(Renal Physiology 1) Renal Functions and Basic Concepts

1. (Renal Physiology 1) Renal Functions and Basic Concepts Dr Ahmad Ahmeda aahmeda@ksu.edu.sa Cell phone: 0536313454 We drip, drip, drip, all day and all night, three to four times more by day than by night, drip from the kidneys into the silent pool of the bladder, an underground dripping into an underground lake. (Gustav Eckstein 1817)

2. Learning Objectives: • Enumerate general functions of the kidney. • Identify and describe that the nephron is the structural and function unit of the kidney. • Explain glomerular filtration membrane & filtration forces. • Describe mechanism of filtration & composition of the glomerular filtrate. • Calculate the net filtration pressure using parameters of Starling forces.

3. Learning Objectives: • Enumerate general functions of the kidney. • Identify and describe that the nephron is the structural and function Unit of the kidney. • Explain glomerular filtration membrane & filtration forces. • Describe mechanism of filtration & composition of the glomerular filtrate. • Calculate the net filtration pressure using parameters of Starling forces.

4. Urinary System Organs • The Kidneys (Shrewd Housewife): They are the organs that perform the functions of the urinary system. The other components are accessory structures to eliminate the urine from the body. • Ureters: transport urine from the kidneys to the bladder

5. Urinary System Organs • Urinary bladder: provides a temporary storage reservoir for urine • Urethra: a thin-walled tube transports urine from the urinary bladder out of the body

6. Urinary System Organs

7. Kidney Functions • Filter 200 liters of blood daily, allowing toxins, metabolic wastes, and excess ions to leave the body in urine, • Regulation of water and electrolyte balance: Maintain the proper balance between water and salts, and acids and bases, • Excretion of bioactive substances (hormones and many foreign substances, especially drugs) that affects body function,

8. Kidney Functions • Regulation of arterial blood pressure: by production of renin (vasoactive substances) and regulate volume and chemical makeup of the blood, • Regulation of red blood cells production: erythropoietin hormone to stimulate RBC production by bone marrow,

9. Kidney Functions • Regulation of vitamin D production : 25, cholecalciferol will be activated in the kidneys to 1,25 dihydrocholecalciferol D3, • Gluconeogenesis: during prolonged fasting glucose can be synthesized in the liver and kidneys.

10. Kidney Location and External Anatomy • The bean-shaped kidneys lie in a retroperitoneal position in the superior lumbar region and extend from the twelfth thoracic to the third lumbar vertebrae • The right kidney is lower than the left kidney. • The lateral surface is convex and the medial surface is concave, with a vertical cleft called the renal hilus leading to the renal sinus

11. Kidney Location and External Anatomy • Ureters, renal blood vessels, lymphatics, and nerves enter and exit at the hilus • Layers of Tissue Supporting the Kidney • Renal capsule – fibrous capsule that prevents kidney infection • Adipose capsule – fatty mass that cushions the kidney and helps attach it to the body wall • Renal fascia – outer layer of dense fibrous connective tissue that anchors the kidney

13. Internal Anatomy • A frontal section shows three distinct regions • Cortex: – the light colored, granular superficial region • Medulla: – exhibits cone-shaped medullary (renal) pyramids

14. Internal Anatomy Pyramids are made up of parallel bundles of urine-collecting tubules Renal columns are inward extensions of cortical tissue that separate the pyramids The medullary pyramid and its surrounding capsule constitute a lobe

15. Internal Anatomy • Renal pelvis – flat, funnel-shaped tube lateral to the hilus within the renal sinus • Major calyces – large branches of the renal pelvis • Collect urine draining from papillae • Empty urine into the pelvis • Urine flows through the pelvis and ureters to the bladder

16. The Nephron • Nephrons are the structural and functional units that form urine, consisting of: • Glomerulus – a tuft of capillaries associated with a renal tubule • Glomerular (Bowman’s) capsule – blind, cup-shaped end of a renal tubule that completely surrounds the glomerulus

17. The Nephron • Renal corpuscle– the glomerulus and its Bowman’s capsule • Glomerular endothelium– fenestrated epithelium that allows solute-rich, virtually protein-free filtrate to pass from the blood into the glomerular capsule

19. Anatomy of the Glomerular Capsule • The external parietal layer is a structural layer • The visceral layer consists of modified, branching epithelial podocytes • Extensions of the octopus-like podocytes terminate in foot processes • Filtration slits – openings between the foot processes that allow filtrate to pass into the capsular space

22. Renal Tubule • Proximal convoluted tubule (PCT) – composed of cuboidal cells with numerous microvilli and mitochondria • Reabsorbs water and solutes from filtrate and secretes substances into it

23. Renal Tubule • Loop of Henle – a hairpin-shaped loop of the renal tubule • Proximal part is similar to the proximal convoluted tubule • Proximal part is followed by the thin segment (simple squamous cells) and the thick segment (cuboidal to columnar cells) • Distal convoluted tubule (DCT) – cuboidal cells without microvilli that function more in secretion than reabsorption

24. Connecting Tubules • The distal portion of the distal convoluted tubule nearer to the collecting ducts • Two important cell types are found here • Intercalated cells • Cuboidal cells with microvilli • Function in maintaining the acid-base balance of the body • Principal cells • Cuboidal cells without microvilli • Help maintain the body’s water and salt balance

26. Types of Nephrons • Cortical nephrons – 85% of nephrons; located in the cortex • Juxtamedullary nephrons: • Are located at the cortex-medulla junction • Have loops of Henle that deeply invade the medulla • Have extensive thin segments • Are involved in the production of concentrated urine

28. Juxtaglomerular Apparatus (JGA) • Where the distal tubule lies against the afferent (sometimes efferent) arteriole • Arteriole walls have juxtaglomerular (JG) cells • Enlarged, smooth muscle cells • Have secretory granules containing renin • Act as mechanoreceptors

29. Juxtaglomerular Apparatus (JGA) • Macula densa • Tall, closely packed distal tubule cells • Lie adjacent to JG cells • Function as chemoreceptors or osmoreceptors • The cells of the macula densa are sensitive to the ionic content and water volume of the fluid in the tubule • produce molecular signals that promote renin secretion by the juxtaglomerular cells

30. Juxtaglomerular Apparatus (JGA) • Mesanglial cells • Have phagocytic and contractile properties • Influence capillary filtration • Intraglomerularmesangial cells provide structural support and regulate blood flow of the glomerular capillaries by their contractile activity

32. Filtration Membrane • Filter that lies between the blood and the interior of the glomerular capsule • It is composed of three layers • Fenestrated endothelium of the glomerular capillaries (Pores are 50-100 nm in diameter) • Visceral membrane of the glomerular capsule (podocytes) • Basement membrane composed of fused basal laminae of the other layers.

35. Filtration Membrane • Glomerular filtration membrane is highly permeable to water and small molecules (less than 10.000 MW) • Large molecules (more than 70.000 MW especially proteins are not filtered due to their large size and negative electrical charge because their passage is repulsed by negatively charged glycoproteins present on endothelial pores, basement membrane and podocytes.

36. Composition of Glomerular Filtration • Glomerular Filtrate has almost the same composition as that of plasma, except that it has no significant amount of proteins (it has about 0.003%) • It is less than 1/2000 protein as compared with plasma.

37. Innervation of the kidney • Sympathetic nerves supply renal blood vessels, regulate blood flow, filtration, water reabsorption, rennin secretion. • ↑ sympathetic = constriction, ↓ blood flow • There is no parasympathetic innervation

38. Thanks