Professional Documents
Culture Documents
1.1 Renal Physiology 1
1.1 Renal Physiology 1
• To form urine
• Excretion of Excessive Waste Products
o Urea – from amino acids
o Creatinine – from muscle creatine
o Uric Acid – from nucleic acid (purine)
o Bilirubin – from end product of hemoglobin breakdown
• Regulation of Water and Electrolyte
o Most of the water and electrolytes in the body are excreted
through the kidneys. This may be a basis for administration
of IV Fluid: 3L/day • There are 2 Kidneys in the body: Right and Left
• Regulation of body fluid osmolality and electrolyte • Located at the upper abdomen, posterior, and retroperitoneal
concentration • Approximately the size of a closed fist
o As it regulates the water and electrolyte balances, the • On the average:
plasma osmolality is also regulated o Length: 10cm
o Wide: 6cm
Starling’s Forces o Thick: 3cm
Inside the Capillary: o Weight: 115 – 170g (Average: 150g each kidney)
✓ Capillary Hydrostatic Pressure – drives away fluid • At the medial portion of the kidney, there is an indentation
✓ Capillary Osmotic (Oncotic/Colloid) Pressure of called the Renal Hilum
Plasma Protein – attracts fluid in o Very important because this is the area where you have the
Outside the Capillary: passage of the following structures:
✓ Interstitium or Tissue Hydrostatic Pressure
→ Renal Vein
✓ Interstitium or Tissue Oncotic Pressure of Plasma
Protein → Renal Artery
Filtration: Capillary Hydrostatic Pressure + Interstitial Osmotic → Renal Pelvis
Pressure → Renal Nerve
Reabsorption: Capillary Osmotic Pressure + Interstitial → Renal Lymphatic
Hydrostatic Pressure o If you have trauma in this area, chances are you will destroy
these 5 important structures
• Regulation of Arterial Pressure • Covered by a non-distensible structure called the Renal Capsule
o Plays a dominant role in long term regulation of arterial o Reason why in acute condition you don’t have enlargement
pressure by excreting variable amounts of Sodium and of the kidney
Water o In chronic conditions, there will be an enlargement of the
o Intermediate regulation of blood pressure: Renal-Fluid Shift kidney
→ ↑ BP = ↓ Urine Output
→ ↓ BP = ↑ Urine Output
o Short term regulation by secreting hormones and vasoactive
factors or substances (Renin) that lead to formation of
vasoactive products (Angiotensin II)
• Regulation of Acid-Base Balance
o 1st: Intra/Extracellular buffers (Ex. Bicarbonates,
Hemoglobin, Calcium, Phosphates, Phosphoric Acids)
o 2nd: Respiratory System
o 3rd: Recruit the Kidney
→ The kidney can only acidify up to the pH 5.0 and
alkalinize until pH 8.0 (Urine pH: 5.0 – 8.0)
• Regulation of Erythrocyte Production
o Erythropoietin – for erythropoiesis (primarily stimulated by
tissue hypoxia)
• Secretion, Metabolism, and Excretion of Hormones
o Renin, Erythropoietin, Vitamin D/1,25-dihydroxyvitamin • Renal Cortex – outer portion
D/Calcitriol (Final Activation) • Renal Medulla – inner portion
• Gluconeogenesis o Contains about 7 to 8 conical structure called the Renal
o Kidneys synthesize glucose from AA and other precursors in Papilla
cases of severe hypoglycemia
o Hallmark of the Medulla: there is a triangular Renal Blood Flow
structure/pyramidal structure called “Renal Pyramids”, the
base is near the cortex. The apex towards the Renal pelvis. True Capillary is
o Apex of the renal pyramid is called “Renal Papilla” → drains between an arteriole
to the minor calyx. and venule →
o The boundaries of the Renal Cortex and Renal Medulla are Peritubular Capillary
the Bases of the Renal Pyramid
• Minor Calyces will join together to form Major Calyces. Special Circulation:
• Major Calyces will form the Renal Pelvis. Glomerular Capillary in
• Urine will now pass through the renal pelvis to the Ureters and between 2 arterioles
will be collected in the Urinary Bladder.
• When the blood flow from one portion to another, the pressure
drops because it meets resistance
• The highest drop would be from the Efferent Arteriole
1. Size
o Substances with molecular weight up to app. 5000 whose
molecular radii are less than 15A (6nm) will have a
plasma:filtrate ratio of 1 (freely filtered)
o Beyond 8nm → no longer filterable
2. Shape • Components:
o For a given molecular weight, a slender and flexible o Mesangial Matrix
molecule will pass through the glomerular filtration o Mesangial Cells (Contract)
membrane more easily than a specific, nondeformable → Primary Function: Provide structural support for the
molecule Glomerular Capillaries
3. Electrical Charge → Secrete extracellular matrix
o The glomerular filtration membrane bears fixed (-) charges → Exhibit phagocytic activity
o These anionic sites consist of glycosaminoglycans rich in → Secretes prostaglandins and pro-inflammatory
heparan sulfate cytokines
→ Influence GFR (Glomerular Filtration Rate) and RBF
Juxtaglomerular Apparatus (Renal Blood Flow) by changing the surface area
→ Made up of Actin and Myosin
Immune Complex
Immune Complex Mesangial Area
Accumulation
Production of
Enhance
Proinflammatory Infiltration of
Inflammatory
Cytokines and Inflammatory Cells
Response Autocoids
[𝑈𝑠 ] 𝑥 𝑉
𝐶𝑠 =
[𝑃𝑠 ] Increase NE and Increases NE and
S = any substance Dopamine release Increasing strength Dopamine Release
in the Renal Nerves in the Renal Nerves
C = Clearance, mL/min
Us = Urine Concentration, mg/mL
Ps = Plasma Concentration, mg/mL
V = Urine Flow Rate, mL/min (+) β1 adrenergic
Renal Directly stimulate
receptors in the JG
Vasoconstriction Renal Tubular Cells
Cells
• Paraaminohippuric (PAH) Acid
o Freely filtered
o Secreted
o Not reabsorbed Increases Renin Decreases GFR and Increases Na and
o Not metabolized secretion RBF H2O Reabsorption
o Not stored
o Not synthesized
• Administer PAH → circulate in the blood → some will be filtered Functions of the Kidney
→ go to the urine (Us) 1. Excretion of metabolic waste products and foreign
• Measure the urine formed per minute (V) chemicals
• Measure the concentration in the plasma (Ps) 2. Regulation of water, plasma volume, and osmolarity
3. Regulation of electrolyte balance and other organic
As the urine concentration increases, the clearance also substances
increases. 4. Regulation of acid-base balance
o If you form a lot of urine per minute, then your clearance 5. Endocrine function and Gluconeogenesis
is good 6. Regulation of arterial blood pressure
o If you check and there is still a lot of the substance left in
the blood then your clearance is low Note: According to Starling and Smith, the kidney is more of a
REGULATORY organ rather than an excretory organ.
EXAMPLE: Effective Renal Plasma Flow (ERPF)
Concentration of PAH in Urine = 14 mg/mL
Urine Flow (V) = 0.9 mL/min
Concentration of PAH in Plasma = 0.02 mg/mL
14 𝑥 0.9
𝐸𝑅𝑃𝐹 = = 630 𝑚𝐿/𝑚𝑖𝑛
0.02