L.1 Introduction to Nephrology Dr.

Foaad

an overview of basic renal anatomy and physiology

Location- relatively high under lower ribs in the retroperitoneal space

 Average size of adult kidney is 12x6x3 cm

 Size variations can occur with age, gender, BMI, pregnancy, kidney disease,
and co-morbid conditions

 Right kidney smaller

 Right kidney lower than left kidney

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Structure of Kidney

 Cortex-the outer layer of the kidney comprising the glomeruli, most of the
proximal tubules, and some of the distal tubules

 Medulla-formed by 7-9 cone shape pyramids which extend into the renal
pelvis

 Renal Pelvis-flat funnel-like tube continuous with ureter as it leaves the

hilus

 Calyces- subdivided into major and minor calyces

 Major calyces- 2 or 3 branches off of renal pelvis

 Minor calyces- cup-shaped areas that enclose the papillae of the pyramids.
Continuously collect urine draining from papillae, emptying it into the renal
pelvis

The Nephron

• The functional unit of the kidney is the nephron.

• Each kidney contains 1 million nephrons.

• There are five parts to the nephron:

1- The glomerulus,

2- The proximal convoluted tubule where most of the filtered load is

reabsorbed ( 60%) i.e by active reabsorption of sodium.

3- The loop of Henle, which is able to concentrate urine .

4-The distal convoluted tubule, which ‘ fine-tunes ’ solute and water reabsorption

5-The collecting system ( Collecting Tubules) run through medullary pyramids

(give them their striped appearance)

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There are two types of nephrons, those localized to the cortex and those
extending into the medulla, the latter characterized by longer loops of Henle and
additional metabolic activity.

 Glomerulus- tuft of capillaries surrounded by Bowman’s capsule. Together

form the renal corpuscle.

Blood and Nerve Supply

 Renal arteries: branch off of the aorta then further divide to form:
segmental arteries:

1. Lobular arteries

2. Interlobar arteries

3. Arcuate arteries

4. Interlobular arteries

Renal artery ---renal sinus --- interlobar arteries (occupy the space

between the renal pelvis and adjacent cortical tissue)-- divide

at the corticomedullary junction-- branching arcuate arteries---

interlobular arteries (traverse the cortex).

No arteries penetrate the medulla.

The kidneys are unique for possessing two capillary beds in series.

The glomerular capillaries are maintained at the high pressure

required for filtration. Peritubular capillaries are low pressure

 More than ¼ of the cardiac output is delivered to the kidneys each minute
(1200ml/min)

 More than 90% of blood entering kidney perfuses the cortex

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Renal Veins- trace pathway of arterial blood supply in reverse.

Empty into the inferior vena cava.

Left renal vein is about 2x longer in order to extend to IVC in its position to right
of vertebral column.

Renal Plexus-network of autonomic nerve fibers and ganglia. Supplied by

sympathetic fibers = thoracic + lumbar splanchnic nerves

Sympathetic fibers- vasomotor fibers that control renal blood flow by adjusting
arteriolar diameters

Functions of Kidney

 Maintenance of body fluids composition (fluid volume, osmolarity,

electrolyte, and acid/base balance.

The kidneys and lungs work together to maintain an arterial pH of 7.35 – 7.45.

The lungs excrete CO 2 .

The kidneys: (i) prevent HCO 3 – loss; (ii) excrete H + ; and (iii) buffer urinary H + .

 Excretion of metabolic end products and foreign substances (i.e. urea,

toxins, drugs).

 Production/secretion of enzymes and hormones

Renal Hormones and Enzymes

 Renin- produced in juxtaglomerular apparatus. Catalyzes production of

angiotensin which is important for sodium balance and blood pressure
regulation
 Erythropoietin- stimulates maturation of RBC’s in bone marrow
 1 alpha hydroxylase enzyme which is responsible for activation of 25(HO)vit
D into 1,25-Dihydroxyvitamin D3-the most active form of Vitamin D3,
which is a steroid hormone that helps the body regulate
calcium/phosphorus balance.

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The kidneys are also an important site of action of several hormones, e.g.
aldosterone (promotes Na + reabsorption), ANP (promotes Na + loss), and ADH
(increases distal tubular permeability, allowing urinary concentration).

Autocrine function:

• Production of NO, endothelins , prostaglandins, natriuretic peptides.

• Protein and polypeptide metabolism, e.g. metabolism of insulin

Alterations in the body fluid composition and fluid volume can impact:

 Cardiac Output and Blood Pressure- dependent on optimal plasma volume

 Enzyme Function- most function best in narrow range of pH and ion

concentrations

 Cell Membrane Potential- depends on potassium concentrations

 Membrane excitability- depends on calcium ion concentrations

Evaluation of Renal Function

 Glomerular Filtration Rate (GFR)

 Serum Creatinine, Blood Urea

 Albumin/Creatinine ratio

 24 hour urine collection for protein :

 If 30-300 mg/day microalbuminuria

 >/= 300mg/day macroalbuminuria

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Note : normal total protein secreted in the urine should be less than 150 mg
/day ( less than 30 mg albumin /day.

GFR- amount of flud filtered from blood into glomerular capsule each minute

GFR- 180 L/day

GFR controlled by:

Auto-regulation (tubuloglomerular feedback)

Neural regulation

Hormonal regulation- renal aldosterone angiotensin system