AUBF311: ANALYSIS OF URINE & BODY FLUIDS

Lecture Module First Semester

Week 03 S.Y. 2023-2024

RENAL FUNCTION
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TOPIC OUTLINE PERITUBULAR CAPILLARIES

1 Renal Physiology  before returning to the renal vein, blood from the
Renal Blood Flow efferent arteriole enters the peritubular capillaries
Glomerular Filtration  surround the proximal & distal convoluted tubules
Tubular Reabsorption  provides immediate reabsorption of essential
Tubular Secretion substances from the fluid in PCT & final
2 Renal Function Tests adjustment of the urinary composition in DCT
Glomerular Filtration Tests
Cystatin C VASA RECTA
Tubular Reabsorption Tests  from the peritubular capillaries to vasa recta
Tubular Secretion & Renal Blood Flow Tests  adjacent to the ascending & descending loops of
Henle
 major exchanges of water & salts take place
RENAL PHYSIOLOGY between the blood & the medullary interstitium
 maintains osmotic gradient (salt concentration)
 each kidney contains approximately 1-1.5 million in the medulla
nephrons (functional unit)
renal blood flow CORTEX & MEDULLA
glomerular filtration  blood flows slowly though the cortex & medulla of
FUNCTION the kidney close to the tubules
tubular reabsorption
tubular secretion

TWO TYPES OF NEPHRONS

CORTICAL NEPHRONS
 make up approximately 85% of nephrons
 primarily in the cortex of the kidney
removal of waste products &
FUNCTION
reabsorption of nutrients

JUXTAMEDULLARY NEPHRONS
 make up approximately 15% of nephrons
 have longer loops of Henle that extend deep into
the medulla of the kidney
FUNCTION concentration of the urine

RENAL BLOOD FLOW (RAGE-PVC)

RENAL ARTERY
 renal artery supplies blood to the kidney
 kidneys receives approximately 25% of blood GLOMERULAR FILTRATION

AFFERENT ARTERIOLES  glomerulus consists of a coil of approximately 8

 blood enters the capillaries of the nephron through capillary lobes
the afferent arteriole  walls of the glomerulus is called as glomerular
filtration barrier
 located within Bowman’s Capsule which forms
GLOMERULUS
the beginning of the renal tubule
 blood then flows through the glomerulus

EFFERENT ARTERIOLES
 after glomerulus, followed by efferent arterioles

College Of Medical Laboratory Science │Ranz Barron Bamba

 AUBF311: ANALYSIS OF URINE & BODY FLUIDS
Lecture Module First Semester
Week 03 S.Y. 2023-2024

FACTORS AFFECT GLOMERULAR FILTRATION GLOMERULAR PRESSURE

1. Structure of Capillary Walls & Bowman’s HYDROSTATIC PRESSURE
Capsule  enhances the filtration
o in good condition, it will be selective in  necessary to overcome the opposition of
molecular weights less than 70,000 pressures from the fluid w/in Bowman’s Capsule &
o impaired condition = higher molecular weight the oncotic pressure of unfiltered plasma proteins
in the glomerular capillaries
2. Hydrostatic Pressure JUXTAMEDULLARY APPARATUS
o pressure exerted by a fluid at equilibrium at  maintains the glomerular blood pressure at a
any point of time due to the force of gravity relatively constant rate regardless of
o pressure that goes outside out of a balloon fluctuations in systemic blood pressure
o proportional to the depth measured from the  when blood pressure drops:
surface as the weight  dilation of the afferent arterioles
 constriction of the efferent arterioles
3. Oncotic Pressure  prevents increase in blood level of toxic waste
o a.k.a Colloid Osmotic Pressure products; prevent overfiltration/damage to
o causes the pull of fluid back into the capillary glomerulus

GLOMERULAR FILTRATION BARRIER TUBULAR REABSORPTION

repels molecules w/ a positive
Shield of charge even though they are small TWO TYPES OF MECHANISMS
Negativity enough to pass through the 3 layers of Active Transport Passive Transport
barrier  substance to be  movement of
reabsorbed must molecules across a
CAPILLARY WALL MEMBRANE combine w/ a carrier membrane as a result
 a.k.a Walls of Glomerulus protein contained in of differences in their
 contains fenestrations (finger-like projections) the membranes of concentration or
which increases capillary permeability but does the renal tubular electrical potential on
not allow large molecules and cells epithelial cells opposite sides of the
 slit-like filtrations for podocytes seen in the inner  responsible for membrane
layer of Bowman’s Capsule reabsorption of  responsible for
glucose, amino reabsorption of
acids & salts in PCT water, urea, &
 chloride in sodium in ascending
ascending loop & loop
sodium in DCT

TUBULAR REABSORPTION
Mechanism Substance Location
glucose, amino
PCT
acid, salts
ACTIVE ascending loop
chloride
of Henle
sodium PCT & DCT
water PCT,
descending,
PASSIVE collecting duct
urea PCT, ascending
sodium ascending

College Of Medical Laboratory Science │Ranz Barron Bamba

 AUBF311: ANALYSIS OF URINE & BODY FLUIDS
Lecture Module First Semester
Week 03 S.Y. 2023-2024

TUBULAR CONCENTRATION  blood test that checks how kidneys are working
tiny filters; removes waste &
 begins in the descending & ascending loops of GLOMERULI
excess fluid in the blood
Henle, where the filtrate is exposed to the high  tests to be used:
osmotic gradient of the renal medulla  Urea Clearance – obsolete method; urea is
 ascending loop of Henle: water & Cl reabsorbed always present in every specimen (no longer
 collecting ducts: final conc. of filtrate happens used because 40% urea is reabsorbed)
 Inulin Clearance – gold standard; not used
COUNTERCURRENT MECHANISM because it’s risky and exogenous procedure
 selective reabsorption process of water and  Creatinine Clearance – most common filtration
maintains osmotic gradient of the medulla test; 24 hr specimen w/ highest source of error;
affected by medications such as Gentamicin,
Cephalosporins & Cietidine (Tagamet)
COLLECTING DUCT CONCENTRATION NORMAL VALUES
male 107-139 mL/min
 final concentration of the filtrate begins in the late female 87-107 mL/min
DCT & continues in the collecting duct
increased hydration = decreased amount of ADH
o increased urine volume TUBULAR REABSORPTION TEST
decreased hydration = increased amount of ADH
o decreased urine volume  a.k.a Concentration Test
OLD TESTS

TUBULAR SECRETION FISHBERG CONCENTRATION TEST

 patient is deprived of fluid for 24 hrs for
 involves the passage of substances from the specific gravity measurement
blood in the peritubular capillaries to the tubular
filtrate MOSENTHAL’S CONCENTRATION TEST
 comparison of day & night urine in terms of
TWO MAJOR FUNCTIONS: volume & specific gravity
when these protein-bound substances
enter the peritubular capillaries, they
Elimination NEW TESTS
develop a stronger affinity for the
of Waste
tubular cells & dissociate from their
Products SPECIFIC GRAVITY
carrier proteins which results transport
in the filtrate by the tubular cells  influenced by the number & density of
bicarbonate ions which are readily particles in a solution
filtered by the glomerulus & must be
expediently returned to the blood to OSMOLALITY
Acid-Base maintain the proper pH 7.4  influenced by number of particles in a
Balance renal tubular cells prevents filtered solution
bicarbonate from being excreted in  Osmometer: used for quantitative measure of
urine causes the return of bicarbonate renal concentrating ability
ion to plasma

TUBULAR SECRETION & BLOOD FLOW TEST

RENAL FUNCTION TESTS
Phenol Sulfonthalein obsolete because results
GLOMERULAR FILTRATION TEST Test difficult to interpret
not filtered by the
 a.k.a Clearance Tests
PAH Test glomerulus but is secreted
SUBSTANCES USED FOR CLEARANCE TEST by the peritubular capillaries
 B2-Microglobulin  Radioisotopes Titratable Acidity & Urinary Ammonia
 Cystatin C  Creatinine & Insulin

College Of Medical Laboratory Science │Ranz Barron Bamba