University based lecturers Chill medicos } Chill medicos CHILL MEDICOS BY- HIMANSHU DASORIYA oo: AIEEE Wh ll © scanned with OKEN ScannerNEPHRON D Nepron ip defined as the. Structure, and ee unit of eldney © Each Naney consist of 1-1-3 mitiibas of Nephrons. ‘AMferent arteriole ‘Bowman capsule Proxima convoluted —— ‘ubule “Tek descending —- segment Thin descending —-——-—-—— ‘segment Hairpin bend \ FIGURE 424: Sucre of nepivon D> Each Nephron consist of two parts: © Renal cospuscle, [alpighian tospuscle. @ Renal tubules 4. RENAL [NALPEquTAnl CoKpuscle + Sphewotd and slighty flattened structure fe Diameter absuh 200 MW. 4 Finction 7— Filtration of ible which forma the 1st phase, of azine Fosmation. © scanned with OKEN Scanner+e Siluabion of Kendl corpuscle and Aypes. of Nephior- i © Renal cospuscle ig “present fn the corter of the: Kidney —s, Near Pevphery 6 : Dies the medalla, ‘TABLE 491 Features of two types of nephron es Melo Wwe 15% 19% Outer atx nea the pariphry Inner ot near mada Shor Long Haipinbendpenattes ony up to outer zone ol medula Hain bend pentats up othe ti of pela Peel caplates Vesa eta Nin the conentation of ine and so formation of ine HE SARUCTORE OF RENGL CORPUSCLE Formation of wine * Renal Coxpuscle. | Pere es “uf oF capillaries a) Consist: of afferent G Efferent ‘ lus £ O -Glomerulu Cay ee 41 ors large capillaries . ctivide, Small capaliauel - divide Afferent A, D large diameler. © Effexent Ay —9 small aliameter. © function >— pmeserse of » fenesteq «Come ‘bration 4unetion off the Glomerdas © scanned with OKEN Scanner® Borman capsule « Lo ceapautarr struchure, 19> enclose “the. -Glomeralis Afferent arteriole — efferent arteriole FIGURE 49.3: Renal corpuscle > formed by Awe layers: © Zoner visceral yer —_ space! ble them confines as lumen of tubular F wfetal Leyer portion @ outer «pa fetal toy cpedide > stytoplaamte extension of eae i Epithelial cet ose PTD cept bla pedicles + podocytes <- [epithelial cat + pedicles] Capita Basement Bloed Fenestra endateliim © scanned with OKEN ScannerA. TovLaR PorTION «oF NEPHRON, +f Tp @ continuation of “Bowman capsule made up of 3- parts ® proxtmal cotvoluted tubule ® Lop ‘of Henle @ Distal convoluted tubule AL. pRoxamar -convowwteD ToeuLe i ssx-O sceiled_ Portion Aisipg Foor Gunen Bowman capsule ay aie © Situated Tn Cortex Per « tontined olevemding Crab “of Loop oF Henle. © functional Histology t— ° cuboidal Epithelive L, tale lite, Projections Brush -Bordered coll 2, LOop oF HENLE DESCE Nir ® pccenosng NG Lene tine. T @ Hareprn: BaD © scanned with OKEN Scannereconsist “of -¢~ @ Descenchtag tinh ee > Brush border cuboidel Ec. thin —> fitted Epithelial cell ® ‘Hairpin Band —s flattened Epithelial cet Thin —s flattened Epithelial cet. ‘ascending. Limb oa o r Thick 3 cuboidal Epithela] cel. + Function 2— Concentration of urine. ® ‘DisTaL convorwtED ToeuLe + present fn the taster of Kidney. function Cubatdel EL; ©. eh luck - ea ae Call CEcells) f ee * Exchange of ions HE COLLECTING Duct = -Cuboidel or columnar Epittetial cell Le foo types of col © peincipal °F P ces © antereolated ov Tells © scanned with OKEN ScannerJUxTAGLOMERULAR APPARATUS © Defination s— Specialized organ ditualed near the giomeritas of cach, nephron “( Taxta> nese) Ht SFRUCTURE OF JUXPAGLONERULAR Apparatus * TG Apparatss formed by. @ macula densa ® Extraglomenslar mesangial cells © Taxtoglomeruiar cells 4. Haculy densa ¢ © Enel portion of hice cascencling Segment before: t+ open. into Def + gituated blo Afferent 6 EfFerent actertols of same, Nephron + ntagala densa ers close fo! affect axtenials 2 fosmest ey Hight packer] cuboidal Epithelial cells. a. Exeraglemer lar Hesanqial Celis. © vsifuated fn the trlanguter Reyion, Hacu! a lens. ‘Afferent —\fJe Efferent A Also called, Pas sagranalay cell, lacis cell, Bengpeasih ormagh bith, cells ‘ ‘Goormegnty at © scanned with OKEN Scanner7 ~ Thick ascending ‘segment Efferent arteriole Extraglomerular mesangial cells Capillaries '~ Glomerular ‘mesangial cells FIGURE 50.1: Juxtaglomeruiar apparatus © Glomerular “nese jaf cell . preset fo glomerular: ‘ Support “the glomerular capellary op Regulation “GFR 4 % contractile, properties. , om ot phagooitte oe fntergtttiat . gecrate -gfomnenular vnatrix > Prostaglandins » agterines 3. Toxtaglomerular celts = specialized smooth Musde catty. situated ia the reall Of afferent ArtedfoleS. Tust- before Enter > Cowman capsule 2 smeth mudeced : ety I nesty present Lurie meta fan. tunica relventitia + Alsé called - Granules cells. [secretacy Jranules | # polar cushion | pol kfasen, © scanned with OKEN ScannerHE Func PIONS OF ToxPAGLoMERULAR AppARAqS @. Seceerronl of HoRHonles. Ls TG Apparatus. Secretar too hormones 1. Renin 2. prestaglanelin Le Renin . : © Taxtaglome ruler cet secrete —> Renin «peptide ith 3x0 AR # Along ‘ith Copfrtentns Renin forms Rental = ANGIOTENSIN “SYSTEM. Lo sttaintenance of °6.P. # secretion of Renin stimulale ba © fat fo avterial GP. @ des in Ece Volume. ® tes sympathetic activity. ® Ves load of na Senor for maul densa 2. prostaglandin: + Extragbmerular resangial cell —> seerete Prastag landint D Notewt antexstital cet [Hedulla] (fige-z-rizc) Ls Also sesvete. prostaglandin © scanned with OKEN Scanner2. SECREPION Of OER, SvBSfancES. Seercle, ‘ + Bxbraglomerular Mesangtal cat) cytorfoa Uke: # Loterleakty = 2 * fumes necrosis # Moaula densq — [fromborane, As page ] Requiarion OF GLOMERVLAR BLooD Flow. GER © Maclay densq —> Aubuloglomexulay Feedback. (| kegutate GFE QBE © scanned with OKEN ScannerIN= ANGIOTENSIN system o parirai Ag- Gebultn.— Langiatenst a] | Substrate. for Renin * Angiotensin- I [decapeptide’] % Angiotensin I [octapeptide] —y Half Life - 1-4 mioute * angiolensto HL CHeptapeptide’] # Angiotensin - TZ [rexapeptide.] at Ehaymes ¢— 4. Angiotensta converting Enzyme [ACE] Gant AngtotensiaI— Angiotensfa Secreted from lungs. 2. Angiotensinase. t 5 conver’ Angin tension Iz —s arajstersien IE presenk RGc G vascular bed Jn many tesue HE Actions OF ANGIOfeNSING 1, ANGlofesral -T physiological Inactive Sere only Precursor ANGIOTENSIN - Ir Ls Host Active fox & Actions on 3— © scanned with OKEN Scanner‘Stimuli for rnin secretion 4. Low lod pressure 2 Low EGF volume 23. Sympattte stimulation FIGURE 802: Renin-angictersin sytem. ECF = Exacellr fi ACE = Angilensin-convering enzyme, GFR = Glomerular ‘iain rl, ADH = Aniureticharmone, CRH = Corcotopinleasng homane, ACTH = Adrenocorcobopicharmone. © scanned with OKEN Scanner[al on glood vessels Ee Nasoconstvietion * potent constricter ~of acterials © tes .P. | eae lp HY pertensin oradtrenshine 4 Sndivect Ta BP by Release, 4? eVaevonstaictor) post ganglionic Smpathelic: Fiber [B] on ‘Adrenal Cortex + Stimulate Zona Glomenutosa [per secrete Aldosteren aes Reral Tubules Loct) e Tes Nat Retention Tes BPs {cJ on Kidney . ely Anqictensig- 2 Regulated GER 5 ae constes erent ros & Nentiiterk. che ves GER Glomerular resangfal Celt ANDRE t= Initial Tes GER Yer Surface Aves oF * fs not Reabsorption Glomerular ay 6 Filtra hor From Renal tubules stop i Uarfes (ocr) @ scanned with OKEN Scanner[a] on Graton a fakbit — Barokeceptor Refler —> da BP » fas woater faluke by stimulate trrist center © Mes secretion of —> “CRA Lrypothalamss | on of “ACTH [pituite ity Rook Le tu secretion oF [rites] ADH Lhypothalames 1 3. ANGINOTeNSIN - IIE o fess BP. * stimulates aldesteron Secretion from advenal cortex Ls Joo% adernocns teal Stimulator AcHivits, Ly Hoy, vasopressor achivity of anginotens ini 4, ANaINofeneIN- & also hos - Ader: Adrenocortical stimulaHon and vasepressoy activities © scanned with OKEN ScannerGLOMERULAR FILTRATION RATE COFRI + GER defined as the, otal quontity of filtrate formed th all the nephrons -of both the Kidneys sia the gue unit of Time. Normal GPR ip 1as-mL] minute ov [80 ]day. + Dis constituent jf Same 04 plasma except gomarer fiitrate, atoesnt haves plasma protein and cellf. GFR= ke[l Pgem Pes T- Dt qe~ res] Kp = filtration Cofficient Rye =" Glomerular Capsule hydrostatic. Pressure = 40 mm rig Pag = toarmns capsule Hydrostatic pressiae. = lomm Va Mge = Glomerular capsule amelie pressure = mars “Res = Bowmans -capsule, osmotic pressure. =o mm ty Gee = tas [[ 40-10] - [2»-oj] = 14.5 [fs0] - Ref] Ia.g [0-20] 125 bl mint © scanned with OKEN Scanneriia: fealty =~ AMES neo J Fihaon finsion = GE Noreial = 19-2°%, aE net filtration Pressuve = Glomesulas —Gotloidel Hydrostabic Capdilary — osmelie. Pressure pressure PL Geum, capsule > G2 OEE) = Zomen 4p Filtration copfieient GER Net Filtration pressure. = Bem, Some Hy G3 OL | farm y HE FACTORS REGULATING (AFFECTING) GFR. © Renal “Blood Flor # GFR Renal Blood Flow hatoregutated ® Aouloglomeralar Fer baex rank _ ‘Renal dabules 1 techaniom Regula, GF by eee eHacula olensa G detects: the godium chloride. concentration © scanned with OKEN Scanner0 Nes fa GER L fes Ta Nlacl concentrafion Tn Renal tubule. ye GFR. Moeula densa { ay 4 ibulogomevulas paola Adenosine. ts ae" | Conskiiction of, Afferent Aeteatole, + bes RR Glomerulag Bleed Flow #E tohen con, of -nacl tes in Fite ves GPR ® us fin Wael con. fa Renal tubule Nacula dlensa Anginetensin, CP Renta eG fn PQED Pages nat Bradytinin pera ' MS constriction of sete Biverent Arte Afferent Ast. Ls tw GFR J +t tohen con. of Nacl Le In Fltate: © Scanned with OKEN Scannerty Aaalefomerda Kernen sensitivi 4 We by. bi S > paral slabriurelic Peptide 7D adenosine and a saa eet > prostaglandta To tom > cane ® Glomerular capdiary pressure. GER & “Glomerular - captllency pressure G onnl= Go omny. depend on —> -Renal blood Flow Prteriad bleed P- ® Colloidal osmotic pressure. GER & Colibtdol osmotic. pressure J itormad = 25 ro Hy poy, he ie > dehyatvation 4 hypo tele © Hydrostatic. pressure tm Goyoman capsule, FR te GPRS crydwatalio Prewure sin eowman copsule, G ta tad obstruction fa aretha > edema of Kine. beneath Renal Cy © scanned with OKEN Scanner© ‘constriction of -Afferent ‘Auteriole Lb hes Glomerular Capillaries blood Fou aes GFR, ® constriction of “AEPFexenk Asteriol, Initial. 1 -GFR Wo, Filtration occur: due te blood stagnation Co GFR or Les GFR). fn -capittaries Gute bleed ow to the capillaries. Systemic Asterial pressure S Renal Blood Flow G GFR Not affected as tong the Mean arterial “blood pressure. ( Go ~ 280 mrtg) Ly eoregutoled , ® Sympathele. stimulation Hoderate stimulaton Sympathelte dere Nob sigrigreanl change fo Gee, Strong. gtimudation Sever Constcdion on efferent than AF frent Thitel focee Fatt La GER, © scanned with OKEN Scanner@ surface aver of corey membrane GPR x surface A. oF capillary 4 ® Permeable of caphilary membrane. GER o& » Permentliby @ contraction of “Glomerular Mesangfal cells G bes Surface Areq of copttary shes GFR, ® Hormona) and other factors # Factors Tes Gee by-3 vasodilation ? Atrial Natriuretfe peptide % Factors Le GER by vase wastriter > Angiotensin -1r i ae > Endothelins — cane > Nor-adrenalfne > Dopamine i ea | > Paes PSP Gy, | (cll © scanned with OKEN ScannerREABSORPTION. OF | WATER PCT © Reabsorption of H90 occurs E Bed collecting: duct. 4. Reabsorptfon of baler > pef Ls cobtigaiogy- tater -teabsorption =3 Reabsosplion of heater depen4 on Na Reabsorption Aubulas lamer cell jes ta con, fr lumen) tes et Nat C wat Ya osmotic fon Ho pressure (he smote. (righor) (Lowe PD pres) 2. Reabsorption of water from distal convoluted tubule Cdct) and callectteg- duct — Laeutative toaber Gpeattative Reabsorption Resheorpiion, © when ADH present © normal Def + collecting Gyo ace Det + colteeding Cimpermeable te H1,9) at Pexmeable, te Hao J © scanned with OKEN Scannerae Mechanism of Ackfon OF ADH Aquaportns. © ADH 425 -Hyo ReobsorpHion in oct @ CT | stimulating pater channels (Aquapoying ) Combine. ADH > Nagopréssin (Va.) Receptors | Activate. Ader cyslase Are ———> cAtp Activates Aquapovined # Aquapoxins La fea eyo Reabsorplien- Ls Henbrane. protefa, Li finetion 24 vocter channel © bp Mammal —3 [0 -Aguaporins Faenkify. 5 Aquaporins found in Humard- Aquaporine -2, 2,3 -D present ia Renal Cubules form rao channel fn Renal tubules aquopesing 7 —> present erin gquapering > present fn salltege gord © scanned with OKEN ScannerCOUNTERCURRENT MECHANISM © -System of U-shaped fubules (fube) tn tohidh ,the Flo of Fluid fn -oppostte divertion fn tio of limb “of the U-shape -lubules Countercurvent: &ystem Countercurrent Counteyeurrent &xchoy mmultiplier ( vasa -€ecta ) ( toop of Henle) 4. COUNTERCURRENT “MULTIPLIER, 13 Loop of “Henle, G responsible for -clevelopment- of Hyperasmolacity. OF medullary. tatenstitial tui{ and medullary diont: a Role of “Leop -of Henle th development of roedultary Gradioucl. 4 Tintermedateony Aleghran play major. Rae. Becawe loop of Nephrone, ip long and Extended fr deeper part of medulla 1 | © scanned with OKEN ScannerMedullary 7 7 interatitiuen Hente loop Collecting duct) FIGURE 53.1: Countercurrent multiplier Numerical incicate osmolarity (mOsm/L) ° “Wyperoemotatty of medulla fnterstitiel -Plald aueto] Ackive. Reabsorption of I From Ascending they solute, Unb of Nacl and other Henle solube Accumulate jin Hedallary tntersttal Fluid > fed asmadlantty : [ue BIE uy Fe cone. graaiant of Hacl fa motaliany, dpate 5 yi ons cise] ato Ae From thoed\ 5, desconaing Aine of tele. 7 Neel < © scanned with OKEN Scanner# fhe gedium and chloride ‘Tors ave Repeatedly Re-civeula- feel - blo Assendling. ain descending. Limbs “of Henie thro + mec sfrtesstitial fled .anel Brat! portion ok Nach excreted . Ly due to - More addin Nac} fn filtrate, and less Excretion of glad Halley. the Nac fn the Fithate and fet medulla i f er it e 0, th Galle Countercarrert- Hulkipuier. tt other factors Responsible for Hyper esreleipy- of Medullary thtewstitial fluid. (iy ReabsorpHion of Sodium From cotecting- eluck * Collecting buck : i Coegeleey pat) Cneslege Interstitial Fisfd) ‘ Ng Ho + fa Ng’ —> fe osmolarity, WH) Reeiveutation of -uves, * collecting, duck Tp impermeable. 4 ures However, ep Gc? Reabsober! H,o = by action of any Cone of urea fes fn per G cf. © scanned with OKEN ScannerA due fo Gane, qradtent ures diffused from CFO 4p (Taner medullary part) nko riedullary faterstitum UyEA Reciveutalion » accounts for sot). of Hyper osenelarit fn inner nesters, space. % uyed ‘transposters $— UTA, , UT-AS. qacivated by AOH 2. COONTERCURRENT EXCHANGER. G@ vasa recta u Responsible ‘maintenane. of medullary gradient 4 Role of vasa Recla -in the Nafntenanee of Medullary Gradient o vasq ‘Rela acs Uke countercurrent Exchanger because of- ths position Ran ti ° Nase Recta descending, Aim ith _, Ascend TP Uta oe un Hente oe? Asscendicg nb LOS pescendiq Limb of Herte loop © scanned with OKEN ScannerSiwb of Henke enter 1° * Reahsorption of Nec! fan post recallary Apace- weet T+ cere? | oaeamary anh a J Nase rela. Criedultens Hy po, J et From daceneligg Unb oF Nook -arol . Riches vega Keele 4 pue te slow blood flow Nvasq Recla — Collent move . -Asceroting itm of ses woirpity (oop (U. ni Neel [redullory apace] Ho © scanned with OKEN Scanner Ascensling 5 Uinb of Mesa Recta.A hese cyde Ip Repeated cand naintain medullary gresient H -Cvasa Recta Refains Neck fn the medullary inteystitum and “Removes toater “prom fk. $0, the “Hyperesen olastty of medliang faterstitum ff maintatned # Recyeng of ere alo, curs through \osa Teele © scanned with OKEN ScannerMICTURATION - REFLEX Hug, Ve + Ws fetter eltted by the mulation oP etretch Receptors on the wal} of reer “bladder and Urethra, 2 Be0-soomi of urine Ip catlected fn bladder ‘Inteavesioal pressure fea Strached bladder Stimulation of Stretch - Keceplows Generation’ of -alerve impulse ‘Sympathetic nerve Parasympathetic nerve - lypogastric ganglion ganglion Hypogastric nerve Internal sphincter’ Urethra ~ External sphincter ! Pudendal nerve Somatic nerve FIGURE 57.3: Nerve supply to urinary bladder and urethra @ scanned with OKEN Scannerat patra Of Mfctusttion ReFlex hig of urinaey bladder timation of: ‘during Mint rifeturition the fiom - of urine ff | Fadliated -by la -abdomtacl pressure te Higher centers or riictarition. © Lptnal. centers sacral Kepfon, Lt Lumbar dent % Spiral centers Reganted 4 righ conten ae facitiatory -centers Sahibi ia) erp “or novartifon fox rticturdtfon. eeate * Pons. ° ears ‘ + Some center-4n cerebral cortex coral Loven 3 Appliol physiology D ‘Aonke blacler —>-distruction of -sensosy A. Fiber ® futemalle bladder —y typesactive micturition Reflex @® Nectumal rifcturttion— {ovotuntar vofding of ustne. aoe night © scanned with OKEN Scanner