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Kidney Function: What Do The Kidneys Do?
Kidney Function: What Do The Kidneys Do?
In order to understand the goals of dialysis and why it is so crucial to the health of people with kidney failure, the function of healthy kidneys must be known.
The working units of the kidneys are called nephrons. There are approximately 500,000 nephrons in each kidney. In the diagram above, the nephrons are located in the cortex (cortical nephrons) and medulla (juxtamedullary nephron). In a given minute, 1200 milliliters of blood flows through the kidneys (Cooney, 270).
Blood flows into the kidneys through the renal artery and enters the glomerulus in Bowman's capsule. In the glomerulus, the blood flow is split into fifty capillaries that have very thin walls. The solutes in the blood are easily filtered through these walls due to the pressure gradient that exists between the blood in the capillaries and the fluid in the Bowman's capsule. The pressure gradient is controlled by the contraction or dilation of the arterioles. After passing through the afferent arteriole, the filtered blood enters the vasa recta. Blood exits the kidneys through the renal vein. On the other hand, the particles and fluid removed from the blood, the filtrate, moves from the Bowman's capsule to the proximal tubule, loops of Henle, distal tubule, and collecting tubule. Urine is formed in the collecting duct and then exits through the ureter and bladder. From the proximal tube to the collecting tubule, the filtered blood and filtrate pass very close together. The peritubular capillaries (containing the filtered blood) are actually surrounded by the tubules. The nutrients that the body needs are reabsorbed into the blood at this point. Along with the nutrients that are reabsorbed into the blood, the balance of water and other molecules such as sodium and chloride is established by the reabsorption from the loop of Henle. In the kidneys, active, passive, and osmotic transport are used to transfer molecules such as those mentioned above. The active transport of Na+ out of one side of the tubule membrane and into the peritubular capillaries creates an electrical potential inside the tubule and a concentration gradient between the tubule interior and membrane that causes Na+ to move from the interior through the membrane. This passive tranport causes another Na+ to enter the tubules on the opposite side due to the concentration gradient. Cl-, HCO3 -, and PO4 2- are also passively transported due to the electrical potential. Unlike those ions, H+ and K+ are actively secreted from the distal tubule and collecting duct. Water is osmotically transported. The osmotic shifts of water lead to diffusion of solutes between the tubules and capillaries. The amount of reabsorption of all the molecules depends on the concentrations in the tubules and in the peritubular capillaries. As well as the amount of the solute present, the amount that can
be transported also depends on the permeabilities of the membranes for the particular solute. In general, wastes are poorly reabsorbed due to their lower membrane permeability, while the essential nutrients are more readily absorbed as their permeabilities are higher.
The maximum urine concentration is limited by the interstitial fluid concentration at the bottom of the loops of Henle. The urine leaving the collecting tubule has the same concentration as the interstitial fluid at that point. The interstitial concentrations are largely a function of blood flow in the three regions. In the cortex, the lower concentrations are the result of the large blood flow in the peritubular capillaries. The capillary blood carries away excess solute and water in the region. In the medulla, the only blood flow is in the vasa recta, approximately 10% of the cortical blood flow. The loop structure of the vasa recta keeps the entering and exiting concentration the same. While solute is absorbed in the descending loop, an equal amount of solute is secreted in the ascending loop.