What is glomerular filtration?

The kidney receive over a liter of blood each minute, and eliminate around
1.5 litres of urine per day, efficiently getting rid of excess water and waste
products that would otherwise cause you some serious problems.

 Glomerular filtration is the first step in making urine. It is the process that
your kidneys use to filter excess fluid and waste products out of the blood
into the urine collecting tubules of the kidney, so they may be eliminated
from your body.

Why we make urine

Your body metabolizes (processes) the things you eat and drink, which
produces energy, as well as the various building blocks that you need to keep
your tissues and organs healthy. While doing this, a variety of other
substances are produced that can’t be used or stored for later, and must be
eliminated to prevent toxic build-up. In addition to waste products, our diets
often contain substances in amounts that are far more than we need on a day-
to-day basis (such as carbohydrates and fats). You get rid of non water-
soluble waste products in feces (e.g., undigested fibre and bacteria), and
water-soluble waste products in urine (e.g., urea and electrolytes - sodium
and potassium). Some foods and medications can change the colour of your
urine; e.g., beets, blackberries and rhubarb can turn urine red or pink. This is
evidence that your kidneys are eliminating the colourful soluble pigments
from your body.

The main substances excreted in urine are:

 metabolic waste products - e.g., urea and creatinine

 electrolytes - inorganic compounds (including sodium, potassium, calcium,
chloride and bicarbonate) that your body uses to control the fluid content
inside your body fluids.
 water
You can think of your kidneys as being your body’s natural blood filter. They
are able to control the amount of water and substances dissolved in your body
fluids (solutes) by reabsorbing what you need and producing urine to get rid
of the rest. The production of urine is obligatory, meaning that it is made
regardless of what is going on with your body; for example, you still make
urine even when you are severely dehydrated. This occurs because of the
need to remove various solutes from the body in order to keep internal
conditions stable and relatively constant (homeostasis), so that your all of
your body’s physiological processes continue operating effectively. Making
urine is a complicated process, and to do it, each of your kidneys contain
around a million specialized structures, called nephrons.

Figure of urinary system and a nephron

How glomerular filtration works
The first step in making urine is to separate the liquid part of your blood
(plasma), which contains all the dissolved solutes, from your blood cells.
Each nephron in your kidneys has a microscopic filter, called a glomerulus
that is constantly filtering your blood.

Blood that is about to be filtered enters a glomerulus, which is a tuft of blood

capillaries (the smallest of blood vessels). The glomerulus is nestled inside a
cup-like sac located at the end of each nephron, called a glomerular capsule.
Glomerular capillaries have small pores in their walls, just like a very fine
mesh sieve. Most capillary beds are sandwiched between arterioles and
venules (the small vessels delivering blood to and collecting blood from
capillary beds), and the hydrostatic pressure drops as blood travels through
the capillary bed into the venules and veins.The glomerulus, on the other
hand, is sandwiched between two arterioles - afferent arterioles deliver blood
to the glomerulus, while efferent arterioles carry it away. Constriction of
efferent arterioles as blood exits the glomerulus provides resistance to blood
flow, preventing a pressure drop, which could not be achieved if blood were
to flow into venules, which do not really constrict. The two arterioles change
in size to increase or decrease blood pressure in the glomerulus. In addition,
efferent arterioles are smaller in diameter than afferent arterioles. As a result,
pressurized blood enters the glomerulus through a relatively wide tube, but is
forced to exit through a narrower tube. Together, these unique features plus
the fact that your heart is supplying your kidneys with over a liter of blood
per minute (around 20% of its output) maintain a high glomerular capillary
pressure and the filtration function of the kidney, regardless of fluctuations in
blood flow. For example, the sympathetic nervous system can stimulate the
 efferent arteriole to constrict during exercise when blood flow to the kidney
is reduced.

The physical characteristics of the glomerular capillary wall determine what

is filtered and how much is filtered into the glomerular capsule. Working
from the inside out, the capillary walls are made up of three layers:

 Endothelium
 this has relatively large pores (70-100 nanometers in diameter), which
solutes, plasma proteins and fluid can pass through, but not blood cells.
 Basement membrane
 this membrane is also made up of three layers, and is fused to the endothelial
layer. Its job is to prevent plasma proteins from being filtered out of the
bloodstream.
 Epithelium
 this layer consists of specialized cells called podocytes. These cells are
attached to the basement membrane by foot processes (pedicels). They wrap
around the capillaries, but leave slits between them, known as filtration slits.
A thin diaphragm between the slits acts as a final filtration barrier before the
fluid enters the glomerular space.
Figure of glomerular capillary wall consisting of the endothelium, basement
membrane, and epithelium

Together the glomerulus and glomerular capsule filtering unit are known as a
renal corpuscle.

Figure of a renal corpuscle

In addition to the unique glomerular capillary bed, the kidneys have other
specialized capillaries, called peritubular capillaries that are tiny blood
vessels that run parallel to and surround the proximal and distal tubules of the
nephron, as well as the loop of Henle, where they are known as the vasa
recta. The vasa recta is important for countercurrent exchange, the process
that concentrates urine.
The glomerular filtration rate
The rate at which kidneys filter blood is called the glomerular filtration rate.
The main driving force for the filtering process, or outward pressure is the
blood pressure as it enters the glomerulus. This is counteracted to some
extent by inward pressure due to the hydrostatic pressure of the fluid within
the urinary space, and the pressure generated by the proteins left in the
capillaries that tend to pull water back into the circulatory system (colloidal
osmotic pressure). The net filtration pressure is the outward pressure minus
the inward pressure.

Figure of a glomerular capsule with glomerular hydrostatic pressure, blood

colloid osmotic pressure, and capsular hydrostatic pressure
 How is the glomerular filtration rate regulated?
It is perfectly normal for your blood pressure to fluctuate throughout the day;
however, perhaps surprisingly, this has no effect on your glomerular filtration
rate. This is because under normal circumstances, your body can precisely
control it:

Intrinsic mechanisms:

 Renal autoregulation
 the kidney itself can adjust the dilation or constriction of the afferent
arterioles, which counteracts changes in blood pressure.
This intrinsic mechanism works over a large range of blood pressure, but can
malfunction if you have kidney disease.

Graph of renal autoregulation occurring between 80 and 160mm Hg mean

arterial pressures

Extrinsic mechanisms:

 Neural (nervous system) control and hormonal control

 these extrinsic mechanisms can override renal autoregulation and decrease
the glomerular filtration rate when necessary. For example if you have a large
drop in blood pressure, which can happen if you lose a lot of blood, your
nervous system will stimulate contraction of the afferent arteriole, reducing
urine production. If further measures are needed your nervous system can
also activate the renin-angiotensin-aldosterone system, a hormone system that
regulates blood pressure and fluid balance.

 Hormonal control
 atrial natriuretic peptide is a hormone that can increase the glomerular
filtration rate. This hormone is produced in your heart and is secreted when
your plasma volume increases, which increases urine production.

Consider the following:

Creatinine is a waste product of creatine metabolism. It is produced in muscle
when creatine is metabolised to generate energy. Creatinine is not reabsorbed
or secreted, but is exclusively filtered through the kidneys, so its rate of
excretion from your bloodstream is directly related to how efficiently your
kidneys are filtering. By measuring the amount of creatinine in a sample of
your blood, and combining this with other information such as your age,
ethnicity, gender, height and weight, your doctor is able to estimate your
glomerular filtration rate (GFR), which can give them a good idea of how
well your kidneys are working.