Normal Kidneys and Their Function

The kidneys are a pair of bean-shaped organs that lie on either side of the spine
in the lower middle of the back. The kidneys are connected to the urinary bladder
by tubes called ureters. Urine is stored in the urinary bladder until the bladder is
emptied by urinating. The bladder is connected to the outside of the body by
another tube like structure called the urethra.

The main function of the kidneys is to remove waste products and excess water
from the blood. The kidneys process about 200 liters of blood every day and
produce about two liters of urine. The waste products are generated from
normal metabolic processes including the breakdown of active tissues, ingested
foods, and other substances. The kidneys allow consumption of a variety of
foods, drugs, vitamins and supplements, additives, and excess fluids without
worry that toxic by-products will build up to harmful levels.

Function of kidney
• Filtration of the blood
– Occurs in the glomerulus’s of the kidney nephron
– Contributes to homeostasis by removing toxins or waste
• Reabsorption of vital nutrients, ions and water
– Occurs in most parts of the kidney nephron
– Contributes to homeostasis by conserving important materials
• Secretion of excess materials
– Assists filtration in removing material from the blood
– Contributes to homeostasis by preventing a build-up of certain
materials in the body such as drugs, waste,etc
• Activation of Vitamin D
– Vitamin D made in the skin is converted to Vitamin D3 by the
kidney
– Active Vitamin D (D3) assists homeostasis by increasing calcium
absorption from the digestive tract
• Release of Erythropoietin
– Erythropoietin stimulates new RBC production
– New RBC’s assist homeostasis by insuring adequate Oxygen and
Carbon Dioxide transport
• Release of Renin
– Renin stimulates the formation of a powerful vasoconstrictor called
Angiotensin II
– Angiotensin II assists homeostasis by causing vasoconstriction
which increases blood pressure
• Release of Prostaglandins
– Prostaglandins dilate kidney blood vessels
– Dilated blood vessels contribute to homeostasis by maintaining
blood flow in the kidneys
 • Secretion of H (+1) and reabsorption of HCO3 (-1)
– Eliminates excess hydrogen ions and conserves buffer material
such as bicarbonate
– Contributes to homeostasis by controlling acid/base conditions in
body fluids.

Diagram of Kidney Nephron

Efferent arteriole Proximal

convoluted tubule
Afferent arteriole Glomerulus

Bowman’s Peritubular capillaries

capsule

Distal convoluted
tubule
Vasa recta

Collecting Decending limb of loop of

duct Henle

Ascending limb of loop of

Henle
Functions of Nephron Structures
• Afferent Arteriole
– Transports arterial blood to the glomerulus for filtration
• Efferent Arteriole
– Transports filtered blood from the glomerulus , through the
peritubular capillaries and the vasa recta, and to the kidney venous
system
• Glomerulus
– The site for blood filtration
– operates as a nonspecific filter; in that, it will remove both useful
and non-useful material
– the product of the glomerulus is called filtrate
• Bowman’s Capsule
– A sac that encloses Bowman’s Capsule and transfers filtrate from
the glomerulus to the Proximal Convoluted Tubule (PCT)
• Proximal Convoluted Tubule (PCT)
– A thick, constantly actively segment of the nephron that reabsorbs
most of the useful substances of the filtrate: sodium (65%), water
 (65%), bicarbonate (90%), chloride (50%), glucose (nearly 100%!),
etc.
– The primary site for secretion (elimination) of drugs, waste and
hydrogen ions
• Decending Limb of the Loop of Henle
– freely permeable to water and relatively impermeable to solutes
(salt particles)
– receives filtrate from the PCT, allows water to be absorbed and
sends “salty”filtrate on the the next segment. “Saves water and
passes the salt”
• Ascending Limb of the Loop of Henle
– impermeable to water and actively transports (reabsorbs) salt
(NaCl) to the interstitial fluid of the pyramids in the medulla. “Saves
salt and passes the water.”

• Distal Convoluted Tubule (DCT)

– receives dilute fluid from the ascending limb of the Loop of Henle
– When aldosterone hormone is present, sodium is reabsorbed and
potassium is secreted. Water and chloride follow the sodium.
• Collecting Duct
– receives fluid from the DCT
– when ant diuretic hormone (ADH) is present, this duct will become
porous to water. Water from the collecting duct fluid then moves by
osmosis into the “salty” (hyperosmotic) interstitium of the medulla.
– The last segment to save water for the body

Glomerular filtration rate

Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal
(kidney) glomerular capillaries into the Bowman's capsule per unit time.

• Rate (GFR): 120 mL/min (normal)

• Substances “Filtered”:
– water, electrolytes (Na, K, etc.), sugars (glucose), nitrogenous
waste (urea, creatinine)
• Substances “Excluded”:
– Substances of size > 70 kDa
– Plasma protein bound substances
Stages of Chronic Kidney Disease

GFR*
Stage Description
mL/min/1.73m2
Normal 120
Slight kidney damage with normal or
1 More than 90
increased filtration
2 Mild decrease in kidney function 60-89
3 Moderate decrease in kidney function 30-59
4 Severe decrease in kidney function 15-29
Kidney failure requiring dialysis or
5 Less than 15
transplantation

Kidney Disease Causes

Although chronic kidney disease sometimes results from primary diseases of the
kidneys themselves, the major causes are diabetes and high blood pressure.

• Type 1 and type 2 diabetes mellitus cause a condition called diabetic

nephropathy, which is the leading cause of kidney disease in the United
States.

• High blood pressure (hypertension), if not controlled, can damage the

kidneys over time.

• Glomerulonephritis is the inflammation and damage of the filtration system

of the kidneys and can cause kidney failure.

• Polycystic kidney disease is an example of a hereditary cause of chronic

kidney disease wherein both kidneys have multiple cysts.

• Use of analgesics such as acetaminophen and ibuprofen regularly over

long durations of time can cause analgesic nephropathy, another cause of
kidney disease. Certain other medications can also damage the kidneys.

• Clogging and hardening of the arteries (atherosclerosis) leading to the

kidneys causes a condition called ischemic nephropathy, which is another
cause of progressive kidney damage.

• Obstruction of the flow of urine by stones, an enlarged prostate, strictures

(narrowings), or cancers may also cause kidney disease.
Kidney Disease Symptoms

The kidneys are remarkable in their ability to compensate for problems in their
function. That is why chronic kidney disease may progress without symptoms for
a long time until only very minimal kidney function is left.

Because the kidneys perform so many functions for the body, kidney disease can
affect the body in a large number of different ways. Symptoms vary greatly.
Several different body systems may be affected. Notably, most patients have no
decrease in urine output even with very advanced chronic kidney disease.

• Fatigue and weakness (from anemia or accumulation of waste products in

the body).

• Loss of appetite, nausea and vomiting

• Need to urinate frequently, especially at night

• Swelling of the legs and puffiness around the eyes (fluid retention)

• Itching, easy bruising, and pale skin (from anemia)

• Headaches, numbness in the feet or hands (peripheral neuropathy),

disturbed sleep, altered mental status (encephalopathy from the
accumulation of waste products or uremic poisons), and restless legs
syndrome

• High blood pressure, chest pain due to pericarditis (inflammation around

the heart)

• Shortness of breath from fluid in lungs

• Bleeding (poor blood clotting)

• Bone pain and fractures

• Decreased sexual interest and erectile dysfunction

When to Seek Medical Care

Several signs and symptoms may suggest complications of chronic kidney

disease. Call your healthcare provider if you notice any of the following
symptoms:

• Change in energy level or strength

 • Increased water retention (puffiness or swelling) in the legs, around the
eyes or in other parts of the body

• Shortness of breath or change from normal breathing

• Nausea or vomiting

• Light-headedness

• Severe bone or joint pain

• Easy bruisability

• Itching

What is diuretic?

Diuretic is a chemical compound which increase the amount of urine

produced by the kidneys & also increase sodium excretion.

Indications for Diuretic Use

• Edema associated with congestive heart failure

• Acute pulmonary edema
• Liver disease (including cirrhosis)
• Renal disease
• Hypertension
• Conditions that cause hyperkalemia
Site of action of Diuretic: