RENAL

FUNCTION
EDISON D. RAMOS, RMT, MPH, MSMT
IMPORTANT FUNCTIONS OF THE KIDNEY
• Elimination of the end product of metabolism

• Elimination of the excess body water

• Elimination of foreign substances like drugs

• Maintenance of electrostatic balance

• Secretion of hormone (erythropoietin)

 PARTS OF KIDNEY
1.Cortex – outer area of kidney
2.Medulla – inner area of kidney
3.Renal Pyramid – striated, triangular structure
within the medulla whose bases face the
cortex and tips point to the center of kidney
(renal papillae)
4.Renal Column – cortical material that extends
between the pyramids
 PARTS OF KIDNEY
5. Minor Calyx – funnel-shaped structures that
surround the tip of renal pyramid
6. Major Calyx – union of minor calyces
7. Renal Pelvis – union of major calyces, large
collecting funnel which narrows to form ureter
8. Hilus – notch in the concave center of the
kidney through which a ureter leaves the
kidney and blood vessels, nerve, lymph vessels
enter and exit the kidney
 RENAL PHYSIOLOGY
• NEPHRON
– Functional unit of kidney, each kidney has 1-1.5M
of nephron
– Close at one end (Bowman’s capsule) and open at
the other end (Collecting duct)
– Responsible for selective clearing of the waste
product from blood
– Responsible for the maintenance of essential
water and electrolyte balance
 Two Types of Nephron
• CORTICAL NEPHRONS
- make up approximately 85% of nephrons
- situated primarily in the cortex of the kidney
- responsible primarily for removal of waste
products and reabsorption of nutrients

• JUXTAMEDULLARY NEPHRONS
- have longer loops of Henle that extend deep
into the medulla of the kidney
- primary function is concentration of the urine
 Parts of Nephrons
1. GLOMERULUS
• Act as non-selective filter of plasma substances
• Tuft of capillary blood vessels located in Bowman’s
capsule where filtration process occur
2. BOWMAN’S CAPSULE
• Containing glomerulus
• Important in order for the glomerulus to form
bundles of capillaries
 Parts of Nephrons
3. AFFERENT ARTERIOLE
• Refers to small artery
• Small branch of renal artery through which the
blood flows to the glomerulus of the kidney

4. EFFERENT ARTERIOLE
• Small branch of renal artery through which blood
flows away from the kidney

* Common function of arterioles – the creation of

hydrostatic pressure (necessary for the filtration process
to occur)
 Parts of Nephrons
5. RENAL TUBULAR SYSTEM
• Tubes that are located in the nephrons
• Parts:
• Proximal Convulated Tubule (PCT)
• Loop of Henle
• Descending Loop
• Ascending Loop
• Distal Convoluted Tubule (DCT)
• Collecting Tubules/Ducts
 Proximal Convulated Tubule
• Tubules that are found nearest to the glomerulus
• Part wherein the reabsorption of essential
substances begin
• Large amounts of water, glucose, protein, amino
acid and electrolytes are REABSORBED
• 65% of Na+ is reabsorbed
• 65% of H2O is reabsorbed
• 90% of filtered bicarbonate (HCO3-)
• 50% of Cl- and K+
 Proximal Convulated Tubule
• Glucose – threshold substance

• Renal threshold – blood concentration of

substance at which reabsorption stops and
increase concentration appears in urine

• 160-180 mg/dL – Renal threshold

• Greater than 180 mg/dL – glucose will start to

appear in urine
 Loop of Henle
• U-shaped structure of the renal tubule
• It contains thin descending limb and thick
ascending limb
• DESCENDING – reabsorption of water,
without reabsorption of salt
• ASCENDING – no reabsorption of water,
with reabsorption of salt
 Loop of Henle
• Control the retention of water
• Creates a gradient of increasing sodium ion
concentration towards the end of the loop
within the interstitial fluid of the renal
pyramid
• 25% Na+ is reabsorbed in the loop
• 15% Water is reabsorbed in the loop
• 40% K+ is reabsorbed in the loop
 Distal Convulated Tubule
• Part of nephron where the final
concentration of the urinary filtrate begins
• Under the influence of the hormone
aldosterone, reabsorbs sodium and secretes
potassium
• Also regulates pH by secreting hydrogen ion
when pH of the plasma is low
• Only 10% of the filtered NaCl and 20% of
water remains
 Collecting Ducts
• Where the final concentration of urine takes
place through the reabsorption of water
• Allows for the osmotic reabsorption of
water
• ADH (antidiuretic hormone) – makes
collecting ducts more permeable to water--
produce concentrated urine
 BASIC MECHANISM OF
URINE BLOOD FLOW
1. Renal Blood Flow
2. Glomerular Filtration
3. Tubular Reabsorption
4. Tubular Secretion
 Renal Blood Flow
• The renal artery supplies blood to the kidney
• The human kidneys receive approximately 25% of
the blood pumped through the heart at all times
• The varying sizes of arterioles help to create the
hydrostatic pressure important for glomerular
filtration and to maintain consistency of glomerular
capillary pressure and renal blood flow within the
glomerulus
• The total renal blood flow is approximately 1200
mL/min, and the total renal plasma flow ranges
600 to 700 mL/min
 Glomerular Filtration
• Non-selective process of filtration

• Factors that influence the actual filtration process

 cellular structure of the capillary walls and
Bowman’s capsule
 hydrostatic and oncotic pressure
 feedback mechanisms of the renin- angiotensin-
aldosterone system
Renin-Angiotensin-Aldosterone System

• Controls the regulation of the flow of blood to and within the

glomerulus.

• The system responds to changes in blood pressure and plasma sodium

content that are monitored by the juxtaglomerular apparatus, which
consists of the juxtaglomerular cells in the afferent arteriole and the
macula densa of the distal convoluted tubule.

• Low plasma sodium content decreases water retention within the

circulatory system, resulting in a decreased overall blood volume and
subsequent decrease in blood pressure.
 LOW BP
LOW SODIUM
Angiotensinogen

RENIN

Angiotensin I

ANGIOTENSIN
CONVERTING
Angiotensin II ENZYME
 Angiotensin II

Vasoconstriction Aldosterone ADH

Na Reabsorption Na Reabsorption
(PCT) (DCT)

Collecting duct
Water resorption
Renin secreted and reacts with the blood-borne
substrate angiotensinogen  produce the inert
hormone angiotensin I  passes through the lungs
 angiotensin converting enzyme (ACE) changes it
to the active form angiotensin II

Angiotensin II corrects renal blood flow in the following ways:

a. causing vasodilation of the afferent arterioles and
constriction of the efferent arterioles
b. stimulating reabsorption of sodium in the proximal
convoluted tubules, and triggering the release of the
sodium-retaining hormone aldosterone by the adrenal
cortex and antidiuretic hormone by the hypothalamus
 Tubular Reabsorption

• Selective filtration

• The body cannot lose 120 mL of water-containing

essential substances every minute. Therefore, when
the plasma ultrafiltrate enters the proximal
convoluted tubule, the nephrons, through cellular
transport mechanisms, begin reabsorbing these
essential substances and water
Reabsorption Mechanisms

ACTIVE TRANSPORT

• The substance to be reabsorbed must combine with

a carrier protein contained in the membranes of the
renal tubular cells

• Active transport is responsible for the reabsorption

of glucose, amino acids, and salts in the proximal
convoluted tubule, chloride in the ascending loop of
Henle, and sodium in the distal convoluted tubule
PASSIVE TRANSPORT

• Movement of molecules across a membrane as a result of

differences in their concentration or electrical potential on
opposite sides of the membrane.

• Passive reabsorption of water takes place in all parts of the

nephron except the ascending loop of Henle, the walls of
which are impermeable to water.

• Urea is passively reabsorbed in the proximal convoluted

tubule and the ascending loop of Henle, and passive
reabsorption of sodium accompanies the active transport of
chloride in the ascending loop.
 Tubular Secretion
• Part/mechanism wherein there is a creation of acid-
base balance
• Several parts of kidney will produce hydrogen ion
• Elimination of waste products not filtered by the
glomerulus
• Many foreign substances cannot be filtered by the
glomerulus because they are bound to plasma proteins.
However, when these protein-bound substances enter
the peritubular capillaries, they develop a stronger
affinity for the tubular cells and dissociate from their
carrier proteins, which results in their transport into
the filtrate by the tubular cells. The major site for
removal of these nonfiltered substances is the proximal
convoluted tubule
ACID-BASE BALANCE MECHANISMS
The removal of H+ from body
fluids & its subsequent
elimination form the body
depend on the following
mechanisms:

1.Buffer Systems
2.Exhalation of CO2
3.Kidney Excretion of H+