Chapter 18 The Urinary System Renal Function
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1 Chapter 18 The Urinary System Renal Functin Chapter Outline Functins f the Urinary System Anatmy f the Urinary System Basic Renal Exchange Prcesses Reginal Specializatin f the Renal Tubules Excretin Functins f the Urinary System Primary Functins Regulate plasma inic cmpsitin, plasma vlume plasma smlarity and plasma ph Remve metablic waste prducts and freign substances frm plasma Secndary Functins Secrete erythrpietin and renin Activate vitamin D3 t calcitril Glucnegenesis 18.2 Anatmy f the Urinary System Fill in this at hme a. frm urine. b. transprt urine frm kidneys t bladder. c. stre urine. d. excrete urine frm bladder t utside f bdy. Anatmy f the Kidney (Figure 18.2 a) Micrscpic Anatmy f the Kidney (Figure 18.2 b and c) Nephrn is the functinal unit. It is cmpsed f renal tubules. It functins in filtratin f bld and frm urine Anatmy f a nephrn (Figure 18.3) = Bwman s capsule +glmerulus Renal tubule: prximal tubule, lp f Henle, distal tubule and cllecting duct Bth crtical/juxtamedullary nephrns prduce. The crtical nephrn (Figure 18.4a) is the mst numerus, 80 85% with shrt lp f Henle The juxtamedullary nephrn (Figure 18.4b) cntains lng lp f Henle extends int medulla. It is respnsible fr establishment f the 1
2 Juxtaglmerular Apparatus (Figure 18.5) Lcated in the initial part f distal tubule Tw cmpnents: macula densa and granular cells (juxtaglmerular cells) Functin: Bld Supply t Kidneys (Figure 18.6a) Kidneys receive 20% f cardiac utput at rest Renal artery segmented arteries interlbar arteries arcuate arteries interlbular arteries afferent arteriles capillary beds interlbular veins arcuate veins interlbar veins segmented veins renal vein Nephrn Bld Supply (Figure 18.6b) Tw capillary beds: peritubular capillaries and vasa recta 18.3 Basic Renal Exchange Prcesses (Figure 18.7) Glmerular is the bulk mvement f prtein-free plasma frm glmerulus t Bwman s capsule is the selective transprt f mlecules frm tubules t peritubular capillaries. is the selective transprt f mlecules frm peritubular capillaries t tubules is the eliminatin f urine frm tubules ut f bdy Three Exchanges Prcesses: glmerular filtratin, reabsrptin and secretin Glmerular Filtratin Lcatin:, which cntains a glmerulus and a Bwman's capsule. Mechanism: Filtratin f small mlecules is nnselective. The filtrate in Bwman s capsule is a mixture that mirrrs the cncentratin f varius slutes in the bld plasma Filtratin membrane is cmpsed f capillary. basement membrane and cell (pdcyte). Large prteins cannt travel acrss the filtratin membrane (basement membrane) Driving frce f glmerulus filtratin =glmerular filtratin pressure ( ) (Figure 18.9a) = (PGC + πbc) (PBC + πgc) = 16 mmhg. Starling Frces Definitin Fr r Against Filtratin Glmerular capillary hydrstatic pressure. It is high due t resistance f efferent arterile Bwman s capsule nctic pressure Bwman s capsule hydrstatic pressure Glmerular nctic pressure Glmerulus filtratin rate ( ) = the vlume f filtrate prduced by bth kidneys/min (Figure 18.9) Averages 115 ml/min in wmen; 125 ml/min in men GFR =125 ml/min = 180 liters/day (45 gallns in men) Filtratin is the fractin f the renal plasma being filtered. Filtratin fractin=gfr /renal plasma flw rate (Figure 18.9) Filtered -is the quantity filtered f a slute per unit time= GFR x Px 2
3 GFR highly regulated by intrinsic and extrinsic mechanisms GFP experience little changes between MAP mmhg MAP beynd 180 mmhg, GFP and GFR MAP< 80 mmhg, GFR Intrinsic Regulatin f GFR: MAP: mm Hg regulatin is similar t the mygenic regulatin f bld flw cvered in Chapter 14. Smth muscle f afferent arterile is sensitive t pressure change (Figure a). When the smth muscle f the afferent arterile stretches due t the increased MAP, vascnstrictin ccurs. feedback ccurs when macula densa cells secrete paracrine in respnse t an increase in flw f fluid past them. Smth muscle f arterile cntract in respnse t this paracrine t prevent significant changes in GFR (Figure 18.11b) cntractin is similar t mygenic regulatin by mdify smth muscle cells arund glmerular capillaries. BP GFR stretches mesangial cells. Mesangial cells cntact t decrease the surface area fr filtratin therefre GFR Extrinsic Cntrl f GFR (Figure 18.12): MAP : < 80 mmhg r > 180 mm Hg. Sympathetic nerve activity regulates the activity f smth muscle in the afferent and efferent arteriles via barreceptr reflex chapter 14). An decreased MAP causes an increased sympathetic nervus activity Reabsrptin (Figure 18.13) Table 18.1 Filtratin and Reabsrptin Rate. Which mlecule is reabsrbed at 100%? Lcatin:Mst ccurs in prximal tubule; sme in distal cnvluted tubule and in distal cnvluted tubule Barriers fr reabsrptin (Figure 18.13) Epithelial cells f renal tubules: apical membrane and baslateral membrane Endthelial cells f capillary (minimal): very permeable, barrier t macrmlecules nly Mechanisms f Reabsrptin (Figure 18.14) Active slute reabsrptin: Eg. Na + Passive water reabsrptin Passive slute reabsrptin via diffusin: Urea Transprt Maximum (Tm)=Rate f transprt when all carriers and pumps are saturated Renal Threshld =Slute in plasma that causes slute in filtrate t saturate carriers and spillver int urine Mechanism f Glucse Reabsrptin (Figure 18.15) Freely filtered at glmerulus Nrmally 100% actively reabsrbed in prximal tubule Carrier prteins fr glucse reabsrptin Apical membrane: with sdium by secndary active transprt Baslateral membrane: facilitated diffusin Glucse Renal Curve (Figure 18.16) 3
4 Transprt maximum fr glucse reabsrptin = 375 mg/min Theretical renal threshld = 300 mg/dl Actual renal threshld = mg/dl Filtered lad = 225 mg/min Secretin Slute mves frm peritubular capillaries int tubules Barriers same as fr reabsrptin Transprt mechanisms same but ppsite directin Secreted substances: ptassium ins, hydrgen ins, chline, creatinine and penicillin (Table 18.2) 18.4 Reginal Specializatin f Renal Tubules Specific regins perfrm special functins Nnregulated reabsrptin in prximal tubule Regulated reabsrptin and secretin in the distal tubule and cllecting duct Water cnservatin in the Lp f Henle Table 18.2 Mst f small rganic mlecules such as amin acids and vitamins are reabsrbed at ; Ins are NOT reabsrbed at. Which tubule segment des nt secrete anything? Which ins are secreted?, ; H + is nly secreted at. Water is nt reabsrbed in. Prximal Tubule Reabsrptin (Figure a) Prximal tubule is the. 70% water and sdium, 100% glucse that is filtered, is reabsrbed here. Reabsrptin is nt regulated. Anatmic features that supprt mass absrptin Brush brder with extensive micrvilli prvides fr large surface area There are a large number f mitchndria in transprt cells Leaky tight junctins allw paracellular transprt Distal Tubule and Cllecting Duct (Figure 18.17b) Transprt can be acrss epithelium since tight junctins limit paracellular transprt Water Cnservatin due t Lp f Henle Lp f Henle establishes in the medulla that is necessary t cncentrate urine t cnserve water Excretin Excretin Rate Amunt f substance excreted = amunt filtered + amunt secreted amunt reabsrbed Basic Renal Prcesses (Figure 18.18) Renal Handling f Slute 4
5 If amunt f slute excreted per minute is less than filtered lad slute was If amunt f slute excreted per minute is greater than filtered lad slute was secreted Clearance Clearance is the vlume f plasma frm which a substance has been remved by kidneys per unit time (Vlume f plasma that cntains the amunt f a substance that has been excreted per unit time) Clinical uses f Clearance Clearance= excretin rate/plasma cncentratin = ( Ux x V)/Px Ux: substrate cncentratin in urine V: flw rate Px: substrate cncentratin in the plasma Estimate f GFR: Use f Inulin (Figure 18.19) is a plysaccharide cmmnly used by researcher t estimate GFR. It is injected t the bld stream. Inulin is freely filtered and neither reabsrbed nr secreted = GFR Amunt f inulin excreted in urine = amunt that was filtered = filtered lad Excretin rate = Filtered lad = GFR x Pi Estimate GFR: Use f Creatinine is by-prduct f muscle metablism. It is used clinically. It is freely filtered, nt reabsrbed and small amunt secreted. Therefre clearance is a little greater than GFR, 140 ml/min Renal Bld Flw (Figure 18.20) (para-aminhippuric acid): a mlecule used clinically t measure renal bld flw Clearance = measure f renal plasma flw. Cnvert plasma flw t bld flw: Bld is 55% plasma CPAH = 625ml/min Determining Fate f Slutes in Renal Tubules If Cx > GFR, then substance was If Cx < GFR, then substance was reabsrbed Micturitin (Figure 18.21) Micturitin = urinatin Urine frmed in renal tubules renal pelvis ureter bladder excreted The micturitin reflex (Figure 18.22) is verridden by vluntary cntrl. Descending pathways frm the cerebral crtex can inhibit parasympathetic neurns and stimulate mtr neurns that excite the external urethral sphincter and thus inhibit the micturitin reflex. Keep Yur Kidneys Healthy Natinal Kidney Disease Educatin Prgram Cleveland Clinic: Urine Clr May Clinic: Water Intake 5
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