Ch 19: The Kidneys. Functional unit of kidneys:?? 4 basic processes of urinary system: Filtration Reabsorption Secretion Excretion

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1 Ch 19: The Kidneys Functional unit of kidneys:?? 4 basic processes of urinary system: Filtration Reabsorption Secretion Excretion

2 Functions of Kidneys Homeostatic regulation of H 2 O & solute concentration ECF volume osmolarity, ion concentration ph (acid-base balance) Further functions Excretion of wastes & foreign substances Hormone and enzyme production etc.

3 Four Processes of Urinary System Filtration, Reabsorption, Secretion, Excretion Related by equation: E = F - R + S Figs 19-2/3 180 L / day filtered, >99% reabsorbed, 1.5 L / day excreted

4 Efferent arteriole Glomerulus Peritubular capillaries S R F Distal tubule Afferent arteriole Bowman s capsule Proximal tubule R S R R R S KEY F = Filtration: blood to lumen Loop of Henle R S E = Reabsorption: lumen to blood = Secretion: blood to lumen = Excretion: lumen to external environment Collecting duct E To bladder and external environment To renal vein

5

6 1) Filtration = Movement of fluid from blood to lumen of nephron (rel. nonspecific process) Once in lumen consider it outside body Composition of filtrate? Fig 19-4

7 Filtration: Passage across 3 Barriers 1. Capillary endothelium 2. Basal lamina (= BM) 3. Bowman s capsule epithelium (visceral layer) Some small molecules (Ca 2+, low m.w. fatty acids) bind to plasma proteins? Fig 19-4

8

9 Cause of Filtration Three types of pressures are at work: Hydrostatic pressure in capillaries (see exchange in tissues) Osm. P in caps > Osm. P in Bowman s capsule Hydrostatic fluid P from presence of fluid in Bowman s capsule Net (?) driving pressure: ~ 10 mmhg Fig 19-6

10 Filtration Pressure Net driving pressure =?

11 Glomerular Filtration Rate = GFR Describes filtration efficiency: Amount of fluid filtered per unit of time Average GFR? influenced by Net filtration pressure Available surface area Fig 19-5

12

13 GFR closely regulated to remain constant over range of BPs ( mm Hg) Goal is to control blood flow though afferent and efferent arterioles via 1. Reflex regulation NS & Hormones (e.g.: angiotensin II and prostaglandins) 2. Autoregulation (myogenic & tubuloglomerular feedback)

14 Autoregulation via Tubuloglomerular Feedback GFR Macula densa cells: release paracrines juxtaglomerular cells (smooth muscle fibers from afferent arteriole): contract GFR Fig 19-10

15 Distal tubule Efferent arteriole Bowman s capsule Glomerulus Macula densa 5 Afferent arteriole Granular cells Proximal tubule GFR increases. Flow through tubule increases. Flow past macula densa increases. Paracrine diffuses from macula densa to afferent arteriole. 5 Afferent arteriole constricts. Collecting duct Loop of Henle Resistance in afferent arteriole increases. Hydrostatic pressure in glomerulus decreases. GFR decreases.

16 Tubular Reabsorption Highly selective and variable Amount of filtrate / day? Urine production / day? % reabsorbed? Fig 19-5 Mostly transepithelial transport (examples: Sodium and glucose) Reabsorption may be active (Na +, glucose) or passive (urea) Figs 19-11(!!!) and 13

17 Filtrate is similar to interstitial fluid. 1 Na Na + is reabsorbed by active transport. Electrochemical gradient drives anion reabsorption. 2 3 Anions H 2 O 3 Water moves by osmosis, following solute reabsorption. 4 K +, Ca 2+, urea Tubule lumen Tubular epithelium Extracellular fluid 4 Concentrations of other solutes increase as fluid volume in lumen decreases. Permeable solutes are reabsorbed by diffusion.

18 Saturation of Renal Transport Same 3 characteristics as discussed in mediated transport Transport maximum determined by Saturation Renal Threshold Specificity Fig Competition Example: Glucose (Fig 19-15)

19 Secretion 2 nd route of entry into tubules for selected molecules Mostly transepithelial transport (analogous to reabsorption). Depends mostly on membrane transport systems (usually 2 o active transport) Provides mechanism for rapid removal of substances (most important for H +, K +, foreign organic ions and drugs such as penicillin etc.)

20 Excretion = Urine Output Excretion of excess ions, H 2 O, toxins, "foreign molecules "nitrogenous waste (NH 4 +, urea) Depends on F, R, S (formula?) Direct measurement of F, R, S impossible infer from blood & urine analysis Kidneys clean or clear plasma of certain substances For any substance: Clearance = plasma volume completely cleared of that substance per minute

21 Clinical Importance of GFR and Clearance GFR is indicator for overall kidney function Clearance non-invasive way to measure GFR (inulin and creatinine) Substance is filtered and reabsorbed but not secreted clearance rate < GFR Substance is filtered and secreted but not reabsorbed clearance rate > GFR

22 Micturition Reflex Spinal cord integration: 2 simultaneous efferent signals In infant just simple spinal reflex Later: learned reflex under conscious control from higher brain centers Various subconscious factors affect reflex Fig 19-18

23 1 Stretch receptors fire. 2 Parasympathetic neurons fire. 3 Motor neurons stop firing. (b) Micturition Smooth muscle contracts. Internal sphincter passively pulled open. External sphincter relaxes. Stretch receptors 1 Sensory neuron Parasympathetic neuron 2 Higher CNS input may facilitate or inhibit reflex. 3 + Internal sphincter 3 Motor neuron 2 Tonic discharge inhibited External sphincter

24 Renal Failure & Artificial Kidney Symptoms when < 25% functional nephrons Hemodialysis: 3/week 4-8h/session due to: 1. Kidney infections 2. Chemical poisoning (lead, paint-thinner) etc.

25 Alternative: Continuous Ambulatory Peritoneal Dialysis CAPD

26 The End

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