RENAL FUNCTION RENAL ANATOMY & PHYSIOLOGY

URINARY SYSTEM  NEPHRON

 Composed of four main components:  The functional unit of the kidney
 KIDNEY- where urine is formed by  Approximately 1 to 1.5 million each kidney
FILTRATION of blood
 URETERS- carry the urine to the bladder PARTS OF NEPHRON:
 BLADDER- stores the urine produced  Glomerulus (Renal Corpuscle)- consists of a
 URETHRA- delivers the urine for coil of approx. eight capillary lobes (capillary
EXCRETION. tuft)
 KIDNEY’S FUNCTION:  Bowman’s Capsule
 Maintaining homeostasis: regulation of  Proximal Convoluted Tubule (PCT)
body fluids, acid–base balance, electrolyte  Loop of Henle (descending/ ascending)
balance  Distal Convuluted Tubule (DCT)
 Excretion of waste products  Afferent arteriole – point of entry
 Concerned with the maintenance of blood (UNFILTERD BLOOD)
pressure and erythropoiesis  Efferent arteriole – point of exit (FILTERED
BLOOD)
 Peritubular capillaries –surround the
proximal and distal convoluted tubules
 Vasa recta – located adjacent to the
ascending and descending loop of Henle

2 TYPES OF NEPHRON:
1. Cortical nephron
- Approximately 85%
- Responsible for removal of waste
products & reabsorption
2. Juxtamedullary nephron (15%)
- Primary function is concentration of
the urine
RENAL FUNCTION RAAS (Renin-Angiotensin-Aldosterone System)
o Renal Blood Flow  This system respond to changes in blood
o Glomerular Filtration pressure and plasma sodium content
o Tubular Reabsorption  Monitored by JUXTAGLOMERULAR APPARATUS
o Tubular Secretion
Mechanism:
A. RENAL BLOOD FLOW
 The kidneys receive a large blood flow (25%)  Water retention  Renin 
 RENAL ARTERY supplies blood to the kidney. Renin + Angiotensinogen  Angiotensin I

RENAL ARTERY  Afferent arteriole  (Angiotensin Converting Enzyme)

Glomerulus (filtration)  Efferent arteriole  ---------------------------------------------> Angiotensin II
Peritubular capillaries (immediate reabsorption) (Lungs)
 Vasa recta (Water & salt exchange)  RENAL
VEIN FUNCTIONS OF ANGIOTENSIN II:
1. Vasodilation of afferent & vasoconstriction of
 Based on average body size of 1.73m: efferent arteriole.
o TOTAL RENAL BLOOD FLOW: approx. 2. Stimulate Sodium reabsorption in the Proximal
1200 mL/min Convoluted Tubule (PCT).
o TOTAL RENAL PLASMA FLOW: 600 to 700 3. Release of the hormone Aldosterone from
mL/min adrenal cortex.
4. Release of Antidiuretic hormone from
B. GLOMERULAR FILTRATION hypothalamus.
GLOMERULUS
 Consists of coil of approx. eight capillary
C. TUBULAR REABSORPTION
lobes referred to as capillary tuft.
 Served as a sieve or a filter of plasma
REABSORPTION MECHANISM
substances with molecular weight of
 ACTIVE TRANSPORT
<70,000
- Substance to be reabsorbed must
 Located within the BOWMAN’S CAPSULE
combine to a carrier protein contained
(forms the beginning of the renal tubule)
in the membranes of the renal tubular
CELLULAR STRUCTURE OF GLOMERULAR cells.
FILTRATION BARRIER - Can be influenced by the
 Must pass through 3 cellular layers: concentration of the substance being
 Capillary wall membrane transported.
- Contains pores and are - Renal threshold- plasma concentration
referred to as fenestrated at which active transport stops.
 Basement membrane  Ex. Renal threshold for glucose
- Presence podocytes is 160 to 180 mg/dL
 Visceral layer of Bowman’s capsule
 PASSIVE TRANSPORT- movement of
GLOMERULAR PRESSURE molecules across membrane as a result of
 Presence of HYDROSTATIC PRESSURE differences in their concentration or
(cause by size of afferent and efferent electrical potential.
arteriole)
 HYDROSTATIC PRESSURE are necessary to
overcome the opposition of pressure from NOTE: Exceeding the renal threshold of substances
the fluid from the Bowman’s capsule and affects the Maximal reabsorptive capacity of the
the ONCOTIC PRESSURE of unfiltered tubules, leading to the appearance of the substance
plasma protein. in the urine.
ACTIVE TRANSPORT D. TUBULAR SECRETION

SUBSTANCE LOCATION 2 MAJOR FUNCTIONS:

 Glucose Proximal Convoluted Tubule 1. Elimination of waste products not filtered by
 Amino acids (PCT) the glomerulus
 Salts  Ex. Urea & Medications

Proximal and Distal 2. Regulation of acid- base balance (secretion of

Sodium Convoluted Tubule hydrogen ions)
(PCT/DCT)  As a result of its molecular size,
hydrogen ion are readily filtered and
PASSIVE TRANSPORT absorbed.
 Secretion of hydrogen ions by the renal
SUBSTANCE LOCATION tubular cells into the filtrate prevents
the filtered bicarbonate from being
 Proximal Convoluted
excreted
Tubule(PCT)
 BICARBONATE ACTS AS BUFFER
Water  Descending Loop of Henle
TO THE BLOOD MAINTAINING
 Collecting Duct NORMAL pH.

 Proximal Convoluted
Urea Tubule (PCT)
 Ascending Loop of Henle

Sodium Ascending Loop of Henle

NOTE: All parts of the tubules can reabsorb water

except your Ascending Loop of Henle because it is
impermeable to water

 TUBULAR CONCENTRATION
- Begins in the descending and ascending
Loop of Henle

 COLLECTING DUCT CONCENTRATION

- Depends on the osmotic gradient in the
medulla and the hormone
VASOPRESSIN (ADH)
- Production of vasopressin is
determined by the state of body
hydration.

NOTE: Vasopressin- Antidiuretic hormone (ADH) =

WATER REABSORPTION
RENAL FUNCTION TESTS
GLOMERULAR FILTRATION RATE

CLEARANCE TEST NOTE:

 Measure the filtering capacity of the glomeruli. o UC= URINE CREA; PC= PLASMA CREA;
 Measures the rate at which the kidneys are able UV= URINE VOLUME; MINUTES= 1440(mins.);
to remove (to clear) a filterable substance from A= Body surface of patient; 1.73= Standard
the blood. body surface
 The substance analysed must be one that is
neither reabsorbed nor secreted by the tubules.
 CCT Significance:
 Stability of substance in urine during 24- hour  GFR
urine collection  Determines the functional capacity of
 Consistency of plasma level nephrons
 Substances availability to the body  Creatinine clearance
 Availability of tests for analysis of the substance  Determines the extent of nephron
 Reported in mL/min damage in known cases of renal dse.
 Monitor the effectiveness of treatment
1. UREA CLEARANCE TEST  Determines the feasibility of
- STANDARD METHOD for GFR administering medications
- Demonstrate progression of renal disease
or response to therapy  Disadvantage:
- Not give reliable estimates of GFR  Some Creatinine is secreted by tubule
(Approximately 40% of filtered urea is
 Chromogens present in human plasma
reabsorbed)  Some medications causes false dec. value
- It is about 50% of creatinine clearance.  Creatinine breakdown by some bacteria
 influenced by heavy diet
2. INULIN CLEARANCE TEST  Interference by muscle wasting disease.
- REFERENCE METHOD for GFR
- Not routinely done because of the
necessity for continuous IV infusion CYSTATIN C
- Higher values in male due to larger renal  Indirect estimate of GFR
mass  A low molecular weight protease inhibitor
o PRIMING DOSE: 25 mL of 10%
 Completely reabsorbed by the PCT, hence its
Inulin solution presence in urine denotes damage to the tubules
o CONTINUOUS INFUSION: 500 mL of  SPECIMEN: Serum or plasma (fasting is not
1.5% inulin solution required
- REFERENCE VALUES:  INCREASED LEVELS: Acute & Chronic Renal
o 127 mL/ min  Male failure, Diabetic nephropathy
o 118 mL/ min  Female  METHOD: Immunoassay
3. CREATININE CLEARANCE
- Most commonly used; screening method BETA 2 MICROGLOBULIN
of GFR  Dissociates from human leukocyte antigens at
- waste product of muscle metabolism constant rate and is rapidly removed from the
- Excellent measurement of renal function plasma by glomerular filtration.
– creatinine is freely filtered by the  A rise has been shown to be more sensitive
glomerulus but not reabsorbed. indicator of decrease in GFR than creatinine
- A measure of the completeness of a 24 clearance.
hour urine collection.  Not reliable in patients who have history of
- REFERENCE VALUES:
immunologic disorders.
o 85-125 mL/ min  Male  METHOD: EIA
o 75- 112 mL/ min  Female
CALCULATED GLOMERULAR FILTRATION ESTIMATES Freezing Point Osmometers
 COCKCROFT AND GAULT  Principle: Measurement of freezing point
depression
Ccr = (140 – age) (weight in kilograms)  Freezing point
72 X Serum creatinine in mg/dL - Temperature at which water and ice are
in equilibrium and is related to solute
For female patients: results are multiplied by 0.85 concentration
 NaCl
NOTE: - Reference standard
o 140-AGE  Total population being tested
o 72  Average serum crea of 140 tested Vapor Pressure Osmometers
 Principle:
- Measurement of dew point (Temperature
TUBULAR REABSORPTION TESTS at which water vapor condenses to a
liquid)
CONCENTRATION TEST  Standard ref: NaCl
 Ability of the tubules to reabsorb the essential
salts and water that have been nonselectively
filtered by glomerulus TUBULAR SECRETION & RENAL BLOOD FLOW TEST
 The specific gravity of urine before entering the
renal tubules is 1.010, the specific gravity will  An exogenous, nontoxic, weak organic acid that
vary when the urine enters the renal tubules for is secreted almost exclusively by the proximal
the reabsorption process. tubules
 It is secreted completely during its first pass
SPECIFIC GRAVITY through the kidneys hence provide not only an
A. FISHBERG TEST excellent indicator of renal tubular secretory
 Patients were deprived of fluids for 24 hours function but also a means of determining Renal
prior to measuring specific gravity Plasma Flow (RPF) and Renal Blood Flow (RBF)
 REFERENCE METHOD for measurement of RPF
B. MOSENTHAL TEST
 Compare the volume and specific gravity of Phenolsulfonphthalein
urine of day and night urine samples  Not completely removed as it passed through
the kidney & unsatisfactory for assessing the
OSMOLARITY RPF.
 Affected only by the number of particles present.
 NORMAL SERUM OSMOLARITY: 275 to 300
mOsm Titratable Acidity and Urinary Ammonia
 NORMAL URINE OSMOLARITY: 50 to 1400  H+  Secretion
mOsm  NH3 (Ammonia)  Production & secretion
 Titratable acid (H+)
 H2PO4
 Substance of interest:  HN4
o Na  Alakaline tides (diurnal variation)  2pm – 8pm
o Cl  Lowest Ph: Night
 Osmole
o 1 g molecular weight of a substance
divided by the number of particles into RENAL TUBULAR ACIDOSIS
which it dissociates.  Inability to produce acid urine
o Unit: milliosmole (mOsm)  Metabolic acidosis
 Impaired tubular secretion