MLS 419: AUBF LEC KIDNEYS:

PRELIMS WEEK 1 – LESSON 1 ➢ Renal Capsule – outer covering

Renal Function Part I ➢ Internal Structures: CORTEX, MEDULLA, and the
RENAL PELVIS
Introduction o Renal Cortex – outer layer of the kidney;
FUNCTIONS OF THE KIDNEY: cortex may invaginate down to the
⎯ Elimination of waste products and conservation of medulla⎯renal column.
important substances o Medulla – Middle layer
− These are the metabolic by products that are ▪ in between renal columns are the
formed in your body Renal Pyramid
− Kidney filters the blood for recirculation and • pointed ends of the pyramid
removes waste product in the form of urine are called renal papillae
⎯ Regulation of body fluids • protrude to minor calyx
⎯ Acid-base balance • Minor calyxes form together
− cooperation with the lungs as Major Calyx
⎯ Electrolyte balance • And, Major calyx will form a
⎯ Maintenance of blood pressure larger structure called renal
⎯ Erythropoiesis pelvis
− produces erythropoietin in response to o Renal Pelvis – expansion of the upper
hypoxia portion of ureter
− Low blood supply will trigger the kidney to
release erythropoietin then stimulate the
bone marrow to release blood cells.
✓ Despite their relatively small size, the kidneys
receive approximately 25% of the cardiac output
o Cardiac output; the blood being pump by the
heart is delivered to the kidney
o Kidney should have stable and ample
amount of blood supply
o It should not run out, because it cannot filter
anymore and there’s no production of urine.
Technically, the kidney will shut down and NEPHRONS:
cause death.
− Functional unit of the kidneys
− 1-1.5 Million per kidney
ANATOMY
− Not capable of regeneration
⎯ Two kidneys; pair, the right and left kidney located at
− HAS TWO TYPES
each side of the Vertebral column and by location are
o Cortical – 85-90% (no vasa recta)
termed to be RETROPERITONEAL.
▪ HAS TWO FUNCTIONS:
o Location is highly significant during infection
• Removal of the waste product
because the doctor will pound in that area
(flank). • Reabsorption of Nutrients
▪ Cortical nephrons are mostly found
⎯ Right kidney is slightly lower than the left
in the cortex
o Because Liver is also located in the right
o Juxtamedullary – 10-15%
portion and it is also a very large organ that
▪ Final concentration/adjustment of
made the kidney adjust its position.
urine composition before it voids out
⎯ Kidneys are part of the urinary system
▪ Its loops of Henle extends to
o Functions in the filtration of blood
medulla
⎯ Adrenal glands are called Suprarenal gland (above
− Another difference has something to do with Loops
the kidney)
of Henle
⎯ Urinary system has 4 main components
o Cortical Nephron – short loop of henle
o Kidney (production of urine); Ureters
o Juxtamedullary – long loop of henle
(Transport of Urine); Urinary Bladder
(temporary storage); Urethra
⎯ HILUS: Important because it’s via the hilus that the
renal artery enters–deliver bloods to the kidneys;
Blood exits via renal vein; and urine exits via the
ureters.

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 Renal Functions
− The ability of the kidney to selectively clear waste
products from the blood and simultaneously maintain
body’s essential water and electrolytes is controlled
by nephron by the following functions
o Renal Blood Flow
o Glomerular Filtration (GF)
o Tubular Reabsorption
o Tubular Secretion

I. RENAL BLOOD FLOW

− Kidney is supplied by blood by the renal artery
− Blood enters the capillaries of the nephron through
the Afferent arterioles (smaller branches of renal
artery) → glomerulus → Efferent arterioles
− Before returning to the renal vein (back for
oxygenation), blood from the efferent arterioles enter
the peritubular capillaries and vasa recta and
Parts of a Nephron – 4 components flows slowly through the cortex and medulla close to
1. Renal Corpuscle: Bowman’s Capsule and the tubules
Glomerulus − Peritubular capillaries surround the proximal and
a. Bowman’s Capsule distal convoluted tubules
− Has two layers; o [Intertwine structure - to maximize the]
1. Parietal Layer – made up of Immediate reabsorption of essential
epithelial cells substances in the PCT and final adjustment
2. Visceral Layer – made up of of urine concentration in DCT
unique cells called Podocyte − Vasa Recta surrounds the loop of Henle
(foot-like cells) o For major exchanges of salt and water
b. Glomerulus (exact or actual structure of
nephron that filters the blood; capillaries)
c. Bowman’s Space – space where the urine
is stored
2. Proximal Convoluted tubule (PCT)
a. Proximal (malapit sa renal corpuscle),
Convoluted (giring-giring)
3. Loop of Henle
a. Ascending Loop
b. Descending Loop
4. Distal Convoluted tubule (DCT)

− Collecting ducts are not considered part of a nephron

o Proceed to papillary ducts then so on.
− PCT and DCT collective term is Renal tubule. Products of Glomerular Filtration (differs on the exit)
1. Filtered blood
a. Blood without impurities
b. Clean blood
c. Exits via Efferent arteriole, peritubular
capillaries and vasa recta, then exits on
renal veins.
d. Recirculated back to the body
2. Ultrafiltrate (Urine)
a. All those impurities and waste products, it
will be made into urine
b. Exit on the PCT, Descending, Loop,
Ascending, DCT, Collecting
c. ELIMINATED

AFFERENT-GLOMERULUS-EFFERENT ARTERIOLES
✓ In the concept of renal blood flow, there is a
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difference on the afferent and efferent arteriole

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Afferent arteriole – larger; more blood enters the glomerulus GLOMERULAR FILTRATION – Shield of Negativity
✓ to ensure that there is a sufficient amount of blood • Another factor that affects the rate of filtration
and maintain the blood supply • The normal histological make up of glomerulus, it
✓ To maintain the hydrostatic pressure to allow the contains negative charge.
glomerulus to filter • If certain substance is negatively charge, it cannot be
Efferent arteriole – smaller, less blood exits the glomerulus filtered out.
• “THE SAME CHARGE, REPELS”
Renal Blood Flow • Ex. Albumin is neg charge. Thus, it is not normally
⎯ In a 70kg (1.73m2 body surface), the total renal filtered and not become part of the urine.
blood flow is 1200 ml/min;
⎯ Total renal plasma flow is 600-700mL/min

II. GLOMERULAR FILTRATION

⎯ Glomerulus – composed of coil of approximately 8
capillary lobes referred to as capillary tufts
enclosed within the Bowman’s capsule
⎯ Glomerulus (Sieve) - Nonselective filter of plasma
substances with MW of less than 70,000 da can be
part of the urine.
▪ Larger molecules go back into the
blood.
⎯ Several factors affect the filtration processes ii. Two Pressure:
i. Structure of the capillary wall I. Glomerular (blood) hydrostatic pressure (55 mm Hg)
▪ Walls that makes up the glomerulus • Greatest impact
ii. Hydrostatic and oncotic pressure • Pressure exerted by the blood that enters
iii. Renin-Angiotensin-Aldosterone System the glomerulus by the afferent arteriole
• The influx of entering blood
i. Structure of the Capillary Wall (barrier) • Created because of the large afferent, this
a. Membrane of the fenestrated (pores) hydrostatic pressure is very important
capillaries because it allows the blood to press against
− Does not allow passage of cells and the capillary and go outside the capillary tuft.
large molecules II. Blood colloid osmotic pressure (30 mm Hg)
b. Basement Membrane • “Oncotic pressure”
− Affect the rate of filtration • Refers to the pressure exerted by the
c. Podocytes [contain foot process⎯pedicel] proteins towards water
of the Visceral epithelium [attached to the • “proteins have a natural pull towards
capillary wall] of the Bowman’s Capsule water−natural affinity”
− Forms the filtration slit • Counteract the push provided by the
hydrostatic pressure
III. Capsular hydrostatic pressure (15 mm Hg)
• Pressure exerted by the Bowman’s capsule
• Demonstrate a push on fluids back in the
glomerulus

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 sodium reabsorption and potassium excretion in
the collecting duct
• To conserve sodium, eliminate
potassium
4. Triggers ANTIDIURETIC HORMONE (ADH) /
VASOPPRESIN / ARGININE VASOPRESSIN
release by the hypothalamus to stimulate water
reabsorption in the collecting duct.

Net filtration = hydrostatic – capsular – oncotic pressure

iii. Renin-Angiotensin-Aldosterone System (RAAS)

Juxtaglomerular apparatus (JGA) – is composed of

juxtaglomerular cells from the afferent arteriole and
macula densa of distal tubule meet at the certain junction
that is collectively called as Juxtaglomerular apparatus.
• This part is responsible in the activation of RAAS

Blood Pressure – the blood circulating in our body exert

pressure towards the artery in which it is flowing.
• Blood pressure is greatly affected by water volume.
o  Water  Pressure
o  Water  Pressure
o Water levels are affected by salt (sodium)
o “Where ever salt goes, water follows.”
o Hypertensive individuals are prescribed with
low salt diet
• Allows our blood to circulate
Conclusion
• Hypertension – High blood pressure
• As a result of the glomerular mechanism:
• Hypotension – low blood pressure
• Approximately 120 mL of water containing low
o Closely associated/related to RAAS
molecular weight substances are filtered every
o Low blood pressure activates RAAS
minute
• Low blood pressure is corrected by our body through
• The only difference between the urine filtrate and
activating the RAAS
plasma is the presence of proteins
• If your body detects that you are having the
• Analysis of the fluids as it leaves the glomerulus
hypotension, it will trigger or tell the Juxtaglomerular
shows to have specific gravity of 1.010
apparatus to release the enzyme renin
o Renin activate Angiotensinogen (liver) to be
converted into Angiotensin I (inactive) and
further converted to Angiotensin II (active
form) and activated by from the Lungs
▪ Angiotensin II will correct the
hypotension
• Multifunctional and triggers
the sympathetic activity
Actions of the RAAS
1. Angiotensin II dilates the afferent arteriole and
constricts the efferent arteriole
2. Direct effect: Stimulates sodium reabsorption in
the proximal convoluted tubule
3. Triggers the adrenal cortex to release the sodium-
retaining hormone ALDOSTERONE to cause
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