KIDNEY

SOME IMPORTANT FACTS:

1. About 25% of left ventricles total output of blood in each cardiac cycle is distributed through the renal arteries
to the kidneys for filtration at rest.

2. WATER IS A DIURECTIC--- x ADH (Vasopressin) release. Vasopressin regulates the body's

retention of waterby acting to increase water reabsorption in the collecting ducts of the kidney nephron.

3. 180L of fluid is filtered/day.

4. 99% of Glomerular filtrate is reabsorbed.
5. 1.5L of urine is excreted in normal human.
6. A 1% decrease in Glomerular filtrate reabsorption will increase the output to 3L.
7. There are 1.4 Million nephron/kidney.
8. 85% of them are SUPERFICIAL NEPHRONS; occupies 2/3rd of cortex (outer) of kidney. They are always
active. Shorter in size.
9. Rest 15% of the nephron are JUXTAMEDULLARY NEPHRONS; OCCUPIES 1/3rd of cortex and major part to
Medulla (inner). They are active only under stress condition. Longer in size.
10. Afferent arterioles (shorter in size, bigger cross sectional area) brings blood about 1200ml/min.
11. Only 20% i.e. 240ml/min enters glomerulus.
12. GFR (Glomerular Filtration Rate) is 125ml/min.

SIMPLIFIED ANATOMY OF JUXTAMEDULLARY NEPHRON AND ITS BLOOD SUPPLY

JUXTAGLOMERULAR APPARATUS

THE FOUR SITES OF SOLUTE

REABSORPTION

Three cardinal processes taking place:

Glomerular Filtration- SITE-I

Selective Tubular Reabsorption SITE- I, II & III

Subsequent secretion. SITE-IV
SITE-I: Proximal convoluted tubule (PT/PCT)
SITE-II: Ascending Limb of Loop of Henle (AscLH)
SITE-III: Cortical diluting segment of Loop of
Henle.
SITE-IV: Distal Tubule (DT) and Collecting Duct
(DC).

SITE-I

PROXIMAL TUBULE

Blood supply to the nephron (from afferent to efferent

arterioles)
Glomerular Filtration- fluid driven from glomerulus to
Bowmans capsule (lined by tight junction simple squamous
epithelium )by hydrodynamic force opposed by oncotic
pressure- permeable to LMW constituents of plasma which
appear in the filtrate.
The Proximal convoluted tubule (lined by leaky junction
columnar epithelium). Water and Na+ enters from capsule and
diffuses passively through PT -65-70% Na+ reabsorption
occurs here. The rate of entry from capsule and reabsorption
from basolateral cells are so that an isotonic milieu is set.
Transport processes in PT
1. direct entry of Na+ from glomerulus to capsuleelectrogenic
2. Transport of Na+ and K+ coupled with glucose, amino
acids, acetate, phosphate through specific symporter. Na +
and glucose elimination is electrogenic.

3. Exchange with Na+/H+ :

4. Cl- diffuses through paracellular pathway: Due to

disproportionate reabsorption of amino acids, acetate,
phosphate, bicarbonate Cl- ion diffuses passively from
later PT cells.
INFERENCE: Sodium, chloride, potassium and water is lost
from lumen. A major change in composition of filtrate is
now entering the descending loop of Henle.

SITE-II [ASCENDING LIMB OF LOOP OF

HENLE]
Medullary part lined by cuboidal cells- Na+ - K+
-2 Cl- symporter, nonelectrogenic. In addition
a Na+ - Cl- symporter moves Cl- down its
electrochemical gradient into E.C.F. and
carries Na+ along. As the tubular fluid
traverses AscLH it progressively becomes
hypotonic as this part is impermeable to
water. Accumulation of NaCl in the medullary
interstitium without water makes it
hypertonic; a corticomedullary osmotic
gradient is set up. This draws in water from
descending limb of LH so that the fluid that
enters AscLH becomes hypertonic.
Cortical part lined by flattened cells.

MECHANISM OF SALT REABSORPTION IN THE THICK

ASCENDING LIMB OF LOOP OF HENLE (AscLH) CELL

SITE-III
CORTICAL DILUTING SEGMENT OF LOOP OF
HENLE

Impermeable to water
Continues to absorb salt through Na+
- Cl- symporter.
Tubular fluid gets further diluted.

SITE-IV DISTAL TUBULE (DT) AND COLLECTING DUCT (CD)

In the late DT and CD, sod. Is again actively

reabsorbed: the cation-anion balance being
maintained by- passive chlor diffusion
and partly by pot and hydrogen. Absorption of
sodium at this site occurs through a specific
amiloride sensitive sod channel and by aldosterone.
DT and CD are rich in K+, a chemical gradient exists
for its diffusion into tubular lumen due to
transmembrane pot.difference.

DIURETICS
Drugs that promote the output of urine excreted
by kidney.
They are used for treatment of:
1. Cardiac oedema related to Congestive Heart Failure
(CHF).
2. Nephrotic syndrome
3. Diabetes insipidus
4. Nutritional oedema.
5. Liver cirrhosis.
6. Hypertension.
7. Oedema of pregnancy.
8. To reduce intraocular and CSF pressure.
9. Special cases: epilepsy, migraine, glaucoma,
anginal syndrome and bromide intoxication.

WHAT DIURETICS CAN DO ?

Diuretics may enhance the rate of
urine formation by :
1. Increasing Glomerular Filtration. May
act at Site-I
2. Depressing Tubular Reabsorption.
May act at Site-II, III, IV

THE NITTY-GRITTY
Diffusion
Osmosis-isotonic, hypotonic, hypertonic, isosmotic
Oncotic pressure:
Composition of blood:
Route of urine formation:
Coport- UniProt- symport- antiport
Medullary interstitium: Themedullary interstitiumis the tissue
surrounding theloop of Henlein therenal medulla. It functions in
renal water reabsorption by building up a highhypertonicity, which
draws water out of thethin descending limb of the loop of Henle and
thecollecting duct system. This hypertonicity, in turn, is created by
an efflux ofureafrom theinner medullary collecting duct .
Malphigian corpuscle:
Basolateral membrane:
Macula densa: In thekidney, themacula densais an area of closely
packed specializedcellslining the wall of thecortical
thick ascending limb, at the transition to thedistal convoluted tubule.
Interstitial fluid: ECF + plasma+ transcellular fluid. 10L