Renal Blood Flow and Glomerular

Filtration
Glomerular Filtration and Renal
Blood Flow
more than 1 L/min, or about 20% of the
cardiac output
A normal hematocrit is 0.45, and a typical
renal blood flow (RBF) is 1.1 L/min. The renal
plasma flow (RPF) = 0.55 x 1.1 L/min = 605
mL/min.
a typical glomerular filtration rate (GFR) is
about 125 mL/min. Thus, of the 605 mL of
plasma that enters the glomeruli via the
afferent arterioles, 125/605, or 20%, filters
into Bowman's space.
This ratioGFR/RPFis known as the
filtration fraction
Flow, Resistance, and Pressure in
the Kidneys
The basic equation for blood flow
through any organ is as follows: Q =
P/R,
Typical glomerular pressures are near
60 mm Hg in a normal unstressed
individual, whereas peritubular
pressures are closer to 20 mm Hg. The
high glomerular pressure is crucial for
glomerular filtration, whereas the low
peritubular capillary pressure is equally
crucial for the tubular reabsorption of
fluid.

Glomerular Filtration
The glomerular filtrate is nearly protein free
and contains most inorganic ions and low-
molecular-weight organic solutes in
virtually the same concentrations as in the
plasma.
On the basis of both molecular size and
electrical charge
For molecules with a molecular weight
ranging from 7000 and 70,000 d, the
amount filtered becomes progressively
smaller as the molecule becomes larger.

Electrical charge is the second variable
determining filterability of macromolecules.
For any given size, negatively charged
macromolecules are filtered to a lesser
extent, and positively charged
macromolecules to a greater extent, than
neutral molecules.
This is because the surfaces of all the
components of the filtration barrier (the cell
coats of the endothelium, the basement
membrane, and the cell coats of the
podocytes) contain fixed polyanions, which
repel negatively charged macromolecules
during filtration.
Direct Determinants of GFR
Rate of filtration = hydraulic permeability x surface
area x NFP

Starling forces
NFP = (P
GC

GC
) (P
BC

BC
)

Because there is normally little protein in
Bowman's capsule,
BC
may be taken as
zero and not considered in our analysis.
GFR = K
f
(P
GC
P
BC

GC
).



Filtered Load
It is the amount of substance that is
filtered per unit time sodium.
Its normal plasma concentration is 140
mEq/L, or 0.14 mEq/mL. (Note: 1 mEq
of sodium is 1 mmol.) A normal GFR is
125 mL/min, so the filtered load of
sodium is 0.14 mEq/mL x 125 mL/min =
17.5 mEq/min.
Autoregulation Mechanism
To counteract changes in GFR
Myogenic mechanism
Increased systemic pressure:
Autoregulation: afferent arteriole diameter
decreased (constricted) to maintain the GFR
Decreased systemic pressure:
Autoregulation: afferent arteriole diameter
increased (dilated) to maintain the GFR
In addition to keeping changes in RBF
fairly small, autoregulatory processes
also keep changes in GFR fairly small
Again, GFR does rise with an increase
in arterial pressure, just not
substantially.
tubuloglomerular feedback
As the filtration rate in an individual
nephron increases or decreases, the
amount of sodium that escapes
reabsorption in the proximal tubule and
loop of Henle also increases or
decreases.
More sodium filtered means more
sodium remaining in the lumen of the
nephron and more sodium flowing from
the thick ascending limb into the distal
tubule.
The macula densa cells sense the amount
of sodium and chloride in the lumen.
One result of changing levels of luminal
sodium chloride is to increase or decrease
the secretion of transmitter agents into the
interstitial space that affect the filtration in
the nearby glomerulus.
High levels of sodium flowing past the
macula densa cause a decrease in
filtration rate; low levels of sodium flowing
past allow a higher filtration rate.
The transmitter agents released by the
salt-sensing macula densa cells produce
vasoconstriction of the afferent arteriole,
thereby reducing hydrostatic pressure in
the glomerular capillaries.
These same agents also produce
contraction of glomerular mesangial cells,
thereby reducing the effective filtration
coefficient. Both processes reduce the
single-nephron filtration rate and keep it at
a level appropriate for the rest of the
nephron

Renal Clearance
renal clearance of a substance is the
volume of plasma that is completely
cleared of the substance by the kidneys
per unit time.

Qualities of agents to measure GFR
Inulin: (Polysaccharide from Dahalia plant)
Freely filterable at glomerulus
Does not bind to plasma proteins
Biologically inert
Non-toxic, neither synthesized nor
metabolized in kidney
Neither absorbed nor secreted
Does not alter renal function
Can be accurately quantified
Low concentrations are enough (10-20
mg/100 ml plasma)
Creatinine:
End product of muscle creatine
metabolism
Used in clinical setting to measure GFR
but less accurate than inulin method
Small amount secrete from the tubule
Para-aminohippurate (PAH):
An organic anion not present in body
Freely filtered, secreted but not
reabsorbed by nephron
Non-toxic, neither synthesized nor
metabolized in kidney
Low concentrations are enough (10
mg/100 ml plasma)
RPF = Clearance
PAH
= U
PAH
.V / P
PAH


Solute Clearance:
Rate of removal from the Blood
Figure 19-16: Inulin clearance
Concept of clearance
Where,
Cx = Clearance of substance X (mg/min)
Ux = Urine concentration of X (mg/ml)
Px = Plasma concentration of X (mg/ml)
V = Urine flow rate of X (ml/min)
GFR = Cx =
Px
Ux . V
Qx extracted = Qx excreted

Px . Cx = Ux . V
Effective renal plasma flow =GFR
ERBF = Cx =
1 - Hct
ERPF
Renal blood flow =
RBF =
Extraction ratio
ERBF
Effective renal blood flow =
Extraction ratio (0.9) =
A
PAH
A
PAH
- V
PAH
Hct=hematocrit
V
PAH
= vein plasma PAH
A
PAH
= arterial plasma PAH

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