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Urinalysis and Body Fluids, 5th Edition

RENAL ANATOMY,
PHYSIOLOGY, AND
FUNCTION TESTING
CHAPTER 2

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Urinalysis and Body Fluids, 5th Edition

Kidneys
They maintain the bodys internal environment by:
Regulating the total volume of water in the body and the total concentration
of solutes in that water (osmolality).
Regulating the concentrations of the various ions in the extracellular fluids.
Ensuring long-term acid-base balance.
Excreting metabolic wastes and foreign substances.
Producing erythropoietin and renin.
Converting vitamin D to its active form.
Carrying out gluconeogenesis during prolonged fasting.

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Urinalysis and Body Fluids, 5th Edition

Kidneys
Location and External Anatomy
The bean-shaped kidneys lie in a retroperitoneal position in the superior
lumbar region.
The right kidney is crowded by the liver and lies slightly lower than the left.
An adults kidney has a mass of about 150 g (5 ounces) and its average
dimensions are 11 cm long, 6 cm wide, and 3 cm thick

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Urinalysis and Body Fluids, 5th Edition

Kidneys
Location and External Anatomy
Three layers of supportive tissue surround each kidney.
Renal fascia: anchors the kidney and the adrenal gland to surrounding
structures.
Perirenal fat capsule: surrounds the kidney and cushions it against
blows.
Fibrous capsule: prevents infections in surrounding regions from
spreading to the kidney
Internal Gross Anatomy
Frontal three distinct regions of the kidney
Renal Cortex: Outermost
Renal Medulla: Deep into the cortex
Exhibits renal pyramids/medullary
Renal columns
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Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Nephrons
Functional and structural unit of the kidney
1 to 1.5 million per kidney
Parts
Renal Corpuscle
Glomerulus
The endothelium of the glomerular capillaries is fenestrated.
The filtrate is the raw material that the renal tubules process to form
urine.
Glomerular Capsule / Bowmans Capsule
Layers: (1) parietal layer, (2) visceral layer

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Urinalysis and Body Fluids, 5th Edition

Nephrons
Functional and structural unit of the kidney
1 to 1.5 million per kidney
Parts
Renal Tubule and Collecting Duct
Proximal Convoluted Tubule
Cuboidal epithelial cells with large mitochondria, and their apical
(luminal) surfaces bear dense microvilli
Nephron Loop (formerly loop of Henle)
Descending thin limb: consists of a simple squamous epithelium
Thick ascending limb: epithelium becomes cuboidal or even low
columnar
Distal Convoluted Tubule
cuboidal and confined to the cortex, but they are thinner and almost
entirely lack microvilli
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Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Nephrons
Two types of nephrons
Cortical
Removal of waste products
Reabsorption of filtered nutrients
Juxtamedullary
Longer loops of Henle
Urine concentration

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Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Nephrons
Nephron Capillary Beds
Glomerulus
Specialized for filtration
It differs from all other capillary beds in the body in that it is both fed and
drained by arteriolesthe afferent arteriole and efferent arteriole,
respectively.
Peritubular capillaries
These low-pressure, porous capillaries readily absorb solutes and water
from the tubule cells.
Vasa recta
Plays an important role in forming concentrated urine

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Urinalysis and Body Fluids, 5th Edition

Nephrons
Nephron Capillary Beds
Juxtaglomerular Complex
Region where the most distal portion of the ascending limb of the
nephron loop lies against the afferent arteriole feeding the glomerulus
(and sometimes the efferent arteriole).
Cells in the JGC
Macula Densa
Closely packed cells in the ascending limb of the nephron loop that
lies adjacent to the granular cells
Chemoreceptors that monitor the NaCl content of the filtrate
entering the distal convoluted tubule
Granular cells / Juxtaglomerular cells
Enlarged smooth muscle cells with prominent secretory granules
containing the enzyme renin
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Urinalysis and Body Fluids, 5th Edition

Nephrons
Nephron Capillary Beds
Juxtaglomerular Complex
Cells in the JGC
Extraglomerular mesangial cells
These cells may pass regulatory signals between macula densa
and granular cells.

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Urinalysis and Body Fluids, 5th Edition

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Urinalysis and Body Fluids, 5th Edition

Kidney Physiology: Mechanisms of Urine


Formation
Glomerular filtration
takes place in the renal corpuscle and
produces a cell- and protein-free filtrate.
Tubular reabsorption
is the process of selectively moving
substances from the filtrate back into
the blood.
It takes place in the renal tubules and
collecting ducts.
Tubular secretion
is the process of selectively moving
substances from the blood into the
filtrate.
it occurs along the length of the tubule
and collecting duct.
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Urinalysis and Body Fluids, 5th Edition

Nephron Functions
Renal blood flow
Glomerular filtration
Tubular reabsorption
Tubular secretion

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Urinalysis and Body Fluids, 5th Edition

Renal Blood Flow


Afferent arteriole (renal artery)
Blood enters the glomerulus
Efferent arteriole
Blood leaves the glomerulus
Peritubular capillaries /proximal convoluted tubule
Vasa recta/loops of Henle
Peritubular capillaries/distal convoluted tubule
Renal vein

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Urinalysis and Body Fluids, 5th Edition

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Renal Plasma Flow


Average body size
Renal blood flow = 1200 mL/min
Renal plasma flow = 600-700 mL/min

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Urinalysis and Body Fluids, 5th Edition

Glomerular Filtration
Definition: is a passive process in which hydrostatic pressure forces fluids and
solutes through a membrane.
Filtration membrane
lies between the blood and the interior of the glomerular capsule.
allows free passage of water and solutes smaller than plasma proteins.
Parts:
Fenestrated endothelium: allow all blood components except blood
cells to pass through.
Basement membrane: forms a physical barrier that blocks all but the
smallest proteins while still permitting most other solutes to pass.
Foot processes of podocytes: If any macromolecules manage to
make it through the basement membrane, slit diaphragmsthin
membranes that extend across the filtration slitsprevent almost all of
them from traveling farther.

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Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

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Urinalysis and Body Fluids, 5th Edition

Glomerular Filtration
Pressures That Affect Filtration
Outward Pressures: promote filtrate formation.
Hydrostatic pressure: It is the chief force pushing water and solutes out
of the blood and across the filtration membrane.
Inward Pressures: Two inward forces inhibit filtrate formation by opposing
HPgc
Hydrostatic pressure in the capsular space (HPcs) is the
pressure exerted by filtrate in the glomerular capsule.

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Urinalysis and Body Fluids, 5th Edition

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Urinalysis and Body Fluids, 5th Edition

Renin-Angiotensin-Aldosterone
System (RAAS)
Regulates blood flow
Responds to blood pressure and plasma sodium
changes
Juxtaglomerular apparatus
Juxtaglomerular cells afferent arteriole
Macula densa efferent arteriole
Macula densa initiates RAAS in response to blood
pressure changes
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Urinalysis and Body Fluids, 5th Edition

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Urinalysis and Body Fluids, 5th Edition

RAAS Cascade
Renin secreted by juxtagolomerular cells
Angiotensinogenblood substance
Angiostensin 1passes through lungs
Angiotensin-converting enzyme (ACE)
Angiotensin II
Aldosterone

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Urinalysis and Body Fluids, 5th Edition

Functions of Angiotensin II
Dilates afferent arteriole
Constricts efferent arteriole
Stimulate sodium reabsorption in proximal convoluted
tubule (PCT)
Trigger release of aldosterone
Reabsorption of sodium in distal convoluted tubule (DCT)
and collecting duct (CD)
Increase potassium excretion
Trigger release of antidiuretic hormone (ADH)
Stimulates water reabsorption in CD
Copyright 2008. F.A. Davis Company
Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Glomerular Filtrate
Normal
120 mL/min of filtrate
Composition
Ultrafiltrate of plasma
Same composition minus plasma proteins,
protein-bound substances, and cells
Ultrafiltrate specific gravity = 1.010

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Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Tubular Reabsorption
Active transport
Cellular energy and carrier proteins needed for
transport back to blood
Glucose, salts (Na is highest), amino acids in
proximal convoluted tubule
Chloride in ascending loop of Henle
Sodium in distal convoluted tubule

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Urinalysis and Body Fluids, 5th Edition

Tubular Reabsorption (contd)


Passive transport
Controlled by substance concentration gradients
on sides of a membrane
Water reabsorption occurs throughout the
nephron
Exceptionis ascending loop of Henle
Accompanies high amount of sodium reabsorption in
PCT
Urea in PCT and ascending loop of Henle
Sodium in the ascending loop of Henle
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Urinalysis and Body Fluids, 5th Edition

Maximal Reabsorptive Capacity (Tm)


Plasma level at which active transport ceases
Renal threshold: plasma level causing active
transport to cease
Normally reabsorbed substance appears in urine
Glucose threshold = 160-180 mg/dL
Normal blood sugar, urine glucose = tubular
damage

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Urinalysis and Body Fluids, 5th Edition

Tubular Concentration
Descending loop of Henle
Passive reabsorption of water into the highly
concentrated medulla
Ascending loop of Henle
Walls are impermeable to water
Chloride actively reabsorbed
Sodium passively reabsorbed

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Urinalysis and Body Fluids, 5th Edition

Tubular Concentration (contd)


Countercurrent mechanism
Maintains concentration in the medulla
Medulla is diluted by the water from the
descending loop
Reconcentrated by sodium and chloride from the
filtrate in the ascending loop
DCT
Aldosterone-controlled Na reabsorption if needed
by body
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Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company


Urinalysis and Body Fluids, 5th Edition

CD Reabsorption
Final filtrate concentration
Water reabsorption controlled by ADH in response
to body hydration
ADH
Controls permeability of DCT and CT walls to
water
Amount of ADH produced by hypothalamus
determines permeability

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Urinalysis and Body Fluids, 5th Edition

Body Hydration = ADH = Urine

Volume
Body Hydration = ADH = Urine

Volume

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Tubular Secretion

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Urinalysis and Body Fluids, 5th Edition

Functions
Reabsorption = filtrate to blood
Secretion = blood to filtrate
Eliminate nonfiltered wastes
Protein-bound substances
Regulate acid-base balance
Secrete H+ ions to return filtered buffers to the blood
Excretion of excess H+ ions

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Urinalysis and Body Fluids, 5th Edition

Bicarbonate
Secretion of H+
prevents excretion
of HCO3-
Filtered bicarbonate
is returned to the
plasma

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Urinalysis and Body Fluids, 5th Edition

Phosphate
Small hydrogen ions
are readily reabsorbed
and may need to be
excreted
Excess hydrogen ions
not needed to return
filtered bicarbonate are
excreted as
H2PO4

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Urinalysis and Body Fluids, 5th Edition

Ammonia
Ammonia (NH3) is
produced and secreted
by the DCT
H+ combines to form
NH4+ that cannot be
reabsorbed
Additional ammonia is
produced from the
metabolism of
glutamine in the PCT
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Urinalysis and Body Fluids, 5th Edition

Renal Function Tests


Tests evaluate:
Glomerular filtration
Tubular reabsorption
Tubular secretion
Renal blood flow

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Urinalysis and Body Fluids, 5th Edition

Copyright 2008. F.A. Davis Company