12.

1 Waste Excretion and Equilibrium

When the body converts large organic molecules into simpler ones, some of these simpler molecules are harmful to the body. In order for life to continue, the body must successfully excrete these toxic substances. The kidneys play a crucial role in removing waste, balancing blood pH, and maintaining water balance. Canadians consume more protein than is required. Protein contains nitrogen. The amino group (NH2) must be excreted from the body. The liver begins this process by converting NH2 to ammonia. This is referred to as deamination. Ammonia is a water-soluble gas and is extremely toxic. In the liver molecules of ammonia combine with carbon dioxide to form urea which is much less toxic. Uric acid is another waste product produced in the liver from the breakdown of nucleic acids, like DNA, for example. The kidneys play a very important role in regulating water balance in the body. You would die in a few days without ingesting water. In order to maintain proper water levels in the body, humans must consume 2 L of fluids each day. Anatomy of the Urinary System Renal arteries bring blood to the kidneys. The kidneys may hold up to 25% of the bodys blood at any one time. Wastes are filtered out of the blood and are carried to the bladder by the ureters. The bladder has a sphincter muscle that helps to control the time of urination. As the bladder fills up, messages are sent to the brain, creating the sensation of having to go. The more full it gets, the stronger the sensation. When urination occurs, urine enters the urethra to be voided from the body. The kidney has an outer layer called the renal cortex. The middle layer is called the renal medulla. The innermost, hollow area is called the renal pelvis. It is from here that urine exits the kidney through the ureter. Nephrons Your kidneys have about 1 000 000 nephrons. They are the functional units, doing the processing required to make urine. A small branch off the renal artery called the afferent arteriole, brings blood to the nephron. The afferent arterioles branch into a capillary bed called the glomerulus. Blood leaves the glomerulus again through the efferent arteriole. Blood then travels through a capillary net called the peritubular capillaries that wrap around the kidney tubule. Blood then leaves the nephron through a venule that meets the renal vein. The glomerulus is surrounded by a funnel-shaped portion of the nephron called the Bowmans capsule. The Bowmans capsule, afferent arteriole, and the efferent arteriole are located in the cortex of the kidney. Fluid to be processed leaves the bloodstream and enters the Bowmans capsule.

 The fluid then travels to the proximal tubule. From there it moves on to the loop of Henle (this loop decends into the renal medulla). Urine then moves on to the distal tubule, the last part of the nephron, into the collecting ducts. The collecting ducts drain urine into the renal pelvis. Formation of Urine There are three steps to urine formation. Filtration As blood flows through the glomerulus, fluid moves from it into the Bowmans capsule due to the pressure gradient. Small dissolved molecules move from the glomerulus into the Bowmans capsule. Plasma proteins, blood cells, and platelets are too big to leave the glomerulus and stay behind in the blood. Below is a table that illustrates the presence of various substances in the glomerulus versus the Bowmans capsule: Reabsorption Solute Glomerulus Bowmans Capsule About 20% of the fluid that enters the glomerulus is Water Yes Yes filtered into the nephron. Sodium Yes Yes It is necessary for much of that fluid to be reabsorbed into chloride the bloodstream, otherwise you would create massive Glucose Yes Yes amounts of urine and be constantly dehydrated. Amino acids Yes Yes Aldosterone is a hormone that is essential for proper Hydrogen ions Yes Yes reabsorption. It causes the reabsoption of Na+ ions into the bloodstream. This changes the osmotic balance and as Urea Yes Yes a result, more water moves into the blood from the Plasma Yes No nephron. proteins Erythrocytes Yes No Na+ ions are brought into the nephron by carrier molecules. Negative ions like Cl- and HCO3- are attracted Platelets Yes No to the positive ions and follow them into the nephron as well. The nephron is lined with mitochondria to supply the necessary ATP for this active transport. Reabsorption occurs until the threshold level (the maximum amount of a substance that can be moved into the nephron) is reached. Excess salt is excreted in the urine. Other substances are actively transported from the proximal tubule . Glucose and amino acids attach to carrier molecules that transport them into the blood. Only so much can be reabsorbed though. The rest will be excreted in urine. The more solutes there are in the bloodstream draw water back into the blood as well due to the osmotic gradient. The plasma proteins that stay in the blood also draw water back into the bloodstream from the interstitial fluid as well. As water leaves the nephron and gets reabsorbed, the solutes left in the nephron become very concentrated. Some molecules of urea and uric acid diffuse back into the blood. Secretion Secretion is the movement of wastes from the blood back into the nephron. This includes ammonia, excess H+ ions, and minerals like K+. Even drugs, such as penicillin, can be secreted.

 There are many mitochondria in the cells that line the distal tubule. They supply the energy required by carrier molecules to move substances against their concentration gradient back into the nephron. Study Table 3, pg. 383. pH Balance The kidneys also help to restore proper pH in the blood. The body produces several substances that would affect pH levels, such as carbonic acid (from respiration). Carbonic acid and other acids produce H+ ions which lowers pH. The pH balance is maintained by buffer systems that absorb excess H+ ions, or negative ions that act a bases. Bicarbonate ions, HCO3-, buffer excess H+ ions in the blood. This produces carbonic acid. The carbonic acid then breaks down to form carbon dioxide and water. The kidneys reverse this reaction to help restore this buffer system. Carbon dioxide is actively transported from the peritubular capillaries into the nephron. The carbon dioxide then combines with water, generating HCO3- and H+ ions. The bicarbonate ions then diffuse back into the bloodstream where they can be used again to buffer the blood. The H+ ions are excreted in urine.

12.2 Kidney Dysfunction

Many kidney disorders can be diagnosed through urinalysis. Diabetes Mellitus Diabetes mellitus is caused by a low to no secretion of insulin from the islet cells of the pancreas. This causes blood glucose levels to rise. Sufferers need to have daily injections of insulin to control their blood glucose. Reabsorption can move only so much glucose back into the blood. Sufferers of diabetes mellitus have very high blood glucose levels, so there is a lot of glucose that cant be reabsorbed into the blood. As a result, glucose is excreted in their urine. This sets up an osmotic gradient causing a lot of water to be excreted in urine. Therefore, suffers are often dehydrated and thirsty. Diabetes Insipidus Diabetes insipidus is caused by the undersecretion of ADH (antidiuretic hormone) from the pituitary gland. ADH makes the distal tubule and collecting ducts more permeable to water, so urine becomes more concentrated when it is released. People with diabetes insipidus excrete abnormally high amounts of dilute urine, up to 20 L per day. Nephritis The term nephritis is used to describe a number of disorders, all of which cause the inflammation of nephrons. Capillaries in the nephron break and allow blood cells and other large components of blood to find way into the Bowmans capsule, and eventually, urine. Urine will contain blood and test positive for the presence of protein. Protein molecules (among other things) draw more water into the nephron. This increases urine output. Nephritis can lead to kidney failure are even death. Kidney Stones Kidney stones are caused by the precipitation of mineral solutes from the blood. If these stones lodge in the renal pelvis they may block urine from reaching the ureter and being excreted by the body. As the stone moves, it damages tissues and causes terrible pain. To treat kidney stones in the past, surgery was required.

 However, nowadays doctors may use high frequency sound waves to blast the stones apart. The smaller granules may be able to be passed without the requirement of surgery. Dialysis Technology If a person cant normally process waste a dialysis machine can help restore the normal solute balance in blood. In dialysis, substances are exchanged across a semipermeable membrane. There are two types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, a machine is connected to a patients vein. The patients blood flows through a machine where solutes diffuse out the blood into dialysis solution. As the solution is frequently changed, things like urea and uric acid are being constantly diffused out of the blood. During this dialysis, hormones the kidneys normally make get added to the patients blood. In peritoneal dialysis, 2 L of dialysis fluid is pumped into the abdomen. Urea and other wastes diffuse from tissue into the fluid. Over the course of a day, the fluid is replaced several times. While dialysis has allowed many people to survive long enough to allow their kidneys to heal, or to get a kidney transplant, it is not perfect. It cant produce the hormones that the kidneys make. Kidney Transplants Kidney transplants are successful in about 85% of all cases. A transplanted kidney does a much better job than dialysis. However, kidney transplant patients must take immunosuppressant drugs that have a host of complications. A simple cold becomes a big issue for a transplant patient. In a kidney transplant, a new kidney and new ureter are placed in the lower abdomen, near the groin. The old kidneys are rarely removed.