Theoretical Physiology 1 Dr.

Faisal Ali
Lecture 7: (Renal Physiology)

The urinary system is composed of:

1. two Kidneys. 2.two Ureters.

3. Urinary Bladder.

4. Urethra.
Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

Renal Functions:
maintenance of acid-base balance; regulation of fluid balance; regulation of

sodium, potassium, and other electrolytes; clearance of toxins; absorption

of glucose, amino acids, and other small molecules; regulation of blood

pressure; production of various hormones, such as erythropoietin and renin

; and activation of vitamin D.

Physiologic anatomy of the kidney:-

• Medulla:- this tissue appears as pyramids their apex are towards the

renal pelvis it appears striated because or the collecting ducts and loops of

Henle.

• Cortex:- this tissue appears granulated because of the large number

of glomeruli, the cortex is surrounded by a connective tissue called Renal

Capsule.
Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

Functional Anatomy:-
• The kidney is a complex structure consisting of more than
one million, structural and functional unites called Nephrons,
separated by connective tissue (interstitial tissue).

• The Nephron is the functional unit because it accomplishes

the entire complex of processes that result in the formation of
urine.
Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

• Each individual renal tubule and its glomerulus is a nephron.

And the size of the kidney in various species is determined largely
by the number of nephrons they contain.

The Nephron consists of:

1. Glomerulus:

200µm in diameter is formed by the invagination of a tuft of

capillaries into the dilated blind end of the nephron (Bowman's
Capsule).” The capillaries are supplied by an afferent arteriole
and drained by an efferent arteriole.

2. Renal tubules:

a.Bowman's capsule: the invaginated end of the tubule surrounding the

glomerular tuft.

two cellular layers separate the blood from the glomerular filtrate in

Bowman's capsule, the two cellular layers :capillary endothelium and

specialized epithelium of the capsule made up of podocytes.

•The endothelium of glomerular capillaries is fenestrated with pores that are

50-100 nm in diameter.
Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

• The epithelium (podocytes) form filtration slits approximately 5 nm in

diameter.

b- Proximal Convoluted Tubule: (PCT) it contains cuboidal cells that are

linked tightly at the apex but contain large lateral intracellular space. Its rich

with mitochondria & the surface is covered with micro-villi. Around 65% of

filtrated fluid is reabsorbed in the PCT.

c- Loops of Henle: thin descending loop with high permeability to water &

thick ascending loop which is impermeable to water but permit Clֿ active

reabsorption followed by Na movement.

* Thick ascending loop passes between the afferent and efferent arterioles

of the same nephron forming juxta glomerular apparatus.

d- Distal Convoluted Tubule: (DCT) the first part(diluting segment)

continues from the ascending thick loop, then the distal segment which are

both under the effect of Aldosteron for Na+-K+ exchange reabsorption.

e. Collecting Duct: cortical and medullary parts, both under effect of Anti

Diuretic Hormone ADH. Contain Principle cells(P-cells) for active Na+

reabsorption and Intercalated cells(I-cells) for H+ secretion.

Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)
Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

Juxta glomerular apparatus:

•The thick ascending limb of the loop of Henle reaches the glomerulus of

the same nephron which the tubule arose & passes close to its afferent

arteriole, the wall of the afferent arteriole contain Renin – secreting Juxta

Glomerular cells. At this point, the epithelium of the tubule is modified

histologically to form Macula Densa.

•The juxta glomerular cells & the macula densa form the Juxta Glomerular

Apparatus (JGA) which is a secretary structure secreting renin &

erythropoietin.

Note: The renin enzyme converts the inactive form of Angiotensinogen (a

protein synthesized in liver) to Angiotensin I hormone in which is converted

to Angiotensin II by convertaze enzyme in the blood.

Functions of Angiotensin II are:-

A. Short term:

1.its a potent vasoconstrictive agent due to increasing Blood Pressure(BP).

2.it also activate the heart which results in increasing the Cardiac

Output(CO).
Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

B. Long term:

1.stimulate secretion of Antidiuretic Hormone(ADH) from the Pituitary

gland.

2.stimulate secretion of Aldosteron from the Adrenal cortex which regulate

the sodium level in the blood.(Aldosteron stimulate reabsorption of Na+

ions & water excretion in urine).

The Main Processes of Kidney:-

1. Filtration:

2-Reabsorption:-

3-Secretion:-

1. Filtration: in filtration, blood pressure forces water across a filtration

membrane (include the glomerular endothelium, the lamina densa, the
filtration slits),

Filtration Pressure:-

The primary factor involved in glomerular filtration is basically the same as

that controlling fluid and solute movement across capillaries throughout the
all body→ it’s the balance between hydrostatic & colloid pressure on either
side of the capillary walls.
Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

Note: The exchange between plasma and interstitial fluid is influenced by

the changes in *hydrostatic pressure(HP) *colloidal osmotic
pressure(COP).

•HP: is the pressure of heart action on blood which push the water and
salts outside the blood vessels (capillaries).

•COP: is resulting from the colloid particles specially protein found in

plasma, its essential in maintaining blood volume and counteracting the HP
exerted by the heart.

• NFP = (GHP-CHP)- (BCOP-CCOP)

• = (55-15) – (30-0)

• = 10 mmHg

• GHP = glomerular (blood) hydrostatic pressure.

• CHP = capsular hydrostatic pressure.

• BCOP = blood colloid osmotic pressure.

• CCOP = capsular colloid osmotic pressure.

• NFP = net filtration pressure.

Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

Hydrostatic pressure (HP): the net hydrostatic pressure tends to drive

water & solutes out of plasma and intercapsular space.

• The net hydrostatic pressure is made up of two opposing components =

glomerular HP & capsular HP.

•NHP = GHP – CHP = 55 – 15 = 40 mmHg.

Colloid Osmotic Pressure (COP): a COP of a solution is the OP resulting

from the presence of suspended proteins.

•the Net COP has two components:

•The blood COP & The Capsular COP.

•NCOP = BCOP – CCOP = 30 – 0 = 30 mmHg.

Glomerular Filtration Rate (GFR):

•GFR is the amount of filtrate produced by the kidney each minute.(each

kidney contains about 6m² of filtration surface), GFR averages 125ml/min.

•The creatinine clearance test is used to estimate the GFR. Creatinine,

which results from the break-down of creatinine phosphate in muscle tissue
& its normally excreted in the urine, creatinine enters the filtrate at the
glomerulus & not reabsorbed in significant amounts. (by monitoring the
amount in blood and amount in urine we can easily estimate GFR).
Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

Note: In the single day, your glomeruli generate about 180 lit (50 gal)
roughly 70 times the total plasma volume. But as the filtrate pass through
the renal tubules, about 99% of it is reabsorbed.

Controlling the GFR:

•Three factors control your GFR:

a*Auto regulation at the local level.

b*Hormonal regulation initiated by the kidney.

c*Autonomic regulation by sympathetic division of ANS.

A. Auto regulation of the GFR:

•The goal of auto regulation is to maintain an adequate GFR despite

changes in local blood pressure (BP) & blood flow (BF).

•this goal is accomplished by changing the diameters of the afferent &

efferent arterioles & glomerular capillaries.

•Systemic BP declines → a reduce in BF & a decline in glomerular BP due

to →

1.dilation of the afferent arteriole.

2.the relaxation of the mesangial cells & dilation of glomerular capillaries.

Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

3.constriction of efferent arteriole (this combination ↑es BF & elevates

glomerular BP to normal levels).

Systemic BP rises → a rise in renal BP → stretches the walls of afferent

arterioles & the smooth muscle cells respond by constricting.

(the reduction in diameter of afferent arteriole → ↓es glomerular BF &

keeps the GFR within normal levels).

B. Hormonal regulation of GFR:

GFR is regulated by hormones: renin & atrial natriuretic peptide (ANP).

► Renin is an enzyme released by JGA when:

• glomerular BP drops

• osmolarity of the tubular fluid at the DCT ↓es

Renin & Angiotensin II have four effects:

•it stimulate the adrenal production of Aldosteron causing Na+ retention &
K+ loss at the kidney.

•it stimulate the secretion of ADH → stimulate water reabsorbtion.

•it stimulate thirst resulting in ↑es fluid consumption → elevation of blood

volume.

•it stimulate the contraction of arterioles → elevates systemic BP.

Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)

► Atrial natriuretic peptide: this hormone is secreted endocrine cells

(cardiac muscle cells) in the walls of the atria when:

• - blood volume (venous blood received) becomes too great so these

cardiac muscles excessively stretch & release the hormone ANP.

(ANP is released in response to the stretching of the atrial walls by ↑es BP

or blood volume (BV)).

*(ANP due to → dilation of afferent arteriole & constriction of efferent

arteriole → elevates glomerular BP & ↑es GFR → ↑es urin production and
↓es BV & BP).

The ANP have four effects that oppose those of

Angiotensin II:

• it promotes the loss of Na+ and water at the kidnys.

• it inhibits renin release and inhibit secretion of ADH and Aldosteron.

• it suppresses thirst.

• it blocks the action of Angiotensin II on arterioles (the result relaxation

of blood vessels → reduced BP).

C. Autonomic Regulation of the GFR:

•Most of the autonomic innervation of the kidneys consisting of sympathetic
postganglionic fibers.

•→ sympathetic activation has one direct effect on GFR → it produces a

powerful vasoconstriction of the afferent arterioles → ↓es GFR & slowing
filtrate production.
Theoretical Physiology 1 Dr. Faisal Ali
Lecture 7: (Renal Physiology)