Chapter 26: Urine Formation By the Kidneys. I.

Glomerular Filtration, Renal Blood Flow and Their Control

Guyton and Hall, Textbook of Medical Physiology, 12th edition

Multiple Functions of the Kidney Excretion of Metabolic Waste Products, Foreign Chemicals, Drugs, and Hormone Metabolites a. Eliminate waste products of metabolism that are no longer needed ( i.e. urea, creatinine, uric acid, hb breakdown products) b. Also rapidly eliminate most toxins, pesticides, drugs, food additives

Functions (cont.) Regulation of Water and Electrolyte Balances a. For homeostatsis, excretion of electrolytes must match intake

b. Governed mostly by eating habits

Functions (cont.) Regulation of Arterial Pressure a. By excreting variable amounts of sodium and water b. Short-term-by secreting hormones and vasoactive factors (i.e. renin) Glucose Synthesis

a. Gluconeogenesis-synthesize glucose from amino acids and other precursors during prolonged fasting.

Functions (cont.) Regulation of Acid-Base Balance a. By excreting acids and by regulating the body fluid buffer stores

b. Kidney is the only means of eliminating sulfuric and phosphoric acids (generated by the metabolism of proteins

Functions (cont.) Regulation of Erythrocyte Production a. Secretes erythropoietin which stimulates the production of red blood cells

Regulation of 1,25-Dihydroxyvitamin D3 Production

a. Produces the active form (calcitriol)

b. Calcitriol is necessary for the normal calcium deposition in bone and calcium reabsorption by the gastrointestinal tract

Physiologic Anatomy of the Kidneys General Organization of the Kidneys and Urinary Tract

Fig. 26.2 General Organization of the Kidneys and Urinary System

Physiologic Anatomy of the Kidneys Renal Blood Supply

Fig. 26.3 Renal Blood Supply

Physiologic Anatomy of the Kidneys The Nephron-functional unit of the kidney a. b. c. d. e. f. g. Each kidney contains 800,000-1,000,000 Decrease with age or injury (cannot be replaced) Contains the glomerulus (Bowmans capsule) Proximal and distal convoluted tubules Loop of Henle Macula densa Collecting ducts

Physiologic Anatomy of the Kidneys

Figure 26.4 Basic tubular segments of the nephron

Physiologic Anatomy of the Kidneys Regional Differences in Nephron Structure: Cortical and Juxtaglomerular Nephrons

Figure 26.5 Cortical and juxtaglomerular nephrons

Physiologic Anatomy of Urinary Bladder Micturition-process by which the urinary bladder empties when it becomes filled a. The bladder fills progressively until the tension within the walls rises above a threshold level b. The micturition reflex empties the bladder or stimulates a conscious desire to urinate c. It is an autonomic reflex that can be altered by centers in the cerebral cortex

Physiologic Anatomy of Urinary Bladder Bladder Anatomy-smooth muscle chamber composed of two main parts: a. Body-where the urine collects b. Neck-funnel shaped extension which connects with the urethra The smooth muscle of the bladder is the detrusor muscle and its contraction is a major step in emptying the bladder.

Fig. 26.6 Anatomy of the urinary bladder in males and females

 Innervation of the Bladder-pelvic nerves through the saccral plexus

Fig. 26.7 Innervation of the urinary bladder

Transport of Urine No significant changes in urine composition from the renal calyces to the ureters to the bladder Peristaltic contractions in the smooth muscle of the ureter are enhanced by parasympathetic stimulation and inhibited by sympathetic stimulation

Micturition Reflex

Fig. 26.8 Normalcystometrogram showing acute pressure waves caused by micturition reflexes

Micturition Reflex

As the bladder fills, micturition contractions occur

Initiated by stretch receptors in the bladder

When partially filled, the contractions relax spontaneously

The reflex is self-regenerative

Micturition Reflex

Reflex is a Single Complete Cycle

a. Progressive and rapid increase of pressure

b. A period of sustained pressure

c. Return of the pressure to the basal tone

Urine Formation

Fig. 26.9 Basic kidney processes that determine the composition of urine

Urine Formation Sum of three renal processes

A. The substance is freely filtered but not reabsorbed

B. The substance is freely filtered but part is reabsorbed C. The substance is freely filtered but not excreted because all is reabsorbed. D. The substance is freely filtered but is not reabsorbed but secreted from the peritubular capillaries into the renal tubules

Fig. 26.10

Glomerular Filtration Composition of the Filtrate a. Protein free and cell free b. Salts and organic molecules are similar to those in plasma c. Does not include calcium and fatty acids that are bound to proteins

Glomerular Filtration (cont.) GFR (Glomerular Filtration Rate) a. Determined by (1) the balance of hydrostatic and colloid osmotic forces acting on the capillary membrane, and (2) the product of the permeability and filtering surface area of the capillaries b.

Glomerular Capillary Membrane

Consists of Three Major Layers

a. Endothelium of the capillary

b. Basement membrane
c. Layer of epithelial cells (podocytes)

Fig. 26.11 A: Basic ultrastructure of the glomerular capillaries; B: Cross-section of the capillary membrane and its major components

Membrane (cont.) Filterability of Solutes is Inversely Related to Their Size

Table 26.1 Filterability of substances by glomerular capillaries based on molecular weight

Substance Water Sodium Glucose Inulin Myoglobin Albumin

Molecular Weight 18 23 180 5,500 17,000 69,000

Filterability 1.0 1.0 1.0 1.0 0.75 0.005

Membrane (cont.) Negatively Charged Large Molecules Are Filtered Less Easily Than Positively Charged Molecules of Equal Molecular Size

Fig. 26.12 Effect of molecular radius and electrical charge of dextran on its filterability by glomerular capillaries

Determinants of the GFR GFR is determined by (1) sum of the hydrostatic and colloid forces across the glomerular membrane (net filtration pressure), and (2) the glomerular capillary filtration coefficient.

Fig. 26.13

Determinants of the GFR

Increased glomerular capillary filtration coefficient increases GFR

Increased Bowmans capsule hydrostatic pressure decreases GFR Increased glomerular capillary colloid osmotic pressure decreases GFR

Fig. 26.14 Increase in colloid osmotic pressure in plasma flowing through the glomerular capillary.

Determinants of the GFR (cont.) Increased glomerular capillary hydrostatic pressure increases GFR

Fig. 26.15 Effect of change in afferent or efferent arteriole resistance on GFR and renal flow.

Renal Blood Flow Renal Blood Flow and Oxygen Consumption

Fig. 26.16 Relationship between sodium reabsorption and oxygen consumption

Renal Blood Flow (cont.) Determinants of Renal Blood Flow

Table 26.3 Approximate pressures and vascular resistances in the circulation of a normal kidney
Percentage of Total Renal Vascular Resistance

Vessel

Beginning

End

Renal Artery

100

100

Interlobar, arcuate, and interlobular arteries

Afferent arteriole Glomerular capill. Efferent arteriole Peritubular capill. Interlobar, arcuate, and interlobular veins Renal vein

Approx. 100

85

16

85 60 59 18 8 4

60 59 18 8 4 Approx. 4

26 1 43 10 4 0

Physiologic Control of GFR and Renal Blood Flow Sympathetic Nervous System Activation Decreases GFR Hormonal and Autacoid Control of Renal Circulation

Hormone or Autacoid
Norepinephrine Epinephrine Endothelin Angiotensin II

Effect on GFR
Decreases Decreases Decreases Constricts efferent arterioles

Endothelian NO
Prostaglandins

Increases
Increases

Autoregulation of GFR and Renal Blood Flow

Fig. 26.17 Autoregulation of renal blood flow and GFR but lack of autoregulation of urine flow during changes in renal arterial pressure

Tubuloglomerular Feedback and Autoregulation of GFR

Links changes in NaCl concentration at the macula densa with the control of renal arteriolar resistance Two components a. An afferent arteriolar feedback mechanism b. An efferent arteriolar feedback mechanism

Fig. 26.18 Structure of the juxtaglomerular apparatus, demonstrating its possible feedback role in the control of nephron function.

Decreased macula densa NaCl causes dilation of afferent arterioles and increased renin release

Fig. 26.19

 Myogenic Autoregulation of Renal Blood Flow and GFR a. Ability of blood vessels to resist stretching during increased arterial pressure

b. Stretch allows the release of calcium from ECF into the cells causing them to contract
High protein intake and increased blood glucose also increase renal blood flow