2- Maintain the proper balance between water and. 3- Maintain the proper acid base balance. glucose by gluconeogenesis. pressure

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1 Filter ~180 liters of blood plasma daily, allowing toxins, metabolic wastes, and excess ions to leave the body in urine 1 Regulate volume and chemical composition of the blood 2 Maintain the proper balance between water and salts ( Osmolality ). 3 Maintain the proper acid base balance. 4 Maintain the proper plasma concentration of glucose by gluconeogenesis 5 play an important role to maintain the normal blood pressure

2 Urinary and Plasma Concentrations of Some Physiologically Important Substances emphasizes the manner by which the kidneys conserve important electrolytes and metabolites while wastes are eliminated in the urine Sbstances Plasma(P) Urine(U) U/P ratio Glucose (mg/dl) Na + (meq/l) Urea (mg/dl) Creatinine (mg/dl)

3 The balance between intake and output is maintained in large part by the kidneys: Effect of 10 fold increase in sodium intake on urinary sodium excretion and extracellular fluid volume.

4 Production of rennin to help regulate blood pressure Production of erythropoietin to stimulate RBC production Activation of vitamin D3 (calcitriol) 25 OH Cholecalciferol 1,25 DOH Cholecalciferol Pa ra crin e s ecretion of pros ta gla n din s, kin in s, Trom boxa n A 2,En doth elin, n itric oxide ( NO ), Aden os in e & Urodila tin lea din g m a in ly to m odu la tion of ren a l blood flow

5 Afferent nerves involve in renal pain sensation, ureterorenal & renorenal reflexes Efferent nerves: parasympathetic sympathetic cholinergic n. from Vague postganglionic from S.M.G. & renal plexus Mostly noradrenergic ( some NANC ) to interlobular A. afferent a. & some in efferent a. Acting on 1 & in less extent on 2 postsynaptic. To juxtaglomerular apparatus (JGA ) via 1 To PT, Thick AL, DT &CD via or

6 Renal blood flow(rbf), it s regional distribution Approximately onefourth (1200 ml) of systemic cardiac output(co) flows through the kidneys/minute Renal Fraction =RBF/CO 100 Overall RBF= 3.5 ml/g tissue/min In cortex 5 ml/g tissue/min In outer medulla 2.5 ml/g tissue/min In inner medulla 0.6 ml/g tissue/min Cortex Outer Medulla For comparison blood flow for the Brain is 0.5 ml/g tissue/min Inner Medulla

7 RBF depends on the total renal vascular resistance: Vessel Pressure in Vessel (mm Hg) Beginning End Per Cent of Total Renal Vascular Resistance Renal artery 100 ~100 ~0 Interlobar, arcuate, and interlobular arteries ~ ~16 Afferent arteriole ~26 Glomerular capillaries ~1 Efferent arteriole ~43 Peritubular capillaries 18 8 ~10 Interlobar, interlobular, and arcuate veins 8 4 ~4 Renal vein 4 ~4 ~0

8 Renal vasoconstriction RBF Epinephrine & Norepinephrine Angiotensin IIproduced by JGA (affects E.a. more than A.a.) Endothelin Adenosine ADH T.A 2 constricts A.a. Renal vasodilatation RBF Prostaglandins PgE 2 and PgI 2 ( medulla ) BF in cortex but in Ach NO Dopamine Glucocorticoids dilates A.a. High protein diet

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10 Urine formation and adjustment of blood composition involves 4 major processes 1. Glomerular filtration 2. Tubular reabsorption 3. Tubular Secretion 4. Excretion

11 filtra tio n occurs at Filtration Membrane Glomerular Filtration Rate (GFR) = The total amount of filtrate formed per minute by 2 kidneys ~125 ml/min which is 1520% of RPF filtration fraction = the portion of plasm a th at is filte re d/m in = ( GFR/RP F ) x 100 = (125/700 ) x 100 = 17.3%

12 Factors affecting the filterability of different particles

13 Filterability of negatively Charged particles in normal & abnormal conditions

14 Glomerular capillary plasma Filtration barrier Filtrate in Bowman s space Negatively Charged + proteins

15 GFR = K f NFP=(A D /T) NFP A=Total surface area available for filtration D=Filtration membrane permeability T=Filtration membrane thickness NFP =Net filtration pressure = P GC ( GC +P T )= 60 ( )=10 mmhg

16 Effect of changes in A & E arteriolar resistance on GFR & RBF

17 Contraction via IP 3 leads to in G.S.A. 1. E & NE 2. Ag II 3. ADH 4. P.D.G.F. 5. P.A.F. 6. PG F 2 7. T A 2 8. Leukoterians C & D 9. Histamine 10. Endothelins f Relaxation via camp or c GMP leads to in G.S.A. 1. ANP 2. Dopamine 3. PG. E 2 4. NO 5. Urodilatin

18 P GC =Hydrostatic pressure in Glomerular capillary P T = Hydrostatic pressure in Bowman's capsule GC = Colloid Osmotic Pressure in Glomerular capillary P UF = Net Ultra filtration Pressure C A B Intra Glomerular Equilibration point

19 Increase in the rate plasma colloid osmotic pressure rises along the glomerular capillary depends on the ltration fraction

20 GFR = K f NFP=(A D /T) NFP A=Total surface area available for filtration D=Filtration membrane permeability T=Filtration membrane thickness NFP =Net filtration pressure = P GC ( GC +P T )= 60 ( )=10 mmhg

21 Contraction via IP 3 leads to in G.S.A. 1. E & NE 2. Ag II 3. ADH 4. P.D.G.F. 5. P.A.F. 6. PG F 2 7. T A 2 8. Leukoterians C & D 9. Histamine 10. Endothelins f Relaxation via camp or c GMP leads to in G.S.A. 1. ANP 2. Dopamine 3. PG. E 2 4. NO 5. Urodilatin

22 Effect of changes in A & E arteriolar resistance on GFR & RBF

23 P GC =Hydrostatic pressure in Glomerular capillary P T = Hydrostatic pressure in Bowman's capsule GC = Colloid Osmotic Pressure in Glomerular capillary P UF = Net Ultra filtration Pressure C A B Intra Glomerular Equilibration point

24 Increases in the ltration fraction increase the rate at which the plasma colloid osmotic pressure rises along the glomerular capillary

25 Tow types of mechanisms control the RPF & GFR AExtrinsic mechanisms 1 Neural control 2 Hormonal control rennin Angiotensin system BIntrinsic mechanisms ( Renal auto regulation ) 1Tubuloglomerular Feedback 2 Myogenic Mechanism

26 NaCL intake by M.D. cells Hormonal Control GFR BP Neural Control Extrinsic mechanisms involved in GFR regulation Ag II Constriction of Efferent arterioles In kidneys GFR

27 Stimulators E & NE Prostaglandins Inhibitors Increased NaCL reabsorption across Macula Densa Increased afferent arteriolar pressure Angiotensin II Vasopressin

28 Myogenic Mechanism Tubuloglomerular Feedback or or RBP or GFR Fluid Delivery To JGA A) Na Cl intake by MD paracrine secretion of TA2, ATP or Adenosine Afferent Arteriole constriction RBF & GFR B) Na Cl intake by MD paracrine secretion of NO Afferent Arteriole Dilation RBF & GFR

29

30 GFR PX =VU UX GFR PX TR =UX VU GFR PX +TS TR =UX VU GFR PX + TS =UX VU TR TS TX = Variable UX VU = Variable

31 This document was created with Win2PDF available at The unregistered version of Win2PDF is for evaluation or noncommercial use only.

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