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Ugs - 1
Ugs - 1
8. Endocrine functions:
- Producing of erythropoietin
➔ To regulates the production of RBCs
- Producing of renin
➔ To regulates the blood volume and blood pressure
- Producing of vitamin D3
➔ Produce the active form of Vit-D3
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0789791324 Mohammad Alomari
Physiological anatomy
General organization:
- We have 2 kidneys in the posterior side of our body,
outside peritoneal cavity.
- Wights about 150 gm, as size of clenched fist, each one
consists of:
➔ Outer cortex
➔ Inner Medulla, contains:
✓ Renal pyramids
✓ Renal papilla
✓ Renal pelvis
✓ The major and minor (calyx) calices
➔ As urine is formed, it drains into the renal pelvis and is channeled into the ureter.
➔ The urine is stored in the bladder ()المثانة.
➔ It is emptied through urethra ()االحليل.
In real life we don’t use all of our 2 million nephrons to filtrate the plasma
of the blood
وحتى فعليا يمكن لو بدك تجيب كلية وتشوفها هل هي بتشتغل في الظروف الطبيعية كلها رح
!تالقي انه ¼ النفرونات بس بشتغلو يعني نظريا الواحد بقدر يعيش بربع كلية فقط
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0789791324 Mohammad Alomari
▪ Efferent arteriole:
➔ Take the remaining filtered plasma
➔ Exit from the Bowman’s capsule and form:
➔ Peritubular capillary that Surround the whole nephron
❖ Tubular Components
▪ Bowmans’s capsule
▪ Proximal convoluted tubule
▪ Loop of Henle
➔ U-shaped, hair-pen structure
➔ Has two parallel segments – ascending & descending limb – that fits with its function (produce
concentrated urine)
▪ Distal convoluted tubule
➔ Passes btw the afferent & efferent arterioles
▪ Collecting duct
➔ Collects the final form of urine from many nephrons & sends it to be excreted out.
➔ In certain conditions we reabsorbed water from it.
➔ (8 to 10) ducts join to form single large collecting duct
Types of nephrons:
Cortical Nephrons (Major)
➔ Most of their structure is found in the cortex
➔ Small part of loop of Henle in the medulla
➔ They are most nephrons in the human kidney (80%)
➔ Most of the filtration & reabsorption will happen here
➔ Receive most of the renal blood flow (95%)
Vasa recta:
➔ The peritubular capillary around the loop of Henle in
Juxtamedullary Nephrons, it is hair-pen like structure &
responsible for maintaining the concentration gradient in the medulla.
Urine formation
- The urine formation consists of 3 main processes:
➔ Glomerular Filtration
➔ Tubular reabsorption
➔ Tubular secretion
- Thus, 20 % of plasma is filtered and 80% are not filtered & passes into efferent arteriole then
peritubular capillaries
𝐺𝐹𝑅
Filtration fraction = = 125/625 = 1/5 = 20%
𝑅𝑒𝑛𝑎𝑙 𝑝𝑙𝑎𝑠𝑚𝑎 𝑓𝑙𝑜𝑤
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0789791324 Mohammad Alomari
➔ High rate of kidney blood flow (Glomerular hydrostatic pressure)
➔ Special properties of glomerular capillary membranes.
- How the body differentiates the bad substances from the good substances in the reabsorption
process?
Renal handling:
- There are 4 types of substances depending on how good the substance for the body:
➔ Substance is freely filtered but neither reabsorbed nor secreted
✓ Those substances are excreted out of the body at rate equal to filtration rate
✓ Like = Creatinine (toxic) and inulin
✓ Clearance of creatinine and inulin = GFR
➔ Substance is freely filtered, but part of is reabsorbed.
✓ Like most electrolytes and urea
➔ Substance is freely filtered but totally reabsorbed
✓ Like Amino Acids & glucose and vitamins
➔ Substance is freely filtered and is not reabsorbed but secreted
✓ H+ and K+ and para-amino-hyperopic-acid (PAH)
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0789791324 Mohammad Alomari
Filtration
Again,
- It is the process in which plasma is filtered from glomerular capillaries into Bowman’s capsule
- It is a random process in which the good and bad substances will be filtrated into the tubular side
of the nephron
- The filtered fluid (filtrate) is:
➔ Similar to plasma but
✓ Protein free and devoid of cellular elements
✓ Less Ca++ and fatty acids because they are bound w/proteins
- The factors that affect the filtrate inside the nephron are the forces and pressure
Glomerular Filtration Forces
Glomerular blood pressure
- Glomerular blood pressure (hydrostatic) is about 60mmHg
- Favors (enhance) filtration
➔ Push water from glomerulus into Bowman’s capsule
leading to increase water & pressure in it
➔ Leaving proteins inside the blood vessel leading to
formation of colloid (osmotic) pressure
Colloid (osmotic) pressure
- Decrease (opposes) the filtration
➔ It is about 32 mmHg
Bowman’s capsule pressure
- Decrease (opposes) the filtration
➔ It is about 18 mmHg
❖ NET filtration
- We have many different forces that affect the filtration which are:
➔ Glomerular blood pressure (+), Bowman’s capsule pressure (-), Colloid (osmotic) pressure (-).
- By summation of all of them, the NET filtration = 10mmHg, which is responsible for formation of:
➔ Filtrate inside the Bowman’s capsule ()السائل الراشح
➔ GFR = 125ml/min
- This structure make the glomerulus has 500 folds more filtration in comparison to other types of
capillaries
Filterability “”مهم
- Depends on size and charges, for example:
➔ The large Molecules can’t pass but the small ones can
➔ The negatively charged molecules can’t pass but positively charged molecules pass
- Back to our question, “are there other factors that affects filtration rather than the forces? “
➔ The filtration depends on the filtration barrier that is have relatively constant effect between the
individuals
ml/min
➔ Thus, we have filtration constant “Kf = 12.5 ”
mmHg
✓ GFR = K* Net filtration pressure
- Net filtration pressure = 10 mmHg & Kf = 12.5 ml/min/mmHg
ml/min
➔ GFR = 10 mmHg x 12.5 = 125 ml/min→ 180 L/day
mmHg
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0789791324 Mohammad Alomari
Biphasic effect
- Firstly, Mild to Moderate vasoconstriction of efferent
arteriole leads to:
➔ Hydrostatic pressure = GFR
- Then, Severe vasoconstriction of efferent arteriole leads
to:
➔ ↓ Renal artery = ↓ Hydrostatic pressure = ↓ GFR
➔ Also, due to GFR the filtration fraction will be increased This is called
✓ Then the colloid osmotic pressure of the glomerulus will increase Donnan effect
✓ That will decrease the GFR.
Mechanisms of Autoregulation:
1. Tubuloglomerular feedback:
Juxtaglomerular Apparatus
▪ This structure consist of:
➔ Distal convoluted tubule
➔ Afferent arteriole
➔ Efferent arteriole
▪ Macula Densa
➔ Elongated cells of the distal tubule
➔ Come very close to afferent & efferent arteriole
➔ Senses any change in NaCl concentration & filtrate volume in DCT
➔ Stimulates the secretion of a locally active vasopressor which acts on afferent arteriole
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0789791324 Mohammad Alomari
▪ Juxtaglomerular cells.
➔ Modified smooth muscles of afferent arteriole
➔ Receive input from the sympathetic NS to control BP through renin secretion
➔ Secrete renin hormone: that lead to increase the BP by angiotensin II
Tubuloglomerular feedback
- blood pressure = GFR = NaCl
➔ This increase will be sensed by Macula densa
✓ Macula densa: release vasoconstrictor to afferent
arteriole to ↓ GFR
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0789791324 Mohammad Alomari
- Angiotensin II constricts efferent arterioles
➔ increase GFR – increase Na & H2O reabsorption
- Endothelial - Derived Nitric oxide
➔ Cause vasodilation so decreases arteriolar resistance and increase GFR
- Prostaglandins & bradykinin
➔ Cause vasodilation so decreases arteriolar resistance and increase GFR
3. Other factors:
1. increase protein intake
➔ increase blood flow and GFR
➔ increase the amino acids reabsorption along with Na
➔ Decreases Na
➔ Autoregulation - Tubuloglomerular feedback
The End
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0789791324 Mohammad Alomari