BIOL 174 – Anatomy and Physiology II

Ms. C. Myers
Thursday 8th April 2010
 What do the Kidneys Do?
The kidneys remove undesireable substances from
 
blood plasma (the liquid part).
1.toxins                       
2. metabolism wastes
3. excess ingested water  
What undesirable 4. excess mineral salts 
substances?

How much do they about 150 quarts of

filter each day?. blood plasma

The kidneys also regulate the acidity of the blood.

by excreting alkaline
How do they do that?
salts
 Renal cortex Renal column

Minor calyx

Renal pyramids
Major calyx
which collectively
form renal medulla
Renal pelvis

Renal papilla

Ureter
Diaphragm
Suprarena
l
gland
Left
Quadratus kidney
lumborum

Psoas Inferior
vena cava

Abdominal
aorta
Ureters

K
K
Ureter

Quadratus
Gonadal vessels lumborum
Psoas major
Common iliac a.
Internal Iliac
vessels
External
iliac vessels
 parietal
peritoneum

perirenal fat
kidney
primary
retroperitoneal
renal capsule
renal fascia psoas major m.
quadratus lumborum m.
pararenal fat
 12th rib
latissimus dorsi

11th & 12th Quadratus

ribs lumborum

Rt. kidney
Outline of
left kidney

external oblique Psoas major

internal oblique
 Suprarenal (adrenal) glands

Lie on superomedial pole of each kidney surrounded by renal fascia

Three arteries (superior, middle and inferior supra-renal)
One vein (suprarenal), left one into left renal vein, right one into IVC
Preganglionic sympathetic innervation to medulla

Suprarenal glands
• Renal artery Segmental Artery
Interlobar Artery Arcuate Arteries
Interlobular Arteries Afferent
Arterioles Glomerular Cap. Efferent
Arterioles Peritubular Cap. Interlobular
veins Arcuate veins Interlobar veins
Renal Vein.
 Inferior phrenic a.
Superior suprarenal aa.

Middle suprarenal a. Suprarenal v.

Inferior
suprarenal a.

? ?
gonadal arteries
Renal circulation
Interlobar
artery
Segmental
artery (end artery)
Arcuate
Renal artery
artery

Interlobular
artery
give rise to afferent
arterioles supplying
glomeruli
 Organs

• Kidneys
– Functional components
of urinary system
• Partially protected by
11th - 12th pairs of ribs
• Right kidney slightly
lower

• ureters
• urinary bladder
• urethra
 Functions
• Functions of the kidneys include:
– Regulating blood ionic composition
• Na+, K+, Ca2+, Cl-, HPO42-
– Regulating blood pH
• Excrete variable amounts of H+ and conserve and produce bicarbonate
– Regulating blood volume
• Conserve and eliminate variable amounts of water in urine
– Regulating blood pressure
• Via regulation of blood volume as well as vasoconstrictive effects of ADH
– Maintaining blood osmolarity (no. of dissolves particles per litre of
solution)
• Separately regulates loss of water and solutes
– Producing hormones
• Calcitriol – active form of vitamin D
• EPO – stimulates production of erythrocytes
– Regulating blood glucose level
• Carries out gluconeogenesis
– Excreting wastes and foreign substances
 Kidney anatomy
• Renal capsule
– protection

– maintains kidney shape

• Adipose capsule
– protection

– holds kidney in place

• Nephroptosis may occur in very
thin people

• Renal fascia
– anchors to surrounding structures
and abdominal wall
 Kidney
• Renal Hilus
– ureters, blood vessels,
lymphatic vessels and nerves
enter and exit kidney
• Structure:
– Cortex
– Medulla
• columns
– Extension of cortex
providing route for nerves
and blood vessels
• pyramids
– Papillary ducts run into apex
(papilla)
– Minor and major calyces
– Renal pelvis
 Nerve and blood supply of
kidney
• Kidneys receive 20-25% of resting
cardiac output
• Each nephron receives an afferent
arteriole
– Divides into ball shaped capillary
network called glomerulus
• Glomerular capillaries reunite to form
efferent arteriole
– Carries blood out of glomerulus

– Vasa recta and peritubular capillaries

extend from some efferent arterioles
• Supply blood to tubular portions of
nephron
– Renal nerves part of sympathetic
division of ANS
• Most are vasomotor nerves that
regulate blood flow through kidney
 Nephron
• Nephron
– functional unit of the
kidney
• Consists of:
– Renal corpuscle
» Glomerulus
» Bowman’s capsule
– Renal tubule
» proximal convoluted
tubule
» loop of Henle
» distal convoluted
tubule
 Nephron
• Two classifications of
nephron:
– Cortical (80-85%)
• glomerulus in outer cortex
• short loop of Henle
– penetrates to outer
medulla
– Juxtamedullary (15-20%)
• glomerulus deep in cortex
• long loop of Henle
– Ascending limb has two
portions
» Thin ascending limb
» Thick ascending
limb
– Penetrates deep into
medulla
– Establish high osmolarity
in renal medulla
 Nephron
• Nephron performs 3
functions:
– glomerular filtration
• Water and most solutes in
blood plasma move across
glomerular capillaries into
capsular space then into renal
tubule
– tubular reabsorption
• Tubule cells reabsorb ~99% of
filtered water and useful solutes
– tubular secretion
• Tubule and duct cells secrete
wastes, drugs, excess ions into
fluid
 Glomerular filtration
• Endothelial cells of glomerular
capillaries encircled by podocytes
– Pedicels of podocytes form filtration
slits
• Filtration membrane
• Permits filtration of water and
small solutes but not blood cells,
platelets or most plasma
proteins
• Mesangial cells
– Located among glomerular capillaries
• Regulate diameter of capillaries
 Glomerular filtration
• Net filtration pressure
depends on
– glomerular blood
hydrostatic pressure

– capsular hydrostatic
pressure

– blood colloid osmotic

pressure
 Clinical note

• In some kidney diseases

glomerular capillaries are
damaged
– Plasma proteins enter
glomerular filtrate
• Reduces blood coloid
osmotic pressure
– More fluid moves into
tissues
From:
» Causes edema http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/NephroticLong.html
 Glomerular filtration rate

• Glomerular Filtration Rate (GFR)

– Volume of filtrate formed in all renal corpuscles of both kidneys
each minute
• Averages 125 ml/min
• If GFR too high
– substances pass too quickly through tubules for adequate reabsorption
» Excess urinary loss
• If GFR too low
– Nearly all filtrate reabsorbed
» Certain wastes may not be adequately excreted
– GFR remains relatively constant due to:
• Adjustments in glomerular blood flow
• Alteration of glomerular capillary surface area available for filtration
– Mesangial cells regulate this
Glomerular filtration rate

• GFR controlled by:

– Renal autoregulation

– Neural regulation

– Hormonal regulation
 Renal autoregulation of GFR

• Renal autoregulation of GFR

– Two mechanisms
• Myogenic
– Stretching triggers contraction of smooth muscle cells in wall of afferent
arterioles

» Glomerular blood flow reduces

» GFR reduces

– Normalises GFR within seconds after a change in blood pressure

• Tubuloglomerular feedback
– Macula densa provides feedback to regulate diameter of afferent arteriole via
the juxtaglomerular apparatus
 Juxtaglomerular apparatus
• Final part of ascending limb of
LOH makes contact with afferent
arteriole
• Tubule cells in this region of LOH
crowded together
– macula densa
• detect changes in delivery of Na+,
Cl- and H20
• Wall of afferent arteriole contains
modified smooth muscle cells
– Juxtaglomerular cells
• release nitric oxide which adjusts
diameter of afferent arteriole
• Macula Densa and
Juxtaglomerular cells together
make Juxtaglomerular apparatus
 Tubuloglomerular regulation of
GFR
• When GFR high less time for
reabsorption of Na+, Cl- and
H20
– macula densa detects
increased delivery of Na+, Cl-
and H20.

– NO release by juxtaglomerular
cells inhibited
• Afferent arteriole constricts
– Decreases blood flow
through afferent arteriole
and decreases GFR
 Neural regulation of GFR
• Blood vessels in kidneys supplied by sympathetic ANS fibres

– Stimulation (such as during exercise etc) causes constriction

of afferent arteriole

• Reduces GFR

– Reduces urine output so as to conserve blood volume

– Permits greater blood flow to other tissues

 Hormonal regulation of GFR
• ANP

– Released by atria when stretched (high blood volume / high BP)

• Causes relaxation of glomerular mesangial cells

– Increases capillary surface area for filtration

» GFR increases

• Angiotensin II

– Vasoconstrictor formed in response to low blood pressure

• Causes constriction of afferent (and efferent arterioles)

– Reduces GFR

» Increases reabsorption to increase BP

 Tubular reabsorption
• Normal rate of GFR (~125 ml/min) means that the volume of fluid entering
the PCT in ½ hour is greater than total plasma volume
– Normally ~99% of filtered water and solute reabsorbed
• PCT makes major contribution to reabsorption

• More distal tubules fine tune reabsorption to maintain water and ion balance

– Solute reabsorption drives water reabsorption because all water reabsorption

occurs via osmosis
• Obligatory water reabsorption
– Water reabsorbed with solutes (water ‘obliged’ to follow solutes)

» Occurs in PCT and descending LOH – always permeable to H2O

• Facultative water reabsorption

– Ability of water to follow solute dependent on availability of ADH

» Occurs mainly in collecting ducts

Reabsorption and secretion - PCT
• Largest amount of solute and water reabsorption occurs in PCT
– Most absorptive processes involve Na+

– Filtered glucose, amino acids, lactic acid, vitamins and other nutrients reabsorbed by
Na+ symporters
– Na+ also reabsorbed by Na+/H+ antiporters
• Can provide mechanism for reducing blood H+

• PCT cells can produce own H+ to keep antiporter running to ensure adequate Na+
reabsoprtion
– H+ produced by carbonic anhydrase reaction

» HCO3- produced from carbonic anhydrase reaction reabsorbed

– NH4+ can substitute for H+

» Produced by deamination of glutamine

» Also produces HCO3- which is reabsorbed

• Reabsorption of solutes promotes water reabsorption via osmosis (obligatory water

reabsorption)
 Reabsorption – Loop of Henle

• Reabsorption of water via

osmosis not automatically
coupled to reabsorption of solutes
– Descending LOH permeable to
water, relatively impermeable to
solutes
• Water reabsorbed via osmosis

– Ascending limb of LOH

permeable to solutes, relatively
impermeable to water
• Solutes reabsorbed via Na+-K+-
2Cl- symporters
 Reabsorption – DCT

• Reabsorption of Na+ and Cl-

via Na+-Cl- symporters
• Relatively impermeable to
water
– Does not follow via obligatory
water reabsorption

• Major target for parathyroid

hormone stimulated increase
in Ca2+ reabsorption
Reabsorption and secretion – collecting
ducts

• By time filtrate reaches end

of DCT 90-95% of filtered
solutes and water have been
reabsorbed
• Collecting ducts relatively
impermeable to water
– Water reabsorption under
facultative control
 Hormonal regulation of tubular
reabsorption and secretion

• Most important regulators of tubular electrolyte

reabsorption and secretion are
– Angiotensin II

– Aldosterone

• Major hormone regulating tubular water

reabsorption is ADH
 Renin – angiotensin – aldosterone
system
• When BP and BV low walls of afferent arteriole stretched
less
– Reduced stretch causes juxtaglomerular cells to release renin
– Renin also released in response to sympathetic stimulation
• Renin clips off 10 amino acid peptide called angiotensin I from
angiotensinogen (plasma protein)
• Angiotensin I converted to angiotensin II (active) in lungs by ACE
(angiotensin converting enzyme) clipping off another 2 amino acids
• Angiotensin II
– constricts afferent arterioles
» reduces GFR and allows more time for reabsorption
– stimulates Na+, Cl-, and water reabsorption in PCT
– stimulates aldosterone secretion by adrenal cortex
» increases reabsorption of Na +, Cl- and H20 in collecting ducts
» Also stimulates thirst centre in hypothalamus
 Antidiuretic hormone
• ADH released by posterior pituitary
– Secretion regulated by negative
feedback
• Hypothalamic osmoreceptors
regulate secretion of ADH in
response to changes in blood
osmolarity
– ADH regulates facultative water
reabsorption in last part of DCT and
collecting ducts
• Stimulates insertion of water channel
(aquaporin-2) into apical membranes of
principal cells
 Urine production

• Homeostasis of body fluid volume

depends in large part on the ability of the
kidneys to regulate the rate of water loss
in urine
• ADH controls whether dilute or
concentrated urine is formed
 Producing dilute urine
• Descending limb of LOH
– permeable to water
– impermeable to solutes
• Water moves out solutes
cannot follow
• Ascending limb and
collecting ducts
– permeable to solutes (active
transport)
• Contribute to medullary
osmotic gradient
– impermeable to water
(dependent on ADH)
• Solutes actively transported
out but water cannot follow
 Producing concentrated urine
• Production of concentrated urine
is dependent on a high osmotic
gradient in the renal medulla
• High osmotic gradient established
by juxtamedullary nephrons:
– Thick ascending limb cells of LOH
reabsorb ions from filtrate and
pass into medulla
– Urea recycling
• Urea recycled from distal tubule to
medulla and equilibrates with LOH
– Maintains medullary osmolarity

– Sluggish flow of blood in vasa

recta allows equilibrium with
medullary osmolarity
• ie blood does not remove solutes
and destroy gradient
 Producing concentrated urine

• ADH increases insertion of

aquaporin-2 in collecting ducts

– When filtrate passes through

high osmolarity of deep renal

medulla water moves according

to osmotic gradient

– Results in concentrated urine

• Hollow

• Muscular organ

• Can withstand great distention

• Transitional epithelium

• Smooth detrusor muscle

• Urethra

• Internal urethral sphincter – smooth m.

• External urethral sphincter – skeletal m.

Bladder Located within a fat-filled, retropubic space
Varies in size, shape, & position:
medial
- Empty – 4-sided pyramid; resides in true pelvis
- Full – ovoid; protrudes anteriorly & superiorly
into the abdominal cavity.

superior view

Image Source: W H Hollinshead and C Rosse, Textbook of Anatomy. 5th ed., Lippincott Raven, 1997
 Bladder: Interior
VIEW: Coronal section of female bladder
Bladder Trigone – smooth area of the
bladder in the non-distended state. Peritoneum
1. Ureters - open into the posterior,
inferolateral aspect of the bladder
Orifices of the fat within
2. Urethra – commences at the neck of the ureters retropubic
bladder as the internal urethral orifice space
neck
Internal Urethral Sphincter
- located at neck of the bladder
- detrusor muscle (smooth m.)
- autonomic innervation inf. pubic
ramus

Sphincter Urethrae (AKA: External

Urethral Sphincter)
- assoc. with membranous urethra
- skeletal muscle
- innervated by pudendal n. Sphincter Urethrae
 Urethra
VIEWS: Coronal sections

MALES – (approx 18-20 cm in length)

1. prostatic urethra
2. membranous urethra – surrounded by sphincter
urethrae
3. penile/spongy urethra – major curve in proximal part
of urethra

FEMALES - urethra
- approx. 4 cm in length
- external urethral orifice opens into vestibule
 Clinical note - diuretics

• Diuretics slow renal reabsorption of water

– Most act by blocking Na+ transporters

• Less Na+ reabsorbed

– Less water reabsorbed by obligatory reabsorption

– Cause diuresis (increased urine production)

• Reduces plasma volume

– Reduces edema
 Urine transport, storage and
elimination
• Urine drains from collecting ducts into calyces, renal pelvis and then ureters

• Stored in urinary bladder

– Average capacity 700-800 ml

– Sensation of fullness initiates conscious desire to urinate before bladder ½ full

• Once bladder approx ½ full stretch receptors in bladder wall transmit afferent

nerve impulses to micturition centre in sacral spinal cord

– Efferent impulses cause contraction of detrusor muscle (lines wall of bladder) and

relaxation of internal urethral sphincter muscle

• Micturition can be delayed through conscious contraction of external urethral sphincter

(skeletal muscle)
Aging and the urinary system

• Kidneys shrink in size

– Reduced blood flow
• Filter less blood

• Sensation of thirst diminishes with age

– Increased dehydration

• Urinary dysfunction more prevalent

– Polyuria – excessive urine production
– Nocturia – excessive urination at night
– Dysuria – painful urination
– Incontinence
– hematuria
Where in the ureter can kidney
stones can be trapped?
1) At the beginning of the ureter
K
2) At the area where the ureter crosses
the pelvic brim
3) At the point where the ureter enters
the bladder

Where is the pain felt and how is

the pain transmitted?

The pain, caused by spasms of the smooth

muscles in the wall of the ureter, is carried
by sympathetic afferents to the spinal cord
at segments T11 – L2.

The pain is then referred to the body wall areas

supplied by the somatic nerves from these
spinal cord segments
 intravenous pyelogram (IVP)
- a diagnostic imaging
technique which uses an x-ray
to view the structures of the
urinary tract. An intravenous
contrast is given so that the
structures can be seen on film.
An IVP also reveals the rate
and path of urine flow through
the urinary tract.
 Cystitis
• Cystitis is an infection of the bladder, but the term is often used
indiscriminately and covers a range of infections and irritations in the lower
urinary system. It causes burning sensations during urination and a frequent
need to urinate.

• Burning sensations or pain during urination.

• Frequent urination.
• Cloudy and foul-smelling urine.
• Pain directly above the pubic bone.
• Children under five years of age often have less concrete symptoms, such as
weakness, irritability, reduced appetite and vomiting.
• Older women may also have no symptoms other than weakness, falls, confusion or
fever.
• Occasional blood in the urine.
 How do you get cystitis?
• Infection from intestinal bacteria is by far the most frequent
cause of cystitis, especially among women, who have a very
short urethra (the tube through which the urine passes from the
bladder to the outside).
• Normally, urine is sterile (there are no micro-organisms such as
bacteria present). Between 20 %to 40 %of women will get
cystitis in their lifetime.
• However, it is possible to have bacteria in the bladder without
having any symptoms (especially in the elderly).
• Inadequate emptying resulting in stagnation of urine may lead
to infection. This may be caused by some drugs (for example,
antidepressants), immobility, abnormal bladder control and
constipation.
• Even the small drop which is always left behind may contain
bacteria. Conditions that may make it easier for the bacteria to
travel through the urethra include those listed below.
 What is Glomerulonephritis
• Glomerulonephritis is a type of kidney
disease that involves the glomeruli.
• The glomeruli are very small, important
structures in the kidneys that supply blood
flow to the small units in the kidneys that
filter urine, called the nephrons.
• During glomerulonephritis, the glomeruli
become inflamed and impair the kidney's
ability to filter urine.
 Pyelonephritis
• Pyelonephritis most often occurs as a result of
urinary tract infection, particularly when there is
occasional or persistent backflow of urine from the
bladder into the ureters or an area called the kidney
pelvis
• Pyelonephritis can be sudden (acute) or long-term
(chronic).
• Acute uncomplicated pyelonephritis is the sudden
development of kidney inflammation.
• Chronic pyelonephritis is a long-standing infection
that does not go away.
 The END
• Next class 15th April 2010

• Continue working on Worksheet #3,

Preparing for exam #2, preparing for oral
and written presentation.

» Have a GREAT WEEK~!!!