RENAL FUNCTION RENAL ANATOMY & PHYSIOLOGY
URINARY SYSTEM
 Composed of four main components:
 KIDNEY- where urine is formed by
FILTRATION of blood
 URETERS- carry the urine to the bladder
 BLADDER- stores the urine produced
 URETHRA- delivers the urine for
EXCRETION.
 KIDNEY’S FUNCTION:
 Maintaining homeostasis: regulation of
body fluids, acid–base balance, electrolyte
balance
 Excretion of waste products
 Concerned with the maintenance of blood
pressure and erythropoiesis
 NEPHRON
 The functional unit of the kidney
 Approximately 1 to 1.5 million each kidney
PARTS OF NEPHRON:
 Glomerulus (Renal Corpuscle)- consists of a
coil of approx. eight capillary lobes (capillary
tuft)
 Bowman’s Capsule
 Proximal Convoluted Tubule (PCT)
 Loop of Henle (descending/ ascending)
 Distal Convuluted Tubule (DCT)
 Afferent arteriole – point of entry
(UNFILTERD BLOOD)
 Efferent arteriole – point of exit (FILTERED
BLOOD)
 Peritubular capillaries –surround the
proximal and distal convoluted tubules
 Vasa recta – located adjacent to the
ascending and descending loop of Henle
2 TYPES OF NEPHRON:
1. Cortical nephron
- Approximately 85%
- Responsible for removal of waste
products & reabsorption
2. Juxtamedullary nephron (15%)
- Primary function is concentration of
the urine
RENAL FUNCTION
o Renal Blood Flow
o Glomerular Filtration
o Tubular Reabsorption
o Tubular Secretion
A. RENAL BLOOD FLOW
 The kidneys receive a large blood flow (25%)
 RENAL ARTERY supplies blood to the kidney.
RENAL ARTERY  Afferent arteriole 
Glomerulus (filtration)  Efferent arteriole 
Peritubular capillaries (immediate reabsorption)
 Vasa recta (Water & salt exchange)  RENAL
VEIN
 Based on average body size of 1.73m:
o TOTAL RENAL BLOOD FLOW: approx.
1200 mL/min
o TOTAL RENAL PLASMA FLOW: 600 to 700
mL/min
B. GLOMERULAR FILTRATION
GLOMERULUS
 Consists of coil of approx. eight capillary
lobes referred to as capillary tuft.
 Served as a sieve or a filter of plasma
substances with molecular weight of
<70,000
 Located within the BOWMAN’S CAPSULE
(forms the beginning of the renal tubule)
CELLULAR STRUCTURE OF GLOMERULAR
FILTRATION BARRIER
 Must pass through 3 cellular layers:
 Capillary wall membrane
- Contains pores and are
referred to as fenestrated
 Basement membrane
- Presence podocytes
 Visceral layer of Bowman’s capsule
GLOMERULAR PRESSURE
 Presence of HYDROSTATIC PRESSURE
(cause by size of afferent and efferent
arteriole)
 HYDROSTATIC PRESSURE are necessary to
overcome the opposition of pressure from
the fluid from the Bowman’s capsule and
the ONCOTIC PRESSURE of unfiltered
plasma protein.
RAAS (Renin-Angiotensin-Aldosterone System)
 This system respond to changes in blood
pressure and plasma sodium content
 Monitored by JUXTAGLOMERULAR APPARATUS
Mechanism:
 Water retention  Renin 
Renin + Angiotensinogen  Angiotensin I
(Angiotensin Converting Enzyme)
---------------------------------------------> Angiotensin II
(Lungs)
FUNCTIONS OF ANGIOTENSIN II:
1. Vasodilation of afferent & vasoconstriction of
efferent arteriole.
2. Stimulate Sodium reabsorption in the Proximal
Convoluted Tubule (PCT).
3. Release of the hormone Aldosterone from
adrenal cortex.
4. Release of Antidiuretic hormone from
hypothalamus.
C. TUBULAR REABSORPTION
REABSORPTION MECHANISM
 ACTIVE TRANSPORT
- Substance to be reabsorbed must
combine to a carrier protein contained
in the membranes of the renal tubular
cells.
- Can be influenced by the
concentration of the substance being
transported.
- Renal threshold- plasma concentration
at which active transport stops.
 Ex. Renal threshold for glucose
is 160 to 180 mg/dL
 PASSIVE TRANSPORT- movement of
molecules across membrane as a result of
differences in their concentration or
electrical potential.
NOTE: Exceeding the renal threshold of substances
affects the Maximal reabsorptive capacity of the
tubules, leading to the appearance of the substance
in the urine.
ACTIVE TRANSPORT D. TUBULAR SECRETION

SUBSTANCE LOCATION 2 MAJOR FUNCTIONS:

 Glucose Proximal Convoluted Tubule 1. Elimination of waste products not filtered by
 Amino acids (PCT) the glomerulus
 Salts  Ex. Urea & Medications

Proximal and Distal 2. Regulation of acid- base balance (secretion of

Sodium Convoluted Tubule hydrogen ions)
(PCT/DCT)  As a result of its molecular size,
hydrogen ion are readily filtered and
PASSIVE TRANSPORT absorbed.
 Secretion of hydrogen ions by the renal
SUBSTANCE LOCATION tubular cells into the filtrate prevents
the filtered bicarbonate from being
 Proximal Convoluted
excreted
Tubule(PCT)
 BICARBONATE ACTS AS BUFFER
Water  Descending Loop of Henle
TO THE BLOOD MAINTAINING
 Collecting Duct NORMAL pH.

 Proximal Convoluted
Urea Tubule (PCT)
 Ascending Loop of Henle

Sodium Ascending Loop of Henle

NOTE: All parts of the tubules can reabsorb water

except your Ascending Loop of Henle because it is
impermeable to water

 TUBULAR CONCENTRATION
- Begins in the descending and ascending
Loop of Henle

 COLLECTING DUCT CONCENTRATION

- Depends on the osmotic gradient in the
medulla and the hormone
VASOPRESSIN (ADH)
- Production of vasopressin is
determined by the state of body
hydration.

NOTE: Vasopressin- Antidiuretic hormone (ADH) =

WATER REABSORPTION
RENAL FUNCTION TESTS
GLOMERULAR FILTRATION RATE
CLEARANCE TEST
 Measure the filtering capacity of the glomeruli.
 Measures the rate at which the kidneys are able
to remove (to clear) a filterable substance from
the blood.
 The substance analysed must be one that is
neither reabsorbed nor secreted by the tubules.
 Stability of substance in urine during 24- hour
urine collection
 Consistency of plasma level
 Substances availability to the body
 Availability of tests for analysis of the substance
 Reported in mL/min
1. UREA CLEARANCE TEST
- STANDARD METHOD for GFR
- Demonstrate progression of renal disease
or response to therapy
- Not give reliable estimates of GFR
(Approximately 40% of filtered urea is
reabsorbed)
- It is about 50% of creatinine clearance.
2. INULIN CLEARANCE TEST
- REFERENCE METHOD for GFR
- Not routinely done because of the
necessity for continuous IV infusion
- Higher values in male due to larger renal
mass
o PRIMING DOSE: 25 mL of 10%
Inulin solution
o CONTINUOUS INFUSION: 500 mL of
1.5% inulin solution
- REFERENCE VALUES:
o 127 mL/ min  Male
o 118 mL/ min  Female
3. CREATININE CLEARANCE
- Most commonly used; screening method
of GFR
- waste product of muscle metabolism
- Excellent measurement of renal function
– creatinine is freely filtered by the
glomerulus but not reabsorbed.
- A measure of the completeness of a 24
hour urine collection.
- REFERENCE VALUES:
o 85-125 mL/ min  Male
o 75- 112 mL/ min  Female
NOTE:
o UC= URINE CREA; PC= PLASMA CREA;
UV= URINE VOLUME; MINUTES= 1440(mins.);
A= Body surface of patient; 1.73= Standard
body surface
 CCT Significance:
 GFR
 Determines the functional capacity of
nephrons
 Creatinine clearance
 Determines the extent of nephron
damage in known cases of renal dse.
 Monitor the effectiveness of treatment
 Determines the feasibility of
administering medications
 Disadvantage:
 Some Creatinine is secreted by tubule
 Chromogens present in human plasma
 Some medications causes false dec. value
 Creatinine breakdown by some bacteria
 influenced by heavy diet
 Interference by muscle wasting disease.
CYSTATIN C
 Indirect estimate of GFR
 A low molecular weight protease inhibitor
 Completely reabsorbed by the PCT, hence its
presence in urine denotes damage to the tubules
 SPECIMEN: Serum or plasma (fasting is not
required
 INCREASED LEVELS: Acute & Chronic Renal
failure, Diabetic nephropathy
 METHOD: Immunoassay
BETA 2 MICROGLOBULIN
 Dissociates from human leukocyte antigens at
constant rate and is rapidly removed from the
plasma by glomerular filtration.
 A rise has been shown to be more sensitive
indicator of decrease in GFR than creatinine
clearance.
 Not reliable in patients who have history of
immunologic disorders.
 METHOD: EIA
CALCULATED GLOMERULAR FILTRATION ESTIMATES
 COCKCROFT AND GAULT
Ccr = (140 – age) (weight in kilograms)
72 X Serum creatinine in mg/dL
For female patients: results are multiplied by 0.85
NOTE:
o 140-AGE  Total population being tested
o 72  Average serum crea of 140 tested
TUBULAR REABSORPTION TESTS
CONCENTRATION TEST
 Ability of the tubules to reabsorb the essential
salts and water that have been nonselectively
filtered by glomerulus
 The specific gravity of urine before entering the
renal tubules is 1.010, the specific gravity will
vary when the urine enters the renal tubules for
the reabsorption process.
SPECIFIC GRAVITY
A. FISHBERG TEST
 Patients were deprived of fluids for 24 hours
prior to measuring specific gravity
B. MOSENTHAL TEST
 Compare the volume and specific gravity of
urine of day and night urine samples
OSMOLARITY
 Affected only by the number of particles present.
 NORMAL SERUM OSMOLARITY: 275 to 300
mOsm
 NORMAL URINE OSMOLARITY: 50 to 1400
mOsm
 Substance of interest:
o Na
o Cl
 Osmole
o 1 g molecular weight of a substance
divided by the number of particles into
which it dissociates.
o Unit: milliosmole (mOsm)
Freezing Point Osmometers
 Principle: Measurement of freezing point
depression
 Freezing point
- Temperature at which water and ice are
in equilibrium and is related to solute
concentration
 NaCl
- Reference standard
Vapor Pressure Osmometers
 Principle:
- Measurement of dew point (Temperature
at which water vapor condenses to a
liquid)
 Standard ref: NaCl
TUBULAR SECRETION & RENAL BLOOD FLOW TEST
 An exogenous, nontoxic, weak organic acid that
is secreted almost exclusively by the proximal
tubules
 It is secreted completely during its first pass
through the kidneys hence provide not only an
excellent indicator of renal tubular secretory
function but also a means of determining Renal
Plasma Flow (RPF) and Renal Blood Flow (RBF)
 REFERENCE METHOD for measurement of RPF
Phenolsulfonphthalein
 Not completely removed as it passed through
the kidney & unsatisfactory for assessing the
RPF.
Titratable Acidity and Urinary Ammonia
 H+  Secretion
 NH3 (Ammonia)  Production & secretion
 Titratable acid (H+)
 H2PO4
 HN4
 Alakaline tides (diurnal variation)  2pm – 8pm
 Lowest Ph: Night
RENAL TUBULAR ACIDOSIS
 Inability to produce acid urine
 Metabolic acidosis
 Impaired tubular secretion