle of desert animals they will have very long
loop of henle to make their water cycling inside their bodies because the more hypertonic
in the loop of henle the more ability to suck the water back if you have 1000 u will have
1000 power full to suck the water and if u have 2000 you have 2000 power so those
animal have very strong C.C.M (counter current multiplayer). M3loooma Gameeela
*** We know that in body fluid we never have a change in the osmolarity, the
starling capillary ,circulation and the regulation
in the kidney does not work all your body when you change to hypertonic or hypotonic you
will be back in few mins maximum mins to normatonic because of the wash out of the
particles in the kidney it doesnt work because of the structure of the Juxamedullary nephron
this is loop of hynly down and up next to it VASA RECTA special vascular structure down and
up only.
between outside and inside the
cell should abolish those changes because the homeostasis do not allow the
tonicity to be hypertonic or hypotonic, by the end of the day these 1200 should be
cleaned should be back to 300 ??!!
VASA RECTA
Plz read this carefully to understand it when the Dr. says in he means (the
plasma going down in the medulla
plasma is normatonic the osmolarity is 300 mosm/L , & outside is
400 mosm/L so it will take the salt from out in and it will get the
water from in out so it equilibrated so the hypertonic now is
not hypertonic when 400 become inside the plasma which is
hypertonic
when it goes a little bit down it will faces other hypertonisity which
is not 400 , its 600 .. so it will equilibrate with the 600 .. so it will get the
water out and the salts in
when it goes farther down again it more hypertonic so it will get
the salts in and get the water out until it reaches the U curve tip the
plasma inside is 1200 mOsm/L and the medulla outside is 1200 mOsm/L
so there is no need for equilibrium.
BUT when the plasma start to going up by the ascending limb the
plasma is hypertonic 1200 and out is hypotonic 900 so there is need
to equilibrium in which way the plasma will give the salt out and will get
the water in .
it goes up a little bit outside is less hypertonic so the plasma will
send the salt out and the water in






we talked about the normal amount of water in the body and now we will
take :
EXTRA WATER WE DO NOT NEED IT
in this case we dont have anti dialitic hormone (ADH)the control of
water reabsorbing if remember what I said in few mins I told you that the
water will be reabsorbed in proximal tubule in the descending part of
loop of henle , But in ascending limb of loop of henle and 1
st
part of distal
tubule No permeability of water distal and collecting duct without ADH
NO permeability of water this red line means that ascending limb of
As a Summary
WHEN the plasma going down in vasa recta it took the salt and loose the
water , WHEN the plasma going up in vasa recta it will do the opposite
thing it will lose the salt and it will take the water back.
So whats going in during downward going on during upward S BY the END
the plasma will leave the loop of henle in the medulla there is no loose no
gain.

loop of henle and distal tubules and collecting ducts have no permeability
of water so when the plasma filtrate coming in it will become hypotonic
hypotnic going out , the windows are closed no water reabsorbing
so every day we excrete diluted urine.
THE TOTAL WATER IN THE BODY LESS THAN NORMAL
and we dont want to lose 1.5 L of urine we will lose the 600 mosm toxic
material with 0.5 L urine only but we will return back 1 L of water HOW?
The ADH will be released the late distal tubules and the collecting duct
will be affected by opening the channels of water this is the function of
ADH .. now when the plasma flow through the ascending limb and first
part of distal tubules there is no reapsorbtion but they will lose the NaCl
and they will keep the water so the urine will be hypotonic BUT when it
goes down in the collecting ducts and the windows are open for water
outside in the cortex its normatonic 300 mosm , but in the medulla

u
remember Countercurrent mechanism 600 mosm > 900mosm > 1200
mosm when I open channels and inside the tubule is hypotonic or
normatonic and outside is hypertonic so the 1200 mosm will suck the
water out with a good force so those channels will suck the water from
here to the end of the collecting tubules with the end of the collecting
duct we already achieved that we already absorbed most of the water
which was in the filtrate and we get the water back to the vascular
system







BY THAT WE ACHEAVE THE ULTEMET GOAL OF THE RENAL SYSTEM we
need the water we open the channels and suck the water , we dont
need the water we close the channels and the water will be excreted
this is the of creating concentrating urine and diluting urine.
ank U ,forgive us for our mistakes and we wish u all the best of the
best ..
Done by : Farah Edwan , Asmaa Almawas , Baraah Alsalamat
U need to remember those two steps without ADH the channels
will be closed because the absent of ADH so the filtrate will be flow
in without water reabsorbing and with ADH there is a bower
hypertonicity in the medulla pushing the water out and getting the
water into the vascular system