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Renal functions Structure of the kidneys and urinary system Structure of a nephron Basic renal processes Renal clearance Renal blood flow Glomerular filtration
Urinary system
Posterior vena cava Renal artery and vein Aorta Ureter Urinary bladder Urethra Kidney
The kidney
Nephron
Types of Nephron
Juxtamedullary nephron
Cortical nephron
Renal cortex
To renal pelvis
Types of nephron
Filtration membrane
4 mm
Juxtamedullary nephron
Cortical nephron
10 m
Afferent arteriole Glomerulus from renal artery Bowmans capsule SEM Proximal tubule Peritubular capillaries
Renal cortex
Collecting duct
Descending limb
Loop of Henle
Ascending limb
Vasa recta
Substance X is filtered and secreted but not reabsorbed. Substance Y is filtered and some of it is reabsorbed Substance Z is filtered and completely reabsorbed.
Excretion of a substance
A substance can gain entry to the tubule and be excreted in the urine by glomerular filtration or tubular secretion or both. Amount excreted = amount filtered + amount secreted- amount reabsorbed Excretion rate = V x Ux Excretion rate: amount of X excreted per minute (mg/min) V: urine flow rate (mL/min) Ux : urine concentration of X ( mg/mL)
Renal clearance
Clearance: a general concept that describes the rate at which substances are removed or cleared from plasma. Renal clearance: the volume of plasma completely cleared of a substance by the kidneys per unit time. (mL/min) Renal plasma clearance C = V x [U]x [P ]x
V = urine flow rate per min (mL/min) U = concentration of substance X in urine (mg/mL) P = concentration of substance X in plasma (mg/mL)
Substances with the highest renal clearances may be completely removed on a single pass of blood through the kidneys. Substance with the lowest renal clearances are not removed at all.
Para-aminohippuric acid (PAH) are both filtered and secreted therefore it has the highest clearance
Glucose is filtered and completely reabsorbed. Renal clearance of glucose is zero. (Substance Z)
Clearance of Urea
Urea is secreted into blood and filtered into glomerular capsule. Urea clearance is 75 ml/min., compared to clearance of inulin (120 ml/min.). 40-60% of filtered urea is always reabsorbed. Passive process because of the presence of carriers for facilitative diffusion of urea.
Clearance ratios
Cx/Cinulin=1.0 the clearance of x equals the clearance of inulin. The substance also must be a glomerular marker (filtered, but neither reabsorbed nor secreted) Cx/C inulin <1.0 the clearance of x is lower than the clearance of inulin, either the substance is not filtered or it is filtered and reabsorbed. (Glucose) Cx/Cinulin> 1.0 The clearance of X is higher than the clearance of inulin. The substance is filtered and secreted. (PAH)
Sample problem
In a 24 hour period, 1.44 L of urine is collected from a man receiving an infusion of inulin. In his urine, the [inulin] is 150 mg/mL, the [Na+] is 200 mEg/mL. In his plasma, the [inulin] is 1mg/mL, and the [ Na+] is 140 mEg/L. What is the clearance ratio for Na+, and what is the significance of its value?
Substances in unfiltered blood must be secreted into tubules to be cleared by active transport (PAH is an example). PAH can be used to measure renal plasma flow.
Filtration and secretion clear only the molecules dissolved in plasma. PAH clearance actually measures renal plasma flow.
Amount filtered = amount excreted GFR = V x[U]inulin [P]inulin [U]inulin: urine concentration of inulin (mL/min) [P]inulin: plasma concentration of inulin (mL/min) V: urine flow rate (mL/min)
Sample problem
A woman who consents to renal studies in the clinical research center is infused with inulin to measure her GFR. Over the course of the measurement, her urine flow rate is intentionally varied by having her drink large amounts of water. The [P]inulin is kept constant at 1mg/mL with an infusion. The urine flow rate and [U] inulin before and after she drinks water are as follows: Before drinking water After drinking water [U]inulin =100mg/mL [U]inulin = 20 mg/mL V= mL/min V= 5mL/min What is the effect of the increase in urine flow (produced by drinking water) on the womans GFR?
Glomerular filtration
Regulation of filtration
Effects of constricting afferent and efferent arterioles on renal plasma flow and glomerular filtration rate