Thephysiologyofrenalsystem ZaidounSalah AQB20122013

KidneyFunc+on

OVERVIEWOFSTRUCTUREANDFUNCTION

Kidneysarehighlyinnervatedandhavearichbloodsupply

Kidneyisdesignedtomaintainseveralhomeosta+c func+ons

Contd

Nephronisthestructuralandfunc+onalunitofthekidney

Threetypesofnephronsareclassiedbyloca+onandarchitectural design
superfecial,midcor@cal,andjuxtamedullarynephrons.

Juxtamedullary nephrons differ in many ways from other

Juxtaglomerularapparatusisthesiteofreninproduc+on

Temaculadensamonitorthecomposi@on oftheuidinthetubulelumen

Teextraglomerularmesangialcellsare con@nuouswithmesangialcellsofthe glomerulus;theymaytransmitin forma@onfrommaculadensacellsto thegranularcells. Thegranularcells(alsoknownas juxtaglomerularcells)aremodifed vascularsmoothmusclecellssynthe sizeandreleaserenin,aproteoly@c enzymethatresultsinangiotensin forma@on

URINEFORMATION Treeprocessesareinvolvedinformingurine:glomerularltra@on,tubularreabsorp@on,and tubularsecre@on

Glomerularltra+oninvolvestheultratra@onofplasmaintheglomerulus.Theltrate enterstheurinaryspaceoftheBowmancapsuleandthenowsdownstreamthroughthe tubulelumen Tubularreabsorp+oninvolvesthetransportofsubstancesoutoftubularurine. Reabsorbedsubstancesincludemanyimportantions(e.g.,Na+,K+,Ca2+,Mg2+,Cl,HCO3, andphosphate),water,importantmetabolites(e.g.,glucoseandaminoacids),andevensome wasteproducts(e.g.,ureaanduricacid). Tubularsecre+oninvolvesthetransportofsubstancesintothetubularurine.

Clearanceisthemeasurementofthekidneysexcre+onability.
therenalclearanceofasubstancecanbedenedasthevolumeofplasmafromwhichthat substanceiscompletelyremoved(cleared)perunit@me.theclearanceformulais:

Inulinclearanceequalstheglomerularltra+onrate
glomerularltra@onrate(GFR)istherateatwhichplasmaislteredbythekidneyglomeruli. AdecreaseinGFRgenerallyindicatesthatkidneyfunc@onisimpaired TheidealsubstancetomeasureGFRisinulin,afructosepolymerwithamolecularweightof about5,000

Frequencyofplasmaltra@onperday

Plasmacrea+nineclearanceisusedclinicallytoes+mateGFR
INclearanceisthegoldstandardformeasuringGFR iothalamate Theseexogenoussubstancesmustbeinfusedintravenouslyandthebladderisusually catheterized,becauseshorturinecollec@onperiodsareused;theseproceduresare inconvenient.

poten+aldrawbacks First,crea@nineisnotonlylteredbutalsosecretedbythehumankidney. Theseconddrawbackisrelatedtoerrorsofmeasuringcrea@nineconcentra@onintheplasma.

Errorsines+ma+ngthecerea+nineGFR

Plasmacrea+nineconcentra+oncanbeusedtoes+mateGFR

Tesamerela@onssipisobservedforseveralothersubstanceswhoseexcre@ondependsonGFR. Forexample,theplasmaureaconcentra@onorbloodureanitrogenriseswhenGFRfalls.The plasmalevelofa13kDaproteinmoleculecalledcysta@nCalsoriseswhenGFRfalls,andithas beensuggestedthatserumcysta@nClevelscanbeusedtoes@mateGFR.

Stagingofchronickidneydiseaseisusuallybasedones+matedGFRmeasurements;avalue <60mL/minmayindicaterenaldisease.

Paraaminohippurateclearancenearlyequalsrenalplasmaow

RPFises@matedbymeasuringtheclearanceoftheorganicanionpaminohippurate(PAH), indusedintravenously. PAHislteredandsovigorouslysecretedthatitisnearlycompletelyclearedfromallofthe plasmaowingthroughthekidneys. TherenalclearanceofPAH,atlowplasmaPAHlevels,approximatestheRPF

whereCPAHisthePAHclearanceandEPAHistheextrac+onra+o EPAHforPAHisthedierencebetweenthearterialandrenalvenousplasmaPAHconcentra@ons (PaPAHPrvPAH)dividedbythearterialplasmaPAHconcentra@on(PaPAH).

Contd
ThePAHissuppliedtothekidneysinthearterialplasmaandleavesthekidneysinurineand renalvenousplasma,or:

Ifweassumeextrac+onofPAHis100%(EPAH=1.00),thentheRPFequalsthePAHclearance

Nettubularreabsorp+onorsecre+onofasubstancecanbecalculated fromalteredandexcretedamounts
Therateatwhichthekidneytubulesreabsorbasubstancecanbecalculatedifweknowhow muchislteredandhowmuchisexcretedperunit@me.

Inequa@ons8and9,weassumethatsubstanceXisfreelylterable. Forexample,about40%ofplasmaCa2+isboundtoplasmaproteins,andso60%ofplasma Ca2+isfreelylterable.

Renalglucosereabsorp+onretrieveslteredglucoseandprevents glucoselossintheurine
Theglucosethresholdisnotxedbutdependson: 1. GFR:lowGFRleadstohigherthreshold 2. TmG:whenreduced,reducesthethreshold 3. amountofsplay:Reasondforsplayincludes: a. Notallthenephronshavethesameltra@on andabsorp@vecapaci@es b. Theglucosecarriersdonthaveinniteanity forglucose,soglucosemightbeexcretedeven beforecarriersbecomesaturated Anincreaseinsplaycausesadecreaseinglucose threshold

Inuncontrolleddiabetesmellitusalotofglucoseisexcretedandresultsinglucosuriathat producesanosmo@cdiuresis

TmforPAHprovidesameasureoffunc+onalproximalsecretory+ssue
PAHissecretedonlybyproximaltubulesinthekidneys.