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Urinary System
Urinary System
Outline
Functions Anatomy Urine formation: - Filtration - Reabsorption - Proximal Convoluted Tubule (PCT) - Loop of Henle - Distal Convoluted Tubule (DCT) - Secretion Regulation of GFR Micturition
Outline
Functions Anatomy Urine formation: - Filtration - Reabsorption - Proximal Convoluted Tubule (PCT) - Loop of Henle - Distal Convoluted Tubule (DCT) - Secretion Regulation of GFR Micturition
Renal functions
1- Regulation of plasma ionic composition 2- Regulation of plasma volume 3- Regulation of plasma osmolarity 4- Regulation of plasma hydrogen ion concentration (pH) 5- Removal of metabolic wastes and foreign substances 6- Secondary endocrine organ
Outline
Functions Anatomy Urine formation: - Filtration - Reabsorption - Proximal Convoluted Tubule (PCT) - Loop of Henle - Distal Convoluted Tubule (DCT) - Secretion Regulation of GFR Micturition
Figure 18.1
Kidney anatomy
Nephron
Figure 18.5
Figure 18.6
Outline
Functions Anatomy Urine formation: - Filtration - Reabsorption - Proximal Convoluted Tubule (PCT) - Loop of Henle - Distal Convoluted Tubule (DCT) - Secretion Regulation of GFR Micturition
Glomerular filtration
Plasma is filtered through fenestrated epithelium About 180 liters of plasma are filtered per day filtrate Filtrate = plasma - proteins
Glomerular capillary hydrostatic pressure due to blood hydrostatic pressure against capillary wall (BHP) Glomerular osmotic pressure due to the presence of solutes (proteins) in the blood (BOP) Bowmans capsule hydrostatic pressure pressure of filtrate against Bowmans capsule wall (CHP) Bowmans capsule osmotic pressure due to the pressure of solutes in the filtrate (COP) Net filtration rate fluid moves from the glomerulus into the capsule
Glomerular filtration
The glomerular filtration rate (GFR) = volume of plasma filtered per unit of time = 125 ml/min 180 liters per day Filtration fraction = GFR/renal plasma flow = 20%
Outline
Functions Anatomy Urine formation: - Filtration - Reabsorption - Proximal Convoluted Tubule (PCT) - Loop of Henle - Distal Convoluted Tubule (DCT) - Secretion Regulation of GFR Micturition
Glucose reabsorption
The transporter for glucose on the basolateral membrane has a limited capacity to carry glucose back into the blood. If blood glucose rises above 180 mg/dl, some of the glucose fails to be reabsorbed and remains in the urine glucosuria
Outline
Functions Anatomy Urine formation: - Filtration - Reabsorption - Proximal Convoluted Tubule (PCT) - Loop of Henle - Distal Convoluted Tubule (DCT) - Secretion Regulation of GFR Micturition
Figure 19.7 (1 of 6)
Figure 18.4
Importance: the collecting tubule runs through the hyperosmotic medulla more ability to reabsorb H2O
Outline
Functions Anatomy Urine formation: - Filtration - Reabsorption - Proximal Convoluted Tubule (PCT) - Loop of Henle - Distal Convoluted Tubule (DCT) - Secretion Regulation of GFR Micturition
-- the cell membrane has receptors able to bind and respond to various hormones: ADH, ANP and aldosterone -- The binding of hormones will modify the membrane permeability to water and ions
ADH is low no binding to receptors H2O is not reabsorbed back into the blood H2O remains in the renal tubule high urine volume
ADH is released by post. Pituitary Binds to receptors in CT channels open H2O moves into the IF and blood low urine volume
Sodium regulation
Hypernatremia causes water retention and high blood pressure Hyponatremia hypotension Because sodium is tightly linked to BP, BP is regulating sodium movement in the tubules Recall that BP directly affects GFR GFR is sensed by the macula densa of the Juxtaglomerular Apparatus (JGA) If too low, the juxta-glomerular cells of the JGA secrete renin into the blood
Sodium regulation
As a result, aldosterone will be secreted by the adrenal cortex promotes sodium reabsorption in the DCT and CT. Another hormone, Atrial Natriuretic Peptide or ANP promotes sodium dumping by the DCT and CT.
Outline
Functions Anatomy Urine formation: - Filtration - Reabsorption - Proximal Convoluted Tubule (PCT) - Loop of Henle - Distal Convoluted Tubule (DCT) - Secretion Regulation of GFR Micturition
Excretion: Molecules are dumped outside the tubules Example of excreted waste products: urea, excess K+, H+, Ca++
Clinical applications
Carbonic anhydrase inhibitors: Osmotic diuretics: Thiazide diuretics Loop diuretics: K+ sparring diuretics:
Diuretics
Site of Action Diuretic Osmotic diuretic (e.g., mannitol) Proximal tubule Thin descending limb Distal tubule Collecting ducts
Mechanisms of Action
- impedes water reabsorption and indirectly impedes Na+ reabsorption by blocking the convective movement of Na+
Carbonic anhydrase inhibitors Proximal tubule - impedes HCO3-, H+, Na+ reabsorption - HCO3- loss, .: acidosis
TAL
Thiazides
- blocks Cl- reabsorption, creating intraluminal negative charge which impedes Na+ reabsorption
Aldosterone bockers
- blocks Na+/K+ antiports, impeding Na+ reabsorption and K+ secretion (K+ sparing effect)
P X GFR = U X V
P = plasma concentration of A, in mg/mL GFR = glomerular filtration rate of plasma, in mL/min U = urine concentration of A, in mg/mL V = rate of urine production in, in mL/min Solving the equation for GFR will give: GFR = (U X V)/P
GFR = (U X V)/P
Urea: cannot be used since it is both secreted and reabsorbed (why is it so?)
Outline
Functions Anatomy Urine formation: - Filtration - Reabsorption - Proximal Convoluted Tubule (PCT) - Loop of Henle - Distal Convoluted Tubule (DCT) - Secretion Regulation of GFR Micturition
GFR regulation: - to increase GFR: **vasoconstrict efferent vessel ** vasodilate afferent vessel
Outline
Functions Anatomy Renal exchange processes Regional specialization of renal tubules Excretion Regulation of GFR Micturition
Micturition
Controlled by the sacral parasympathetic NS Stretch sensors in the bladder wall send impulses to the sacral spine reflex opening of the urethral smooth muscle Impulses also sent to the cortex to notify the brain of the need to urinate if the moment is OK, the person will go to the bathroom (hopefully!), and will open the skeletal (voluntary) muscle of the urethral sphincter the person will be able to urinate
Clinical applications:
Water intake: - drink - food - catabolism
Water output
Overall, intake should equal output Urine output should be less than water intake (drinks) Urine is constantly formed at a minimum rate of about 20-30 ml/h
Clinical cases
1- Martha is a patient in a nursing home. She is 84 yearold, senile and weak. She is bed bound and does not feed herself anymore. She has a urinary catheter and you noticed, at the beginning of your shift that the bag had a small amount of dark yellow urine. I&O (intake and output): intake 650 cc and output 250 cc. 2- Henrietta is Martha's roommate, also in not very good shape. She has been on IV fluid receiving 100ml/h. I&O 900ml. Her urine output is 250 ml (she has a catheter).
What do you think? - are the numbers balanced? - if not, what could be wrong?
What do you think? - are the numbers balanced? - if not, what could be wrong?