BASIC ANATOMY

AND PHYSIOLOGY
KIDNEY
1. STRUCTURE
1. MACROSCOPIC
2. MICROSCOPIC
◦ 2. RENAL PHYSIOLOGY – Based on the function of each microscopic components.
◦ A. GLOMERULAR FUNCTION – to strain proteins from the plasma and produce a “protein free” –
filtrate that becomes urine.
◦ 1. The GLOMERULAR FILTRATION RATE (GFR) equals 125 to 130 ml protein free fluid formed per minute.
◦ 2. CLEARANCE indicates the number of millilitres of plasma from which the kidney can remove all of a given
substance in 1 minute. Assessment of “Clearance” is an assessment of glomerular filtration rate.
◦ 3. PLASMA RENAL FLOW – is the number of millilitres of plasma passing through the kidney in 1 minute.
Normal is 625 mL/min.

B. TUBULAR FUNCTION – to reabsorb certain substances back into the body. Proximal Tubule resorbs 75% of water ,
sodium, much of glucose, amino acids, certain ions and small molecules. Some substances have maximum
concentration in plasma so the tubule cannot resorb it all. Excess substances then spills over to the urine. Proximal
tubule allows for the elimination of urea and creatinine.
C. LOOP OF HENLE adjust urine osmolality to keep the urine watery.
D. DISTAL TUBULE – resorbs some salt, water and bicarbonate, but eliminate uric acid, ammonia, and
hydrogen ions. The distal tubule is under hormonal control.
E. COLLECTING DUCTS – under hormonal control for resorption of water and sodium.
◦ 3. RENAL SYSTEM FUNCTION – maintain balance of water, ions and pH; to eliminate non
protein nitrogen and to synthesize certain hormones.
◦ A. WATER BALANCE – maintain by ingestion of water and excretion/resorption of water in the renal
tubules under hormonal control by ADH hormone.
◦ B. IONIC BALANCE of sodium, potassium, phosphate, calcium and magnesium is maintained by tubule
resorption under hormonal control of aldosterone. Chloride is partially resorb with sodium.
◦ C. ACID BASE BALANCE – is controlled by kidney conservation of bicarbonate ions and removal
of metabolic acids to conserve pH level.
◦ D. NON PROTEIN NITROGEN (urea, creatinine, and uric acid) is eliminated or filtrated by the glomerulus.
Some urea and uric acid are reabsorb into the blood.
◦ E. SYNTHESIS OF 3 HORMONES AND 1 ENZYME – kidney aslso serve as a site for hormonal action of
aldosterone and ADH.
◦ 1. RENIN – vasoconstrictor synthesized in renal medulla
◦ 2. PROSTAGLANDIN synthesized in the kidney and affect renal blood flow.
◦ 3. ERYTHROPOITEN increase the heme production and iron insertion into red blood cells and is formed in
conjunction with an enzyme made in the kidney.
◦ 4. DIHYDROXYCHOLECALCIFEROL hydrolase activates Vitamin D into usable form.
4. RENAL SYSTEM DISORDERS – affect the glomerulus, the tubules or other components of
the system.
◦ A. GLOMERULAR DISEASE – affects the portion of the glomerular structure.
◦ 1. GLOMERULONEPHRITIS is related to group a b-hemolytic steptococcal infections. immune complexes
damage the structure of the glomerulus which leads to anemia, uremia and edema.
◦ 2. NEPHROTIC SYNDROME - refers to the increased permeability of the glomerular cell basement membrane
which also leads to proteinuria and edema.

B. Tubular diseases occur in all renal disease as GFR fails and affect the acid-base balance.
C. Urinary Tract infection – are bacterial infections that produce bacteuria and pyuria.
d. Renal calculi (kidney stones) – these are deposits of calcium and uric acid that follow urinary tract infections and lead to
hematuria.
E. RENAL FAILURE CAN BE ACUTE OR CHRONIC AND AFFECTS MANY CHEMISTRY ANALYTES.
1. ACUTE RENAL FAILURE – typically caused by cardiovascular system failure (PRERENAL), necrosis of the
tubular system (RENAL), or obstruction of the lower urinary tract (POST RENAL) This condition leads to oliguria
proteinuria and hematuria.
2. chronic renal failure – results from the chronic loss of excretory and regulatory functions. Causes vary from
chronic glomerulonephritis to obstructive uropathy to renal vascular disease.