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ANATOMY & PHYSIOLOGY OF
KIDNEY & KIDNEY DISORDERS
Presented by:




o Sameerah Firdaus BAUHADOOR

o Housna Nazifah KORUMTOLLEE

o Dr Shanoo SUROOWAN
The kidneys:
An Excretory organ or a Regulatory
             organ?!!!
The Kidneys- function

• The main purpose of the kidney is to
  separate urea, mineral salts, toxins, and
  other waste products from the blood.

• They also do the job of conserving water,
  salts, and electrolytes.

• At least one kidney must function properly
  for life to be maintained.
The Human Kidney
 bean shaped, reddish brown
  organs.

 about the size of your fist.

 It measures 10-12 cm long.

 covered by a tough capsule of
  fibrous connective tissue-
  renal capsule

 Adhering to the surface of
  each kidney-two layers of fat
  to help cushion them.
The Human Kidneys
 concaved side having a
  depression where a renal
  artery enters, and a renal vein
  and a ureter exit the kidney.

 located in the upper rear
  region of the abdominal cavity
  just above the waistline.

   protected by the ribcage.

 The renal cortex, the renal
  medulla and the renal pelvis -
  major regions of the kidney.

 The left kidney lies slightly
  above the right kidney.
The Kidney Diagram
Kidneys and their structures
 The Renal Arteries
• transport oxygenated
  blood from the heart
  and aorta to kidneys
  for filtration

 The Renal Veins
• Transport the filtered,
  deoxygenated blood
  from kidneys to the
  posterior vena cava
  and finally the heart
Kidneys and their structures
 Renal Capsule
  (inferior/superior)
• Outer membrane which
  encloses and protects
  kidneys against infections
  and trauma.

 The Renal Cortex
• Outer layer (granulated)
  of the kidney that
  contains most of the
  nephrons.
Kidneys and their structures

   Nephron
• Most basic microscopic
  structures of the kidneys

• Inside each kidney,
  there are about 1 million
  nephrons

• Physiological unit of the
  kidney used for filtration
  of blood, and
  reabsorption and
  secretion of materials
Kidneys and their structures

The Renal Medulla
• Inner layer (radially striated) of the kidney

• contains renal pyramids, renal papillae,
  renal columns, renal calyces
  (minor/major),renal pelvis and part of
  nephron, not located in the cortex

• Site for salt, water and urea absorption
Kidneys and their structures
 The Renal Pyramid
• Triangular shaped unit in
  the medulla

• houses the loop of Henle
  and collecting duct of the
  nephron


 The Renal Column
• Area between the
  pyramids, located in the
  medulla

• Used as a space for blood
  vessels
Kidneys and their structures
 The Renal Papillae
• The tips of the renal
  pyramids
• release urine into the
  calyces

 The Renal Calyces
• Collecting sacs that
  surround the renal
  papillae

• Transport urine from
  renal papillae to renal
  pelvis
Kidneys and their structure

The Renal Pelvis
• Cavity which lies in the
  centre of the kidney
  and which extends into
  the ureter

• Collects urine from all
  of the calyces in the
  kidney
Kidneys and their structures

 The Ureters (right/left)
• Tubes that transports urine
  from the renal pelvis to the
  bladder


 The Urinary Bladder
• Hollow, expandable,
  muscular organ located in
  the pelvic girdle

• Functions as a temporary
  reservoir for urine
The Kidney Nephron Diagram
The two types of Nephrons

Cortical
•The loop of Henle
does not extend past
the cortex of the
kidney.

Juxtamedullary
•Loop of Henle
extends past the
cortex and into the
medulla of the kidney.
Nephron structures and functions

Afferent Arteriole
• Transport arterial
  blood to glomerulus for
  filtration

Efferent Arteriole
• Transports filtered
  blood from glomerulus
  through the peritubular
  capillaries and the vasa
  recta, and to the
  kidney venous system
Nephron structures and functions
 Glomerulus
• The site for blood filtration

• operates as a nonspecific
  filter - removes both useful
  and non-useful material

• the product of the
  glomerulus – filtrate


 Bowman’s Capsule
• A sac that encloses
  glomerulus
• transfers filtrate from the
  glomerulus to the Proximal
  Convoluted Tubule (PCT)
Nephron structures and functions

Proximal Convoluted Tubule (PCT)
• A thick, constantly active segment of the
  nephron

• that reabsorbs most of the useful substances
  of the filtrate: sodium (65%), water (65%),
  bicarbonate (90%), chloride (50%), glucose
  (nearly 100%)

• The primary site for secretion (elimination) of
  drugs, waste and hydrogen ions.
Nephron structures and functions
 The loop of Henle
• U-shaped tube that consists
  of a descending limb and an
  ascending limb.

• begins in the cortex,
  receiving filtrate from the
  PCT, extends into the
  medulla, and then returns to
  the cortex to empty into the
  distal convoluted
  tubule(DCT).

• Its primary role is to
  concentrate the salt in the
  interstitium, the tissue
  surrounding the loop.
Nephron structures and functions

Decending Limb of the Loop of Henle
• A part of the counter current multiplier

• fully permeable to water and completely
  impermeable to solutes (salt particles)

• receives filtrate from the PCT, allows water to be
  absorbed and passes “salty” filtrate to the next
  segment.
 “Saves water and passes the salt”
Nephron structures and functions

Ascending Limb of the loop of Henle
• a part of the counter current multiplier

• impermeable to water and actively transports
  (reabsorbs) salt (NaCl) to the interstitial fluid of
  the pyramids in the medulla.
 “Saves salt and passes the water.”

• the passing filtrate becomes dilute and the
  interstitium becomes hyperosmotic
Nephron structures and functions

Distal Convoluted
 Tubule (DCT)
• Variably active portion
  of the nephron


• receives dilute fluid
  from the ascending
  limb of the loop of
  Henle
Nephron structures and functions

Collecting Duct
• variably active portion
  of the Nephron

• receives fluid from the
  DCT

• The last segment to
  save water for the
  body
Nephron structures and functions
Peritubular
 Capillaries
• transport reabsorbed
  materials from the PCT
  and DCT into kidney
  veins and eventually
  back into the general
  circulation

• help complete the
  conservation process
  (reabsorption) that
  takes place in the
  kidney
PHYSIOLOGY
Kidney nephron
The nephrons are the functional units of the
kidney and are the site of:

1. Filtration of blood
2. Maintainance of Renal blood pressure
3. Formation of urine
4. Counter current mechanism
5. Acid-base balance
6. Regulation of electrolytes
7. Reabsorption of materials
8. Secretion of materials( production of hormones)
9. Excretion of wastes
1. Filtration of Blood
The glomerulus is the site of filtration of blood.
The Bowman’s capsule (basement membrane +
 podocytes)

•   filters blood,

•   hold back large molecules such as proteins,

• passes through small molecules such as
  water, salts, and sugar

• Aids in the formation of urine
Kidney anatomy, physiology and disorders
PODOCYTES:
• Also known as visceral epithelial cells


• Cells in the Bowman's capsule in the kidneys that
  wrap around the capillaries of the glomerulus
  leaving slits between them.


• They are involved in regulation of glomerular
  filtration rate (GFR). When podocytes contract,
  they cause closure of filtration slits. This
  decreases the GFR by reducing the surface area
  available for filtration.
2.    2. Maintainance of Renal Blood
                      Pressure
• This process is achieved by the Juxtaglomerular
  apparatus.
The three cellular components of the apparatus
are the

1. juxtaglomerular cells
2. macula densa,
3. extraglomerular mesangial cells, and
The Juxtaglomerular Apparatus
Function of the JC cells

1. Release of Renin
Stimulus : Low blood pressure
Action : Release of Renin
Angiotensin         Angiotensin I         Angiotensin II

Angiotensin II
It acts as a vasoconstrictor to raise blood pressure.

It stimulates the release of aldosterone hormone from the
 adrenal cortex.
22. Release of Aldosterone hormone

It stimulates the DCT to reabsorb salt.
3. 3. Reabsorption of salt (NaCl)

• Salt reabsorbtion induces the movement of water to the
  blood by osmosis thereby raising the blood volume and
  hence increasing the blood pressure.
Function of the Macula Densa Cells

• It monitors the salt content of the blood.

• If concentration of salt is raised, the macula
  densa cells inhibit the release of renin from the
  JC cells.

• No release of renin         No angiotensin II ,
  No aldosterone . Blood pressure decreases until it
  is sent back to normal.
Function of the extra glomerular mesangial cells


• It secretes erythropoietin

• Erythropoietin is a glycoprotein hormone which
  controls erythropoiesis or red blood cell production.
Kidney anatomy, physiology and disorders
OSMOLARITY:
Osmolarity is the measure of solute
concentration, defined as the number of
osmoles(Osm) of solute per liter (L) of
solution(osmol/L or Osm/L).



NOTE: Molarity measures the number of moles of solute per
  unit volume of solution,
3.Formation of urine
• Takes place in 3 main steps;
1. Ultrafiltration
  –    seeping of fluid from glomerular capillaries to
      the Bowman’s capsule along with useful
      substances (e.g. glucose, vitamins ,amino acids)
2. Reabsorption along the nephron
  – PCT; selective reabsorption of useful substances
  – LOH, DCT and CD Reabsorption of water and salts
3. Secretion from blood to tubule
4.Counter Current Multiplier
• A system of limbs
  running in opposite
  directions
• Consists of;
   Descending limb and
   Ascending limb of the
   Loop of Henle.
• Helps in the absorption
  of water from fluid
  found in the LOH
Counter current Multiplier
        Interstitial fluid should be
        hypertonic for water to be
                reabsorbed
Counter current multiplier
Na+ is actively pumped out
 of the ascending limb into the
 interstitial fluid.
• Cl- follows Na+ passively
• Increases the Na+ and Cl-
   of interstitial fluid by about
   4 times.
• Water seeps out of the of
   the descending limb into
   the interstitial fluid by
   osmosis
Counter current multipier
• Down the descending limb of the LOH, fluid becomes
  more concentrated due to loss of water.
• Na+ and Cl- concentration increase as fluid turns and
  heads on towards the ascending limb.
• All the way up osmotic pressure of fluid in LOH is
  almost equal to the osmotic pressure in interstitial
  fluid.
• The fluid again passes through hypertonic interstitial
  fluid loosing water again until into the collecting duct.
• The final product in the CD is urine!!!!
5.     Regulation of electrolytes
Electrolytes are substances that become ions in
solution and acquire the capacity to conduct
electricity.

The primary ions of electrolytes are sodium (Na+),
potassium(K+), calcium (Ca2+), magnesium (Mg2+),
chloride (Cl−), hydrogen phosphate (HPO42−), and
hydrogen carbonate (HCO3−).
Maintainance of an electrolyte balance occurs
so that the osmolarity of both the body fluids and the
urine is the same.



Maximum electrolyte balance is maintained by
the release of hormones which are going to
trigger the reabsorption of certain ions thereby
preventing electrolyte disbalances.
ADH
• Also known as vasopressin
• Released by hypothalamus
Stimulus: Low blood level

• Prevents the production of dilute urine
• Helps in reabsorption of water in kidneys
• Maintains osmolarity of plasma levels normal
6.     Acid-base balance

• Forms part of human homeostasis
• Is important to maintain cellular stability
• Alterations in the acid-base balance are resisted by
  extracellular and intracellular chemical buffers and
  by respiratory and renal regulation.

In acid-base balance, the kidney is responsible
for 2 major activities:
• Reabsorption of filtered bicarbonate: 4,000 to 5,000
   mmol/day
• Excretion of the fixed acids (acid anion and
   associated H+): about 1 mmol/kg/day.
Kidney anatomy, physiology and disorders
Formation of H+
Secretion from the organic acid and base secretory
  system (uric acid, antibiotics and diuretics).
H2CO3           H+ + HCO3-


In case of high H+
H+ is bound to ammonia, phosphate and bicarbonate
  to form NH4+, H2PO4-, CO2 and H2O.
7. Reabsorption of materials
Nutrients such as glucose, amino acids
and other metabolites are reabsorbed in
the medulla such that the body does not
lose important nutrients.

Location: convoluted proximal tubule
situated in the cortex of the kidney
8. Secretion of substances
Release of several substances occur in
order to aid in the functions of the kidney:

1. Calcitriol (activated form of vitamin D
   promotes intestinal absorption of calcium and
   the renal reabsorption of phosphate)

2. renin,

3. Erythropoietin
4. ADH

5. Prostaglandins

6. Kinins

7. 1,25-dihydroxyvitamin D3
9. Excretion of wastes
The kidney is also involved in the
excretion of wastes such as:
1. Urea
( from protein metabolism)

2. Uric acid
( from nucleic acid metabolism)
3. Creatinine (from metabolic breakdown of
   creatine phosphate)

4. End-products of Hb metabolism

5. Metabolites of hormones

6. Foreign substances: drugs, pesticides, other
   chemicals ingested in food
Finding the amount of a substance
          excreted per unit time
Given
• Amount filtered in gNaCl/day
• Amount reasorbed in gNaCl/day
• Amount excreted in gNaCl/day

Amount excreted = Amount filtered – Amount
 reabsorbed
Plasma clearance rate

It is defined of the amount of blood cleaned of a
substance per unit time.

Clearance is a function of glomerular filtration,
secretion from the peritubular capillaries to the
nephron, and reabsorption from the nephron back
to the peritubular capillaries.
Finding plasma clearance rate

                       C = V x U/P

C= plasma clearance rate in ml/min
V=urine production rate in ml/min
U=concentration of a substance in urine in mg/ml
P=concentration of a substance in plasma in mg/ml

Units of plasma clearance rate: ml/min
Question


Assume urine production rate (V) is 2 ml/min.

If after a dose of inulin, a man’s urine has 30
mg/ml and his plasma has 0.5 mg/ml of this
substance, what is the inulin clearance rate?
Answer
Inulin clearance rate = 120ml/min.
RENAL PATHOLOGY
Kidney anatomy, physiology and disorders
Kidney disorders
• Are diseases that affect the kidney.

• Usually affects both kidneys.

• The kidneys ability to remove waste products and
  control water balance is severely affected.

• This causes an accumulation of waste products
  and fluids causing severe uremia.

• Uremia=kidney failure
Causes
                       Hereditary
                       disorders;
                     inflammatory
                         &non-
                     inflammatory



 Renal                                      Other causes
tumours

                        Renal
                     pathologies




                                    Congenital
     Kidney stones
                                     disease
Signs of kidney problems!!!
• proteins, blood or glucose in urine

• The GFR is usually assessed to confirm kidney
  disease; determine amount of inulin excreted.

• A fall in GFR= kidney disease is obvious
Pathology
                Polycystic kidney disease(PKD):

• Hereditary disease

• Caused by a mutation in the PKD(PKD1/PKD2) gene
  causing defects in the uptake of ca++, leads to formation of
  cysts.

• Kidney enlarges due to the presence of hundreds /thousands
  of renal cysts that can be up to 20 cm in diameter

• Causes uremia ,i.e. kidney failure
kidneys with cysts
Pathology
           Kidney stones( renal calculi)
• Urine becomes saturated with salts of calcium,
  phosphate, oxalate, urate and other salts so its pH
  changes

• change in pH favors precipitation of the salts and
  hence formation of stones.

• Blood may be seen in urine=hematuria
Kidney tumors-dissection




tumour
Pathology
               Urinary tract cancer

• Invades fats that surround the kidney.

• Symptoms: hematuria, pain.

• Surgical removal of kidney as treatment
Pathology
    Nephrotic syndrome(Non-inflammatory)
• Loss of podocyte structure

• Large proteins can enter the renal corpuscle

• Increase in urinary protein
  secretion=proteinuria
Kidney anatomy, physiology and disorders
Pathology
         Alport’s syndrome(inflammatory)
• Inflammation of glomerular
  capillaries=glomerulonephritis

• Basement membrane becomes
  irregular in thickness and fails to
  serve as an effective filtration barrier to
  blood cells and proteins.
Pathology
                 Incontinence
• caused by inability to control voluntary micturition
  (releasing urine from the bladder).

• Causes: age, emotional disorders pregnancy,
  damage to the nervous system, stress, excessive
  laughing and coughing

• leads to wetting of clothing, discomfort and
  embarrassment
Treatment
             Drug therapy




             Treatment


                              Change in
Dialysis                       lifestyle;
therapy                     exercise, diet,
                             water intake
Drug treatment
• Drug treatment very effective to relieve pain in
  difficult conditions such as renal calculi

• ROWATINEX, a common drug found in the
  pharmacy relaxes urinary tract spasm and
  allows the easy passage of kidney stones into
  urine
Dialysis therapy
• Dialysis is a process that artificially removes
  metabolic wastes from the blood in order to
  compensate for kidney (renal) failure.
• Most common type is homodialysis
Dialysis therapy

                                   Homodialysis



Patients blood is transported through a semipermeable tube into an apparatus which
                                 contains dialysis fluid



                   The dialysis fluid creates a diffusion gradient




          Allows abnormal substances to diffuse out of blood, cleaning it
Purpose of homodialysis
• Allows patient to survive even though his 2
  kidneys cannot filter blood
• Used to treat patient with ESRD(end stage
  renal disease), poisoning and overdose
REFERENCES
• Grays anatomy

• Wikipedia

• http://www.cliffsnotes.com/study_guide/Anatomy-of-the-Kidneys

• http://www.comprehensive-kidney-facts.com/kidney-anatomy.htm

• http://www.biologymad.com/resources/kidney.swf
I am happy that
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more about me!!!
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Kidney anatomy, physiology and disorders

  • 1. ANATOMY & PHYSIOLOGY OF KIDNEY & KIDNEY DISORDERS
  • 2. Presented by: o Sameerah Firdaus BAUHADOOR o Housna Nazifah KORUMTOLLEE o Dr Shanoo SUROOWAN
  • 3. The kidneys: An Excretory organ or a Regulatory organ?!!!
  • 4. The Kidneys- function • The main purpose of the kidney is to separate urea, mineral salts, toxins, and other waste products from the blood. • They also do the job of conserving water, salts, and electrolytes. • At least one kidney must function properly for life to be maintained.
  • 5. The Human Kidney  bean shaped, reddish brown organs.  about the size of your fist.  It measures 10-12 cm long.  covered by a tough capsule of fibrous connective tissue- renal capsule  Adhering to the surface of each kidney-two layers of fat to help cushion them.
  • 6. The Human Kidneys  concaved side having a depression where a renal artery enters, and a renal vein and a ureter exit the kidney.  located in the upper rear region of the abdominal cavity just above the waistline.  protected by the ribcage.  The renal cortex, the renal medulla and the renal pelvis - major regions of the kidney.  The left kidney lies slightly above the right kidney.
  • 8. Kidneys and their structures  The Renal Arteries • transport oxygenated blood from the heart and aorta to kidneys for filtration  The Renal Veins • Transport the filtered, deoxygenated blood from kidneys to the posterior vena cava and finally the heart
  • 9. Kidneys and their structures  Renal Capsule (inferior/superior) • Outer membrane which encloses and protects kidneys against infections and trauma.  The Renal Cortex • Outer layer (granulated) of the kidney that contains most of the nephrons.
  • 10. Kidneys and their structures Nephron • Most basic microscopic structures of the kidneys • Inside each kidney, there are about 1 million nephrons • Physiological unit of the kidney used for filtration of blood, and reabsorption and secretion of materials
  • 11. Kidneys and their structures The Renal Medulla • Inner layer (radially striated) of the kidney • contains renal pyramids, renal papillae, renal columns, renal calyces (minor/major),renal pelvis and part of nephron, not located in the cortex • Site for salt, water and urea absorption
  • 12. Kidneys and their structures  The Renal Pyramid • Triangular shaped unit in the medulla • houses the loop of Henle and collecting duct of the nephron  The Renal Column • Area between the pyramids, located in the medulla • Used as a space for blood vessels
  • 13. Kidneys and their structures  The Renal Papillae • The tips of the renal pyramids • release urine into the calyces  The Renal Calyces • Collecting sacs that surround the renal papillae • Transport urine from renal papillae to renal pelvis
  • 14. Kidneys and their structure The Renal Pelvis • Cavity which lies in the centre of the kidney and which extends into the ureter • Collects urine from all of the calyces in the kidney
  • 15. Kidneys and their structures  The Ureters (right/left) • Tubes that transports urine from the renal pelvis to the bladder  The Urinary Bladder • Hollow, expandable, muscular organ located in the pelvic girdle • Functions as a temporary reservoir for urine
  • 17. The two types of Nephrons Cortical •The loop of Henle does not extend past the cortex of the kidney. Juxtamedullary •Loop of Henle extends past the cortex and into the medulla of the kidney.
  • 18. Nephron structures and functions Afferent Arteriole • Transport arterial blood to glomerulus for filtration Efferent Arteriole • Transports filtered blood from glomerulus through the peritubular capillaries and the vasa recta, and to the kidney venous system
  • 19. Nephron structures and functions  Glomerulus • The site for blood filtration • operates as a nonspecific filter - removes both useful and non-useful material • the product of the glomerulus – filtrate  Bowman’s Capsule • A sac that encloses glomerulus • transfers filtrate from the glomerulus to the Proximal Convoluted Tubule (PCT)
  • 20. Nephron structures and functions Proximal Convoluted Tubule (PCT) • A thick, constantly active segment of the nephron • that reabsorbs most of the useful substances of the filtrate: sodium (65%), water (65%), bicarbonate (90%), chloride (50%), glucose (nearly 100%) • The primary site for secretion (elimination) of drugs, waste and hydrogen ions.
  • 21. Nephron structures and functions  The loop of Henle • U-shaped tube that consists of a descending limb and an ascending limb. • begins in the cortex, receiving filtrate from the PCT, extends into the medulla, and then returns to the cortex to empty into the distal convoluted tubule(DCT). • Its primary role is to concentrate the salt in the interstitium, the tissue surrounding the loop.
  • 22. Nephron structures and functions Decending Limb of the Loop of Henle • A part of the counter current multiplier • fully permeable to water and completely impermeable to solutes (salt particles) • receives filtrate from the PCT, allows water to be absorbed and passes “salty” filtrate to the next segment. “Saves water and passes the salt”
  • 23. Nephron structures and functions Ascending Limb of the loop of Henle • a part of the counter current multiplier • impermeable to water and actively transports (reabsorbs) salt (NaCl) to the interstitial fluid of the pyramids in the medulla. “Saves salt and passes the water.” • the passing filtrate becomes dilute and the interstitium becomes hyperosmotic
  • 24. Nephron structures and functions Distal Convoluted Tubule (DCT) • Variably active portion of the nephron • receives dilute fluid from the ascending limb of the loop of Henle
  • 25. Nephron structures and functions Collecting Duct • variably active portion of the Nephron • receives fluid from the DCT • The last segment to save water for the body
  • 26. Nephron structures and functions Peritubular Capillaries • transport reabsorbed materials from the PCT and DCT into kidney veins and eventually back into the general circulation • help complete the conservation process (reabsorption) that takes place in the kidney
  • 28. Kidney nephron The nephrons are the functional units of the kidney and are the site of: 1. Filtration of blood 2. Maintainance of Renal blood pressure 3. Formation of urine 4. Counter current mechanism 5. Acid-base balance 6. Regulation of electrolytes 7. Reabsorption of materials 8. Secretion of materials( production of hormones) 9. Excretion of wastes
  • 29. 1. Filtration of Blood The glomerulus is the site of filtration of blood.
  • 30. The Bowman’s capsule (basement membrane + podocytes) • filters blood, • hold back large molecules such as proteins, • passes through small molecules such as water, salts, and sugar • Aids in the formation of urine
  • 32. PODOCYTES: • Also known as visceral epithelial cells • Cells in the Bowman's capsule in the kidneys that wrap around the capillaries of the glomerulus leaving slits between them. • They are involved in regulation of glomerular filtration rate (GFR). When podocytes contract, they cause closure of filtration slits. This decreases the GFR by reducing the surface area available for filtration.
  • 33. 2. 2. Maintainance of Renal Blood Pressure • This process is achieved by the Juxtaglomerular apparatus.
  • 34. The three cellular components of the apparatus are the 1. juxtaglomerular cells 2. macula densa, 3. extraglomerular mesangial cells, and
  • 36. Function of the JC cells 1. Release of Renin Stimulus : Low blood pressure Action : Release of Renin Angiotensin Angiotensin I Angiotensin II Angiotensin II It acts as a vasoconstrictor to raise blood pressure. It stimulates the release of aldosterone hormone from the adrenal cortex.
  • 37. 22. Release of Aldosterone hormone It stimulates the DCT to reabsorb salt.
  • 38. 3. 3. Reabsorption of salt (NaCl) • Salt reabsorbtion induces the movement of water to the blood by osmosis thereby raising the blood volume and hence increasing the blood pressure.
  • 39. Function of the Macula Densa Cells • It monitors the salt content of the blood. • If concentration of salt is raised, the macula densa cells inhibit the release of renin from the JC cells. • No release of renin No angiotensin II , No aldosterone . Blood pressure decreases until it is sent back to normal.
  • 40. Function of the extra glomerular mesangial cells • It secretes erythropoietin • Erythropoietin is a glycoprotein hormone which controls erythropoiesis or red blood cell production.
  • 42. OSMOLARITY: Osmolarity is the measure of solute concentration, defined as the number of osmoles(Osm) of solute per liter (L) of solution(osmol/L or Osm/L). NOTE: Molarity measures the number of moles of solute per unit volume of solution,
  • 43. 3.Formation of urine • Takes place in 3 main steps; 1. Ultrafiltration – seeping of fluid from glomerular capillaries to the Bowman’s capsule along with useful substances (e.g. glucose, vitamins ,amino acids) 2. Reabsorption along the nephron – PCT; selective reabsorption of useful substances – LOH, DCT and CD Reabsorption of water and salts 3. Secretion from blood to tubule
  • 44. 4.Counter Current Multiplier • A system of limbs running in opposite directions • Consists of; Descending limb and Ascending limb of the Loop of Henle. • Helps in the absorption of water from fluid found in the LOH
  • 45. Counter current Multiplier Interstitial fluid should be hypertonic for water to be reabsorbed
  • 46. Counter current multiplier Na+ is actively pumped out of the ascending limb into the interstitial fluid. • Cl- follows Na+ passively • Increases the Na+ and Cl- of interstitial fluid by about 4 times. • Water seeps out of the of the descending limb into the interstitial fluid by osmosis
  • 47. Counter current multipier • Down the descending limb of the LOH, fluid becomes more concentrated due to loss of water. • Na+ and Cl- concentration increase as fluid turns and heads on towards the ascending limb. • All the way up osmotic pressure of fluid in LOH is almost equal to the osmotic pressure in interstitial fluid. • The fluid again passes through hypertonic interstitial fluid loosing water again until into the collecting duct. • The final product in the CD is urine!!!!
  • 48. 5. Regulation of electrolytes Electrolytes are substances that become ions in solution and acquire the capacity to conduct electricity. The primary ions of electrolytes are sodium (Na+), potassium(K+), calcium (Ca2+), magnesium (Mg2+), chloride (Cl−), hydrogen phosphate (HPO42−), and hydrogen carbonate (HCO3−).
  • 49. Maintainance of an electrolyte balance occurs so that the osmolarity of both the body fluids and the urine is the same. Maximum electrolyte balance is maintained by the release of hormones which are going to trigger the reabsorption of certain ions thereby preventing electrolyte disbalances.
  • 50. ADH • Also known as vasopressin • Released by hypothalamus Stimulus: Low blood level • Prevents the production of dilute urine • Helps in reabsorption of water in kidneys • Maintains osmolarity of plasma levels normal
  • 51. 6. Acid-base balance • Forms part of human homeostasis • Is important to maintain cellular stability • Alterations in the acid-base balance are resisted by extracellular and intracellular chemical buffers and by respiratory and renal regulation. In acid-base balance, the kidney is responsible for 2 major activities: • Reabsorption of filtered bicarbonate: 4,000 to 5,000 mmol/day • Excretion of the fixed acids (acid anion and associated H+): about 1 mmol/kg/day.
  • 53. Formation of H+ Secretion from the organic acid and base secretory system (uric acid, antibiotics and diuretics). H2CO3 H+ + HCO3- In case of high H+ H+ is bound to ammonia, phosphate and bicarbonate to form NH4+, H2PO4-, CO2 and H2O.
  • 54. 7. Reabsorption of materials Nutrients such as glucose, amino acids and other metabolites are reabsorbed in the medulla such that the body does not lose important nutrients. Location: convoluted proximal tubule situated in the cortex of the kidney
  • 55. 8. Secretion of substances Release of several substances occur in order to aid in the functions of the kidney: 1. Calcitriol (activated form of vitamin D promotes intestinal absorption of calcium and the renal reabsorption of phosphate) 2. renin, 3. Erythropoietin
  • 56. 4. ADH 5. Prostaglandins 6. Kinins 7. 1,25-dihydroxyvitamin D3
  • 57. 9. Excretion of wastes The kidney is also involved in the excretion of wastes such as: 1. Urea ( from protein metabolism) 2. Uric acid ( from nucleic acid metabolism)
  • 58. 3. Creatinine (from metabolic breakdown of creatine phosphate) 4. End-products of Hb metabolism 5. Metabolites of hormones 6. Foreign substances: drugs, pesticides, other chemicals ingested in food
  • 59. Finding the amount of a substance excreted per unit time Given • Amount filtered in gNaCl/day • Amount reasorbed in gNaCl/day • Amount excreted in gNaCl/day Amount excreted = Amount filtered – Amount reabsorbed
  • 60. Plasma clearance rate It is defined of the amount of blood cleaned of a substance per unit time. Clearance is a function of glomerular filtration, secretion from the peritubular capillaries to the nephron, and reabsorption from the nephron back to the peritubular capillaries.
  • 61. Finding plasma clearance rate C = V x U/P C= plasma clearance rate in ml/min V=urine production rate in ml/min U=concentration of a substance in urine in mg/ml P=concentration of a substance in plasma in mg/ml Units of plasma clearance rate: ml/min
  • 62. Question Assume urine production rate (V) is 2 ml/min. If after a dose of inulin, a man’s urine has 30 mg/ml and his plasma has 0.5 mg/ml of this substance, what is the inulin clearance rate?
  • 66. Kidney disorders • Are diseases that affect the kidney. • Usually affects both kidneys. • The kidneys ability to remove waste products and control water balance is severely affected. • This causes an accumulation of waste products and fluids causing severe uremia. • Uremia=kidney failure
  • 67. Causes Hereditary disorders; inflammatory &non- inflammatory Renal Other causes tumours Renal pathologies Congenital Kidney stones disease
  • 68. Signs of kidney problems!!! • proteins, blood or glucose in urine • The GFR is usually assessed to confirm kidney disease; determine amount of inulin excreted. • A fall in GFR= kidney disease is obvious
  • 69. Pathology Polycystic kidney disease(PKD): • Hereditary disease • Caused by a mutation in the PKD(PKD1/PKD2) gene causing defects in the uptake of ca++, leads to formation of cysts. • Kidney enlarges due to the presence of hundreds /thousands of renal cysts that can be up to 20 cm in diameter • Causes uremia ,i.e. kidney failure
  • 71. Pathology Kidney stones( renal calculi) • Urine becomes saturated with salts of calcium, phosphate, oxalate, urate and other salts so its pH changes • change in pH favors precipitation of the salts and hence formation of stones. • Blood may be seen in urine=hematuria
  • 73. Pathology Urinary tract cancer • Invades fats that surround the kidney. • Symptoms: hematuria, pain. • Surgical removal of kidney as treatment
  • 74. Pathology Nephrotic syndrome(Non-inflammatory) • Loss of podocyte structure • Large proteins can enter the renal corpuscle • Increase in urinary protein secretion=proteinuria
  • 76. Pathology Alport’s syndrome(inflammatory) • Inflammation of glomerular capillaries=glomerulonephritis • Basement membrane becomes irregular in thickness and fails to serve as an effective filtration barrier to blood cells and proteins.
  • 77. Pathology Incontinence • caused by inability to control voluntary micturition (releasing urine from the bladder). • Causes: age, emotional disorders pregnancy, damage to the nervous system, stress, excessive laughing and coughing • leads to wetting of clothing, discomfort and embarrassment
  • 78. Treatment Drug therapy Treatment Change in Dialysis lifestyle; therapy exercise, diet, water intake
  • 79. Drug treatment • Drug treatment very effective to relieve pain in difficult conditions such as renal calculi • ROWATINEX, a common drug found in the pharmacy relaxes urinary tract spasm and allows the easy passage of kidney stones into urine
  • 80. Dialysis therapy • Dialysis is a process that artificially removes metabolic wastes from the blood in order to compensate for kidney (renal) failure. • Most common type is homodialysis
  • 81. Dialysis therapy Homodialysis Patients blood is transported through a semipermeable tube into an apparatus which contains dialysis fluid The dialysis fluid creates a diffusion gradient Allows abnormal substances to diffuse out of blood, cleaning it
  • 82. Purpose of homodialysis • Allows patient to survive even though his 2 kidneys cannot filter blood • Used to treat patient with ESRD(end stage renal disease), poisoning and overdose
  • 83. REFERENCES • Grays anatomy • Wikipedia • http://www.cliffsnotes.com/study_guide/Anatomy-of-the-Kidneys • http://www.comprehensive-kidney-facts.com/kidney-anatomy.htm • http://www.biologymad.com/resources/kidney.swf
  • 84. I am happy that now you know more about me!!!