26.

1 fuctions of the urinary system  RENAL SINUS (space) - medial side of the kidney that is continuous with an
adipose and connective tissue-filled cavity of the kidney; The renal artery and
URINARY SYSTEM
nerves enter the kidney at the hilum then pass through the renal sinus.
 Major excretory system (primary excretory organs)
 Consits of 2 kidneys
 Each kidney has a tube attached to it called the ureter that carries wastes
liquids going into a single urinary bladder and is emptied by the urethra
 Filters large volume of blood
 The waste collected forms urine consisting of excess water, ions, metabolic
wastes, toxic substances
FUNCTIONS
1. Excretion
2. Regulation of blood volume and pressure
3. Regulation of blood solute concentrations
4. Regulation of extracellular fluid pH
5. Regulation of red blood cell synthesis
6. Regulation of vitamin D synthesis
26.2 Kidney Anatomy and Histology
LOCATION AND EXTERNAL ANATOMY OF THE KIDNEYS
 bean-shaped
 adrenal gland located superior pole of the kidney
 RETROPERITONEAL - behind the peritoneum located on each side of the
vertebral column near the psoas major muscles; extend from the lower portion
of the rib cage at the level of the last thoracic (T12) vertebra to the third lumbar
(L3) vertebra; measures about 11 cm long, 5 cm wide, and 3 cm thick, and each
weighs about 130 g
 RENAL CAPSULE – an outer layer of connective tissue surrounding the
kidneys; an adipose tissue surrounds the renal capsule which cushions and
protects the kidneys
 RENAL FASCIA - thin layer of connective tissue that anchor the kidneys to the
abdominal wall.
 HILUM - a small area on the concave
INTERNAL ANATOMY AND HISTOLOGY OF THE KIDNEYS TYPES OF NEPHRONS
 Organized into 2 major regions: 1. Outer cortex 2. Inner medulla (surrounds  JUXTAMEDULLARY NEPHRONS - have renal corpuscles that are found
renal sinus) deep in the cortex near the medulla; have long loops of HENLE that are well
adapted for water conservtion.
MEDULLA
 CORTICOL NEPHRONS - have renal corpuscles that are distributed
 RENAL PYRAMIDS – cone-shaped structures whose bases project into the throughout the cortex; have short hoops of HENLE which are more closer
cortex; a collection of tubes and ducts that transport fluid throughout the kidney to the outer edge of cortex
and modify it into urine then transports it towards the renal sinus
 MEDULARY RAYS – projection of the renal pyramid
 RENAL COLUMNS - extensions of cortical tissue toward the medulla between
renal pyramids.
 RENAL PAPILAE - tips of the pyramids that points toward the renal sinus.
 MINOR CALYX - small, funnel-shaped chamber surrounding the tip of the
papilla; 8 and 20 minor calyces forms into
 MAJOR CALYX - larger, funnel-shaped chamber; 2 or 3 major calyces
 RENAL PELVIS - funnel-shaped chamber, embedded in and surrounded by
the renal sinus
 hilum narrows down into small diameter forming URETER
URINE – from RP empties into MC to MJ to RPLVS to URETER for transport to
URINARY BLADDER
STRUCTURE OF A NEPHRON
 NEPHRON – histological and functional unit of the kidney; there are 1.3 millions
distributed throughout the kidneys, measures about 50-55 mm length.
 RENAL CORPUSCLE – filters blood
 PROXIMAL CONVULTED TUBULE – returns filtered substances of the blood
 LOOP OF HENLE – helps conserve water and solutes
 DISTAL CONVOLUTED TUBULE – rids the blood of additional wastes.
FLUID (in DCT) empties into a collecting duct, carries URINE from COTEX to
RENAL PAPILLA to MINOR CALYX.
 PAPILLARY DUCT – a large-diameter tubule that emerges from several
collecting ducts.
THE RENAL CORPUSCLE
 Filtration portion of the nephron
 GLOMERULUS – network of capillaries
 BOWMAN CAPSULE – an indented, double-walled chamber surrounding the
glomerulus
o PARIETAL LAYER – outer layer; simple squamous epithelial cells
o VISCERAL LAYER – inner layer; PODOCYTES specialized cell that
wraps around glomerular capilliaries
FUNCTIONS
 FENESTRAE – its presence makes the GLOMERULAR CAPILLARIES highly
permeable
 FILTRATION SLITS – gaps between the podocytes
 HIGH PRESSURE – AFFERENT ARTERIOLE supplies blood to the
glomerulus for filtration. EFFERENT ARTERIOLE transports the filtered blood
away from the glomerulus. High Pressure due to the smaller diameter of EA
 FILTRATION MEMBRANE - consists of capillary endothelium, the basement
membrane, and the podocytes of the Bowman capsule
o 1st major step in urine production – begins when FM filters blood, the
filtered fluid enters the space in the bowman capsule
 JUXTAGLOMERULAR APPARATUS - An important regulatory structure;
consists of a unique set of specialized cells
o JUXTAGLOMERULAR CELLS – specialized smooth muscle that
surrounds afferent arteriole that is inside the renal corpuscle
o MACULA DENSA – group of specialized cells that lies between affarent
and efferent arteriole next to renal corpuscle
THE RENAL TUBULE
 PROXIMAL CONVOLUTED TUBULE – the first section that the urine passes
through; 14 mm long and 60 μm in diameter; rest on a basement membrane,
which forms the outer surface of the tubule; has many microvili; simple cuboidal
epithelium
 LOOP OF HENLE – rt continues to descend to medulla, it is then called loop
of henle, every loop has 2 limbs
o DESCENDING LIMB - The portion of the loop of Henle that extends into
the medulla becomes very thin near the bend of the loop. Transition from
simpl cuboidal to simple squamous
o ASCENDING LIMB – Thin then becomes thicker; simple cuboidal
replaces simple squamous; thick part returns toward the renal corpuscle
and ends by transitioning to the distal convoluted tubule
 DISTAL CONVOLUTED TUBULE – shorter than PCT; simple cuboidal; has
fewer microvilli; connects to a single collecting duct
ARTERIES AND VEINS OF THE KIDNEYS
 The renal arteries branch off the abdominal aorta and enter the kidneys
1. The renal artery delivers approximately 21% of cardiac output per minute.
2. The segmental arteries branch from the renal artery to each portion of the
kidney.
3. The interlobar arteries pass between the renal pyramids.
4. The arcuate arteries branch from the interlobar arteries. They arch between
the cortex and the medulla.
5. Interlobular arteries branch off the arcuate arteries and project into the cortex.
6. The afferent arterioles arise from branches of the interlobular arteries. The
afferent arterioles lead into the glomerular capillaries.
7. The glomerular capillaries are the locations of filtration.
8. Efferent arterioles extend from the glomerular capillaries.
9. The peritubular (around the tubes) capillaries branch from the efferent
arterioles. They surround the proximal convoluted tubules, the distal convoluted
tubules, and the loops of Henle. The vasa recta are specialized portions of the
peritubular capillaries that extend deep into the medulla of the kidney and
surround the loops of Henle and collecting ducts. Blood from these two will
return to the general circulation through the veins of the kidney
FILTRATION
26.3 Urine Production
 Regulate body fluid composition
 Nephron – responsible for sorting substances from the blood (removal of
wastes or return of sbstances to maintain homeostasis)
1. FILTRATION - Filtration (blue arrow) is the movement of materials across the
filtration membrane into the Bowman capsule to form filtrate. It is nonselective
and separates based only on size (small) or charge of molecules.
2. TUBULAR REABSORPTION - Solutes are reabsorbed (purple arrow) across
the wall of the renal tubule into the interstitial fluid by transport processes, such
as active transport and cotransport. Water is reabsorbed (orange arrow) across
the wall of the renal tubule by osmosis. Water and solutes pass from the
interstitial fluid into the peritubular capillaries.
3. TUBULAR SECRETION - Solutes are secreted (green arrow) across the wall
of the renal tubule into the filtrate.
 Urine consists of substances filtered directly from the blood and those that are
secreted into the renal tubule, minus any reabsorbed substances.
 The kidneys also demonstrate size filtration by filtering the blood, but here, the
driving force of filtration is blood pressure. Filtration is a nonspecific process
whereby materials are separated based on size or charge. All blood
components except blood cells and most proteins can leave the glomerular
 capillaries and enter the Bowman capsule as filtrate. In this case, the driving
force of filtration is gravity.
 RENAL FRACTION - percentage of cardiac output that flows through the
kidneys, varies from 12% to 30% of the cardiac output in healthy, resting adults,
but it averages 21%
 Indication of proper kidney function
FILTRATION PRESSURE
 These components prevent molecules larger than 7 nm in diameter from
passing through.
 Most plasma proteins are larger and are retained in glomerular capillaries
 Albumin, thyrotropin-releasing hormone, oxytocin, and antidiuretic hormone,
are small enough to pass through the filtration membrane
 Any protein that is filtered is actively reabsorbed by endocytosis and
metabolized by the cells in the proximal convoluted tubule.
 The basement membrane and the podocytes contain negatively charged
glycoproteins, which repel negatively charged plasma proteins and prevent
them from exiting the blood.

 When calculated over the entire day, there are about 180,000 mL, or 180 L, of
filtrate produced daily.
 a healthy person produces only 1000–2000 milliliters (1–2 liters) of urine each
day
 99% of filtrate is reabsorbed into the blood and less than 1% becomes urine
FILTRATION MEMBRANE
 Separates materials on the basis of size and charge of the blood components.
 Allows water and small molecules to leave the blood
 Prevents blood cells and most proteins from leaving the blood
 Structures that make the filtration membrane:
1. Fenestrae (7nm in diameter)
2. Basement membrane and
3. Podocytes in Bowman Capsule

 3 forces, or pressures, determine the amount of filtrate formed.
1. Glomerular capillary pressure (GCP)
 Blood pressure inside the glomerular capillaries that is an outward pressure
from blood pressing on the fenestrated capillary walls.
 Forces fluid and solutes out of the blood into the Bowman capsule.
 Eferrent arteriole – smaller diameter, greater pressure (the resistance to blood
flow through the vessel is greater)
 as the blood flows from the larger-diameter afferent arteriole through the
glomerular capillaries to the smaller-diameter efferent arteriole, the blood
pressure increases in the glomerular capillaries.
2. Capsular hydrostatic pressure (CHP)
 an inward pressure that opposes filtration.
 due to pressure from the filtrate fluid in the capsular space
3. Blood colloid osmotic pressure (BCOP)
 an inward pressure that opposes filtration
 Through osmosis, plasma proteins draw fluid back into the glomerular capillary
from the Bowman capsule
REGULATION OF GLOMERULAR FILTRATION RATE
 Stable
 Does not change if the bp drops to 90 mm Hg or rises up to 180 mm Hg
INTRINSIC MECHANISMS: AUTOREGULATION
 Achieved through 2 processes:
1. MYOGENIC MECHANISM – associated with the smooth muscles (in
efferent and afferent arteriole) that acts as a stretch receptors that
detects changes in bp. Raised bp = increased stretch of smooth muscle
(in afferent arteriole) = causes vasoconstriction. Decreased bp = relaxes
= causes vasodilation. As a result, blood supply flactuates a little (to
glomerulus, GFR)
2. TUBULOGLOMERULAR FEEDBACK - When the macula densa cells
detect an increased flow rate, they send a signal to the juxtaglomerular
cells of the afferent arteriole to constrict. Thus, glomerular filtration rate
decreases due to a decreased glomerular capillary pressure.
EXTRINSIC MECHANISMS: SYMPATHETIC NERVOUS SYSTEM HORMONES
 Autoregulation maintains renal blood flow and filtrate formation at a relatively
constant rate unless sympathetic stimulation is intense.
 Small changes in sympathetic stimulation have a minimal effect on renal blood
flow and filtrate formation.
 The kidneys are innervated by sympathetic nerves of the autonomic nervous
system. Sympathetic nervous activity decreases blood flow to the kidney,
making more blood available to other areas of the body during times of stress.
The arteriolar myogenic mechanism maintains a steady blood flow by causing
arteriolar smooth muscle to contract when blood pressure increases and
causing it to relax when blood pressure decreases. Tubuloglomerular feedback
involves paracrine signaling at the JGA to cause vasoconstriction or
vasodilation to maintain a steady rate of blood flow.
TUBULAR REABSOPRTION
 Transport of water and solutes from the filtrate into the blood (the process that
moves solutes and water out of the filtrate and back into your bloodstream.)
 The water movement in kidney is governed by osmosis
 The movement of solute is often through diffusion across the renal tubule cells.
 Uses transport proteins for large molecules to pass through the plasma
membrane - Symporters
 Critical in preventing the body from becoming overly dehydrated and deficient
in important materials.
 The filtrate leaves the lumen of the Bowman capsule and flows first through the
proximal convoluted tubule, onto the loop of Henle, and the distal convoluted
tubule and then finally into the collecting ducts
 Inorganic salts, organic molecules, and about 99% of the filtrate volume leave
the renal tubule and enter the interstitial fluid.
o these substances enter the peritubular capillaries and flow through the
renal veins to enter the general circulation
 Solutes reabsorbed from the lumen of the renal tubule to the interstitial fluid
include:
 the filtrate (approximately 1%) that forms urine contains urea, uric acid,
creatinine, K+, and other substances
 nephrons maintains the body fluid homeostasis (keeps extracellular body fluid
volumes stable maintaining the right levels of salts and minerals vital for the
function of tissues and organs)
 divided into 5 segments that perform different functions:

 Passive transport – substances uses specific transporters to move down their

REABSORPTION OF SODIUM, NUTRIENTS, WATER, AND OTHER IONS
1. Reabsorption is a two-step process:
1. Passive/active movement of water & dissolved substances from the
inside of tubule through the tubule wall into the intertitial space
2. Passive/active transport of water and substances moving trough the
capillary walls back into the bloodstream
2. The walls of the nephron are made up of simple cuboidal epithelial cells which
then changes depending on the function of the segment they are located
3. The surface of the cells facing the lumen of PCT are covered in microvilli which
then increases the surface are for reabsorption of substances into the blood.
4. Packed with mitochondria that fuels the active transport system needed for
reabsorption
concentration gradient (high to low), charged ions – down their electrochemical
gradient
 Active transport – substances move against their cocentration gradient or
electrochemical gradient (low to high). Substances are transported back to the
bloodstream via active transport proteins
 The amount of sodium in the fluid influences its volume, which in turn
determines blood volume and blood pressure
 Na+ in extracellular fluid
 Reabsorbed in the proximal tubule (NaHCO₃ & NaCl)
 Sodium reabsorption is the movement of water within or across the tubule walls,
which maintains extracellular body fluid volume.
 When sodium moves, water follows, and this balances the osmotic pressure
inside and outside the tubules
 Reabsorption in the early proximal convoluted tubule – most essential
substances in the filtrate are reabsorbed in the first half (glucose, amino acids,
phosphate, lactate and citrate attached to the sodium co-transporters -
membrane proteins that link the movement of two or more specific solutes
 together). Moves sodium down its electrochemical gradient into tubule sodium/proton exchangers and actively transported through the tubule
epithelial cells. wall to the bloodstream by the sodium/potassium ATPase.
o Sodium/potassium – ATPase, a sodium pump (active transporter) that
moves 3 sodium ions out of the cell for reabsorption into the bloodstream,
and pumps 2 potassium ions back into the cell
o Sodium/proton exchanger – enables reabsorption of bicarbonate.
Glucose, amino acids and other substances diffuse out of the epithelial
cell down their concentration gradients on passive transporters and then
reabsorbed by the blood capillaries.

 Reabsorption in the loop of Henle – responsible for concentrating or diluting

the tubular fluid using a process called countercurrent multiplication. DCT and
Collecting ducts are responsible for reabsorbing water as required to produce
urine at a concentration that maintains body fluid homeostasis.
 Reabsorption in the thick ascending limb – 25% of the sodium and
potassium is reabsorbed through the walls of the thick ascending limb of the
loop of Henle via:
o Three-ion cotransporter (sodium/potassium/chloride) – and the
 Reabsorption in the late proximal convoluted tubule – fluid entering has sodium/potassium ATPase, which as before maintains the sodium
been depleted of essential substances. Chloride ion that has been left in the concentration gradient. Sodium is actively pumped out, while potassium
tubule are the ones being reabsorb in this section. They are transported into and chloride diffuse down their electrochemical gradients through
the tubule epithelial cells through the following processes: channels in the tubule wall and into the bloodstream.
o Chloride/formate anion exchangers – driven by the high concentration
of chloride in the filtrate. Chloride diffuses out of the cell through
channels in the cell wall, and then on into the bloodstream.
o Passive movement – through the tight junctions in the tubule wall.
Sodium continues to be reabsorbed in this part of the tubule via

 Reabsorption in the distal tubule and collecting duct – the early distal
tubule reabsorbs 5% of sodium while the late distal tubule and collecting ducr
reabsorbs 3% to determine how much sodium will be excreted. Sodium
reabsorption in the late distal tubule and collecting duct is regulated by
hormones, which stimulate or inhibit sodium reabsorption as necessary.
CHANGES IN THE CONCENTRATION OF UREA AND OTHER SOLUTES IN THE
NEPHRON
 One of the nephron’s major functions is to remove wastes from the body.
 Urea a protein breakdown product, enters the glomerular filtrate at the same
concentration as in the plasma.
 Renal tubules are only moderately permeable to urea, which slows the
reabsorption of urea.
 As the volume of filtrate decreases in the renal tubule, the concentration of urea
increases.
 they become more concentrated in the filtrate as the volume of the filtrate
becomes smaller.
 These substances are toxic if they build up in the body, so their accumulation
in the filtrate and elimination in urine help maintain homeostasis.
TUBULAR SECRETION
 The movement of nonfiltered substances from the blood into the filtrate
 The transfer of materials from peritubular capillaries to the renal tubular lumen
and occurs mainly by active transport and passive diffusion.
 The mechanisms by which secretion occurs are similar to those of
reabsorption, however these processes occur in the opposite direction.
o Passive diffusion—the movement of molecules from the peritubular
capillaries to the intersitial fluid within the nephron.
o Active transport—the movement of molecules via ATPase pumps that
transport the substance through the renal epithelial cell into the lumen
of the nephron.
 It is the tubular secretion of H+ and NH4+ from the blood into the tubular fluid
that helps to keep blood pH at its normal level—this is also a respiratory
process.
URINE CONCENTRATION MECHANISM
COUNTERCURRENT MECHANISMS
 Where fluid in separate structures flows in opposite directions relative to each
other. As the fluids pass by each other, materials can be exchanged between
the fluids.
1. COUNTERCURRENT MULTIPLIER (loop of henle) - responsible for a
large percentage of a very high concentration of solutes that is found in
the interstitial fluid within the medulla of the kidney.
2. COUNTERCURRENT EXCHANGER (vasa recta) - maintains the high
solute concentration in the interstitial fluid. Flow rate and bp are slow
and low, the blood and insterstitial fluid are in equilibrium and solutes
are not carried away from the interstitial fluid.
COUNTERCURRENT MECHANISMS: MEDULLARY CONCENTRATION
GRADIENT
SUMMARY OF URINE FORMATION
26.4 Regulation of Urine Concentration and Volume
HORMONAL MECHANISMS
 Two major hormonal mechanisms are involved in regulating urine
concentration and volume each activated by stimuli which works together to
achieve homeostasis
1. Renin-Angiotensin-Aldosterone Hormone Mechanism – sensitive to
changes in bp
2. Antidiuretic hormone mechanism – sensitive to changes in blood
osmolarity
RENIN-ANGIOTENSIN-ALDOSTERONE HORMONE MECHANISM
Renin and angiotensin help regulate aldosterone secretion. Renin, an enzyme, is
secreted by cells of the juxtaglomerular apparatuses in the kidneys. Renin acts on
angiotensinogen, a plasma protein produced by the liver, and converts it to
angiotensin I. Angiotensin I is rapidly converted to a smaller peptide called
angiotensin II by angiotensin-converting enzyme (ACE). Angiotensin II acts on the
adrenal cortex, causing it to secrete aldosterone.
Aldosterone increases the rate of active transport of Na+ in the distal convoluted
tubules and collecting ducts. In the absence of aldosterone, large amounts of Na+
remain in the nephron and become part of the urine. A high Na+ concentration in the
filtrate causes water to remain in the nephrons and increases urine volume. Therefore,
when the rate of active transport of Na+ is slow, urine volume increases, and the urine
contains a high concentration of Na+. Because Cl− is attracted by the positive charge
on Na+, Cl− is cotransported with Na+.
When blood pressure suddenly or when the concentration of Na+ in the filtrate
becomes too low, the kidney releases renin. The resultant increase in aldo-sterone
causes an increase in Na+ and Cl− reabsorption from the nephrons. Water follows the
Na+ and Cl−. Thus, the volume of water lost in the form of urine declines. This method
of conserving water helps prevent a further decline in blood pressure.
ANTIDIURETIC HORMONE MECHANISM
Antidiuretic hormone (ADH), secreted by theposterior pituitary gland, passes
through the circulatory system to the kidneys. ADH regulates the amount of water
reabsorbed by the distal convoluted tubules and collecting ducts. When ADH levels
increase, the permeability of the distal convoluted tubules and collecting ducts to water
increases, and more water is reabsorbed from the filtrate. Consequently, an increase
in ADH results in the production of a small volume of concentrated urine. On the other
hand, when ADH levels decrease, the distal convoluted tubules and collecting ducts
become less permeable to water. As a result, less water is reabsorbed, and a large
volume of dilute urine is produced.
The release of ADH from the posterior pituitary is regulated by the hypothalamus.
Certain cells of the hypothalamus are sensi-tive to changes in solute concentration.
When the solute concen-tration in the blood increases, action potentials are sent along
the axons of the ADH-secreting neurons of the hypothalamus to the posterior pituitary,
and ADH is released from the ends of the axons. A reduced solute concentration in
the blood causes inhibition of ADH release.
Baroreceptors that monitor blood pressure also influence ADH secretion. A large
decrease in blood pressure causes an increase in ADH secretion, and a large increase
in blood pressure decreases ADH secretion.
PRODUCTION OF CONCENTRATED URINE
 Water moves by osmosis out of the distal convoluted tubule and collecting duct
into the more concentrated interstitial fluid when ADH is present.
 ADH increases the permeability of the distal convoluted tubule and the
collecting ducts to water by binding to membrane-bound receptors.
 Activates a G protein mechanism that increases cAMP (responsible for the
insertion of aquaporins in the apical membrane) synthesis inside these cells.
 There are multiple forms of aquaporins.
o In cells of the DCT and collecting ducts, the basal membranes contain
aquaporin molecules — aquaporin-3 and aquaporin-4 — that are
insensitive to ADH. These provide channels for water to exit from the
collecting duct cells into the interstitial fluid.
o Aquaporin-2 molecules regulate water movement into the cells.
 In response to ADH, the increased cAMP initiates the incorporation of the
membranes of vesicles containing aquaporin-2 channels into the apical
membrane.
 When ADH is present, water moves by osmosis from the distal convoluted
tubules and collecting ducts into the interstitial fluid.
 Filtrate in the end of collecting ducts = 19& reabsorbed, 1% reamined becomes
urine.
 The osmolality of the filtrate at the ends of the collects ducts is approximately
1200 mOsm/kg.
 In addition to the dramatic decrease in filtrate volume and osmolality, a marked
alteration occurs in the composition of urine.
 Waste products, such as creatinine and urea, and excess ions are at a much
higher concentration in urine than before.
 Overall, the processes of reabsorption and secretion are selective.
PRODUCTION OF DILUTE URINE
 No ADH present = less permeable to water, water remains in the distal
convoluted tubules and collecting ducts to become urine.
 This lowered permeability dampens water reabsorption.
 The concentration of urine produced is less than 1200 mosm/kg, and the
volume is increased.
 The volume of this more dilute urine can be much larger than 1% of the filtrate
formed each day. 20-30L/day
 No ADH secreted = osmolality of urine is close to the osmolality of filtrate in the
DCT
 Even when the kidneys produce dilute urine, the concentration of waste
products in the urine is large enough to maintain homeostasis.
 With the production of concentrated urine, beneficial substances are retained,
and both toxic substances and excess water are eliminated.
ATRIAL NATRIURETIC HORMONE
Atrial natriuretic hormone (ANH) is secreted from cardiac muscle cells in the right
atrium of the heart when blood pressure in the right atrium increases above normal.
ANH acts on the kidney to decrease Na+ reabsorption. Therefore, Na+ and water
remain in the nephron to become urine. The increased loss of Na+ and water as urine
reduces the blood volume and the blood pressure.
26.5 Plasma Clearance and Tubular Maximum
 PLASMA CLEARANCE is the volume of plasma that is cleared of a specific
substance each minute.
 Plasma clearance can be used to estimate GFR
o Inulin is a nonphysiological polysaccharide that does not get reabsorbed
and is removed from the blood as it passes through the kidney.
o The rate of inulin removal, called plasma clearance, is equal to the GFR.
 Plasma clearance can also be used to calculate renal plasma flow
o As blood flows through the kidney, essentially all the Paraaminohippuric
acid PAH is either filtered or secreted into the renal tubule.
o The clearance calculation for PAH is equal to the volume of plasma
flowing through the kidney each minute.
 The concept of plasma clearance can be used to help determine how drugs or
other substances are excreted by the kidney

 TUBULAR LOAD is the total amount of a substance that enters the renal
tubule each minute.
 the tubule’s capacity to actively transport glucose across the epithelium of the
tubule is limited
 excess glucose remains in the urine if the tubular load is greater than the
26.6 Urine Movement
capacity of the tubule to reabsorb it.
 TUBULAR MAXIMUM is the fastest rate at which a substance is reabsorbed ANATOMY AND HISTOLOGY OF THE URETERS AND URINARY BLADDER
from the renal tubule.
URETERS
 determined by the number of active transport carrier proteins and the rate at
which they are able to transport molecules of the substance.  tubes through which urine flows from the kidneys to the urinary bladder
 extend inferiorly and medially from the renal pelvis and exit the kidney at the
renal hilum
 descend through the abdominal cavity and enter the urinary bladder
URINARY BLADDER
 a hollow, muscular container that lies in the pelvic cavity just posterior to the
symphysis pubis
  ureters enter on its posterolateral surface
 the volume increases and decreases, depending on how much or how little
urine is stored in it.
 MALE - just anterior to the rectum
 FEMALE - just anterior to the vagina and inferior and anterior to the uterus
URETHRA
 transports urine to the outside of the body
 exits the urinary bladder inferiorly and anteriorly
 lined with pseudostratified columnar epithelium
TRIGONE
 triangular area of the urinary bladder’s posterior wall
 does not expand with the urinary bladder wall as it fills
 acts as a funnel for emptying the urinary bladder
TRANSITIONAL EPITHELIUM
 lines both the ureters and the urinary bladder
 specialized enables the cells to slide past each other
 decreases as the volume of ureters and urinary bladder increases
DETRUSOR MUSCLE
 the wall of the urinary bladder is thick as it consists of these primarily smooth
muscle
 contraction of these forces urine out
INTERNAL URETHRAL SPHINCTER
 junction of the urinary bladder and the urethra, smooth muscle that prevents
urine leakage from the urinary bladder
 MALE – well defined; contracts to keep semen from entering the urinary
bladder during sexual intercourse
 FEMALE – not well defined; have smooth muscle fibers within the wall of the
urethra at the neck of the bladder that assist with preventing urine leakage
EXTERNAL URETHRAL SPHINCTER
 is formed of skeletal muscle that surrounds the urethra as the urethra extends
through the pelvic floor.
 allows a person to voluntarily start or stop the flow of urine through the urethra
 MALE - extends to the end of the penis, where it opens to the outside
 FEMALE – shorter; opens into the vestibule anterior to the vaginal opening
URINE FLOW THROUGH THE NEPHRON AND URETERS
 Hydrostatic pressure forces urine through the nephron.
 This pressure gradient forces the filtrate to flow from the Bowman capsule
through the renal tubule into the renal pelvis
 Peristalsis moves urine through the ureters.
 Pressure inside the urinary bladder compresses that part of the ureter to
prevent urine from backing up into the ureters.
MICTURITION REFLEX
 Flow of urine from kidney – ureter – urinary bladder is continuous
 Urinary acts as a reservoir for the urine; can stretch to hold large volume with
the max of 1l
o The wall of the urinary bladder contains large folds
o The lining of the urinary bladder is transitional epithelium, which
stretches
o The smooth muscle wall of the urinary bladder stretches to
accommodate fluid
 Urination is called micturition
 Micturition reflex is activated when the urinary bladder wall is stretched as
urine fills the urinary bladder
 Occurs in the sacral region and modified by the pons and cerebrum
26.7 Effects of Aging on the Kidneys
1. The kidneys gradually decrease in size due to a decrease in renal blood flow.
2. The number of functional nephrons decreases.
3. Renin secretion and vitamin D synthesis decrease.
4. The renal tubule’s ability to secrete and absorb declines.
REFERENCES:
Online:
https://www.khanacademy.org/test-prep/mcat/organ-systems/the-renal-
system/a/tubular-reabsorption-
article#:~:text=Tubular%20reabsorption%20is%20the%20process,digestive%20tract
%20after%20a%20meal.
https://courses.lumenlearning.com/boundless-ap/chapter/physiology-of-the-
kidneys/#:~:text=Tubular%20secretion%20is%20the%20transfer,active%20transport
%20and%20passive%20diffusion.
https://www.brainkart.com/article/Regulation-of-Urine-Concentration-and-
Volume_21975/

Book:
VanPutte, C. L., Regan, J. L., Russo, A. F., Seeley, R. R., Stephens, T. D., & Tate,

P. (2019, February 15). Seeley’s anatomy & physiology (12th ed.) [E-book].

McGraw Hill.