The Kidney Function

By M. Rasjad Indra

Main function Excretion of metabolic waste products & foreign chemicals Regulation of:
water & electrolyte balances. body fluid osmolarity & electrolyte concentration. acid-base balance. arterial pressure.

Secretion, metabolism, and excretion of hormones Gluconeogenesis

Blood Clearance
Efective Pore What and how much should be removed Filtration Glomerulus Na K Cl Hydrogen Glucose Protein Creatinine Urea Still needed Pressure Place Time Energy Efficient

Unsufficient

Difusion Osmosis

Bioche mistry

Peritubular I

Tub. Proks.

Reabsorption

Secretion

Vasa recta

Ansa Henle

Peritubular II Excretion

Tub. distalis

SELESAI

Renal Blod Flow

1200 ml/minute or 20-25% of cardiac out put Both kidney weigh: 300 gr or 0.5% b.w. Blood flow per grams of kidney tissue: 4 ml / minute => 1200 ml / 300 gr, why? Blood flow is highest in the renal cortex, why? RBF & GFR change relatively little if arterial blood pressure between 80 - 180 mmHg, why?

The nephron ~ Functional Unit

Each kidney contains about 1 million nephrons The kidney cannot regenerate new nephrons. After age 49 the number usually decrease 10 % every 10 years. Regional differences in nephron structure:
Cortical nephrons: they have short loops. Juxtamedullary nephrons: they have long loops.

Urine formation results from: Glumerular filtration, tubular reabsorption, and tubular secretion.

Urinary excretion rate = Filtration rate- Reabsorption rate + Secretion rate

Ke Counter Current

Two capillary beds: The glomerular & Peritubular capillaries

Are arranged in series Separated by the efferent arterioles

Regulate the hydrostatic pressures in both sets of capillaries. The glomerular (high ~ 60 mmHg) => for filtration. The peritubular (low ~ 13 mm Hg) => for reabsorption. The kidneys regulate the hydrostatic pressure of the glomerular & peritubular capilaries. Changing the rate of filtration and / or tubular reabsorption. Response to body homeostatic demands.
KEMBALI

Hydrostatic pressure:

By adjusting the resistances of afferent and efferent arterioles

Glomerular Filtration

Urine formation start with the filtration of plasma in the glomeruli: GFR determined by:
The balance of hydrostatic & colloid osmotic forces across the glomerular membrane The glomerular filtration coefficient (Kf) Net Filtr.Pressure= PG - PB - G+ B. GFR= Kf x Net Filtration Pressure

Glomerular filtration is rather non selective:

Protein are mostly retained in the plasma Low-molecular weight substance are freely filtered (excepts that are bound to the plasma protein). Negative charged large molecules are filtered less easily than positively charged molecules of equal molecules size

Macula densa

Juxtaglomerular cells

Reabsorption & Secretion

Tubular reabsorption includes Passive & Active mechanism.

1.Across the tubular epithelial cells into interstitiel 2.Through the peritubular capillary membrane back into the blood

Active transport (against electrochemical gradient & requires energy.

1.Primary active transport

Expl: Sodium transport in luminal membrane prox. Tub. Expl.: Glucose & amino acid reabs.

2.Secondary active reabsorption

Secondary active Secretion:

Expl: Hydrogen ion: Counter-transport with sodium reabsorption in luminal membrane

Glucose: All of the filtered are actively reabsorbed and sodium dependent. Urea & Chloride are passively reabsorb. Active absorb. of Na+ --> the driving force for tubular reabsorb. of water, glucose, amino acids, chloride and phosphate. Some organic compounds are secreted from the blood into the tubular urine.

Transport Maximum

Transport maximum for substances that are actively reabsorbed: Glucose 320 mg/min. Phosphate 0.10 mM/min. Sulfate 0.06 mM/min. Amino acid 1.5 mM/min. Uric acid 15 mg/min. Lactate 75 mg/min Plasma protein 30 mg/min Transport maximum for substances that are actively secreted: Creatinin 16 ng/min Para-aminohipuric acid 80 ng/min

Constituent Water Sodium Potasium Chloride Bicarbonate Phosphate Glucose Urea Uric acid Creatinine**

Filtered 167.5 liters 24,000 mmoles 720 mmoles 19,500 mmoles 4,500 mmoles 6g 150 g 50 g 8g 1.5 g

Reabsorbed 166 liters 23,900 mmoles 630 mmoles 19,400 mmoles 4,498 mmoles 5g 150 g 25 g 7.2 g 0g

Excreted 1.5 liters 100 mmoles 90 mmoles 100 mmoles 2 mmoles 1g 0g 25 g 0.8 g 1.8 g

Reabsorption of glucose

Glucose is cotransport with sodium across the luminal cell membrane (uphill)
the energy from:
the sodium gradient, how? the electrical gradient

Glucose leave the cell membrane to peritubular capillary blood by facilitated difussion

Glucose Threshold

The ability to reabsorb is limited At normal plasma glucose levels (65-90 mg/dl) => completely reabsorb. At 180-200 mg/dl => glucose first appear in the urine (threshold). Tubular transport maximum (Tm) for glucose: the maximal rate of glucose reabsorption.

Sodium (Na+): Most filtered sodium is reabsorbed. The proximal tubules: 70%. The loop of Henle: 20% The distal tub. and collecting duct: 9% The quantity of Na+ excreted =>important role in body sodium balance.

Countercurrent Mechanism

Loop of Henle (countercurrent multipliers) & Vasa recta (countercurrent ex-changers) Loops of Henle: establish an osmotic gradient in the medulla. The descending limb: water permeable The ascending limb: Active sodium transport Low water permeability The vasa recta: remove water from the medulla.
Ke Slide 8

The collecting ducts:

Final regul. of Na+excretion.

Aldosterone and ADH: increase Na+ and water reabs. by the collecting duct. Potasium (K+): Filtered, reabsorb and secreted The cortical collecting tubules: important site of K+ secretion.

Ke Slide 4

The Clearance Concept (CX) to Quantify Kidney Function

Clearance(CX)= UX x V (ml plasma/ minute) PX The Inulin clearance (CIN) = GFR .....Why ? Endogenous Creatinine Clearance also = GFR ..... Why ? Clearance Ratio = Cx CInulin PAH clearance (CPAH)= Effective Renal Plasma Flow (ERPF) Renal Plasma Flow (RPF) = CPAH EPAH =PPAH-VPAH (Extraction Ratio) EPAH PPAH Renal Blood Flow (RBF) = RPF 1-Hematocrit Excretion Rate = Ux x V Reabsorption Rate = Filtered Load Excretion Rate = (GFR x Px) (Ux x V) Secretion Rate = Excretion Rate Filtered Load

Clearance Inulin ~ GFR

Inulin: Not be reabsorbed or secreted by the kidney Not be metabolized, synthesized, or stored through the glomerular filtration Pass barrier unhindered Nontoxic Be able to measure in plasma and urine

Clearamce PAH ~ ERPF

PAH is avidly secreted by tubules that it is almost completely cleared from all of the plasma in one passage of blood through the kidneys

mg ( x) / ml (urine) Xml (urine) / min ute Cx ml ( plasma ) / min ute mg ( x) / ml ( plasma )

Urea Recirculation in Renal Tubules

The two ureters are muscular tubes that carry the urine from the kidneys to the bladder. The urinary blader functions as a reservoir for urine and is periodically emptied (micturition).

MICTURITION A complex act involving autonomic and somatic nerves, spinal reflexes, and higher brain centers.

Ke slide 4