structure and function of the renal and urologic systems chapter 35 mosby items and derived items ©...
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Structure and Function of the Renal Structure and Function of the Renal and Urologic Systemsand Urologic Systems
Chapter 35Chapter 35
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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Structures of the KidneyStructures of the Kidney KidneysKidneys
RetroperitonealRetroperitoneal Renal capsuleRenal capsule Renal fasciaRenal fascia HilumHilum
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Structures of the KidneyStructures of the Kidney
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Structures of the KidneyStructures of the Kidney Renal cortexRenal cortex Renal medullaRenal medulla Renal pyramidsRenal pyramids Renal columnsRenal columns Minor calyx Minor calyx Major calyxMajor calyx Renal pelvisRenal pelvis
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Structures of the KidneyStructures of the Kidney
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NephronNephron 1.2 million nephrons per kidney 1.2 million nephrons per kidney Functional unit of the kidneyFunctional unit of the kidney
Superficial cortical nephronsSuperficial cortical nephrons Midcortical nephronsMidcortical nephrons Juxtamedullary nephronsJuxtamedullary nephrons
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NephronNephron Renal corpuscleRenal corpuscle
GlomerulusGlomerulus Bowman capsuleBowman capsule Mesangial cellsMesangial cells
Bowman spaceBowman space
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GlomerulusGlomerulus FiltrationFiltration Formation of Formation of primary primary urineurine
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GlomerulusGlomerulus Glomerular filtration membraneGlomerular filtration membrane
Glomerular endotheliumGlomerular endothelium Basement membraneBasement membrane Capillary epitheliumCapillary epithelium
• Also referred to as podocytes or visceral epitheliumAlso referred to as podocytes or visceral epithelium
• Filtration slitsFiltration slits
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NephronNephron Juxtaglomerular apparatus Juxtaglomerular apparatus
Juxtaglomerular cellsJuxtaglomerular cells Macula densaMacula densa
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Juxtaglomerular ApparatusJuxtaglomerular Apparatus
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NephronNephron Renal tubulesRenal tubules
Proximal tubuleProximal tubule Loop of HenleLoop of Henle Distal tubuleDistal tubule Collecting ductCollecting duct Principal cellsPrincipal cells Intercalated cellsIntercalated cells
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Structures of the KidneyStructures of the Kidney
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Structures of the KidneyStructures of the Kidney
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Blood VesselsBlood Vessels Renal arteriesRenal arteries Interlobar arteriesInterlobar arteries Arcuate arteriesArcuate arteries Interlobular arteriesInterlobular arteries Afferent arteriolesAfferent arterioles Glomerular capillariesGlomerular capillaries Efferent arteriolesEfferent arterioles Peritubular capillaries and vasa rectaPeritubular capillaries and vasa recta
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Structures of the KidneyStructures of the Kidney
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Structures of the KidneyStructures of the Kidney UretersUreters
30 cm long30 cm long Long, intertwining muscle bundlesLong, intertwining muscle bundles Pass obliquely though posterior aspect of bladderPass obliquely though posterior aspect of bladder Peristaltic activityPeristaltic activity Micturition compresses the lower end of the ureter Micturition compresses the lower end of the ureter
to avoid urine refluxto avoid urine reflux
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Structures of the Urologic SystemStructures of the Urologic System BladderBladder
Detrusor muscleDetrusor muscle Transitional epitheliumTransitional epithelium TrigoneTrigone Micturition reflexMicturition reflex
UrethraUrethra Internal and external sphinctersInternal and external sphincters 3 to 4 cm in females3 to 4 cm in females 18 to 20 cm in males18 to 20 cm in males
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Bladder and UrethraBladder and Urethra
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Renal Blood Flow (RBF)Renal Blood Flow (RBF)
Receive 1000 to 1200 ml of blood per minuteReceive 1000 to 1200 ml of blood per minute 600-700 ml as plasma (renal plasma flow [RPF])600-700 ml as plasma (renal plasma flow [RPF])
Glomerular filtration rate (GFR)Glomerular filtration rate (GFR) Filtration of plasma into the Bowman spaceFiltration of plasma into the Bowman space 20% of the RPF (120-140 ml/min)20% of the RPF (120-140 ml/min) Directly related to the perfusion pressure in the Directly related to the perfusion pressure in the
glomerular capillaries (RBF)glomerular capillaries (RBF)• Strict maintenance of 80-180 mmHg provides constant Strict maintenance of 80-180 mmHg provides constant
GFRGFR
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Regulation of RBF/GFRRegulation of RBF/GFR AutoregulationAutoregulation
Myogenic mechanism (stretch)Myogenic mechanism (stretch) Tubuloglomerular feedback (NaCl content)Tubuloglomerular feedback (NaCl content)
Neural regulationNeural regulation Sympathetic nervous systemSympathetic nervous system
• Vasoconstriction (diminishes GFR)Vasoconstriction (diminishes GFR)
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Renal FunctionsRenal Functions Regulation of blood volume and serum Regulation of blood volume and serum
osmolarity (water/sodium balance)osmolarity (water/sodium balance) ADHADH Renin-angiotensin-aldosterone systemRenin-angiotensin-aldosterone system
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Renal FunctionsRenal Functions Excrete metabolic wastesExcrete metabolic wastes
Creatinine, urea (end product of protein Creatinine, urea (end product of protein metabolism), certain drugsmetabolism), certain drugs
Regulate acid-base balanceRegulate acid-base balance Balance of HBalance of H++ and HCO and HCO33
Secrete hormonesSecrete hormones Renin-angiotensin-aldosterone systemRenin-angiotensin-aldosterone system ErythropoietinErythropoietin Conversion of vitamin D to usable formConversion of vitamin D to usable form
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Renal ProcessesRenal Processes FiltrationFiltration
Movement of protein free plasma across the Movement of protein free plasma across the glomerular membrane (hydrostatic pressure)glomerular membrane (hydrostatic pressure)
Tubular reabsorptionTubular reabsorption Movement of fluid/solutes from tubular lumen to Movement of fluid/solutes from tubular lumen to
the peritubular capillariesthe peritubular capillaries Tubular secretionTubular secretion
Transfer of substances from the peritubular Transfer of substances from the peritubular capillaries to the tubular lumencapillaries to the tubular lumen
ExcretionExcretion Elimination of fluids/substances in the final urineElimination of fluids/substances in the final urine
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Nephron FunctionNephron Function Glomerular filtrationGlomerular filtration
Net filtration pressureNet filtration pressure• Glomerular hydrostatic pressureGlomerular hydrostatic pressure
• Capsular hydrostatic pressureCapsular hydrostatic pressure
• Blood oncotic pressureBlood oncotic pressure
Filtration rateFiltration rate
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Tubular TransportTubular Transport Active transport of fluids and substancesActive transport of fluids and substances
Reabsorption: normally 99% of the glomerular Reabsorption: normally 99% of the glomerular filtrate is reabsorbed!filtrate is reabsorbed!
Urea: major constituent of urine, along with Urea: major constituent of urine, along with waterwater 50% of urea is reabsorbed, 50% excreted in the 50% of urea is reabsorbed, 50% excreted in the
urineurine Provides osmotic gradientProvides osmotic gradient
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Renal “Clearance”Renal “Clearance”
The ability of the kidneys to filter a substance The ability of the kidneys to filter a substance and excrete it in the urine is a reflection of the and excrete it in the urine is a reflection of the GFR, tubular secretion, and tubular reabsorption GFR, tubular secretion, and tubular reabsorption (thus also RBF and functioning of nephrons)(thus also RBF and functioning of nephrons)
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Glomerular FiltrationGlomerular Filtration
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Nephron FunctionNephron Function
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Nephron FunctionNephron Function
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Concentration and Dilution of Concentration and Dilution of UrineUrine
Countercurrent exchange systemCountercurrent exchange system Contributes to production of concentrated urineContributes to production of concentrated urine Fluid flows in opposite direction through parallel Fluid flows in opposite direction through parallel
tubestubes Fluid moves up and down the parallel limbs of the Fluid moves up and down the parallel limbs of the
loop of Henleloop of Henle The longer the loop, the greater the concentration The longer the loop, the greater the concentration
gradientgradient
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Countercurrent Exchange SystemCountercurrent Exchange System
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Concentration and Dilution of Concentration and Dilution of UrineUrine
UreaUrea CatecholaminesCatecholamines Antidiuretic hormone (ADH)Antidiuretic hormone (ADH) UrodilantinUrodilantin Natriuretic peptideNatriuretic peptide DiureticsDiuretics
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Renal HormonesRenal Hormones Vitamin DVitamin D ErythropoietinErythropoietin
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Tests of Renal FunctionTests of Renal Function Clearance and glomerular filtration rateClearance and glomerular filtration rate
InulinInulin CreatinineCreatinine
Clearance and renal blood flowClearance and renal blood flow Blood testsBlood tests
Plasma creatinine concentrationPlasma creatinine concentration Plasma cystatin C concentrationPlasma cystatin C concentration Blood urea nitrogen (BUN)Blood urea nitrogen (BUN)
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Tests of Renal FunctionTests of Renal Function UrinalysisUrinalysis
Urine colorUrine color Urine pHUrine pH Specific gravitySpecific gravity Urine sedimentUrine sediment
• RBCsRBCs• CastsCasts• CrystalsCrystals• WBCsWBCs
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Tests of Renal FunctionTests of Renal Function UrinalysisUrinalysis
Reagent strips (dipsticks)Reagent strips (dipsticks)• GlucoseGlucose• BilirubinBilirubin• UrobilinogenUrobilinogen• Leukocyte esteraseLeukocyte esterase• NitratesNitrates• KetonesKetones• ProteinsProteins• RBCs, hemoglobin, and myoglobinRBCs, hemoglobin, and myoglobin
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Aging and Renal FunctionAging and Renal Function Decrease in kidney sizeDecrease in kidney size Decrease in renal blood flow and GFRDecrease in renal blood flow and GFR Number of nephrons decrease due to renal Number of nephrons decrease due to renal
vascular and perfusion changesvascular and perfusion changes Glomerular capillaries atrophyGlomerular capillaries atrophy Tubular transport response decreasesTubular transport response decreases Increased bladder symptomsIncreased bladder symptoms
Urgency, frequency, and nocturiaUrgency, frequency, and nocturia