Renal Function

Urine • is a liquid produced by the KIDNEY to remove waste products from the bloodstream.
• ULTRAFILTRATE of PLASMA.
Why analyze? - To check for disease or infection involving the URINARY
TRACT.
- To monitor course of treatment of diseases like diabetes,
kidney stones and UTI.
- A part of regular physical examination.
- When patients- are bothered with abnormal color, odor of
their urine. Have pain when micturation.
Glomerular - When there is presence of red cell casts it strongly confirms glomerular hematuria.
hematuria
RBCs Cellular Casts

Urinary Tract 2 Kidneys The kidneys are two bean-shaped organs that extract waste
System from blood, balance body fluids, form urine, and produce a
very important hormone called erythropoetin that promotes
production of rbc
2 Ureters 2 long narrow tubes that carries urine from the kidneys to the
bladder. When smooth muscles in the ureter contract,
peristalsis is initiated, pushing the urine down to the urinary
bladder.
Urinary Bladder a hollow pear shape / muscular organ that serves as storage of
urine. Can store up to 500 mL of urine
Micturation When the bladder is stretched, this signals the
parasympathetic nervous system to contract the
detrusor muscle. (The detrusor muscle is a layer
of the urinary bladder wall made of smooth
muscle fibers arranged in spiral, longitudinal,
and circular bundles.) This encourages the
bladder to expel urine through the urethra.
Urethra The tube that leads from the bladder and transports and
discharges urine outside the body. In males, the urethra travels
through the penis and carries semen as well as urine. In
females, the urethra is shorter than in the male, and it emerges
above the vaginal opening.
Kidney Renal Capsule tough fibrous layer surrounding the kidneys

Cortex reddish brown layer of tissue, below the capsule where

ultrafiltration occurs
Medulla innermost layer, consisting of pale conical-shaped striations,
the renal pyramids. Renal pyramids consist of blood vessels
and elongated portions of tube-like structures like loop of
henle as well as the collecting tubules.
Calyces cuplike extensions of renal pelvis surrounding the tips of the
pyramids and collects urine. Urine in pelvis passes down the
ureters to the bladder.
Renal Perlvis funnel-shaped structure that acts as a receptacle for the urine
formed by the kidney
Nephron - Each kidney has 1-1.5M functional units called nephron.
- 2 kinds of nephron:
1. Cortical-85%
2. Juxtamedullary-15%
Cortical Nephron situated in the cortex and responsible for removal of waste and
reabsorption of nutrients.

Juxtamedullary have longer loops of Henle that extend deeply in the medulla
and its primary function is concentration of the urine.
Urine Afferent arteriole Brings 20-25% of blood from left
Formation ventricle of the heart to the nephron
to be filtered
Glomerulus: Capillary tuft or cluster of capillaries
where FILTRATION occurs. NON-
SELECTIVELY filters <70k MW
Bowman's Capsule First part of nephron where filtrate is
collected.
Efferent arteriole Removes blood from nephron

Proximal Convoluted Tubule Where selective REABSORPTION

Loop of Henle
Distal Convoluted Tubule
occurs. SECRETION of non-filtered
(glomerulus) substances like
medications, drugs which are protein
bounded & H+ ions .
lies adjacent to Vasa Recta where
MAJOR exchange of H2o and ions
occur - Important for establishing a salt
gradient( RENAL CONCENTRATION) in
the medulla
Final site of selective REABSORPTION
of Na (due to Aldosterone). Secretion
of K.

Collecting Duct where final concentration of filtrate

(due to ADH which initiates water
reabsorption) occurs cruising to the
ureter.
- The ability of the kidneys to clear waste products SELECTIVELY
simultaneously maintaining the body’s electrolyte and water
balance is controlled in the nephron by the following renal
functions : glomerular filtration, tubular re absorption, tubular
concentration and tubular secretion.
- Reabsorption –
- Active- combines with carrier protein ( glucose, aminoacids, and
salts in proximal CT.)( Cl in THICK ascending LoH) and Na in distal
CT.Passive- re absorption due to changes in concentration and
electical potential of the opposite sides of membrane ( there must
be water ) ( Urea in PCT and ascending LoH , THIN asceding LoH –
Na+)
- Tubular concentration – water is reabsoRbed in the descending
LoH. EXCESSIVE REABSORPTION OF WATER is PREVENTED BY
IMPERMEABLE ASCENDING LoH. Dilution of the interstitial medulla
is prevented by reabsorption of Na ( passive) and Cl ( active) , This
process is called “ counter current mechanism) Cl ( active) in the
ascending LOH).
- Passive

Renal
Circulation
Factors that Cellular structure of the - the fenestrated pores of the glomerular capillary walls allows
Influence glomerulus and Bowman’s only entrance of less than 70k MW of plasma substances.
Glomerular Capsule
Filtration - Thin membranes covering the filtration slits formed by
intertwining foot processes of the PODOCYTES in the
basement membrane of BC restrict LARGE molecules
Glomerular capillary - must be consistent!
pressure - A juxtaglomerular apparatus – has an auto regulatory
function that maintains the glomerular blood pressure at a
relatively constant rate REGARDLESS of the fluctuations of the
systemic blood pressure.

TOTAL Renal Blood flow: 1200ml/min

GFR: 120 ml/min
Ultrafiltrate of plasma:
• Sp grav 1.010
Renin-Angiotensin- When there is low plasma sodium / low water retention/ low
Aldosterone System overall blood volume and low BP – juxtaglomerular cells release
RENIN ( enzyme)
- Renin converts an INERT angiotensinogen to angiotensin 1 –
passes to the lungs and with the ACE ( angiotensin converting
enzyme) becomes angiotensin II
Angiotensin II – vasodilation of the afferent arteriole and
constriction of the efferent arteriole. Stimulates reabsorption of
Na+ in proximal tubules.
- Triggers the adrenal cortex to release Aldosterone (aids in re
absorption in PCT)
- Released of ADH by hypothalamus (initiates water re-
absorption in collecting duct).
Tubular Active Transport - substances combine with protein carriers. The
Reabsorption electrochemical energy created by this interaction transfers
the substances across cell membranes back to blood stream
- Active transport, like passive transport, can be influenced by
the concentration of the substance being transported When
the plasma concentration of a substance that is normally
completely reabsorbed reaches an abnormally high level, the
filtrate concentration exceeds the maximal reabsorptive
capacity (Tm) of the tubules, and the substance begins
appearing in the urine
Passive Transpor is the movement of substances across the membranes due to the
differences of concentration and electric potential on opposing
sides of the membrane

Renal threshold concentration of substance above which the substance appears in

urine
Eg. Glucose – 160-180mg/dl
Tubular
Concentration

Tubular Importance of Tubular Secretion:

Secretion 1. Removal of unfiltered waste – medications Eg. heparin
2. Regulation of the Acid-Base Balance of the body
Acid- Base H+ secretion
Balance HCO3-
reabsorption
Excretion of:
H2PO4
NH4-
Final Re absorption / retention of water : vasopressin, ADH
Concentration • Late part of DCT
of Urine • Collecting Duct
Dehydrated:
Hydrated:
Tubular - Re
absorption ,
Concentration
& Secretion

Clearance - STANDARD test used to measure the FILTERING CAPACITY of the glomeruli.
Tests / - Ability to REMOVE a filterable substance from the blood
Glomerular Urea Clearance - EARLIEST glomerular filtration test
tests - 40% of filtered UREA is RE absorbed
Inulin Clearance - a polymer of FRUCTOSE, NOT re absorbed or secreted in the
tubules
- NOT a normal body constitient and NEEDED to be injected
- WAS the original reference method for clearance tests.
Creatinine Clearance - NORMALLY found @ a relative constant level in blood
- ENDOGENOUS procedure for evaluating GLOMERULAR function
MUST measure:
1. Total Volume of Urine in 24HR
2. Concentration of Plasma creatinine
3. Concentration of Urine creatinine
NV: Male – 107-139 ml / min
Female – 87-107 ml / min
eGFR Formula being used
1. Modification Diet in Renal Disease
2. Natinal Kidney Disease Education program – present formula
- The formula = to the results of a referenced BODY size 1.73m2
and use SERUM creatinine based on ENZYATIC assay.
- NOT accurate for pediatric patients
Cystatin C - a small protein produced at a constant rate by ALL nucleated
cells.
- Readily filtered by glomerulus and re absorbed .
- NO secretion happens
- SERUM Cystatin C= directly related to GFR
- Recommended for pediatric patients, persons w/ diabetes ,
elderly and critically ill patients
- INDEPENDENT of muscle mass.
- CYSTATIN C and creatinine CAN provide accurate information of
GFR
B2- Microglobulin - dissociates from human leukocyte antigens @ a CONSTANT rate
and rapidly removed via glomerular filtration.
- SENSITIVE indicator of decrease GFR than creatinine clearance.
- NOT reliable for patients with immunologic disorders or
malignancy
 Tubular Osmolality
Reabsorption
tests
Tubular PAH test - para amino hippuric acid test
Secretion - Exogenous compound used to measure renal blood flow.
Tests - IV infused and monitored so the REMOVAL is NOT via glomerulus
BUT via peritubular capillaries.
Titratable Acidity and - The ability of the kidney to produce an acid urine depends on
Urinary Ammonia tubular secretion of H ions and production and secretion of
ammonia by the cells of DCT
- Renal tubular acidosis Metabolic acidosis with inability to produce
an acid in urine
- Measure: Urine pH , titrable acidity & Urinary Ammonia
Phenolsulfonphthalein - Excretion of dye PSP
test- OLD test Disadvantage ( NOT performed)
- Difficulty in standardization & interpretation of test
- Interference of medications
- Increase of waste products

Practice Questions: (Boards)