Vous êtes sur la page 1sur 11

Kidney Function:

1. Maintain homeostasis by:

Maintaining constant levels of ions, H2O, potassium, calcium, hydrogen ions, and
excreting waste products such as urea, uric acid and creatine
2. Endocrine function:
To produce erythropoietin (for RBC production), and maintain the composition of pH of
interstitial fluid
3. Regulate Blood pressure (indirectly), by secreting renin
4. Metabolizing vitamin D to its active form
5. Components of urinary system consist of: 2 kidneys, 2 ureters, 1 urinary bladder, and 1 urethra
Kidney Anatomy:

Retroperitoneal, at the levels of T12-L3 vertebrae

Right kidney is lower due to liver
Protected somewhat by the rib cage
External Anatomy:
Lateral surface is convex
Concave medial surface is the hilus that leads into the renal sinus, where the renal BV,
lymphatics, and nerves all join each kidney
3 layers of supportive tissue surround each kidney:
Innermost layer: Fibrous capsule
o Renal capsule made up of smooth transparent fibrous membrane that is
continuous with the coverings of the ureter and hilus
o Provides some protection and aids in prevention of infections spreading to the
Middle layer: Perirenal fat capsule
o adipose capsule- a mass of peri-renal fat to protect from trauma, cushions and
holds kidney in place
Outer layer: renal fascia
o Dense fibroaeolar connective tissue
o Surrounds all other layers, and anchors the kidney and the adrenal gland to
surrounding structures
Internal Anatomy
o Outer layer (deep to renal capsule)
o Contains millions of renal corpuscles (glomeruli and Bowmans capsule)
o Renal columns (extensions of cortex) project down and between the renal
pyramids of the medulla

o Found deep to the cortex
o Contains up to 8-18 triangular shaped medullary (renal) pyramids, their striped
appearance is due to the many parallel tubules
o Base of pyramids are toward the cortex, and apex (which include the papillae)
toward renal pelvis
Renal pelvis:
o Continuous with the ureters
o Papilla of each pyramid communicates with a portion of the minor calyx of the
pelvis (8-18), which join together and form the major calyx (2-3)
o Walls of calyces, pelvis, and ureter contains smooth muscle which propels (via
peristalsis) urine to the bladder when it contracts
Blood and Nerve Supply

Renal veins and arteries deliver about of the total cardiac output each minute (1200 mL)
Aorta-> Renal Artery-> Segmental Artery-> Interlobar artery-> Arcuate artery (medullacortex junction)-> cortical radiate arteries-> Afferent arterioles-> Glomerulus (capillaries)->
Efferent arteriole-> Peritubular capillaries/Vasa recta-> Cortical radiate-> Arcuate vein->
Interlobar vein-> Renal vein-> Inferior VC
Nerve Supply
Renal plexus:
o Variable network of autonomic nerve fibers and ganglia
o Provides nerve supply of the kidney and its ureter
o Offshoot of the celiac plexus, largely supplied by sympathetic fibers from the
most inferior thoracic and first lumbar splanchnic nerves which coarse along
with the renal artery to reach the kidney
o Sympathetic vasomotor fibers regulate renal blood flow by adjusting the
diameter of renal arterioles and thus control urine production
The smallest histological and functional unit of the kidney (functions in urine
Consists of: glomerulus and renal tubule
Glomerulus: network of parallel capillaries
o Glomerular endothelium is fenestrated ( penetrated by many pores)
o Parietal layer:
portion of capsule (endothelial capsular membrane) is made of simple
squamous epithelium (that becomes cuboidal as it starts at the
proximal convoluted tubule) and basement membrane (basal lamina)
o Inner visceral layer:
Adjacent to glomerulus

Clings to the glomerular capillaries

Made up of podocytes (branching epithelial cells) which adhere to the
basement membrane/lamina of capillaries as they intertwine
The space between their intertwining pedicles are called filtration slits

Renal tubule:
o A tubule like structure with an enlarged double wall cup called glomerular
(Bowmans) capsule at the proximal end
o Renal corpuscle: glomerulus plus (Bowmans)enclosed glomerulus
o All together the capillaries, basement membrane, and the filtration slits are the
filtering membrane
Leaves the glomerular capsule as proximal convoluted tubule (PTC)-> loop of Henle->
distal convoluted tubules (DCT)-> collecting ducts (receives urine from many
nephrons)-> papillary duct (duct of Bellini), fusion of many collecting ducts which
deliver urine into the minor calcyes via the papillary duct
Two types of nephrons:
o Cortical nephrons: 85%
Located in the cortex, many slightly penetrate medulla
o Juxtamedullary nephrons:
Originate close to the cortex-medulla junction
Play an important role in the kidneys ability to produce concentrated
Descending loop, ascending loop, and the loop of Henle penetrate deep
into the medulla
Capillary Beds: (microvasculature)
Glomerulus (capillary bed):
o Specialize in filtration
o Fed and drained by arterioles (not drained by venules); afferent arteriole and
efferent arteriole
o Blood pressure in the glomerulus is extraordinarily high because: Incr. diffusion
Arterioles are high-resistance vessels
Afferent arteriole has a larger diameter than efferent
This high blood pressure easily forced fluid and solutes out of the blood
into the glomerular capsule
Peritubular capillary (bed):
o Arise from efferent arterioles draining from the glomeruli
o Surrounds all the tubules and reabsorbs filtered substance
o Only the juxtamedullary nephrons have vasa recta (capillary loop)which extend
deep into the medulla paralleling the longest loops of Henle
o Vasa recta plays an important role in forming concentrated urine (reclaims

Juxtaglomerular Apparatus (JGA):

Juxtaglomerular cells: aka Granular cells
o Enlarged, smooth muscle cells of the afferent arterioles; they are modified, they
enlarge, their nuclei becomes round, and they have cytoplasm granules that
produce and store renin (prorenin)
o Granular cells act as mechanoreceptors that sense blood pressure changes in
the afferent arteriole
Macula densa:
o Chemoreceptors that respond to changes in the NaCl content of the filtrate
Juxtaglomerular cells + macula densa= juxtaglomerular apparatus

Kidney Physiology: Mechanism of Urine Formation

3 steps: Glomerular filtration, tubular reabsorption, and tubular secretion

Glomerular filtration: (out of blood into tubules)
Non-selective filtration, due primarily to pressure gradients produced, mostly by
hydrostatic pressure, which force fluids and solutes through the filtration-membrane
This fluid is now referred to as filtrate and contains most plasma components, usually
free of proteins, RBCs and WBCs
Some small proteins or RBCs may be filtered through but will reabsorb in PCT
Filtration: process that forces H2O, and solutes through a cell membrane (wall), due to a
pressure gradient (down or along the gradient)
Net Filtration pressure (NFP): responsible for filtrate formation, involves 3 distinct
processes (forces)
o Glomerular hydrostatic pressure (GHP):
55 mm Hg
Glomerular blood pressure
Chief force pushing water and solutes out of the blood (glomeruli) and
across the filtration membrane into capsule
o Glomerular osmotic pressure (GOP):
Solutes in blood
30 mm Hg
Pulls water and solutes into glomeruli and out of capsule
o Capsule hydrostatic pressure (CHP):
Fluids in capsular space
15 mm Hg
Pushes water and solutes into the glomeruli from the capsule
o Net filtration pressure (NFP+) = 10 mm Hg
o NFP= Glomerular hydrostatic pressure (GHP) (GOP + CHP)
o Kidney will filter about 120-125 ml/min; this will produce a glomerular filtration
rate (GFR) of 180 L/day

GFR is directly proportional to NFP, so any changes in NFR (GHP, GOP, CHP)
changes GFR
Regulation of glomerular filtration:
Intrinsic controls:
o kidneys can determine their own rate of blood flow (autoregulation) act locally
within the kidney; this allows them to maintain the necessary filtration
o Myogenic mechanism:
Smooth muscle contracts with greater force when stretched
Increase systemic blood pressure-> decrease diameter
Decrease systemic blood pressure-> increase diameter
This mechanism must be working effectively for proper absorption to
take place, specifically to maintain NFP-GFR
o Tubuloglomerular feedback mechanism (macula densa)
Due to decreased osmolarity
Directed by the macula densa cells
Will trigger juxtaglomerular cells to release renin
Renin-> angiotensin-> aldosterone-> Increase BP
Extrinsic Control:
o During stress or emergency sympathetic NS stimulation can override autoregulatory mechanism when blood is needed in the vital organs
o Action will be a strong vasoconstriction of afferent arteriole -> Decrease NFP ->
decrease urine production
o Sympathetic will also intrinsically cause JG cells to release renin -> Inc. BP
Tubular Reabsorption: (into blood out of tubules [tubule cells are reabsorbing from the
Reclamation process:
o Reduces filtrate to urine, containing mostly urea, uric acid, and metabolic
o Produces only about 1-2 L of urine per day in spite of filtering 180 L
o Specific amounts of certain substances will be reabsorbed depending on the
bodys needs (for those substances)
o Approx. 99% of filtrate is reabsorbed either actively and or passively
o Nonreabsorbed substances: due to:
1. Lack of carriers for that specific substance
2. Substance NOT being lipid soluble, and able to diffuse through the plasma
3. Substance being too larger to diffuse into cells (nitrogenous waste..)
Active tubular reabsorption:
o Movement of substances against gradients (chemical or electrical)
o Filtrate will move into tubule cells, by an actively transported, (ATP-dependent)
carrier from basolateral membrane out of the cell and into the interstitial
space-> then diffuse into peritubular capillaries (passively)

Contransport processes:
One carrier will carry two solutes at once (may be carrying Na+ but will
also carry Cl, glucose)
o Tubular/transport maximum (Tm):
There are specific amounts of specific carriers for specific substances
When all carriers for specific substances are being used, the remainder
of will NOT be reabsorbed, and that substance will end-up in the
Passive tubular reabsorption:
o Diffusion:
Tendency of molecules or ions to scatter evenly throughout the
Movement due to kinetic energy
Substance move away from areas of higher concentration to area of
lesser concentration (along or down a concentration gradient)
o Osmosis:
Diffusion of a solvent such as water, through a selectively permeable
o Facilitated diffusion:
Certain molecules transported passively even though they are unable to
diffuse through the lipid bilayer. So they are transported through the
membrane via protein carriers or through protein channels (water filled)
o Obligatory: Aldosterone
Occurs mostly in proximal convoluted tubules (aldosterone)
Active reabsorption of Na+ (aldosterone; H2O will passively follow
Tubules have no control over water movement
o Facultative: (ADH)
Occurs at distal convoluted tubules and collecting ducts
ADH acting on these tubules will increase their plasma membrane
permeability -> increase H2O reabsorption due to existing gradient in
the medulla caused by the osmotic pressure within the interstitial fluid
Na+ is not involved
o Passive passage of water can be due to active transport of Na+ and other
o How much and which anions are absorbed depends on blood pH (HCO3, CL,
Na+, K+, or H+ to restore neutrality)
o Solvent drag: water leaving will pull substance from filtrates with it; they simply
follow concentration gradient into tubule cells

Tubular Secretion: (out of blood into tubules)

Substances such as potassium and hydrogen ions, ammonium, creatine etc.

Helps control pH -> renal mechanism of acid-base balance

Regulation of Urine Concentration:

Formation of Dilute urine:

If ADH or aldosterone are absent -> it will stay dilute
Formation of concentrated urine:
ADH will cause increased permeability of collecting tubules allowing water to pass freely
out of the tubules back into interstitium by osmosis
If ADH or aldosterone are present -> it will become more concentrated
Urine passes through kidney medulla (still in the collecting ducts)
Osmolarity of the medullary interstitium will rise from 300 mosm up to 1200 mosm,
(this sets up a gradient between the collecting ducts and the fluid in the medulla)-> with
increased permeability of tubules, due to ADH the fluid osmotically laves the ducts by
(facultative reabsorption)
Urine concentration will increase up to 1200 mosm (in equilibrium with osmotic
pressure of medulla)
Decrease BV (hemorrhage, excessive sweating, diarrhea, vomiting), decrease blood
pressure, can increase solute concentration, due to increased reabsorption of water as
the body tries to compensate for loss of blood (fluid)
If solute concentration rises above 300 mosm in plasma (and the medullary osmotic
pressure), it will cause the release of ADH

Renal Clearance:

Rate at which a particular substance is eliminated or cleared from the plasma by the kidney in
one minute
Can detect damage to glomerulus and/or renal disease
Inulin is the standard used to determine GRF, because it has complete renal clearance (neither
reabsorbed nor secreted by kidneys)
Values (measured in urine)
If less than inulin-> some cleared; it has been partially reabsorbed
If zero-> non has been cleared; all reabsorbed
If greater than inulin-> all has been cleared; none reabsorbed

Characteristics and Composition of Urine:

Physical Characteristics:
Color and transparency:
o Yellow or amber
o Varies with concentration and diet

o Can become turbid upon standing (bacteria), or with pathology

Odor (aromatic)
o May become ammonia-like upon standing (NH4-> NH3)
o Fruity/sweet with diabetes mellitus
o slightly acidic- 4-8 pH
o Protein-> increased acidity
o Vegetables-> increased alkalinity
Specific gravity:
o Relative weight of a specific volume of liquid (urine) compared with an equal
volume of distilled H2O (1.000)
o Range 1.001 to 1.035
o Increase concentration of solutes -> increase specific gravity
Chemical Concentration:

95% water
Remaining are 5% solutes derived from cellular metabolism- urea (deamination of proteins), uric
acid (catabolism of nucleic acids-found in calculi), and creatine (nitrogenous substances in
muscle tissue)
List of normal substance in urine: urea, sodium chloride, potassium, phosphate ion, sulfate ion,
creatine, uric acid. Maybe calcium, Magnesium or bicarbonate ions

Other organs:

Connects and transports urine from kidneys to bladder
Retroperitoneal at the pelvic cavity
Turn medially and enter urinary bladder on posterior-inferior surface (arrangement
prevents backflow)
Walls are composed of three layers:
o Inner layer:
Mucosa made of transitional epithelium (also found in bladder and
o Middle layer:
Muscular layer composed of two layers:
Inner: longitudinal layer of smooth muscle
Outer: circular layer of smooth muscle
o Outer layer:
Adventitia: fibrous CT (helps keep ureters in place)
Urinary Bladder (2-3 in. long)
Rests on the floor of the pelvic cavity (also retroperitoneal) just posterior to the pubic

o A hollow, muscular organ
o Smooth, triangular-shaped area at the base of the bladder called the trigone
The two openings at the base of the trigone are where the ureters open
into the bladder
The opening at the apex is where the urethara exists the bladder
3 layers:
o Inner layer:
Mucosa made of transitional epithelium
With little or no urine the shape of the bladder is somewhat flattened,
with the mucosa thrown into folds called rugae
o Middle Layer:
Muscular layer (detrusor muscle) three layers:
Inner layer and outer layers are longitudinal
Middle is circular
o Outer layer:
Adventitia: Fibrous
o Holds urine
o With an accumulation of about 300 ml there will be a sense of urgency, but
soon passes if ignored
o With an increase of another 200-300 ml there will be a stronger sense of panic
this time.
o This too may pass, because the bladder can hold up to 800-1000ml

Thin-walled muscular tube that drains urine from the bladder and conveys it out of the
body and lined with mucus membrane
o Mucosa:
Transitional epithelium near the bladder (proximal end)
Pseudostratified columnar epithelium (middle)
Stratified squamous epithelium (distal end)
Exists from the inferior portion of the bladder and drains urine from the
bladder out of the body
o Sphincters:
Internal urethral sphincter:
Formed by the smooth muscle of the bladder as it wraps around
the urethra (bladder-urethra junction)
External urethral sphincter:

Formed of the skeletal muscle within the urogenital diaphragm

(pelvic floor)
o Length of function (differ in two sexes):
Females: 1.5 inches long
Directly posterior to Symphysis pubis and embedded on the
anterior surface of the vagina
external urethral orifice: located between clitoris and vaginal
Functions only to aid the conduction of urine from the
Males: 8 inches long
3 parts: (named according to the region it passes)
Prostatic urethra- within the prostate
Membranous urethra- within the pelvic floor
Penil- cavernous penis
Has two fold function: conduction of urine and semen
Micturition: Urination
Bladder fills and distends-> activates stretch-> or mechanoreceptors, which triggers
reflex arc-> afferent impulses to sacral region of spinal cord -> up to the brains (sense of
fullness in the bladder)-> returns inhibitory or stimulatory impulse
Stimulatory impulses:
o Efferent (parasympathetic) pelvic nerves to contract detrusor muscle and to
relax internal urethral sphincter-> urine is moved past the internal sphincter->
the external urethral sphincter is relaxed (conscious control)-> urination can
Inhibitory impulses:
o Efferent (sympathetic) pelvic nerves relax the detrusor muscle and to contract
the internal urethral sphincter-> no urine should move past it-> external
urethral sphincter is contracted (conscious control)-> no urination
Incontinence: lack of voluntary control over urination
Natural in babies (due to lack of control of external urethral sphincter)
If seen in older children and adults, usually is due ot emotional problems or nervous
system problems
Retention: Inability to void urine
May be due to obstruction (urethra or bladder)
UTI, prostatitis, or prostate cancer