Renal Blood flow and Glomerular filtration

Renal blood circulation :

 Kidneys Receive 22 % of the cardiac output (1.1-1.2 L)

 Glomerular capillaries are first capillary network where large
amounts of fluid and solutes (except the plasma proteins) are
filtered to begin urine formation.
 Peritubular capillaries :are second capillary network that
surround the renal tubules. They are formed from the efferent
arteriole which is the distal ends of the capillaries of each
glomerulus .
 Vasa recta: is a specialized peritubular capillaries that extend
downward into the medulla, lying side by side with the loops of
Henle of the juxtamedullary nephrons. It has an essential role in
the formation of concentrated urine.

Special features of the renal circulation :

 It has two capillary beds, the glomerular and peritubular capillaries

arranged in series and separated by the efferent arterioles.
 Adjusting the resistance of afferent or efferent arterioles can affect
glomerular pressure and GFR .
 High hydrostatic pressure in the glomerular capillaries (60mmHg)
causes rapid fluid filtration while slow flow and low hydrostatic
pressure in the peritubular capillaries (8-10 mmHg) permits rapid
fluid reabsorption

Hormones and chemical factors control the renal blood flow:-

↓RBF :
 Nor epinephrine ,epinephrine → constricts renal vessels mainly afferent
arteriole →↓RBF
 Angiotensin II→ exerts a greater constrictor effect on the efferent
arteriole more than the afferent arteriole →↓RBF .also (↑ glomerular
hydrostatic pressure →↑GFR ).
  Endothelin (a peptide that can be released by damage vascular
endothelium of kidney and other tissue → constricts renal vessels
→↓RBF
↑RBF:
 Dopamine →is made in the kidney and cause renal vasodilatations
→↑RBF
 Prostaglandin PGE2 , PGI2→ ↑blood flow in the renal cortex
 nitric oxide released by vascular endothelium ↑ RBF
 Acetylcholine causes vasodilation . ↑ RBF
 High protein diet ↑ RBF

Glomerular filtration :

Is the process by which the plasma filtrates in the

glomeruli through the glomerular membrane.

Factors affecting Glomerular filtration

1. Filtration pressure : determined by the

hydrostatic and colloid osmotic forces across the glomerular
membrane, These forces include :

a) Glomerular hydrostatic pressure: hydrostatic pressure inside the

glomerular capillaries which enhance filtration PG = 60mmhg
b) the hydrostatic pressure in Bowman’s capsule which opposes (
against) filtration (PB=18 mmHg)
c) Colloid osmotic pressure of the glomerular capillary plasma
proteins which opposes (against) filtration (πG= 32 mmHg)
d) Colloid osmotic pressure of the proteins in Bowman’s capsule
(πB), which enhancefiltration. (Under normal conditions, the
concentration of protein in the glomerular filtrate is so low and
considered zero.)

 The sum of the hydrostatic and colloid osmotic forces across the
glomerular membrane gives the net filtration pressure.

Net pressure = outward pressure –inward pressure

= PG -PB - πG
= 60 -18 -32 = 10 mmHg.
 2. permeability of the capillary: depends on:
 size:
o decrease permeability for large size molecules
o substances with diameter of 4 nm to < 8nm can pass
freely
 Electrical charge:
o filtration of –ve charged (anion) substance is less than
+ve charged & neutral substance of the same size
because basement have a –ve charge.( -ve charge
substances repel each other)

3. Filtration surface area: - It is the total size of the capillary bed

available for filtration .it is affected by contraction of mesangial cells
(↓S.A.)
Note :
 filtration coefficient (Kf)= permeability X S.A
 In certain kidney diseases, the -ve charges on the basement
membrane are lost→ albumin are filtered and appear in the urine, a
condition known as proteinuria or albuminuria.

Glomerular filtration rate (GFR) is the volume of plasma that is filtrated

by all glomeruli each minute.

 GFR=125 ml/min in male (female is 10%less )

 GFR = filtration pressure X kf (membrane permeability x S.A)

Factors affecting GFR :

1. ↓ Kf reduces GFR.
 ↓the number of functional glomerular capillaries (↓ the surface
area) or by ↑ the thickness of the glomerular capillary basement
membrane cause ↓ GFR . Ex: DM and Hypertension
  If one kidney is removed (half of the functioning nephrons lost),
GFR decreases only about 25% because the other nephrons
compensate

2. Glomerular capillary hydrostatic pressure ,which is affected by

I. Systemic blood pressure
II. Afferent arteriole resistance:
 Constriction (sympathetic stimulation) →↓blood flow→↓ G.pr.→↓
GFR.
 Dilatation → ↑Blood flow .→↑ G.pr.→↑ GFR.
III. Efferent arteriole resistance :
 Mild Constriction →↑ resistance to out flow from the glomeruli→↑
G.pr. → ↑GFR.↓RBF
 Dilation →↓GFR

3. Glomerular capillary Colloid osmotic pressure :Affected by plasma

colloid osmotic pressure .
4. Bowman Capsule hydrostatic pressure: when ↑like in renal tubular
obstruction (ex: stone) →↓GFR.
 Estimation of GFR :

 Estimation of GFR are used clinically as an index of renal function and to

assess the severity and the course of renal disease
 ↓ GFR means the disease is progressing while ↑GFR indicate recovery
 Estimation of GFR depends on the concept of clearance.

Plasma clearance :

Renal clearance of a substance is the volume of plasma that is completely

cleared of the substance by the kidneys per unit time

 Clearance = Us x V (excretion rate) / Ps .

Us: Concentration of the substance in urine

V: urine flow rate
Ps: Concentration of the substance in plasma

 Ideal substance to use is not toxic , not metabolized ,stable plasma conc.,
easily measured in the plasma and urine, completely filtered ,Neither
reabsorbed nor secreted by the tubules (The amount of the Sub filtered /min =
amount of Sub excreted in urine/min)
Ps × GFR =Us × Vu
GFR = Us x Vu / Ps = clearance .
Substances used to determine GFR

1. Inulin:
 polysaccharide molecule present in the root of certain plants
 Gold standard to determined GFR ;it fits the above criteria
(completely filtered but neither reabsorbed nor secreted) but it is
not used clinically .
 Not produced by the body and it administered IV .
 GFR = C inulin =125 ml/min

2. Creatinine: Is a by-product of muscle metabolism (endogenously produced

→It is a preferred indicator used to estimated GFR
  There is some secretion of creatinine by renal tubule →amount of
creatinine excreted is a little > filtered (clearance > GF =140 ml /min)
 If GFR ↓by 50%, the kidneys will excrete only half as much creatinine
→accumulation of creatinine in the body fluids →↑plasma concentration.
 Plasma creatinine is not a very sensitive measure of reduced GFR. At the
beginning a large ↓of GFR produces a little ↑ serum creatinine conc.
 It is best to do cretinine clearance (urine volume , plasma Cr conc.,urine
Cr. conc.)

3. Urea :
 is a waste product formed during protein metabolism
 Easily filtered, not metabolized, not secreted but reabsorbed
 C urea < GFR = GFR-plasma reabsorbed C urea = 75 ml/min.
 Urea depends on protein metabolism and intake .