RENAL SYSTEM

FISIOLOGY

LELI MULYATI,SKp,M.Kep.Sp.MB

Renal system summary

Functions:

1. Remove wastes from the body (urine) 2. Regulates fluid balance, maintains homeostasis
Structures: 2 kidneys - filter blood, produce urine 2 ureters - transport urine (kidneys to bladder) bladder - reservoir for urine urethra - transport of urine

FUNGSI GINJAL Kidneys carry out four functions Filter nitrogenous wastes, toxins, ions, etc. from blood to be excreted as urine. Regulate volume and chemical composition of blood (water, salts, acids, bases). Produce regulatory enzymes. Renin regulates BP/ kidney function Erthropoeitin stimulates RBC production from marrow. Metabolism of Vitamin D to active form.

Vascular component of nephron

Made up of blood vessels:
1. Glomerulus - network of capillaries within Bowmans capsule 2. Afferent arteriole - leading into glomerulus 3. Efferent arteriole - leading out of glomerulus 4. Peritubular capillaries - surrounding tubules 5. Vasa recta - specialised loops of blood vessels around long Loop of Henle (juxtamedullary nephrons)

Blood supply to the kidney:

Renal arteries from abdominal aorta enter hilum and branch: 1. Interlobar arteries - pass through renal columns and reach junction between medulla and cortex 2. Arcuate arteries run parallel with the base of the pyramids 3. Interlobular arteries move up into the cortex and branch to form the afferent arteriole The peritubular capillaries unite to form the interlobular veins, arcuate vein, interlobar vein, renal vein The renal vein exits at hilus and joins the IVC

Nephrons: 85% are cortical, 15% are juxtamedullary

Renal corpuscle

III. Renal Corpuscle

Secondary processes interdigitate around glomerular capillaries. The narrow space between processes is the filtration slit. 19-5

efferent arteriole

afferent arteriole

Glomerular Filtration

Bowmans capsule
Filters blood; proteins cant pass through

glomerulus

Proximal Convoluted Tubule

Reabsorbs: water, glucose, amino acids, and sodium.
65% 65% 90% 50% of of of of Na+ is reabsorbed H2O is reabsorbed filtered bicarbonate (HCO3-) Cl- and K+

Loop of Henle
Creates a gradient of increasing sodium ion concentration towards the end of the loop within the interstitial fluid of the renal pyramid.
25% Na+ is reabsorbed in the loop 15% water is reabsorbed in the loop 40% K is reabsorbed in the loop

Distal Convoluted Tubule

Under the influence of the hormone aldosterone, reabsorbs sodium and secretes potassium. Also regulates pH by secreting hydrogen ion when pH of the plasma is low.
only 10% of the filtered NaCl and 20% of water remains

Collecting Duct
Allows for the osmotic reabsorption of water.
ADH (antidiuretic hormone)- makes collecting ducts more permeable to water-- produce concentrated urine

Urine
Water- 95% Nitrogenous waste: urea uric acid creatinine Ions: sodium potassium sulfate phosphate
From the original 1800 g NaCl, only 10 g appears in the urine

efferent arteriole afferent arteriole

glomerulus

artery
peritubular capillaries

Bowmans capsule proximal convoluted tubule distal convoluted tubule collecting duct

vein

loop of Henle

Regulation of Water Balance

Brain monitors water content of blood

If low water content, pituitary releases ADH

ADH travels in blood to nephron

ADH causes more water to move from urine back into blood

Ureters

Pyelogram (colour-enhanced)

tubes that transport urine from renal

pelvis to bladder

20-30 cm long muscular walls - peristaltic waves force

urine down to bladder

retroperitoneal

pressure in the bladder compresses

ureter, helps prevent backflow of urine

(physiological valve) - still allows urine

to flow into the bladder

Bladder
hollow muscular organ retroperitoneal, posterior to pubic symphysis
Capacity ~ 300-400 ml (max = 1000 ml) empty: looks like a deflated balloon, rugae full spherical rises above abdominal cavity Males: anterior to rectum, above prostate Females: inferior to uterus, anterior to vagina
Martini p983

Support of bladder
superior surfaces - peritoneum
middle umbilical ligament superior border to umbilicus lateral umbilical ligaments - sides

Martini p983

of bladder to umbilicus

At base, tough ligamentous bands anchor bladder to pelvic and pubic bones

Trigone : triangular area bounded by openings of ureters and exit to urethra

cystitis - inflammation of the bladder wall

Urethra

Martini p983

Female ~ 4cm long

opens to exterior between

clitoris and vaginal opening

Male ~ 20 cm long
passes through prostate

gland

pierces urogenital diaphragm enters penis and extends

throughout length opens at urethral orifice

Stretch receptors stimulated when filled to ~ 200 ml afferent fibres to spinal cord motor neurons to sm in bladder wall contracts m. detrusor and increases pressure

Micturition reflex:

need to relax both internal and external sphincter - external under voluntary control if external sphincter does not relax, internal sphincter remains closed & sm in bladder wall relaxes again

Once volume exceeds 500 ml, micturition reflex may generate enough P to open internal sphincter leads to reflexive relaxation of external sphincter