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Anatomy and Physiology of the Kidneys

Location of the Kidneys

There are two kidneys which lie retroperioneally in the lumbar area. The right kidney is
lower than the left due to displacement by the liver.
Connective tissue anchors the kidneys to surrounding structures and helps maintain their
normal position.

Each kidney is bean shaped and measures approximately 11cm x 6cm x 3cm and weighs
120 – 170 grams. The kidneys are enclosed by a fibrous capsule and the parenchyma
consists of a cortex and a medulla. Within the medulla approximately 8 – 18 triangular
structures called renal pyramids are found, and at the base of these pyramids renal papillae
are directed towards the centre of the kidney. Together the cortex and the renal pyramids
constitute the parenchyma of the kidney and structurally the parenchyma of each kidney
consists of approximately 1 million nephrons which are the functional units of the kidney.
Renal Blood Supply

The kidneys receive their blood supply from


the renal arteries which branch to the left
and right from the abdominal aorta. This
blood supply to the kidney is equal to 21%
of cardiac output and 99% of this cardiac
output returns to the general body
circulation via the renal vein. The remaining
1% undergoes further processing in the
nephron resulting in urine.

The Nephron

The function unit of the kidney is the nephron and each nephron contains two components:
• Glomerulus and Bowmans capsule (Renal Corpuscle)
• Tubular Component

The Glomerulus and Bowmans Capsule allows blood to be filtered. This is followed by the
proximal Convoluted tubule which can absorb the bulk of the filtrate. The next segment is
the Loop of Henley which is divided into the Descending and Ascending Limb. The
remainder of the nephron consists of a Distal Convoluted which drains into the Collecting
Ducts.

The kidneys perform the essential function of removing waste products from the blood and
regulating the water fluid levels. The diagram above shows the basic structure of the
kidney.
The kidneys receive blood through the renal artery. The blood is passed through the
structure of the kidneys called nephrons, where waste products and excess water pass out
of the blood stream, as shown in the diagram above.

• Each nephron of the kidney contains blood vessels and a special tubule. As the filtrate flows
through the tubule of the nephron, it becomes increasingly concentrated into urine. Waste
products are transferred from the blood into the filtrate, while nutrients are absorbed from
the filtrate into the blood.
There are approximately one million nephrons in each kidney that filter water and substances
out of the blood to produce urine.

Filtration

The first step in the production of urine is called glomerular filtration which is the forcing of
fluids and dissolved substances through a porous membrane by pressure. When blood
enters the glomerulus the blood pressure in the glomerulus forces water and dissolved
substances through the membrane.

The resulting fluids is called filtrate however this amount also depends on opposing forces
in the Bowmans capsule and the glomerulus.

Functions of the Kidney

• Maintains fluid balance


• Maintains electrolyte balance
• controls acid base balance
• removes wastes and toxins
• activates vitamin D produces rennin (Renin is a protein (enzyme) released by
special kidney cells when you have decreased salt (sodium levels) or low blood
volume, Renin also plays a role in the release of aldosterone, a hormone that helps
control the body's salt and water balance)
• produces erythropoietin. ( A hormone produced by the kidney that promotes the
formation of red blood cells in the bone marrow )

1& 2 Fluid and Electrolyte Balance

Production of urine begins with the formation of an ultrafiltrate of plasma by the glomerulus.
The quantity of filtrate formed by the nephrons of both kidneys is 125mls/minute or
180litres/day. The filtrate is similar to plasma except it does not contain red blood cells,
platelets or plasma protient. This filtrate contains waste products such as urea, creatinine
and excess electrolytes (eg. Sodium and potassium)
To prevent depletion of electrolytes the tubules selectively reabsorb and final adjustments
take place in the distal tubule and collecting duct. The collecting duct is also where water is
reabsorbed under the influence of a hormone anti-diuretic hormone which is produced from
the posterior pituitary in the hypothalamus. When the body needs to lose excess fluids this
hormone is not produced and a dilute urine results.

3 Acid Base Balance

The role of the kidney in acid base balance is to:


• excrete hydrogen ions
• maintain normal plasma bicarbonate

The kidney work in conjunction with the lungs to maintain body homeostasis.

4 Removal of Wastes

Urea which in the end product of protein metabolism and creatinine which is a nitrogenous
waste from muscle tissue are excreted by the kidneys

5 Activation of Vitamin D

The kidney is the major organ responsible for the production of Vitamin D. Its synthesis is
carefully regulated and its major effect is to stimulate calcium absorption from the gut.
Without this calcium absorption, calcium will be leached from the bones and result in bone
disease eg osteomalacia. (softening of the bones due to defective bone mineralization)

6 Production of Renin

Renin is an enzyme which is synthesised, stored and secreted mainly by the kidneys. It has
no know physiological effect but acts on the liver to form angiotensin 1. Angiotensin 1 also
has no known effect but is converted to angiotensin 11 by a circulating prohormone in the
lungs. Angiotensin 11 is a powerful Vasoconstrictor and will therefore increase blood
pressure.

7 Erythropoietin

In response to decreased oxygen tension in the renal blood supply the kidneys secrete a
hormone called erythropoietin. This hormone stimulates the bone marrow to produce red
blood cells.

The Urinary system

Collecting ducts of the nephron open and drain filtrate into the calycea system (major and
minor) of the kidney which joins to form the renal pelvis which is at the upper end of the
ureter. Each kidney has one ureter draining into a single bladder. The bladder can store
approximately 500mls of urine before being expelled by micturition though the uretha.
RENAL PHYSIOLOGY

ANATOMY

The Nephron

• The functional unit of the kidney


• Approximately 1,000,000 in each kidney
• The composite of the:
o Glomerulus and other vascular
o The Bowman’s Capsule
o The entire tubule

The nephron is structured and functions in a way that allows the following processes to
occur:

1. Glomerular filtration
2. Passive and active tubular reabsorption
3. Tubular secretion
4. Concentration of the urine

Vasculature

• The Glomerulus is the capillary bed within the capsule


• Afferent arterioles are found proximal to the glomerulus
• Efferent arterioles follow the glomerulus
• Distal to this are the peri-tubular capillaries that enmesh the convoluted tubules.
Following this the capillary network drains into a venule
• Also rising from the efferent arterioles are the vessels known as the vasa reta.
These vessels form capillary beds that surround the loop of Henle. The vasa recta
then drains into a venule

PHYSIOLOGY

Glomerular Filtration

• The capillary network is especially adapted in that it has several larger than average
fenestrae (are small pores in endothelial cells to allow for rapid exchange of
molecules between blood vessels and surrounding tissue. These pores may enlarge
and contract at the action of various stimuli such as noradrenaline.) in the endotheial
membranes of the capillaries.
• The permeability characteristics are thus very different. Even very small protein
molecules can diffuse through.
• The glycoprotein basement membrane prevents passage of larger proteins.
• The basement membrane construction of the inter-digitating podocytes form filtration
slits that prevent the progress of smaller proteins.
• Glomerular capillary (blood) hydrostatic pressure is very much (~ 60mmHg) than in
systematic capillary beds because of:
o The Renal artery being a direct branch of the aorta.
o The structural adaptations that allow the kidney to “auto-regulate” it’s blood
hydrostatic pressure to a much finer degree. Arteriole-Capillary-Arteriole
• The glomerular filtration rate of approximately 125 mls/min occurs as there is a very
significant and effective filtration pressure (Peff). The estimate of the Peff ~ 10
mmHg.
• Reabsorption occurs at approximately 124 mls/min

Tubular Reabsorption

• Filtration cause the peri-tubular capillary BHP (blood hydrostatic pressure) to drop.
At the same time, the blood osmotic pressure (BOP) in these vessels rises.
• As the filtrate passes through the proximal convoluted tubule (PCT), there is an
obligatory passive reabsorption of water and smaller ions.
• The epithelial cells lining the tubule at this point have their surface area maximised
by the existence of microvilli.
• Glucose is absorbed via simple diffusion and facilitated diffusion.

Secretion

• Substances like creatine, ammonia, organic acids, K+, H+, Ca2+, are excreted into
the tubule. K+ is often exchanged for Na+.

Hormonal Input

• Aldosterone secreted by the adrenal cortex affects the permeability of the tubular
cells, especially in the distal convoluted tubule (DCT). This hormonal input causes
increased absorption of Na+ and sometimes H+. K+ is excreted in exchange for
these ions. A net water reabsorption occurs because of this process.
• Anti-diuretic hormone secreted by the posterior pituitary in response to sensed
hyperosmolar conditions, changes the permeability of the DCT and the collecting
duct, allowing substantial water reabsorption. Atrial naturetic peptide, in contrast,
inhidits ADH and aldosterone secretion and ablates (To remove or destroy the
function of) the thirst reflex.
• The actions of ADH and aldosterone assist in the process of urine concentration.
• The counter current mechanism that occurs in the loop of henle of juxta – medullary
nephrons result in the formation of urine with an osmolarity far in excess of the
plasma.

Counter Current Mechanism

• The kidneys use counter currents to produce small volumes of concentrated urine
• The concentrating phenomenon occurs in the juxta-medullary nephrons in the region
of the loops of henle
• A concentration gradient is established in the interstitial fluid of the medullary regions
of the kidney
• The creation of this hyper-osmolar region is dependant on the current flow through
the descending and ascending loops, the collecting duct, and the sluggish blood
through the vasa recta
• The epithelial cells of the descending limb are readily permeable to water, though
impermeable to Na+ and other solutes. Thus the tubular osmolarity increases.
• Cells on the epithelium of the ascending limb are relatively impermeable to water.
They actively transport Na+ ions into interstitial fluid of the medullary region. Cl- ions
follow passively. As a result, the tubular fluid osmolarity decreases.
• Water flows into the interstitial space because of the osmotic pressure gradient
there. The pressure gradient can range from 300-600mOsm in the cortical regions,
to 1200 mOsm in the medullary areas.
THE KIDNEY
Kidney
The kidneys are solid organs found in the middle back that are responsible for removing water and water
soluble waste from the blood. The waste produced by the kidneys is called urine. Urine drains from the
kidneys through that ureters to the bladder. Urine is stored in the bladder until it is convenient to excrete from
the body through the urethra.

Structures of the kidney:

1.Renal pyramid - One of multiple cone-shaped portions of the kidney where urine is removed from blood and
drained into the renal calices.

2.Interlobar artery - One of the mid-sized blood vessels that bring blood to the nephron to be filtered.

3.Renal artery - The main blood vessel that brings blood to the kidney from the aorta.

4.Renal vein - The main blood vessel that brings blood away from the kidney back to the inferior vena cava.

5.Renal hylum - This is where tubes enter and leave the kidney.

6.Renal pelvis - This is where urine collects prior to leaving the kidney.

7.Ureter- This is the tube where urine drains from the kidney to the bladder.

8.Minor calyx- This is one of the mid-sized tubes that collects urine to be drained from the kidney.

9.Renal capsule- This is the outer covering of the kidney.

10.Inferior renal capsule- This is the bottom part of the outer covering the kidney.

11.Superior renal capsule- This is the top part of the outer covering of the kidney.

12.Interlobar vein- One of the mid-sized blood vessels that brings blood away from the nephron.

13.Nephron- This is the working unit of the kidney.

14.Minor calyx- This is one of the mid-sized tubes that collects urine to be drained from the kidney.

15.Major calyx- This is one of the large tubes that collects urine to be drained from the kidney.

16.Renal papilla- This is the pointed end of a renal pyramid.

17.Renal column- This is a solid portion of the kidney where blood vessels travel to and from the nephron.
Acid Base Homeostatsis

Obtained by:
• Lung excretion of the CO2
• Buffering – occurs when chemicals combine with strong acids to
produce weak acids (Phosphates, Hb, Proteins & HCO3). The kidneys
play a major role in this buffering process.

When the venom induces clotting, the fibrin is


deposited in the tubules. As the tubules are
blocked, the kidneys are not able to remove
the same amount of waste products from the
blood, and urea and cretinine begin to
accumulate in the blood. If these chemicals
are not removed, the concentrations become
lethal.
(Kidneys help maintain a person's blood pressure. When blood pressure becomes low, the
kidneys secrete an enzyme called Renin that increases water absorption and blood volume
which raises the blood pressure.)

Urinary System

Introduction

After the body oxidizes nutrient substances, it must deal with excretion (the elimination of
metabolic waste products) to prevent their accumulation and potential poisoning. The
kidneys are essential to the body's excretory needs. They constantly filter the blood, and
selectively reabsorb vital constituents for conservation. Concentrated waste products and
some remaining water form urine. The kidneys are also key to the homeostatic regulation of
blood volume and pressure, ion concentration, pH, and red blood cell production.

Kidneys: location and structure

The kidney is a reddish bean-shaped organ in the lower back near the twelfth rib. It sits
within perirenal fat and renal fascia (connective tissue) that protect against injury. The
lighter-colored outer part of the kidney is the renal cortex. The darker inner part is the renal
medulla. Blood is filtered in the renal cortex and medulla to form urine.
Within the kidney, urine travels through many structures before it reaches the ureter. The
renal medulla contains dark triangular areas of tissue called the renal pyramids. Urine flows
through a renal pyramid and exits at the renal papilla, the tip. The renal papilla has
collecting ducts, small openings that allow urine to pass through. From the collecting ducts,
the urine progresses to the renal pelvis, a widened area of the kidney, and exits through the
ureter. The urine passes through the ureters to the urinary bladder. When the urinary
bladder is full, the body releases urine through the urethra during urination, or micturition.

Kidneys: function

The functional unit of the kidney is the nephron. It contains a glomerular (Bowman's)
capsule, a cup-shaped structure that surrounds a glomerulus (group of capillaries).
Together, the glomerular capsule and glomerulus form a unit called the renal corpuscle.
Attached to the Bowman's capsule is a long, twisting renal tubule that has four parts: the
proximal convoluted tubule, the loop of Henle, the distal convoluted tubule, and a collecting
duct.
Filtration of the blood occurs in the renal corpuscle between the Bowman's capsule and
glomerulus. In this nonselective process, fluid and tiny particles in the glomerulus pass from
the blood into the Bowman's capsule and renal tubules. The liquid substance within the
renal tubules is filtrate.

Blood reaches the kidney through the renal arteries, a branch of the aorta. The path from
the renal artery to the glomerulus runs as follows: lobar artery, interlobar artery, arcuate
artery, interlobular artery, and afferent arterioles. "Afferent" means that the arteriole is
carrying blood toward the glomerulus.

Small openings called fenestrations fill the capillaries that make up the glomerulus.
Fenestrations allow tiny particles and water to pass into the filtrate. Surrounding the
glomerulus are cells called podocytes. The interlocking pedicels (foot processes) of these
cells surround the capillaries to form the filtration barrier. This barrier prevents the passage
of blood cells, platelets, and protein molecules into the filtrate. Seven types of matter are
small enough to pass through the filtration barrier: blood plasma (the liquid part of blood),
glucose, amino acids, potassium, sodium, chloride, and urea (nitrogenous waste).

Some materials in filtrate are needed to maintain homeostasis (a stable internal


environment); the reabsorption process returns these materials to the bloodstream.
Reabsorption begins after blood leaves the glomerulus through the efferent arteriole.
"Efferent" means that the arteriole is carrying blood away from the glomerulus. The efferent
arteriole forms a peritubular capillary bed that envelops the renal tubule. As the peritubular
capillaries pass near the renal tubule, useful substances in the filtrate such as glucose,
vitamins, amino acids, water, and ions are reabsorbed into the bloodstream.

Urine production
Urine, the fluid that enters the collecting duct, passes to the urinary bladder through the
ureters. Antidiuretic hormone (ADH) and aldosterone control how much urine the body
produces. If the body becomes dehydrated, the pituitary gland releases ADH. This
hormone reduces urine volume by causing the collecting tubules to allow more water to be
reabsorbed into the bloodstream. If too much fluid is in the body, the pituitary gland stops
releasing ADH and the excess water passes out of the body as dilute urine.

Aldosterone enhances sodium reabsorption, which increases water reabsorption into the
blood from the collecting tubules. Because of the effect of aldosterone on the collecting
tubules, the amount of water excreted in the urine decreases and blood volume and blood
pressure increase.

Endocrine cells in the kidneys produce the hormone erythropoietin, which controls
erythrocyte production.
Kidney

The kidneys are bean-shaped excretory organs in

vertebrates. Part of the urinary system, the kidneys


filter wastes (especially urea) from the blood and
excrete them, along with water, as urine. The
medical field that studies the kidneys and diseases
affecting the kidney is called nephrology, from the
Greek name for kidney; the adjective meaning
"kidney-related" is renal, from Latin.

Human kidneys viewed from behind with spine removed

In humans, the kidneys are located in the posterior part of the abdomen. There is one on
each side of the spine; the right kidney sits just below the liver, the left below the diaphragm
and adjacent to the spleen. Above each kidney is an adrenal gland (also called the
suprarenal gland). The asymmetry within the abdominal cavity caused by the liver results in
the right kidney to be slightly lower than the left one.
The kidneys are retroperitoneal, which means they lie behind the peritoneum, the lining of
the abdominal cavity. They are approximately at the vertebral level T12 to L3, and the right
kidney usually lies slightly lower than the left in order to accommodate the liver. The upper
parts of the kidneys are partially protected by the eleventh and twelfth ribs, and each whole
kidney is surrounded by two layers of fat (the perirenal fat and the pararenal fat) which help
to cushion it. In very rare cases, it is possible to have developed three kidneys.
Above each human kidney is one of the two adrenal glands.

Organization

In a normal human adult, each kidney is about 11 cm long and about 5 cm thick,
weighing 150 grams. Kidneys weigh about 0.5 percent of a person's total body weight.
The kidneys are "bean-shaped" organs, and have a concave side facing inwards
(medially). On this medial aspect of each kidney is an opening, called the hilum, which
admits the renal artery, the renal vein, nerves, and the ureter.
The outer portion of the kidney is called the renal cortex, which sits directly beneath
the kidney's loose connective tissue/fibrous capsule. Deep to the cortex lies the renal
medulla, which is divided into 10-20 renal pyramids in humans. Each pyramid together
with the associated overlying cortex forms a renal lobe. The tip of each pyramid (called
a papilla) empties into a calyx, and the calyces empty into the renal pelvis. The pelvis
transmits urine to the urinary bladder via the ureter.

Blood supply

Each kidney receives its blood supply from the renal artery, two of which branch from
the abdominal aorta. Upon entering the hilum of the kidney, the renal artery divides
into smaller interlobar arteries situated between the renal papillae. At the outer
medulla, the interlobar arteries branch into arcuate arteries, which course along the
border between the renal medulla and cortex, giving off still smaller branches, the
cortical radial arteries (sometimes called interlobular arteries). Branching off these
cortical arteries are the afferent arterioles supplying the glomerular capillaries, which
drain into efferent arterioles. Efferent arterioles divide into peritubular capillaries that
provide an extensive blood supply to the cortex. Blood from these capillaries collects in
renal venules and leaves the kidney via the renal vein. Efferent arterioles of glomeruli
closest to the medulla (those that belong to juxtamedullary nephrons) send branches
into the medulla, forming the vasa recta. Blood supply is intimately linked to blood
pressure.

Nephron

The basic functional unit of the kidney is the nephron, of which there are more than a
million within the cortex and medulla of each normal adult human kidney. Nephrons
regulate water and soluble matter (especially electrolytes) in the body by first filtering
the blood under pressure, and then reabsorbing some necessary fluid and molecules
back into the blood while secreting other, unneeded molecules. Reabsorption and
secretion are accomplished with both cotransport and countertransport mechanisms
established in the nephrons and associated collecting ducts.

Collecting duct system

The fluid flows from the nephron into the collecting duct system. This segment of the
nephron is crucial to the process of water conservation by the organism. In the
presence of antidiuretic hormone (ADH; also called vasopressin), these ducts become
permeable to water and facilitate its reabsorption, thus concentrating the urine and
reducing its volume. Conversely, when the organism must eliminate excess water,
such as after excess fluid drinking, the production of ADH is decreased and the
collecting tubule becomes less permeable to water, rendering urine dilute and
abundant. Failure of the organism to decrease ADH production appropriately may lead
to water retention and dangerous dilution of body fluids, which in turn may cause
severe neurological damage. Failure to produce ADH (or inability of the collecting ducts
to respond to it) may cause excessive urination, called diabetes insipidus.
After being processed along the collecting tubules and ducts, the fluid, now called
urine, is drained into the bladder via the ureter, to be finally excluded from the
organism.

Functions

Excretion of waste products

The kidneys excrete a variety of waste products produced by metabolism, including the
nitrogenous wastes: urea (from protein catabolism) and uric acid (from nucleic acid
metabolism).

Homeostasis

Acid-Base Balance
The kidneys regulate the pH, mineral ion concentration, and water composition of the
blood.
By exchanging hydronium ions and hydroxyl ions, the blood plasma is maintained by
the kidney at a neutral pH 7.4. Urine, on the other hand, is acidic at pH 5 or alkaline at
pH 8.
The pH is maintained through four main protein transporters: NHE3 (a sodium-
hydrogen exchanger), V-type H-ATPase (an isoform of the hydrogen ATPase), NBC1 (a
sodium-bicarbonate cotransporter) and AE1 (an anion exchanger which exchanges
chloride for bicarbonate). Due to the polar alignment of cells in the renal epithelia
NHE3 and the H-ATPase are exposed to the lumen (which is essentially outside the
body), on the apical side of the cells, and are responsible for excreting hydrogen ions
(or protons). Conversely, NBC1 and AE1 are on the basolateral side of the cells, and
allow bicarbonate ions to move back into the extracellular fluid and thus are returned
to the blood plasma.
Blood Pressure
Sodium ions are controlled in a homeostatic process involving aldosterone which
increases sodium ion absorption in the distal convoluted tubules.
When blood pressure becomes low, a hormone called Renin is secreted by cells of the
juxtaglomerular apparatus (part of the distal convoluted tubule) which are sensitive to
pressure. Renin acts on a blood protein, angiotensinogen, converting it to angiotensin.
Angiotensin stimulates the secretion of Aldosterone by the adrenal cortex, which
affects the kidney tubules.
Aldosterone stimulates an increase in the reabsorption of sodium ions from the kidney
tubules which causes an increase in the volume of water that is reabsorbed from the
tubule. This increase in water reabsorption increases the volume of blood which
ultimately raises the blood pressure.
Plasma Volume
Any rise or drop in blood osmotic pressure due to a lack or excess of water is detected
by the hypothalamus, which notifies the pituitary gland via negative feedback. A lack
of water causes the posterior pituitary gland to secrete antidiuretic hormone, which
results in water reabsorption and an increase in urine concentration. Tissue fluid
concentration thus returns to a mean of 98%.

Hormone secretion

The kidneys secrete a variety of hormones, including erythropoietin, urodilatin and


vitamin D.

Terms

• renal capsule: The membranous covering of the kidney.


• cortex: The outer layer over the internal medulla. It contains blood vessels, glomeruli
(which are the kidneys' "filters") and urine tubes and is supported by a fibrous matrix.
• hilus: The opening in the middle of the concave medial border for nerves and blood
vessels to pass into the renal sinus.
• renal column: The structures which support the cortex. They consist of lines of blood
vessels and urinary tubes and a fibrous material.
• renal sinus: The cavity which houses the renal pyramids.
• calyces: The recesses in the internal medulla which hold the pyramids. They are used
to subdivide the sections of the kidney. (singular - calyx)
• papillae: The small conical projections along the wall of the renal sinus. They have
openings through which urine passes into the calyces. (singular - papilla)
• renal pyramids: The conical segments within the internal medulla. They contain the
secreting apparatus and tubules and are also called malpighian pyramids.
• renal artery: Two renal arteries come from the aorta, each connecting to a kidney. The
artery divides into five branches, each of which leads to a ball of capillaries. The arteries
supply (unfiltered) blood to the kidneys. The left kidney receives about 60% of the renal
bloodflow.
• renal vein: The filtered blood returns to circulation through the renal veins which join
into the inferior vena cava.
• renal pelvis: Basically just a funnel, the renal pelvis accepts the urine and channels it
out of the hilus into the ureter.
• ureter: A narrow tube 40 cm long and 4 mm in diameter. Passing from the renal pelvis
out of the hilus and down to the bladder. The ureter carries urine from the kidneys to
the bladder by means of peristalsis.

Diseases and disorders

Congenital

• Congenital hydronephrosis
• Congenital obstruction of urinary tract
• Duplicated ureter
• Horseshoe kidney
• Polycystic kidney disease
• Renal dysplasia
• Unilateral small kidney

Acquired

• Azotemia is a toxic condition characterized by abnormal and dangerously high levels of


urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in
the blood.
• Diabetic nephropathy
• Glomerulonephritis
• Hydronephrosis is the enlargement of one or both of the kidneys caused by obstruction
of the flow of urine.
• Interstitial nephritis

• Kidney stones are a relatively common and particularly painful disorder.


• Kidney tumors
o Wilms tumor
o Renal cell carcinoma
• Lupus nephritis
• Minimal change disease
• In nephrotic syndrome, the glomerulus has been damaged so that a large amount of
protein in the blood enters the urine. Other frequent features of the nephrotic syndrome
include swelling, low serum albumin, and high cholesterol.
• Pyelonephritis is infection of the kidneys and is frequently caused by complication of a
urinary tract infection.
• Renal failure
o Acute renal failure
o Chronic renal failure
• Trauma

Dialysis and kidney transplants

Generally, humans can live normally with just one kidney. Only when the amount of
functioning kidney tissue is greatly diminished will renal failure develop. If renal
function is impaired, various forms of medications are used, while others are
contraindicated. Provided that treatment is begun early, it may be possible to reverse
chronic kidney failure due to diabetes or high blood pressure. If creatinine clearance (a
measure of renal function) has fallen very low ("end-stage renal failure"), or if the
renal dysfunction leads to severe symptoms, dialysis is commenced. Dialysis is a
medical procedure, performed in various different forms, where the blood is filtered
outside of the body.
Kidney transplantation is the only cure for end stage renal failure; dialysis, is a
supportive treatment; a form of "buying time" to bridge the inevitable wait for a
suitable organ.
The first successful kidney transplant was announced on March 4, 1954 at Peter Bent
Brigham Hospital in Boston. The surgery was performed by Dr. Joseph E. Murray, who
was awarded the Nobel Prize in Medicine in 1990 for this feat.
There are two types of kidney transplants: living donor transplant and a cadaveric
(dead donor) transplant. When a kidney from a living donor, usually a blood relative, is
transplanted into the patient's body, the donor's blood group and tissue type must be
judged compatible with the patient's, and extensive medical tests are done to
determine the health of the donor. Before a cadaveric donor's organs can be
transplanted, a series of medical tests have to be done to determine if the organs are
healthy. Also, in some countries, the family of the donor must give its consent for the
organ donation. In both cases, the recipient of the new organ needs to take drugs to
suppress their immune system to help prevent their body from rejecting the new
kidney

Medical terminology

• Medical terms related to the kidneys involve the prefixes renal- and nephro-.
• Surgical removal of the kidney is a nephrectomy, while a radical nephrectomy is
removal of the kidney, its surrounding tissue, lymph nodes, and potentially the
adrenal gland. A radical nephrectomy is performed for the removal of cancers.

See also

• Urology
• Nephrology
• Nephropathy
• Human anatomy
• Kidney development

Urinary system - Kidney - edit


Renal capsule | Renal cortex | Renal medulla (Renal sinus, Renal pyramids) | Renal calyx |
Renal pelvis
Nephron - Renal corpuscle (Glomerulus, Bowman's capsule) → Proximal tubule →
Loop of Henle → Distal convoluted tubule → Collecting ducts

Juxtaglomerular apparatus (Macula densa, Juxtaglomerular cells)

Renal circulation - Renal artery → Interlobar arteries → Arcuate arteries →


Cortical radial arteries → Afferent arterioles → Glomerulus → Efferent arterioles → Vasa recta →
Arcuate vein → Renal vein
Renal physiology
Filtration - Ultrafiltration | Countercurrent exchange

Hormones effecting filtration - Antidiuretic hormone (ADH) | Aldosterone |


Atrial natriuretic peptide

Endocrine - Renin | Erythropoietin (EPO) | Calcitriol (Active vitamin D) | Prostaglandins


Assessing Renal function / Measures of Dialysis
Glomerular filtration rate | Creatinine clearance | Renal clearance ratio | Urea reduction ratio |
Kt/V | Standardized Kt/V | Hemodialysis product
Urinary system - edit
Kidneys | Ureters | Urinary bladder | Urethral sphincters | Urethra
Endocrine system - edit
Adrenal gland | Corpus luteum | Hypothalamus | Kidney | Ovaries | Pancreas |
Parathyroid gland | Pineal gland | Pituitary gland | Testes | Thyroid gland