RENAL SYSTEM

Soe Thu Tun

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 Renal System
Contents
General Characteristics of the Urinary System .................................................................................................................................... 2
Kidneys ................................................................................................................................................................................................................. 2
Functions of the Kidney ............................................................................................................................................................................ 2
Kidney Structure .......................................................................................................................................................................................... 3
Renal Blood Vessels .................................................................................................................................................................................... 3
Nephron........................................................................................................................................................................................................... 3
Glomerulonephritis .................................................................................................................................................................................... 5
Urine Formation ............................................................................................................................................................................................... 6
Glomerular Filtration ................................................................................................................................................................................. 6
Tubular Reabsorption ............................................................................................................................................................................... 9
Tubular Secretion ..................................................................................................................................................................................... 10
Regulation of Urine Concentration and Volume .......................................................................................................................... 10
Urea and Uric Acid Secretion ............................................................................................................................................................... 12
Urine Composition ................................................................................................................................................................................... 13
Renal Clearance ......................................................................................................................................................................................... 13
Storage and Elimination of Urine ........................................................................................................................................................... 13
Ureters .......................................................................................................................................................................................................... 13
Urinary Bladder......................................................................................................................................................................................... 14
Urethra .......................................................................................................................................................................................................... 14
Micturition................................................................................................................................................................................................... 15
Kidney Stones ................................................................................................................................................................................................. 16
Active Recall Questions ............................................................................................................................................................................... 16
General Characteristics of the Urinary System
• A major part of homeostasis is maintaining the composition, pH and volume of body fluids within normal
ranges

Kidneys
• Reddish brown, bean-shaped organ
• Lie on either side of the vertebral column
• Location – TV12 – L3, retroperitoneally
• The left kidney is typically about 1.5 to 2 centimeters higher than the right one

Functions of the Kidney

• Main function – to regulate the volume and composition of body fluids
• Secrete erythropoietin, renin and activate vitamin D

Hemodialysis
• Blood is rerouted across an artificial membrane that cleanses it, removing substances that would normally
be excreted in the urine, and adding some substances that kidneys normally produce
Continuous ambulatory peritoneal dialysis
• Infuses solution into abdominal cavity through a permanently implanted tube. The solution stays in for four
to eight hours, while it takes up substances that would normally be excreted into urine. Then, the patient
drains the waste-laden solution out of the tube, replacing it with clean fluid.
Kidney Structure

• Functional units – nephrons

• Nephron – renal corpuscle + renal tubule
• Two types of nephron
• Cortical nephron – corpuscle near the capsule
• Juxtamedullary nephron – corpuscle near the medulla in the cortex

Renal Blood Vessels

• Renal artery → segmental artery → interlobar artery → arcuate artery → cortical radiate artery → afferent
arteriole → glomerular capillaries → efferent arteriole → peritubular capillaries or vasa recta → cortical
radiate vein → arcuate vein → interlobar vein → segmental vein → renal vein

Nephron
• Portal system – afferent arteriole, glomerular capillaries, efferent arteriole, peritubular capillaries
• Renal corpuscle + Renal tubule

Renal corpuscle
• Renal corpuscle – glomerulus + renal (Bowman’s) capsule
• Renal (Bowman’s) capsule
• Two layers of epithelium: visceral layer that covers the glomerulus and parietal layer continuous with
the visceral layer and wall of the renal tubule
• Parietal layer – simple squamous epithelial cells
• Visceral layer – podocytes, numerous processes (pedicels)
• Glomerulus
• Network of tiny blood vessels where filtration of blood takes place

Renal Tubule
• Proximal tubule
• proximal convoluted tubule and proximal straight tubule
• Reabsorption of water, ions and nutrients occurs
• Loop of Henle
• descending limb + ascending limb
• Role in maintaining water and electrolyte balance
• Distal tubule
• distal convoluted tubule + connecting tubule
• Resorption and secretion take place
• Collecting Duct
• Collecting tubule: collecting ducts receive urine from several nephrons through connecting tubule
• Collecting duct: carries urine through the medulla to the renal pelvis
Juxtaglomerular Apparatus
• Location:
• JGA is located near the glomerulus, specifically at the point where the afferent arteriole comes into
contact with the distal convoluted tubule (DCT)
• Components:
• Macula densa: specialized cells in the wall of the DCT that monitor the concentration of sodium and
chloride in this filtrate
• Juxtaglomerular cells: modified smooth muscle cells in the afferent arteriole, and they can sense blood
pressure changes
• Regulation of secretion of the enzyme rennin

Glomerulonephritis
• Definition:
• Inflammation of the glomeruli.
• Causes:
• Immunological: caused by body’s immune system
• Infections: certain infections, like streptococcal infections
▪ Follows bacterial infection of beta-hemolytic streptococcus
▪ Antigen-antibody complexes are deposited in and block the glomerular capillaries
▪ Capillaries may become abnormally permeable, allowing plasma proteins and red blood cells to
enter the urine
• Autoimmune disorders: e.g., lupus
• Symptoms
• Hematuria – blood in the urine
• Proteinuria – protein in the urine
• Edema
• High blood pressure
Urine Formation
• Urinary Excretion = glomerular filtration + tubular secretion – tubular resorption

Glomerular Filtration
• Glomerular filtration filters water and other small dissolved molecules and ions out of the glomerular
capillary plasma and into the glomerular capsules. Large molecules, such as proteins, are restricted
primarily because of their size.
• The glomerular capillaries are many times more permeable than ordinary capillaries, due to fenestrae in
the walls
• Glomerular filtrate – about the same composition as tissue fluid elsewhere in the body
• Filtration rate regulation: by adjusting the diameter of the afferent and efferent arterioles

Filtration Pressure
• Main force – hydrostatic pressure of the blood inside
• The afferent arterioles have diameters larger than efferent arterioles. The greater resistance to blood flow
of the efferent arterioles causes blood to back up into the glomerular capillaries.
Net Filtration Pressure = force favoring filtration – force opposing filtration
(Glomerular capillary (Capsular hydrostatic pressure and glomerular
hydrostatic pressure) capillary colloid osmotic pressure)

Glomerular filtration rate

• Filtration
• Kidneys receive approximately 25% of the cardiac output, about 20% of the blood plasma is filtered as
it flows through the glomerular capillaries
• Not all of it is excreted as urine. Instead, most of the fluid that passes through the renal tubule is
reabsorbed and re-enters the plasma
• Importance
• GFR reflects the efficiency of the kidneys filtering waste products and excess substances from the blood
to form urine
• Measured in mL/min
• Decrease in GFR can be an early sign of kidney dysfunction or disease, therefore used by healthcare
professionals to diagnose and monitor kidney diseases
• Determinants of GFR
• Blood Pressure
• Afferent and Efferent Arterioles
• Surface Area of Glomerulus
• Normally, glomerular hydrostatic pressure is the most important factor determining net filtration pressure
and GFR
• Afferent and efferent arterioles – any change in the diameters of these vessels is likely to change glomerular
hydrostatic pressure
• Afferent arteriole constricts → filtration pressure decreases
• Efferent arteriole constricts → blood backs up into the glomerulus and filtration pressure rises
• Vasodilation of these vessels → opposite effects
• Much more fluid is filtered by glomerular capillaries than by capillaries elsewhere because of the relatively
high hydrostatic pressure in the glomerular capillaries
• Hydrostatic pressure in the glomerular capsule is another factor that may affect net filtration pressure and
GFR. This capsular pressure can change as a result of an obstruction, such as a stone in a ureter or an
enlarged prostate gland pressing on the urethra.
• If GFR is too low, blood urea nitrogen (BUN) and creatinine rises
Control of Filtration Rate
• Glomerular filtration rate remains relatively constant by a process called autoregulation
• However, GFR increases or decreases within limits in order to maintain homeostasis

• Autoregulation
• Myogenic Mechanism: The smooth muscle cells in the afferent arteriole can contract or relax in
response to changes in blood pressure. If blood pressure increases, these cells constrict, reducing blood
flow and maintaining a steady filtration rate.
• Neural Regulation
• Sympathetic nervous system
▪ Precise control of GFR is possible because the glomerular capillaries are between two arterioles
▪ Low blood pressure: sympathetic stimulation → afferent constriction – maintain peripheral
resistance, lower filtration pressure. Efferent constriction – raise filtration pressure.
▪ High blood pressure: Opposite happens with parasympathetic stimulation
• Hormonal Regulation
• Renin-angiotensin-aldosterone system (RAAS)

• Shock
• If arterial blood pressure drops greatly, such as during shock, the resulting increase in sympathetic
stimulation may cause so much afferent arteriolar constriction that glomerular hydrostatic pressure
falls below the level required for filtration, leading to acute renal failure
• Prolonged → tubular necrosis → chronic kidney disease

• Renin-Angiotensin system
• Stimulation from sympathetic nerves and pressure-sensitive cells, called renal baroreceptors
• Macula densa – sense the rate at which sodium and chloride ions flow through the ascending limp,
decreased rate – renin secretion from juxtaglomerular cells
Tubular Reabsorption
• If active transport is involved at any step of the way, the overall process is considered active.

• Location
• Tubular reabsorption primarily occurs in the renal tubules, specifically in the PCT, loop of Henle and
DCT.
• Proximal Convoluted Tubule (PCT)
• Water and solutes: about 65% of water and many solutes, including glucose and amino acids are
reabsorbed.
• Ions: sodium ions are actively transported out, creating osmotic gradient for water to follow
• Loop of Henle
• Water and Ions: descending limb is permeable to water, allowing for water reabsorption. The
ascending limb actively pumps out sodium and chloride ions, creating a concentration gradient.
• Distal Convoluted Tubule (DCT) and Collecting Duct
• Fine-tuning: DCT and collecting duct play a role in fine-tuning electrolyte balance and water
reabsorption based on the body’s needs.
• Hormonal Influence
• Anti-diuretic Hormone (ADH): released in response to dehydration, ADH increases the permeability
of the collecting duct to water, promoting water reabsorption.
• Aldosterone: stimulates sodium reabsorption in the DCT and collecting duct, influencing water
reabsorption.

• Enhancing the rate of fluid reabsorption from renal tubule

• Peritubular capillary blood is under relatively low pressure because it has already passed through two
arterioles and a capillary bed
• High glomerular filtration rate increases the protein concentration, hence, colloid osmotic pressure of
the peritubular capillary plasma
• Most reabsorption occurs in proximal portion
• Segments of renal tubule are adapted to reabsorb specific substances, using particular modes of transport
• Glucose
▪ glucose reabsorption, only in proximal tubule, by active transport
• Water
▪ Water is also rapidly reabsorbed in proximal tubule by osmosis
▪ Permeability of the collecting tubule to water can vary
• Amino acids
▪ are reabsorbed in proximal tubule, normally a trace amount remains in the urine
• Proteins
▪ Filtrate nearly free of proteins
▪ May squeeze thorough glomerular capillaries
▪ Transported by endocytosis
▪ Inside epithelial cells, proteins are degraded into amino acids and move to peritubular capillary
• Glucose reabsorption
• All of the glucose in glomerular filtrate is reabsorbed, since there are enough carrier molecules
• Above critical level (renal plasma threshold), more glucose in filtrate than the carriers can handle →
glucose in urine (diabetes mellitus)
• Non-absorbed glucose – osmotic diuresis
Sodium and Water Reabsorption
• Sodium Reabsorption:
• Location: Sodium reabsorption primarily occurs in the renal tubules, especially in the proximal
convoluted tubule (PCT) and the loop of Henle.
• Proximal Convoluted Tubule (PCT): Actively reabsorbs about two-thirds of the filtered sodium. This
sets up an osmotic gradient, facilitating water reabsorption.
• Loop of Henle: The ascending limb actively pumps out sodium and chloride ions, creating a
concentration gradient in the medulla that further contributes to water reabsorption.
• Distal Convoluted Tubule (DCT): only in the presence of aldosterone
• Water Reabsorption:
• Osmosis: Water reabsorption follows the movement of solutes like sodium. Where sodium goes, water
tends to follow due to osmosis.
• Proximal Convoluted Tubule (PCT): As sodium is actively reabsorbed in the PCT, water passively
follows, and about two-thirds of the water is reabsorbed here.
• Loop of Henle: The descending limb is permeable to water, allowing for additional water reabsorption.
• Collecting Duct: The permeability of the collecting duct is regulated by antidiuretic hormone (ADH). In
the presence of ADH, the collecting duct becomes more permeable to water, leading to increased water
reabsorption.
• Hormonal Regulation
• Aldosterone
• Anti-diuretic hormone
• By the end of proximal tubule equilibrium is reached, the tubular fluid, interstitial fluid and peritubular
capillary are isotonic
• Almost all of sodium and water (97 to 99) that enters as part of glomerular filtrate are reabsorbed before
urine is excreted

Tubular Secretion
• Certain substances move from the plasma of the peritubular capillary into the fluid of the renal tubule
• Location
• Tubular secretion occurs in various segments of the renal tubules, including PCT, DCT and collecting
ducts.
• Substances secreted:
• Hydrogen ions: helps regulate blood pH by eliminating excess acidity
• Potassium ions: mainly under the influence of aldosterone
• Certain drugs and toxins: Probenecid can be used to prolong the half-life of certain drugs because it
blocks tubular secretion of certain antibiotics

Regulation of Urine Concentration and Volume

• Kidneys have ability to concentrate the urine, which requires reabsorbing large volumes of water
independently of solute reabsorption
• Interstitial fluid surrounding the collecting duct is hypertonic, particularly in the medulla.
• Cells in the collecting duct are essentially impermeable to water, unless anti-diuretic hormone (ADH) is
present. (ADH inserts proteins called aquaporins)
• Juxtamedullary nephrons that are most important in regulating water reabsorption
• Juxtamedullary nephrons generate the hypertonic medullary interstitial fluid, setting up an osmotic
gradient between the collecting duct and interstitial fluid in renal medulla
Countercurrent Mechanism
Countercurrent Flow
The fluid in the descending limb flows in the opposite direction to the fluid in the ascending limb. This is
termed countercurrent flow.

Descending Limb
Permeability to Water: The descending limb is highly permeable to water but not to salts. As the fluid descends,
water moves out of the tubule into the surrounding interstitial fluid.
Concentration Increase: This results in an increase in the concentration of solutes (especially sodium and
chloride ions) in the interstitial fluid.

Ascending Limb
Active Salt Pumping: The ascending limb is impermeable to water but actively pumps out salts (sodium and
chloride ions) into the interstitial fluid.
Dilution of Fluid: As the fluid ascends, it becomes increasingly diluted because water cannot follow the salts out
of the tubule.

Establishment of Osmolarity Gradient

The countercurrent flow in the loop of Henle establishes an osmolarity gradient in the medulla of the kidney.
This means that the concentration of solutes in the interstitial fluid increases as you move deeper into the
medulla.

Role in Concentrating Urine

Passive Water Reabsorption: As the urine precursor (filtrate) flows through the loop, water is reabsorbed
passively in response to the increasing osmolarity of the interstitial fluid.
Concentration of Urine: By the time the filtrate reaches the collecting duct, it is concentrated due to the
reabsorption of water in the loop of Henle.

Water Conservation
The countercurrent mechanism allows the kidneys to produce concentrated urine, conserving water when the
body is dehydrated.
Urea Recycling
• Urea recycling also contributes to corticopapillary pressure gradient

Countercurrent Exchange
• Purely passive process that helps maintain the gradient established by countercurrent multiplier.

Urea and Uric Acid Secretion

• Urea
• Urea is the by-product of amino acid catabolism in the liver
• Filtered, reabsorbed and secreted
• Net effect – 80% is reabsorbed and 20% of the filtrate is excreted
• Uric Acid
• Metabolism of certain nucleic acid bases
• Completely reabsorbed
• 10% of filtrate – secretion – excreted
Urine Composition
• Output 50-60 mL/hr – normal
• < 30 mL/hr – kidney failure

Renal Clearance
• The rate at which a chemical is removed from the plasma is called the renal clearance of that substance
• Inulin clearance test: to measure GFR
• Can calculate GFR
• Inulin is constantly infused into blood
• It is not reabsorbed nor secreted
• Creatinine clearance test: estimate for GFR
• Can calculate GFR
• Creatinine has constant level in the blood
• Compares a patient’s blood and urine creatinine concentration
• Para-aminohippuric acid (PAH): measure renal plasma flow
• All PAH passing through the kidney appear in urine (all of them are secreted)
• Rate of PAH clearance can be used to calculate rate of plasma flow thorough the kidneys
• If hematocrit is known, rate of total blood flow can also be calculated

Storage and Elimination of Urine

Ureters
• The ureter is a muscular tube that plays a crucial role in the urinary system by transporting urine from the
kidneys to the bladder. Let's break down its anatomy:
• Location
• Ureters are paired tubes, one for each kidney.
• They extend from the renal pelvis of each kidney and travel down to the bladder.
• Structure
• Inner Mucosa: Lined with transitional epithelium that allows for stretching.
• Middle Muscular Layer: Made up of smooth muscle that propels urine through peristaltic contractions.
(transverse and longitudinal layers)
• Outer Adventitia: Connective tissue that anchors the ureter in place.
• Length and Diameter
• Ureters are approximately 25-30 cm long.
• The diameter varies along the length, with the upper part being narrower than the lower part.
• Course
• Ureters follow a retroperitoneal course, which means they are located behind the abdominal cavity.
• Entrance to the Bladder
• The lower end of each ureter passes through the bladder wall obliquely, preventing backflow of urine
into the ureter when the bladder contracts.
• Peristaltic waves
• Originates in renal pelvis
• Urine in renal pelvis initiates these waves
• Frequency keeps pace with urine formation → if urine forms quickly, peristaltic wave may pass every
few seconds; if it forms more slowly, a wave may pass every few minutes
• Ureter Obstruction
• by kidney stone (renal calculus)
• strong peristaltic waves try to pass the stone
 • presence of stone stimulates sympathetic reflex (ureterorenal reflex) that constricts renal arterioles
and reduces urine production

Urinary Bladder
• The urinary bladder is a vital organ in the urinary system responsible for storing urine until it is ready to be
excreted from the body.
• Structure:
• The bladder is a hollow, muscular organ with a distensible wall that allows it to expand and contract.
• It is located in the pelvic cavity, posterior to the pubic symphysis, inferior to parietal peritoneum.
• Layers of the Bladder Wall:
• Mucosa (Inner Layer): Lined with transitional epithelium that allows for stretching and prevents urine
from diffusing back into the bladder wall.
• Muscularis (Middle Layer): Contains smooth muscle fibers arranged in three layers: longitudinal,
circular, and oblique. This muscle layer facilitates the contraction and relaxation needed for urine
expulsion, called detrusor muscles.
▪ Neck of the bladder has increased muscle tone, called internal urethral sphincter
▪ Sympathetic stimulation – contraction of the sphincter → prevents bladder from emptying
▪ Parasympathetic stimulation – contraction of detrusor muscles → function in reflex that pass the
urine
• Adventitia/Serosa (Outer Layer): Composed of connective tissue that anchors the bladder in place.
▪ Upper surface of the bladder: serous coat
▪ Elsewhere, out coat is composed of fibrous connective tissue
• Shape and Position:
• The bladder has a somewhat triangular shape when empty and becomes more spherical as it fills. The
superior surface of the bladder expands upwards into a dome that can reach the level of umbilicus and
press against the coils of small intestine.
• It is situated in the pelvic cavity but can extend into the abdominal cavity when full.
• When the bladder is empty, its inner wall forms many folds, but as it fills with urine, the wall becomes
smoother.
• Inlets and Outlets:
• Internal floor of the bladder contains triangular area called trigone, which has openings in each of its
three angles.
• Ureteric Orifices: posteriorly at the base of the trigone
• Internal Urethral Orifice: anteriorly and inferiorly, at the apex of the trigone, funnel-shaped, called
neck of the bladder.
• The trigone generally remains in a fixed position, even though the rest of the bladder distends and
contracts.
• Capacity:
• The bladder's capacity varies among individuals but is typically around 500-600 milliliters.

Urethra
• Location:
• The urethra extends from the urinary bladder to the external urethral orifice.
• Length:
• The length of the urethra varies between males and females.
• In males, it is longer and has a dual function for both urine and semen transport.
• In females, it is shorter and primarily serves for urine elimination.
• Structure:
 • Inner Mucosa: Lined with transitional epithelium in the urinary bladder region, changing to stratified
or pseudostratified columnar epithelium in the rest of the urethra. Urethral glands
• Middle Muscular Layer: Composed of smooth muscle that facilitates the expulsion of urine.
• Outer Connective Tissue Layer: Provides structural support.
• In males:
• The male urethra is divided into three sections:
• Prostatic Urethra: Passes through the prostate gland.
• Membranous Urethra: Short segment between the prostate and the penis. It passes thorough the
urogenital diaphragm, and is surrounded by fibers of the external urethral sphincter muscle.
• Spongy (Penile) Urethra: Travels through the length of the penis. It passes through the corpus
spongiosum of the penis, within erectile tissue.
• In females:
• The female urethra is shorter and opens into the vestibule, an area between the vaginal opening and the
clitoris.
• External Urethral Orifice (Urinary meatus):
• The urethra terminates with an opening called the external urethral orifice, which is located in different
positions in males and females.
• Urinary Tract Infection
• Urethra – urethritis
• Bladder – cystitis
• Ureters – ureteritis
• Urination is frequent, painful, scant and may be bloody

Micturition
• The micturition reflex, also known as the urination reflex, is the physiological process that controls the
emptying of the urinary bladder. It involves a complex interplay between the nervous system and the
muscles of the bladder and urethra.
• Filling of the Bladder:
• As the bladder fills with urine, stretch receptors in the bladder wall are activated.
• Afferent Signals:
• These stretch receptors send afferent signals to the sacral region of the spinal cord through the pelvic
nerves.
• Integration in the Spinal Cord:
• Integrating center – sacral region
• The spinal cord integrates the incoming signals and sends efferent signals back to the bladder and
urethra.
• Parasympathetic Stimulation:
• Parasympathetic nerves (specifically, the pelvic splanchnic nerves) are activated, leading to the release
of acetylcholine.
• Contraction of Detrusor Muscle:
• Acetylcholine stimulates the detrusor muscle in the bladder wall to contract, promoting the expulsion of
urine.
• Inhibition of Sphincters:
• Simultaneously, the parasympathetic stimulation inhibits the sympathetic nerves, relaxing the internal
urethral sphincter.
• Voluntary Control (In Adults):
• At this point, in adults, there is voluntary control over the external urethral sphincter, which is under
somatic motor control.
• Micturition (Voiding):
 • When the urge to urinate becomes strong and the external urethral sphincter is voluntarily relaxed,
micturition (voiding or urination) occurs.

Autonomic Bladder
• Damage to spinal cord above sacral region may abolish voluntary control of urination
• If micturition center is uninjured, micturition may continue to occur reflexively.

Kidney Stones
• Kidney stones, also known as renal calculi, are hard deposits that form in the kidneys and can cause
significant pain and discomfort.
• Formation:
• Kidney stones are formed when certain substances in the urine, such as calcium, oxalate, and
phosphorus, become highly concentrated and crystallize.
• Types of Kidney Stones:
• Calcium Stones: The most common type, usually in the form of calcium oxalate.
• Uric Acid Stones: Formed when the urine is too acidic.
• Struvite Stones: Often associated with urinary tract infections.
• Cystine Stones: Rare and related to a genetic disorder (cystinuria).
• Symptoms:
• Kidney stones may not cause symptoms until they move into the ureter.
• Common symptoms include severe pain in the back or side (renal colic), blood in the urine, and
frequent urination.
• Risk Factors:
• Dehydration, family history of kidney stones, certain diets (high in oxalate or calcium), and certain
medical conditions increase the risk.
• Diagnosis:
• Imaging tests such as CT scans, X-rays, and ultrasound help in confirming the presence of kidney stones.
• Treatment:
• Small stones may pass on their own with increased fluid intake.
• Pain management with medications.
• Medical expulsive therapy to facilitate stone passage.
• Larger stones may require intervention, such as shock wave lithotripsy, ureteroscopy, or surgical
removal.
• Prevention:
• Stay hydrated to dilute urine.
• Dietary modifications, including reducing salt and certain foods high in oxalate.
• Medications may be prescribed to prevent stone formation in some cases.
• Complications:
• Kidney stones can lead to complications such as urinary tract infections, kidney damage, or obstruction
of the urinary tract.

Active Recall Questions

Question: What is the main function of the kidneys?
Answer: The main function of the kidneys is to regulate the volume and composition of body fluids.
Question: What are the two types of nephrons, and where are they located in the kidney?
Answer: The two types of nephrons are cortical nephrons (near the capsule) and juxtamedullary nephrons
(near the medulla in the cortex).

Question: Describe the pathway of blood flow through the renal blood vessels.
Answer: Renal artery → segmental artery → interlobar artery → arcuate artery → cortical radiate artery →
afferent arteriole → glomerular capillaries → efferent arteriole → peritubular capillaries or vasa recta → cortical
radiate vein → arcuate vein → interlobar vein → segmental vein → renal vein.

Question: What are the components of the renal corpuscle?

Answer: The renal corpuscle consists of the glomerulus and the renal (Bowman’s) capsule.

Question: Where is the juxtaglomerular apparatus located, and what are its components?
Answer: The juxtaglomerular apparatus is located near the glomerulus. Its components include the macula
densa and juxtaglomerular cells.

Question: What is the main force driving glomerular filtration, and how is net filtration pressure
calculated?
Answer: The main force is the hydrostatic pressure of the blood inside the glomerular capillaries. Net Filtration
Pressure = force favoring filtration – force opposing filtration.

Question: How does the autoregulation of glomerular filtration rate (GFR) work?
Answer: Autoregulation involves the myogenic mechanism and neural regulation. Myogenic mechanism
includes contraction or relaxation of smooth muscle cells in the afferent arteriole in response to changes in
blood pressure.

Question: Where does tubular reabsorption primarily occur, and what substances are reabsorbed in
the proximal tubule?
Answer: Tubular reabsorption primarily occurs in the renal tubules. In the proximal tubule, about 65% of
water and many solutes, including glucose and amino acids, are reabsorbed.

Question: How is sodium reabsorbed in the proximal convoluted tubule, and what hormonal influence
affects water reabsorption?
Answer: Sodium is actively transported out in the proximal convoluted tubule, creating an osmotic gradient for
water to follow. Antidiuretic hormone (ADH) influences water reabsorption.

Question: What is the purpose of the countercurrent mechanism in the loop of Henle?
Answer: The countercurrent mechanism establishes an osmolarity gradient in the medulla, allowing the
kidneys to produce concentrated urine and conserve water.

Question: Where does urea originate, and what is the fate of urea in the renal tubules?
Answer: Urea originates from amino acid catabolism in the liver. It is filtered, reabsorbed, and secreted, with
about 80% being reabsorbed.
Question: What is renal clearance, and how is it measured using the inulin clearance test?
Answer: Renal clearance is the rate at which a chemical is removed from the plasma. The inulin clearance test
involves infusing inulin into the blood, as it is neither reabsorbed nor secreted, allowing the calculation of GFR.

Question: What are the three layers of the ureter wall, and what role does the ureter play in the
urinary system?
Answer: The three layers are inner mucosa, middle muscular layer, and outer adventitia. The ureter transports
urine from the kidneys to the bladder.

Question: What are the layers of the bladder wall, and what is the purpose of the trigone?
Answer: The layers are mucosa, muscularis, and adventitia/serosa. The trigone is a triangular area with
ureteric orifices and the internal urethral orifice, contributing to bladder function.

Question: Describe the differences in the male and female urethra.

Answer: In males, the urethra is longer and has three sections (prostatic, membranous, and spongy), while in
females, it is shorter and primarily serves for urine elimination.

Question: What triggers the micturition reflex, and what happens during the reflex?
Answer: The micturition reflex is triggered by stretch receptors in the bladder wall as it fills with urine. It
involves parasympathetic stimulation, detrusor muscle contraction, and relaxation of the internal urethral
sphincter.

Question: What substances can form kidney stones, and what are common symptoms of kidney
stones?
Answer: Kidney stones can form from substances like calcium, oxalate, and phosphorus. Common symptoms
include severe back or side pain, blood in the urine, and frequent urination.