‫االسم ‪ /‬محمود محمد فخري إسماعيل رمضان‬

‫الفرقة‪ /‬الثانية‬
‫‪/‬عنوان المقال ‪Renal physiology‬‬
‫سكشن ‪12/‬‬
 Renal physiology
Introduction
the study of the physiology of the kidney. This encompasses all functions
of the kidney, including maintenance of acid-base balance; regulation of
fluid balance; regulation of sodium, potassium, and other electrolytes;
clearance of toxins; absorption of glucose, amino acids, and other small
molecules; regulation of blood pressure; production of various hormones,
such as erythropoietin; and activation of vitamin D. Much of renal
physiology is studied at the level of the nephron, the smallest functional
unit of the kidney.

Each nephron begins with a filtration component that filters the blood
entering the kidney. This filtrate then flows along the length of the
nephron, which is a tubular structure lined by a single layer of specialized
cells and surrounded by capillaries. The major functions of these lining
cells are the reabsorption of water and small molecules from the filtrate
into the blood, and the secretion of wastes from the blood into the urine.
Proper function of the kidney requires that it receives and adequately
filters blood. This is performed at the microscopic level by many
hundreds of thousands of filtration units called renal corpuscles, each of
which is composed of a glomerulus and a Bowman's capsule. A global
assessment of renal function is often ascertained by estimating the rate of
filtration, called the glomerular filtration rate (GFR)

The Basic Components of the Kidney

 Outer fibrous capsule: A tough outer capsule surrounds the

parenchyma and this prevents the kidney expanding. It is easily
stripped away from a healthy kidney but adheres where pathology
has occurred.
  Renal Cortex: 2 Parts. External zone. Internal zone (juxtamedullar).
Contains the following parts of the nephron (Renal corpuscle,
Proximal convoluted tubule, Distal convoluted tubule and
Medullary Rays).
 The Inner Stripe: Located inside of the outer stripe this section
contains the following parts: Thin ascending and thick ascending
limbs of the loop of henle. Outer medullary collecting ducts.

Function: The kidneys excrete a variety of waste products produced by

metabolism into the urine. The microscopic structural and functional unit
of the kidney is the nephron. It processes the blood supplied to it via
filtration, reabsorption, secretion and excretion; the consequence of those
processes is the production of urine. These include the nitrogenous wastes
urea, from protein catabolism, and uric acid, from nucleic acid
metabolism. The ability of mammals and some birds to concentrate
wastes into a volume of urine much smaller than the volume of blood
from which the wastes were extracted is dependent on an elaborate
countercurrent multiplication mechanism. This requires several
independent nephron characteristics to operate: a tight hairpin
configuration of the tubules, water and ion permeability in the descending
limb of the loop, water impermeability in the ascending loop, and active
ion transport out of most of the ascending limb. In addition, passive
countercurrent exchange by the vessels carrying the blood supply to the
nephron is essential for enabling this function. The kidney participates in
whole-body homeostasis, regulating acid-base balance, electrolyte
concentrations, extracellular fluid volume, and blood pressure. The
kidney accomplishes these homeostatic functions both independently and
in concert with other organs, particularly those of the endocrine system.
Various endocrine hormones coordinate these endocrine functions; these
include renin, angiotensin II, aldosterone, antidiuretic hormone, and atrial
natriuretic peptide, among others.

Formation of urine:

 Filtration, which takes place at the renal corpuscle, is the process

by which cells and large proteins are retained while materials of
smaller molecular weights are filtered from the blood to make an
ultrafiltrate that eventually becomes urine. The kidney generates
180 liters of filtrate a day. The process is also known as hydrostatic
filtration due to the hydrostatic pressure exerted on the capillary
walls.
 Reabsorption: Tubular reabsorption is the process by which
solutes and water are removed from the tubular fluid and
transported into the blood. It is called reabsorption (and not
absorption) both because these substances have already been
absorbed once (particularly in the intestines) and because the body
is reclaiming them from a postglomerular fluid stream that is well
on its way to becoming urine (that is, they will soon be lost to the
urine unless they are reclaimed).
 Reabsorption is a two-step process beginning with the active or
passive extraction of substances from the tubule fluid into the renal
interstitium (the connective tissue that surrounds the nephrons),
and then the transport of these substances from the interstitium into
the bloodstream. These transport processes are driven by Starling
forces, diffusion, and active transport.
 Influence of hormones: Some key regulatory hormones for
reabsorption include:
1- aldosterone, which stimulates active sodium reabsorption (and
water as a result)
 2- antidiuretic hormone, which stimulates passive water reabsorption

Both hormones exert their effects principally on the collecting ducts.

Tubular secretion occurs simultaneously during reabsorption of

filtrate. Substances, generally produced by body or the by-products

of cell metabolism that can become toxic in high concentration,

and some drugs (if taken). These all are secreted into the lumen of
renal tubule. Tubular secretion can be either active or passive or
co-transport. Substances mainly secreted into renal tubule are; H+,
K+, NH3, urea, creatinine, histamine and drugs like penicillin.
Tubular secretion occurs at Proximal Convoluted Tubule (PCT)
and Distal Convoluted Tubule (DCT); for example, at proximal
convoluted tubule, potassium is secreted by means of sodium-
potassium pump, hydrogen ion is secreted by means of active
transport and co-transport, i.e. antiporter, and ammonia diffuses
into renal tubule.

Hormone secretion: The kidneys secrete a variety of hormones,

including erythropoietin, calcitriol, and renin. Erythropoietin is released
in response to hypoxia (low levels of oxygen at tissue level) in the renal
circulation. It stimulates erythropoiesis (production of red blood cells) in
the bone marrow. Calcitriol, the activated form of vitamin D, promotes
intestinal absorption of calcium and the renal reabsorption of phosphate.
Renin is an enzyme which regulates angiotensin and aldosterone levels.

Blood pressure: Although the kidney cannot directly sense blood, long-
term regulation of blood pressure predominantly depends upon the
kidney. This primarily occurs through maintenance of the extracellular
fluid compartment, the size of which depends on the plasma sodium
concentration. Renin is the first in a series of important chemical
messengers that make up the renin–angiotensin system. Changes in renin
ultimately alter the output of this system, principally the hormones
angiotensin II and aldosterone. Each hormone acts via multiple
mechanisms, but both increase the kidney's absorption of sodium
chloride, thereby expanding the extracellular fluid compartment and
raising blood pressure. When renin levels are elevated, the concentrations
of angiotensin II and aldosterone increase, leading to increased sodium
chloride reabsorption, expansion of the extracellular fluid compartment,
and an increase in blood pressure. Conversely, when renin levels are low,
angiotensin II and aldosterone levels decrease, contracting the
extracellular fluid compartment, and decreasing blood pressure.

Osmolality: The kidneys help maintain the water and salt level of the
body. Any significant rise in plasma osmolality is detected by the
hypothalamus, which communicates directly with the posterior pituitary
gland. An increase in osmolality causes the gland to secrete antidiuretic
hormone (ADH), resulting in water reabsorption by the kidney and an
increase in urine concentration. The two factors work together to return
the plasma osmolality to its normal levels.

Glucose formation: The kidney in humans is capable of producing

glucose from lactate, glycerol and glutamine. The kidney is responsible
for about half of the total gluconeogenesis in fasting humans. The
regulation of glucose production in the kidney is achieved by action of
insulin, catecholamines and other hormones. Renal gluconeogenesis takes
place in the renal cortex. The renal medulla is incapable of producing
glucose due to absence of necessary enzymes.