Respiratory system:

Anatomy of the respiratory tract and lungs, physiology of respiration,

lungs volume and lungs capacity, carries of oxygen and carbon
dioxide, chloride shift, mechanism of breathing and common
respiratory diseases (bronchitis, asthma, common cold, tuberculosis).

Excretory system:
Kidney - Structure and function of nephron, glomerular filtration rate,
selective reabsorption and secretion, endocrine function of the
kidney, the role of kidney - water, electrolyte and acid base balance of
the body.
General Organization of the kidneys and urinary tract
 The component parts of the Urinary system

1. A pair of kidneys: Form urine

2. A pair of ureters: Convey urine from kidney to bladder

3. A urinary bladder: Temporary reserviour of urine

4. Urethra: Excrete urine from bladder to the exterior

 Parts of the kidney
Kidney consist of two parts –

1. Outer cortex : Reddish colour due to the large blood supply

2. Inner medula: Pale in colour due to the less blood supply

Content of the Cortex:

i. Renal corpuscles
a. Glomerulus
b. Bowman’s capsule
ii. Proximal convoluted tubules
iii. Distal convoluted tubules
iv. Collecting tubules
v. Afferent and efferent arterioles
vi. Peritubular cappilary plexus
vii. Juxtra glomerulur apparatus
Content of the Meddula:
Limb of loop of Henle

Loop of Henle

Ascending limb of loop of Henle

Collecting duct

Vasa recta
 Nephron
Nephrons are tiny tubules (miniature tubes) which are the
smallest working part of the kidney. This is where the kidney
removes waste, excess salt, and excess water.

Each nephron starts in the cortex of the kidney, then goes into
the medulla of the kidney, before coming back to the cortex, then
goes through the medulla into the pelvis of the kidney. In the
pelvis, the nephrons join up with the ureter.

It is the structural and functional unit of kidney.

In humans, a normal kidney has between 800,000 and 1.5 million

nephrons.
It consists of two parts
A Glomerulus
B Renal tubules

It consist of :
Bowman's capsule (including glomerulus)

Proximal convoluted Tubule

Descending loop of Henle

Ascending loop of Henle

Distal convoluted tubule

Collecting duct
Renal Blood Supply
 (except the plasma proteins)

The Renal circulation is unique in having two capillary beds, the glomerular and
peritubular capillaries separated by the efferent arterioles.

HHP in glomerular capillary cause rapid fluid filtration

LHP in peritubular capillary cause rapid fluid reabsorption
 Mechanism of formation of urine

Urine formation takes place by the following three mechanism

i. Formation of glomerular filtrate

ii. Reabsorption of glomerular filtrate from tubule

iii. Tubular secretion

Mechanism of Urine Formation
Concentrated and
Diluted Urine
Formation
 Hormones acting on the kidney

There are some hormones which acts upon kidney.

i. Aldosterone

ii. Anti-diuretic hormone

iii. Parathormone

iv. Growth hormone

Aldosterone: It is secreted by adrenal cortex.
i. It controls the reabsorption of Na+ ions from the late distal tubule and the
cortical collecting tubule.
ii. It also controls the secretion of K+ ions from the pertitubular capillary blood into
the tubular lumen.

Anti-diuretic hormone: It is secreted by the supraoptic (5/6) and paraventricular

nucleus (1/6) of hypothalamus and is stored in posterior pitutary. ADH controls
the permeability of the late distal tubule, cortical collecting tubule and
medullary collecting tubule to water.

Parathormone: It is secreted by the parathyroid gland.

iii. It increases the renal tubular reabsorption of Ca ++ ion.

iv. It increases the renal tubular secretion of phosphate.

Growth hormone: Secreted by the anterior pitutary. It also acts upon kidney and
caused the release of somatomedins from kidney. These somatomedins help in
bone and cartilage growth.
 Hormones of the kidneys

The kidneys produce three hormones:

1. 1, 25-dihydroxycholecalciferol: It increases the absorption of Ca++

ion.

2. Renin: It converts angiotensinogen into angiotensinogen-I then

cnverted into angiotensinogen-II which increases the systolic and
diastolic blood pressure by vasoconstriction.

3. Erythropoietin: It increases the synthesis of haemoglobin, and

production and release of red blood cells from the bone marrow are
increased during hypoxia or anemia.
Glomerular Membrane

It is the membrane of the glomerular capillaries through which fluids are

filtered from glomerular capillary to Bowman’s capsule.

Layers of glomerular membrane:

i. The endothelial layer of capillary itself.
ii. A basement membrane
iii. A layer of epithelial cells that lines the Bowman`s capsule.

The permeability of the glomerular membrane is from 100 to 500 times as

great as the usual capillary.

Functionally, the glomerular membrane permits the free passages of neutral

substances upto 4 nm in diameter and almost totally excludes those
with diameters greater than 8 nm.

However, the charges in molecules as well as their diameters affect their

passage into Bowman’s capsule.
The basement portion of the glomerular pores are lined with a complex of
proteoglycans that have very strong negative electrical charges.

Functional structure of the glomerular membrane

Why proteins can not pass through the glomerular membrane?

The pores of the membrane are larger (80 A0 or 8 nm) than the molecular
diameter of the plasma protein-albumin ( 6 nm), yet the protein can not
pass through the membrane. Because the glomerular pores are lined with a
complex of glycosylated proteins that have very strong negative electrical
charges. The plasma protein also have strong negative electrical charges.
Therefore, electrostatic repulsion of the protein molecules by the pores
walls keeps these molecules from passing through.
Glomerular filtration

The filtration that occurs through the glomerular capillary is called

glomerular filtration.

Cause: Due the effective filtration pressure GF occurs. The pressure inside
the glomerular capillaries promotes GF. On the other hand colloidal
osmotic pressure in blood and the pressure in the Bowman’s capsule
opposes the filtration.

The inword force or glomerular capillary pressure = 60 mm of Hg

The outword force is = Capsular pressure + Colloidal osmotic pressure
= 18 + 32 = 50 mm of Hg

So the effective filtration pressure = 60 -50 mm of Hg

= 10 mm of Hg

Which causes the filtration of glomerular filtrate.

Gomerular filtrate
The fluid that filters through the glomerulus into Bowman’s capsule is
called glomerular filtrate.

Normal glomerular filtrate = 180 liter/day

= 7.5 liter/hour
= 125 ml/minute
Composition of glomerular filtrate

Its composition is as the fluid that filters from the arterial ends of the
capillaries into the interstitial fluid.

1. It is isotonic to plasma (osmotic pressure 300 mosm/liter)

2. It contains no red blood cells
3. It contains about 0.03% protein, or about 1/240 the protein in the plasma
4. The electrolyte and other solute composition is similar to that of
interstitial fluid. But-
a) The concentration of the nonprotein negative ions (Cl-, HCO3 etc) or
5% higher than plasma
b) The concentration of positive ions is about 5% lower than plasma
Glomerular Filtration rate (GFR)
The quantity of glomerular filtrate formed in each minute by all the nephrones of
both kidneys is called GFR.
It is about- 125ml/min

Factors affecting GFR

a. Glomerular capillary pressure: It promotes filtration through the glomerular

membrane.
b. Plasmid colloidal osmotic pressure: Of the plasma proteins also oppose
filtration.
c. Bowman’s capsule pressure: Opposes filtration.
d. The colloidal osmotic pressure of the proteins bowman’s capsule promotes
filtration. But this factor has no significance.

The other factors which also affect GFR

i. Renal blood flow: Increased blood flow increases glomerular pressure that
inturn increases GFR
Constriction of afferent arteriole: It decreases the rate of blood flow to the
glomerulus which decreases glomerular pressure that inturn decreases GFR.

Constriction of the efferent arteriole: Mild constriction increases the registance

to outflow of blood which increases the glomerular pressure thus increases
GFR.

Arterial blood pressure: Increased arterial pressure decreases GFR due to

autoregulation.

Renal Fraction
The portion of the total cardiac output that passes through the kidneys is called
the renal fraction.

The total cardiac output of 70 Kg adult: 5600 ml/min.

Rate of blood flow through both kidneys: 1200 ml/min

So, Renal fraction = 1200x100/5600 = 21%

Range : 12-30%
Filtration fraction
It is the fraction of renal plasma flow that becomes glomerular filtrate.
The normal plasma flow through both kidney = 650 ml/min
The glomerular filtration rate = 125 ml/min.
So, Filtration fraction = 125 x100/650
= 19%

Filtration Pressure
The filtration pressure is the net pressure forcing fluid through the glomerular
membrane. It is about 10 mm of Hg

Filtration pressure = GP- (GCOP+CP)

= 60 – (32+18) mm of Hg
= 10 mm of Hg

The pressure (10 mm of Hg) causes the filtration of glomerular filtrate to occur.
Autoregulation of GFR
The process by which the GFR is maintaining in a remarkably constant level
though the arterial pressure is changed, known as autoregulation of GFR.

Why autoregulation of GFR occurs?

For occuring autoregulation of GFR the glomerular filtrate must flow into the
tubular system at an appropriate rate-
i. To allow the unwanted substance to pass on into the urine.
ii. Reabsorbing the wanted substances.

Autoregulation of renal blood flow

The process by which the renal blood flow remain near the normal level despite
considerable change in the arterial pressure, is called autoregulation of renal
blood flow.
 Mechanism of autoregulation

https://www.youtube.com/watch?v=o25xpuGqFHU
Plasma clearance
The plasma clearance constitute the virtual volume of plasma (in ml) which
contains the amount of constituent which is excreted out through urine in each
minute.

Plasma clearance of any substance can be determined by the following

formula:

Plasma clearance = Conc. of substance in urine x volume of urine

(ml/min)/Conc. of substance in plasma in ml

Use of plasma clearance:

i. Determination of GFR
ii. Measurement of renal plasma flow
iii. Calculation of filtration fraction
Plasma clearance value of Urea is 70 ml- Explain

We know that the plasma clearance of any substance-

= Conc. of substance in urine x volume of urine (ml/min)/Conc. of substance in

plasma in ml

Normal conc. of Urea excreted in urine = 0.26 mg/ml

Amount of Urea excreted in urine = 18.2 mg/min

Plasma clearance of Urea = 18.2 x 1/0.26

= 70 ml

So, the clearance value of Urea is 70 ml/min means-70 ml of plasma contain

the amount of urea which is excreted in the urine per minute.
Reabsorption and secretion along different parts of the nephron

Proximal tubule
A. Proximal tubular reabsorption:
1. Sodium: 65% (may be increased or decreased)
2. Water: 65% (may be increased or decreased)
3. Chloride: Slightly lowered percentage
4. Bicarbonate: 80% (may be increased or decreased)
5. Potassium
6. Glucose: 100%
7. Aminoacids: 100%

B. Proximal tubular secretion:

1. Hydrogen ion (H+)
2. Bile salts
3. Oxalate
4. Urate
5. Catecholamines
6. Drugs i.e. Penicillin, Salicylates, PAH etc
 Mechanism of reabsorption and secretion in PCT

Sodium Potassium ATPase pump: Sodium, chloride and water

Co-transport: Sodium along with glucose, amino acids, and other solutes (in
the first half of PCT)

Diffusion of chloride: In the 2nd half of the PCT through the intercellular
junctions from the tubular lumen into the renal interstitial fluid.

Counter transport mechanism: Sodium reabsorption while secreting other

substances into the tubular lumen, especially hydrogen ions.
PCT
 PCT

https://www.youtube.com/watch?v=Ej_qLnwqRTE
PCT
 Loop of Henle

Descending thin segment:

Highly permeable to water and moderate permeable to most solutes, including
urea and sodium (20% of the filtered water is reabsorbed in the loop of Henle).

Thick segment of the ascending limb of loop of Henle:

Are capable of active reabsorption of sodium, chloride and potassium. About
25% of the filtered loads of sodium, chloride, and potassium are reabsorbed in
the loop of Henle, mostly in the thick ascending limb.

Considerable amounts of other ions such as calcium, bicarbonate, and

magnesium are also reabsorbed in the thick ascending loop of Henle and it is
virtually impermeable to water.

Thin segment of the ascending limb of loop of Henle:

This segment has a much water reabsorptive capacity than the thick segment.
Loop of
Henle

https://
www.youtube.
com/watch?
v=mz2dkCij1Y4
 Distal Tubule

Very first portion:

Forms part of the juxtra glomerular complex that provides feedback control of
glomerular filtration rate and blood flow in this same nephrone.

Early part of the distal tubule:

Reabsorbs most of the ions, including sodium, potassium and chloride, but is
virtually impermeable to water and urea.

Late distal tubule and cortical collecting tubule:

The principal cells reabsorb sodium and water from the lumen and secrete
potassium ions into the lumen.

The intercalated cells reabsorb potassium and bicarbonate ions and secrete by
hydrogen ions into the tubular lumen
 DCT
and
CCD

https://www.youtube.com/watch?v=Ugu1jYRoYis
 Medullary collecting duct

Reabsorb less than 10% of the filtered water and sodium. The permeability of
the water is controlled by the level of ADH.

Is permeable to urea

Capable of secreting large amounts of hydrogen.

 Control of blood pressure by the kidney
(Renin angiotensin mechanism)

Renin is synthesized and stored in an inactive form called prorenin in the

juxtraglomerular cells of the kidneys.

When the arterial pressure falls intrinsic reactions in the kidneys themselves cause
many of these prorenin molecules to split and release renin. Most of the renin enters
the blood.

Renin is an enzyme, not a vasoactive substance itself. It acts enzymatically on

another plasma protein. A globulin called renin substrate (or angiotensinogen), to
release a 10-amino acids peptide, angiotengin-I. The renin persist in the blood for
30 minutes to an hour and continues to cause formation af angiotensin-I during this
entire time.

Within a few seconds after formation of the angiotensin-1, two additional amino
acids are split from it to form the 8-amino acid peptide angiotensin-II, catalyzed by
the converting enzyme, prsent in the endothelium of the lung vessels. However, it
persists in the blood only for a minute or two because it is rapidly inactivated by
multiple blood and tissue enzymes collectively called angiotensinase.
 During its persistence in the blood, angiotensin-II causes intense vasoconstriction in
the arterioles and, less extent in the vein.
 Decrease the excretion of both salt and water, this increase the extracellular fluid
volume.
Thus the blood pressure is increased.
https://www.youtube.com/watch?v=JjiKkPEupdI&t=11s
Role of kidney in acid base balance