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1
Renal Structure and Function
2
Kidneys
• Paired
• Retroperitoneal
• Partially protected by the 11th
and 12th
ribs
• Right slightly lower due to liver
• Surrounded by renal capsule
• Adipose capsule
• Renal fascia
3
4
5
Anatomy
• Hilum (hilus)
• Renal artery and vein
• Cortex
• Medulla
• Renal pyramids and renal papillae
• Major and minor calyces
• Renal Pelvis
• Ureters
6
7
• Ureters connect kidneys to urinary bladder
• Urethra leads from bladder outside the
body
8
9
• Kidneys make up 1 % of body mass, but
receive about 25% of cardiac output.
• Kidney has two major functions:
1. Filtration of blood
• Removes metabolic wastes from the body,
esp. those containing nitrogen
10
2. Regulation:
Blood volume and composition
Electrolytes
Blood pH
Blood pressure
11
Nephron
• Functional unit of the kidney
• Filtration, tubular reabsorption, tubular
secretion
• Renal corpuscle:
– Glomerulus – capillaries
– Glomerular or Bowman’s capsule
12
• Bowman’s capsule
– Receives filtrate
• Proximal convoluted tubule
– Reabsorption of water and solutes
• Nephron loop or Loop of Henle
– Regulates concentration of urine
• Distal convoluted tubule and Collecting
duct
• Reabsorption of water and electrolytes
–ADH, aldosterone, ANP
– Tubular secretion
13
14
15
16
17
Filtration
• Renal corpuscle
• Filtration membrane
– Fenestrated endothelium of capillaries
– Basement membrane of glomerulus
– Slit membrane between pedicels of podocytes
18
Forces that influence filtration
• Glomerular blood hydrostatic pressure
• Opposing forces:
– Plasma colloid osmotic pressure
– Capsular hydrostatic pressure
19
20
Glomerular Filtration Rate
• Volume of plasma filtered / unit time
• Approx. 180 L /day
• Urine output is about 1- 2 L /day
• About 99% of filtrate is reabsorbed
21
22
GFR influenced by:
• Blood pressure and blood flow
• Obstruction to urine outflow
• Loss of protein-free fluid
• Hormonal regulation
– Renin – angiotensin
– Aldosterone
– ADH
– ANP
23
Juxtaglomerular apparatus
• Juxtaglomerular cells lie in the wall of
afferent arteriole
• Macula densa in final portion of loop of
Henle – monitor Na+
and Cl-
conc. and
water
• Control blood flow into the glomerulus
• Control glomerular filtration
24
25
26
Tubular reabsorption
• Water, glucose, amino acids, urea, ions
• Sodium diffuses into cell; actively pumped
out – drawing water with it
27
28
29
• In addition to reabsorption, also have
tubular secretion – substances move from
peritubular capillaries into tubules – a
second chance to remove substances
from blood.
30
31
• By end of proximal tubule have
reabsorbed:
• 60- 70% of water and sodium
• about 100% of glucose and amino acids
• 90 % of K+, bicarb, Ca++, uric acid
• Transport maximum – maximum amount
of a substance that can be absorbed per
unit time
• Renal threshold – plasma conc. of a
substance at which it exceeds Tm.
32
Loop of Henle
• Responsible for producing a concentrated
urine by forming a concentration gradient
within the medulla of kidney.
• When ADH is present, water is
reabsorbed and urine is concentrated.
• Counter-current multiplier
33
34
Distal convoluted tubule and
collecting ducts
• What happens here depends on ADH
• Aldosterone affects Na+ and K+
• ADH – facultative water reabsorption
• Parathyroid hormone – increases Ca++
reabsorption
35
36
Distal convoluted tubule and
collecting ducts
• Tubular secretion to rid body of
substances: K+, H+, urea, ammonia,
creatinine and certain drugs
• Secretion of H+ helps maintain blood pH
(can also reabsorb bicarb and generate
new bicarb)
37
38
Renal diagnostic procedures
• Urinalysis is non-invasive and inexpensive
• Normal properties are well known and
easily measured
39
pH
• Normally 4.8 – 8.0
• Higher in alkalosis, lower in acidosis
• Diabetes and starvation ↓ pH
• Urinary infections ↑ pH
– Proteus and pseudomonas are urea splitters
40
Specific gravity
• Normal values 1.025 -1.032
• High specific gravity can cause
precipitation of solutes and formation of
kidney stones
• When tubules are damaged, urine specific
gravity approaches that of glomerular
filtrate – 1.010 – remains fixed = 2/3 of
nephron mass has been lost
41
• Diabetes insipidus = 1.003
• Diabetes mellitus = 1. 030
• Emesis or fever = 1.040
42
Microscopic analysis
• Red blood cells – should be few or none
– Hematuria – large numbers of rbc’s in urine
– Catheterization
– Menstruation
– Inflamed prostate gland
– Cystitis or bladder stones
43
• Casts – precipitate from cells lining the
renal tubules
– Red cells – tubule bleeding
– White cells – tubule inflammation
– Epithelial cells – degeneration, necrosis of
tubule cells
44
• Crystals –
– Infection
– Inflammation
– stones
45
• White blood cells
– Pyuria
– Urinary tract infection
• Bacteria
46
Substances not normally present in
urine
• Acetone
• Bile, bilirubin
• Glucose
• Protein – albumin
–Renal disease involving glomerulus
47
Blood Urea Nitrogen BUN
• Urea produced by breakdown of amino
acids - influenced by diet, dehydration,
and hemolysis
• Normal range 10-20 mg/ dL
• If the GFR decreases due to renal disease
or blockage, or decreased blood flow to
kidney - BUN increases
• General screen for abnormal renal
function
48
Creatinine clearance
• Creatinine is an end product of muscle
metabolism
• Muscle mass is constant; creatinine is
constant
• Normal 0.7 – 1.5 mg/ dL in plasma
• Can then be compared to creatinine in
urine over 24 hour period to determine
clearance
49
• Creatinine clearance is an indirect
measure of GFR and renal blood flow
• Creatinine is neither reabsorbed nor
secreted, just freely filtered.
• Amount excreted = amount filtered
• Useful to monitor changes in chronic renal
function
• Increases with trauma with massive
muscle breakdown
50
Diagnostic testing
• Inulin clearance - not absorbed or
secreted = GFR
• PAH – para-aminohippuric acid – not
absorbed ; actively secreted = renal
plasma flow

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Renal structure and function physiology

  • 2. 2 Kidneys • Paired • Retroperitoneal • Partially protected by the 11th and 12th ribs • Right slightly lower due to liver • Surrounded by renal capsule • Adipose capsule • Renal fascia
  • 3. 3
  • 4. 4
  • 5. 5 Anatomy • Hilum (hilus) • Renal artery and vein • Cortex • Medulla • Renal pyramids and renal papillae • Major and minor calyces • Renal Pelvis • Ureters
  • 6. 6
  • 7. 7 • Ureters connect kidneys to urinary bladder • Urethra leads from bladder outside the body
  • 8. 8
  • 9. 9 • Kidneys make up 1 % of body mass, but receive about 25% of cardiac output. • Kidney has two major functions: 1. Filtration of blood • Removes metabolic wastes from the body, esp. those containing nitrogen
  • 10. 10 2. Regulation: Blood volume and composition Electrolytes Blood pH Blood pressure
  • 11. 11 Nephron • Functional unit of the kidney • Filtration, tubular reabsorption, tubular secretion • Renal corpuscle: – Glomerulus – capillaries – Glomerular or Bowman’s capsule
  • 12. 12 • Bowman’s capsule – Receives filtrate • Proximal convoluted tubule – Reabsorption of water and solutes • Nephron loop or Loop of Henle – Regulates concentration of urine • Distal convoluted tubule and Collecting duct • Reabsorption of water and electrolytes –ADH, aldosterone, ANP – Tubular secretion
  • 13. 13
  • 14. 14
  • 15. 15
  • 16. 16
  • 17. 17 Filtration • Renal corpuscle • Filtration membrane – Fenestrated endothelium of capillaries – Basement membrane of glomerulus – Slit membrane between pedicels of podocytes
  • 18. 18 Forces that influence filtration • Glomerular blood hydrostatic pressure • Opposing forces: – Plasma colloid osmotic pressure – Capsular hydrostatic pressure
  • 19. 19
  • 20. 20 Glomerular Filtration Rate • Volume of plasma filtered / unit time • Approx. 180 L /day • Urine output is about 1- 2 L /day • About 99% of filtrate is reabsorbed
  • 21. 21
  • 22. 22 GFR influenced by: • Blood pressure and blood flow • Obstruction to urine outflow • Loss of protein-free fluid • Hormonal regulation – Renin – angiotensin – Aldosterone – ADH – ANP
  • 23. 23 Juxtaglomerular apparatus • Juxtaglomerular cells lie in the wall of afferent arteriole • Macula densa in final portion of loop of Henle – monitor Na+ and Cl- conc. and water • Control blood flow into the glomerulus • Control glomerular filtration
  • 24. 24
  • 25. 25
  • 26. 26 Tubular reabsorption • Water, glucose, amino acids, urea, ions • Sodium diffuses into cell; actively pumped out – drawing water with it
  • 27. 27
  • 28. 28
  • 29. 29 • In addition to reabsorption, also have tubular secretion – substances move from peritubular capillaries into tubules – a second chance to remove substances from blood.
  • 30. 30
  • 31. 31 • By end of proximal tubule have reabsorbed: • 60- 70% of water and sodium • about 100% of glucose and amino acids • 90 % of K+, bicarb, Ca++, uric acid • Transport maximum – maximum amount of a substance that can be absorbed per unit time • Renal threshold – plasma conc. of a substance at which it exceeds Tm.
  • 32. 32 Loop of Henle • Responsible for producing a concentrated urine by forming a concentration gradient within the medulla of kidney. • When ADH is present, water is reabsorbed and urine is concentrated. • Counter-current multiplier
  • 33. 33
  • 34. 34 Distal convoluted tubule and collecting ducts • What happens here depends on ADH • Aldosterone affects Na+ and K+ • ADH – facultative water reabsorption • Parathyroid hormone – increases Ca++ reabsorption
  • 35. 35
  • 36. 36 Distal convoluted tubule and collecting ducts • Tubular secretion to rid body of substances: K+, H+, urea, ammonia, creatinine and certain drugs • Secretion of H+ helps maintain blood pH (can also reabsorb bicarb and generate new bicarb)
  • 37. 37
  • 38. 38 Renal diagnostic procedures • Urinalysis is non-invasive and inexpensive • Normal properties are well known and easily measured
  • 39. 39 pH • Normally 4.8 – 8.0 • Higher in alkalosis, lower in acidosis • Diabetes and starvation ↓ pH • Urinary infections ↑ pH – Proteus and pseudomonas are urea splitters
  • 40. 40 Specific gravity • Normal values 1.025 -1.032 • High specific gravity can cause precipitation of solutes and formation of kidney stones • When tubules are damaged, urine specific gravity approaches that of glomerular filtrate – 1.010 – remains fixed = 2/3 of nephron mass has been lost
  • 41. 41 • Diabetes insipidus = 1.003 • Diabetes mellitus = 1. 030 • Emesis or fever = 1.040
  • 42. 42 Microscopic analysis • Red blood cells – should be few or none – Hematuria – large numbers of rbc’s in urine – Catheterization – Menstruation – Inflamed prostate gland – Cystitis or bladder stones
  • 43. 43 • Casts – precipitate from cells lining the renal tubules – Red cells – tubule bleeding – White cells – tubule inflammation – Epithelial cells – degeneration, necrosis of tubule cells
  • 44. 44 • Crystals – – Infection – Inflammation – stones
  • 45. 45 • White blood cells – Pyuria – Urinary tract infection • Bacteria
  • 46. 46 Substances not normally present in urine • Acetone • Bile, bilirubin • Glucose • Protein – albumin –Renal disease involving glomerulus
  • 47. 47 Blood Urea Nitrogen BUN • Urea produced by breakdown of amino acids - influenced by diet, dehydration, and hemolysis • Normal range 10-20 mg/ dL • If the GFR decreases due to renal disease or blockage, or decreased blood flow to kidney - BUN increases • General screen for abnormal renal function
  • 48. 48 Creatinine clearance • Creatinine is an end product of muscle metabolism • Muscle mass is constant; creatinine is constant • Normal 0.7 – 1.5 mg/ dL in plasma • Can then be compared to creatinine in urine over 24 hour period to determine clearance
  • 49. 49 • Creatinine clearance is an indirect measure of GFR and renal blood flow • Creatinine is neither reabsorbed nor secreted, just freely filtered. • Amount excreted = amount filtered • Useful to monitor changes in chronic renal function • Increases with trauma with massive muscle breakdown
  • 50. 50 Diagnostic testing • Inulin clearance - not absorbed or secreted = GFR • PAH – para-aminohippuric acid – not absorbed ; actively secreted = renal plasma flow