Kidney Anatomy the kidney mass and protect the vital

tissue from injury.

The Nephron, Cortex, Medulla, and Capsule
Adipose capsule
KIDNEY - layer of fat around the kidneys that helps
to keep it protected.
- Two small, but mighty bean-shaped organs - also called the perirenal fat.
that remove excess fluid and waste products
from the body.
Renal Protection
o about the size of your fist.
- Located at the back of the peritoneum
(retroperitoneal) in the superior lumbar
region.
o located just right below the rib cage
on each side of the spine.
o right kidney is located a little bit
lower than your left kidney to
accommodate the liver, just below
the diaphragm.
Structures that help to protect the kidneys.
➢ capsule
➢ the perirenal fat
➢ renal fascia
- these structure meant to caution and
protect our kidneys from damage, trauma,
being hit, and absorbing shock.

Renal Capsule
Layers of the Kidney
- Tough fibrous connective tissue layer that
covers the outside of each kidney
- Composed primarily of collagen and elastin
- protective sack or case around the kidneys.

How many liters of blood do kidneys filter per day?

About 142 liters of blood

- for example, you'll have to drink soda in a 2-

Renal Medulla
- near the innermost part of the kidney, or
the middle.
- contains the renal pyramids where urine
formation takes place.
Renal cortex
- surrounded on its outer edges by the renal
capsule, a layer of fatty tissue.
- together your renal capsule and your renal
cortex, house and protect the inner
structures of the kidney.
Renal Ins and Outs
Renal capsule
- thin membranous sheath that covers the
outer surface of each kidney.
- composed of tough fibers, chiefly
collagen, and elastin, that help to support
liter bottle, that would be 71 bottles of Coca-
Cola, that's a phenomenal amount of fluid
going through your kidneys every day; But
most of the water and other substances that
filter through the kidneys are return to the
blood by the tubules. Only one to two liters
become urine. So, you got 142 liters of blood
rising through the kidneys, but only one to two
liters actually get peed out of your body as
urine.
➢ Blood flows into your kidneys through the
renal artery that is connected to the aorta
▪ major vessel that brings
oxygenated blood from the
heart to the rest of the body.

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 ➢ Blood exits each kidney through the renal Renal Pyramids
vein that is connected to the inferior vena
Each kidney has several “pyramidal tissue masses”
cava.
which are
• take the use of blood
back to the heart to • triangle shaped.
be oxygenated again • located in the medulla of the kidney.
through the lungs. • made up of a dense network of nephrons.
➢ Urine exits the kidneys via the ureter to the - small structures that contain string of
bladder. nephrons and tubules.
o each one of the kidneys has a ureter. o These tubules will transport fluid into
o when that isn't flowing well, we can the kidney and later on this fluid will
have all kinds of problems in our move away from the nephrons
kidneys. toward the inner structures that will
o people with high blood pressure collect and transport urine out of the
really risk problems in their kidneys kidney.
▪ unregulated blood flow,
nandun lang sa kidney
o if we have kidney stones, or
something breaks loose in the kidneys
and travels into that ureter, it will
block the urine flow and all the stuff
flowing goes back to the kidney and
will cause renal problems.

Renal Cortex

The space where the nephrons of the kidneys are

perfused by:

1. Renal artery arterioles

- renal artery down to the arterioles
2. Renal vein venules
3. Glomerular capillaries
- this is where the nephrons of the kidneys are
perfused by the blood vessels, the renal artery,
The Renal Artery arterioles, the renal vein venules and the
glomerular capillaries
- blood comes to the kidney through the renal
artery that comes off the aorta and then the
renal artery is smaller than the aorta; and
then,
- The renal artery branches into progressively
smaller blood vessels until the blood reaches
the nephrons.
- Blood enters each kidney through the renal
artery

In the renal cortex, the protection of your

erythropoietin happens.
➢ erythropoietin is a hormone, and this
hormone is necessary for the synthesis of
your new red blood cells
People with kidney problems have:
- low red blood cell counts
- anemic and always tired

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 - don't have enough oxygen being perfused to
all the rest of the tissues.
- don't have enough erythropoietin
Nephron
- Functional unit of the kidney
- Each kidney has 1,000,000 nephrons
- Nephrons stretch from the cortex to the medulla
of the kidney
- perform the primary function of the kidneys.
o regulate the concentration of water and
other substances in the body.
o filter the blood, reabsorb what the body
needs, and excrete the rest as urine.
3 Main Parts of a Nephron
1. distal convoluted tubule
2. proximal convoluted tubule
3. glomerulus
▪ glomerulus is this tangle of
capillaries and it’s surrounded
by the Bowman's capsule
GLOMERULUS AND BOWMAN’S CAPSULE
- The glomerulus is a tangle of capillaries.
o very small, but powerful.
- When blood flows into the glomerulus, blood
pressure forces water and solutes out of the
capillaries and into the lumen of the BOWMAN’S
CAPSULE
o You've got the blood flowing into this
glomerulus at the rate of your blood
pressure.
o if the blood pressure is just hammering
the glomerulus, a client may start to have
some real renal damage.
o A healthy kidney with normal blood
pressure - blood pressure is going to
push that blood into the glomerulus at
the same force as your blood pressure,
and it will force the water and solutes out
of the capillaries and into the lumen of
the Bowman's capsule.
- Water, salts, amino acids, and wastes that make
it into the capsule are collectively called the
filtrate.
- The filtrate is filtered from the blood into the
tubules that is why this stage is called filtration.
▪ First
stage
In a Nutshell
✓ The kidneys remove excess fluid and waste
products from the body.
✓ The anatomy of the kidneys involves layers from
the internal medulla to the external layer of
pararenal fat.
✓ Blood flows into the kidney through the renal
artery and exits the kidney through the renal vein.
✓ Urine exits the kidneys via the ureter (and drains) to
the bladder.
✓ Nephrons are the working units of the kidney and
stretch from the medulla to the cortex.
Kidney Functions
THE BODY’S SMALL BUT MIGHTY SUPERHEROES
Main Functions (Superpowers) of the Kidneys
✓ Cleaning and maintaining extracellular fluid.
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 o fluid can only be in two spaces in the
body, the intracellular and the
extracellular; and the kidneys’ job is to
keep that extracellular fluid, the fluid
that's outside of the cell, clean and well-
balanced.
✓ Maintaining acid-base balance
o I assume that you already know the
arterial blood gases and we look at the
pH of the blood. Kidneys are a major
player in maintaining a strong and solid
acid-base balance. Diuretic Sites of Action in the Nephron
o in normal pH it is 7.35 to 7.45.
✓ Excreting wastes and substances (drugs, etc.)
o peeing right or urinating well
o when the kidneys are functioning well,
we can get rid of the drugs and other
waste products from the body.
o When the kidneys aren't functioning, you
tend to have a buildup, possibly even
toxic levels
✓ Regulation of blood pressure
o people with kidney disease have high
blood pressure. blood pressure can also
at the middle line across, on the top of that is the
be related to salt and water balance
cortex and below is the medulla and the nephron
▪ The more salt you have, the more
is stretched from cortex through the medulla.
water you have to hang on to.
o your intravascular volume goes up as Nephron
your blood pressure. So, they clean and - one of the biggest areas of trouble for a
maintain acid-base balance, excrete patient with kidney failure or kidney problems
waste, and they manage their regulation - they can't get rid of that waste, and they can't
of the blood pressure. get rid of that volume. So, we use diuretics.
✓ Reabsorption of water, glucose, and amino ▪ This is a medication that will
acids. increase how much of the fluid
o reabsorb the things that we need to keep is excreted from the body.
the tubules PCT
in the body
- about 65 to 70% of the sodium is reabsorbed
✓ Producing hormones and an enzyme.
there.
o calcitriol and erythropoietin (Hormones)
The tubule DCT
o Renin (enzyme)
- 25% of sodium potassium chloride is
RAAS - one that plays another major role in reabsorbed
o 5% of the sodium chloride is absorbed
maintaining our blood pressure.
o 1% to 5% of sodium potassium nitrate
What percentage of filtered blood is reabsorbed and is reabsorbed
put back into circulation through the renal vein? this tells us how strong or how potent A diuretic is
going to be depending on where exactly it works
• 99 % in the nephron
o fluid and waste and acid-base
balance in the body

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The 65% to 70% are the carbonic anhydrase
inhibitors, So this drug is given to clients who have
glaucoma, an eye problem.
In loop diuretics, Lasix or furosemide are the
strongest diuretic medications that are given to
clients who have renal failure.
- get our biggest impact with most patients
Loop diuretics will cause the most significant drop
in potassium, but thiazide diuretics will also cause
a drop in potassium.
potassium-sparing diuretics - At the end of the
line, and that's why they're not very intense.
- used on special occasions or to help patients
who are losing too much potassium in
treatment
In a Nutshell
✓ Kidney superpowers: (functions)
• Cleaning and maintaining extracellular fluid
• Maintaining acid-base balance
• Excreting wastes and substances (drugs, etc.)
• Regulation of blood pressure
• Reabsorption of water, glucose, and amino acids
• Production of hormones (erythropoietin, calcitriol)
and an enzyme (renin)
✓ Diuretics are used with patients who are overloaded
with fluid volume (so they need to get rid of these extra
fluid) and need the medication to stimulate the
kidneys to excrete an increased amount of fluid.
✓ Diuretics that work in the nephron include CAI’s loop
diuretics, thiazide diuretics, and potassium-sparing
diuretics.
KIDNEY PHYSIOLOGY: Mechanisms of Urine Formation
Functions of the nephrons:
• Filtration
• Tubular reabsorption
• Tubular secretion
Filtration
- Occurs when blood pressure nonselective forces water
and other small molecules out of glomerular
capillaries and into Bowman’s capsule, forming a fluid
called filtrate.
• From the renal artery, the blood flows into
glomerulus under the influence of pressure and
due to the narrowness of efferent arteriole
o This is what we call pressure filtration
• Sa video yung arrow na papasok is from arteriole or
afferent arteriole.
• Renal artery is hooked up in aorta, so lahat ng mga
papasok is from afferent arteriole or renal artery
• Sa kabila, we have the efferent arteriole, so palabas,
so meaning that the autosomal renal vein and then
the process of filtration will be done in the
glomerulus
o Glomerulus filters the waste molecules
(urea, salt, glucose, amino acids, and
water)
o Process will be done in the glomerulus.
• Blood gets filtered through the kidneys about 6
times a day
Tubular Reabsorption
it is the movement of substances from the filtrate across
the wall of the nephron back into the blood of the
peritibular capillaries.
• The filtrate obtained from the glomerulus is what
we call the primary urine
o Almost equal to blood in chemical
composition, except the presence of
blood cells
• The filtrate substances will pass into the PCT or the
proximal convoluted tubule, when passing there
the PCT then will reabsorb the useful substances
present in that primary urine, such as glucose,
amino acids, vitamin C, potassium, calcium,
sodium chlorides and the most abundant is the
water
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Tubular Secretion
- Is the active transport of solute across the nephron
walls into the filtrate.
• Tubular secretion
o Third important process in the formation
urine
• Secretion
o Process by which the substances move
into the distal convoluted tubules from
blood in the capillaries around the tubules
o moves substances out of the blood
o When the substances will move into the
DCT or the distal convoluted tubules and
the substances will go out from the blood,
palabas na siya. Later on, these
substances will be converted into urine
▪ Urine is composed of hydrogen,
potassium and ammonia and
other drugs that will be secreted
later on and eventually this is
what we call the elimination of
urine
• Reabsorption
o Moves substances out of the tubules (the
PCT) and into the blood
o When the substances will go to the PCT,
there will be reabsorption and pupunta sa
blood stream
Renin- Angiotensin- Aldosterone Mechanism
Renin-Angiotensin-Aldosterone System (RAAS)
- Hormonal system that controls blood pressure
- Responsible for long-term regulation
Barrow Reflex
- Short-term response to sudden changes in blood
pressure
In the kidneys, Within the walls of Afferent arterioles,
there are specialized cells producing pro-renin called
juxtaglomerular cells
o Upon activation by a drop in blood
pressure, pro-renin is cleaved to form
renin which is released into the blood
• Renin converts a plasma protein called
angiotensinogen, produced by the liver into
angiotensin 1
o A peptide of 10 amino acids
• Angiotensin 1 is further converted into
angiotensin 2, an 8 amino acid peptide, by the
angiotensin-converting enzyme (ACE)
o Predominantly present in the lungs and
kidneys
• Angiotensin 2 is a hormone
o It binds to angiotensin 2 receptors in
tissues to exert various effects
o It stimulates vasoconstriction in
systemic arterioles
o It promotes sodium reabsorption in
proximal convoluted tubules of the
kidneys
o It induces the release of aldosterone
from the adrenal cortex
▪ Aldosterone promotes
sodium and water retention in
the kidneys
In the central nervous system, angiotensin 2 has several
effects
• It acts on the hypothalamus to stimulate thirst
and encourage water intake
• It induces the posterior pituitary to release
antidiuretic hormone
o Promotes water retention by the
kidneys
• It reduces the sensitivity of baroreceptor
response to increased blood pressure so that
this response would not counteract the effect of
RAAS
• all these actions lead to an increase in blood
volume and blood pressure
• angiotensin 2 is short-lived, with a half-life of 1-
2 minutes
o it is degraded into angiotensin 3 and 4
which have lesser effects
Overactive or inappropriately activated RAAS is a cause
for hypertension,
• RAAS is a frequent target of anti-hypertensive
drugs
o ACE inhibitors and angiotensin
receptor blockers are common
treatment for hypertension
Renin-angiotensin-aldosterone System (RAAS)
• Renin
o Enzyme that is secreted by the cells of
juxtaglomerular apparatus in the kidneys
o Act as the angiotensinogen
• Angiotensinogen
o Plasma protein that produced by a liver
and then later on it will convert into
angiotensin 1
• Angiotensin 1
o Connects with ACE or angiotensin
converting enzyme
▪ ACE / angiotensin converting
enzyme
• Will be angiotensin 2
o Will be later on converted to a smaller
peptide, called angiotensin 2
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 • Angiotensin 2 • Kidney
o Acts on the adrenal cortex causing to o Plays an important role in removing waste
secrete aldosterone and reabsorbing what we want
▪ Responsible for maintaining o They’re going to empty out through the
blood pressure ureters to fill the bladder
ANTIDIURETIC HORMONE MECHANISM • Urethra
o Last exit out of the body
What happens in your body when you start getting
Parts Most Often Involved in a UTI
dehydrated?
Water levels in the blood decrease and this is detected by
receptors on cells in the hypothalamus
o These receptors are called
osmoreceptors
• In response, the cells secrete the signaling
molecule, antidiuretic hormone or ADH
o Hydrophilic peptide hormone
o Released from the pituitary
o Travels in the blood to the kidneys,
where urine is produced
Nephrons in the kidney filter urea, salts and other
UTI can actually be any part of the urinary system, the
solutes of the blood
kidney, ureters, bladder, and urethra
• the last part of the nephron, the collecting duct,
• But most often either the urethra and bladder
is the final place the body can reabsorb water
• If it progresses, it can easily travel up to the ureters
o ADH receptors are located on cells
and to the kidneys, and now we have something
lining the collecting duct
much more complex than just a bladder infection
• ADH binding to its receptor triggers a cascade
• Anywhere in the UTI infection is a risk. Most often
of interactions between molecules inside the
likely to see it in the bladder or in the urethra that’s
cell
why it really burns when urinating
o This process is called signal
• If the bacteria travels up the ureters to the kidney,
transduction
it is a much more serious problem
▪ It activates vesicles
Think about the young female patients when they are just
containing water channels
learning how to clean themselves after using the bathroom
called aquaporins
• Oftentimes, they contaminate that spot with E. coli
• These are inserted
because they are not wiping appropriately from
into the plasma
front to back
membrane
• That E. Coli can travel up to the urethra and to the
• More water can now move the collecting duct
bladder, and that’s what causes a bladder
back into the blood
infection
• Because of ADH, less water ends up in the urine
• If that gets out of control, that infection can travel
and the urine becomes more concentrated
up to the ureters and the kidneys
• If dehydrated, ADH helps to conserve water by
KIDNEYS
decreasing urine production
- Released by the POSTERIOR PITUITARY GLAND and - One located on each side of the spine
regulated by the HYPOTHALAMUS - Filter 120-150 liters of blood each day
- Functions to reabsorb WATER - Produce 1-2 liters of urine each day

THE URINARY TRACT

- The body’s drainage system

URINARY TRACT

URETERS

- Ureters are the thin tubes of muscle that carry

urine from each of the kidneys to the bladder.

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 • This can be problematic when those become
blocked
• For example, in a kidney stone
o When that moves out of the kidney,
travels into the ureter. We can have a
blockage
• So to everyone’s benefit that those ureters, both of
them to stay open so they can drain urine from the
kidneys into the bladder
Each kidney has one ureter that leads to the bladder. The Female Urethra

THE BLADDER

• Located in the pelvis between the pelvic bones

• Is a hollow, muscular, balloon-shaped organ that • The female urethra is about 4 cm, or 1.5 inches

expands as it fills with urine. long, and that's not very long

o Most of us had an experience when we’ve o which is why it's very common for women

let it overfill and we’ll talk about why that to develop bladder infections or urinary

shoots a painful message to our brain tract infections.

• Can be voluntarily controlled (unlike the kidneys ) The Male Urethra

o Most of us after potty training, we’re able

to learn to voluntarily control our bladder.
• Is a storage tank for urine delivered via the ureters
from the kidneys
• Can hold 360-480 mL of urine
o But every one of us had pushed it way
beyond its maximum of 480, which is when
you’ve had that panic feeling you might
not make it to the restroom in time

• their length of urethra is 20 centimeters, so that is

around 7 to 7.9 inches.
• Men end up having problems later in life when their
prostate gets a little bigger.
o we have there the prosthetic urethra.
▪ That's the part that travels
through the prostate.
• As men age, the prostate gets bigger and bigger,
and it kind of squeezes down the urethra, making it
THE URETHRA
difficult for them to fully empty their bladder and

- This will separate male anatomy from female they feel like they have to urinate a lot.

anatomy. Other parts of the urethra

o We know that the bladder empties
through the urethra, but they're very
different in male and female bodies.
o membranous urethra
o bulbar urethra
o penile urethra
• a male urethra is about five times the length of a
female urethra, which is why, if a man is diagnosed
with a UTI, it's usually considered a complicated
one
o because something insignificant had to
go for a bacteria to travel that far up.

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Your Brain and Urination o So as their central nervous system
matures, it acquires voluntary control
So what goes on when you have that panic feeling when
over the external urethral sphincter.
you really, really want to urinate?
• So the urination is controlled mainly by the
maturation center in the pons.
• There are nerve endings in the bladder wall that
o So this center will receive sensory signals
are sensitive to the bladder stretching.
from the bladder and will communicate
o They are stretched way beyond what they
with the cortex about the
should be.
appropriateness of urinating at the
o Now they start shooting a message right
moment
up to the brain.
o when it is not convenient to urinate, the
o This nerve impulse will go straight to the
center will send an inhibitory signal to
cerebral cortex and will say hello di ko na
keep the sphincter closed and prevent
kaya, kailangan ko na umihi, ihing-ihi na
voiding.
ako, or something like that.
• when you wish to urinate, this inhibition is
o What the brain ships back down is it will
removed, spinal cord will instruct the muscle of
stimulate the detrusor muscle to contract
the bladder to contract, and the sphincters open
and it stimulates relaxation of the internal
to let the urine out.
urethral sphincter.
3 simultaneous events must occur:
▪ So that's a very intense message
sent to your brain.
• Contraction of the detrusor by the ANS
o That's why you really or you can't really
• Opening of the internal urethral sphincter by the
think very well if you have to go to the
ANS
bathroom because they are screaming at
• Opening of the external urethral sphincter by the
your brain to do something about it.
somatic nervous system
• Now, a result of that detrusor muscle contracting
WHAT IS URINE
and the internal urethral sphincter opening up
and relaxing is that those bladder walls will
contract and the sphincter muscles will release
and when it relaxes, that opens a shoot to let the
urine leave the body.
• That's why when you're really, really panicking and
you're dancing around, it is because your brain is
screaming to your bladder to let this happen.

So what's all this stuff filling up the bladder?

Micturition
- Micturition is also called urination or voiding
- This is a neural control of urination and also known as
your micturition reflects.
• So when the bladder is full, the stretch receptors in
the wall of the bladder will send nerve impulses to
the spinal cord
• So by the way of the parasympathetic response,
the signals will return to the bladder and will
stimulate contraction of the muscle in the bladder
and the relaxation of the internal urethral
sphincter
o So this part of the reflex is involuntary
and is predominant in infants and young
children.
o Well, it is mostly water.
• What's in your urine is 95%, even a little more than
that water.
• Now most of you are really good about drinking
water, so you know when you first wake up in the
morning, it is more concentrated.
o In fact, we use the first urine of the
morning for some specialized urine
testing, but as you go through the rest of
the day and you're drinking adequately,
you will notice that your urine should be
getting lighter in color, but urine is
predominantly greater than 95% water.
• So what's in the other 5%?
o So we have the urea, chloride, sodium,
potassium creatinine and we've got some
other
o so let's just call them the dissolved ions.
o So we have the inorganic and organic
compounds Like the proteins, hormones
and metabolites.

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Abnormal Urine Output
Urea = urine
Proteinuria
- Protein content in urine, often due to leaky or damaged
glomeruli
• Protein content in urine is extra high tells us that
our kidneys are having a problem because the
glomeruli were damaged and protein is leaking
into the urine that shouldn’t be there
• it has a kind of foam on top, so that's a real
characteristic of a lot of protein in the urine.
• A urine analysis can tell us exactly how much
protein is in the urine.
• So particularly if a patient is diabetic, they're at
extremely high risk for kidney disease.
Oliguria
- An abnormally small amount of urine, often due to
shock or kidney damage
• Olig = scant
• abnormally small amount of urine, often because
the patient is super dehydrated, they've had
kidney damage or even shock.
Polyuria
- An abnormally large amount of urine, often caused by
diabetes
• exact opposite of oliguria
• poly = lot
• So if abnormally large amount of urine is seen, It is
often caused by diabetes, so that's a key sign to
someone If they have lost weight and they weren't
really trying and they're putting out lots and lots of
urine, this is a key cardinal symptom of diabetes.
Dysuria
- Painful or uncomfortable urination, often from urinary
tract infections
• Dys = difficulty
• So this means it is painful or uncomfortable when
someone is urinating and sometimes or most of the
time this burns.
• So this is one of the main symptoms people report
when they have a UTI or urinary tract infection.
Hematuria
- Red blood cells in urine from infection or injury
• Hema = blood
• so blood in the urine, red blood cells in the urine
could be from infection.
• That's one of the signs of infection or there could
be some injury of the kidneys
• You can look this further through urinalysis
Glycosuria
- Glucose in urine, due to excess plasma glucose in
diabetes, beyond the amount able to be reabsorbed in
the proximal convoluted tubule
• Glyco = too much sugar
• glucose in the urine.
• Now those strips at the photo are examples, so
they're chemicals that are put on a little ship.
• So the example here is when you have too much
glucose in your urine, you've got so much glucose
in your bloodstream for diabetics, it's beyond the
amount that can be reabsorbed by the kidneys in
the proximal convoluted tubules
In a Nutshell
✓ The urinary tract includes the kidneys, ureters,
bladder, and urethra.
✓ The nerves in the wall of the bladder are sensitive
to stretching and send signals to the brain.
✓ The average urine is composed of 95% water
✓ Assessment of a patient’s urine can help identify
several clinical problems.
✓ Micturition or urination is controlled involuntarily
by the ANS and voluntarily by the skeletal muscles
of the urethra
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