Function of the Kidney Flashcards
What does the kidney excrete?
Metabolic waste products and foreign chemicals
What production does the kidney regulate?
Red blood cell production
What does the kidney keep in balance?
Regulates acid-base balance
Water & electrolyte balance
What pressure does the kidney regulate?
Arterial pressure
What part of body fluids does kidney regulate?
Body fluid osmolality
Electrolyte concentration
What hormone does the kidney synthesise?
Calcitriol
What are the 5 symptoms of kidney impairment?
- Body weakness
- Blood pressure is high
- Swollen legs
- Loss of appetite
- Vomiting
What abnormal levels of ions can affect the heart in kidney impairment?
High K+
Low Ca2+
What is a xenotransplant?
A transplant from a donor of a different species from the recipient
What does the ureter lead from and to?
From kidney to urinary bladder
What is the role of the urethra?
Urine stored in the bladder is emptied through the urethra
How many lobes does a kidney have and what are they composed of?
18 lobes composed of nephrons
What is the outer layer of the kidney called?
Renal cortex = granular apprearing
What is the inner layer of the kidney called?
Renal medulla = striated-appearing
What is the role of the renal pelvis?
Collects the urine as it is produced
What does the renal pelvis lie outside of?
Peritoneal cavity
What is the flow of urine through the calyxes?
Renal pyramid > Renal Papillae > Minor renal calyx > Major renal calyx > Renal pelvis
What happens to nephrons when damaged?
Nephrons cannot be regenerated
Treatment can only try to preserve what is remaining
What two layers separate the blood from the glomerular filtrate?
Capillary endothelium
Specialized epithelium of Bowman’s capsule
Describe the capillary endothelium
Endothelium is fenestrated = has small pores
Completely surrounded by glomerular basement membrane and podocytes
Podocytes create filtration slits
What are podocytes?
Bowman’s capsule cells that have foot processes
They interact with each other to forma mesh-like structure
Where are mesangial cells located?
Between endothelium and glomerular basement membrane (basal lamina)
Commonly found between two neighbouring capillaries
What do mesangial cells do?
Regulate blood flow in glomerulus
By regulating the surface area available for filtration by contracting or relaxing in response to various signals
What does the juxtaglomerular complex consist of?
Macula densa
Juxtaglomerular cells
What and where are macula densa and their role?
Tubule cells in initial portion of the distal tubule
They act as chemoreceptors, sensing changes in NaCl concentration in the tubular fluid
What are juxtaglomerular cells and their function?
Special cells of the blood vessel walls
Blood vessels = afferent and efferent arterioles
Produce and release the enzyme renin = primary function
What is the function of the juxtaglomerular complex?
Regulate blood pressure, Na reabsorption and glomerular filtration
Synthesize renin
What are the two types of nephron?
Cortical nephron = 85%
Juxtamedullary nephron = 15%
Describe the cortical nephron
Short loop of Henle
Small network of vasa recta
Describe the juxtamedullary nephron
Long loop of Henle = reaches medulla
Large network of vasa recta
What role does the juxtamedullary nephron play?
Concentrating and diluting urine
What is the vasa recta and their role?
Network of blood vessels that run parallel to the loops of Henle in the kidney medulla = arise from the efferent arterioles
Supply oxygen and nutrients to the medullary tissue while also removing waste products
Crucial role in maintaining the osmotic gradient in the medulla, which is essential for the kidney’s ability to concentrate urine
What percentage is renal blood flow in relation to cardiac output?
22% of CO = 1,100 mL/min
What capillary beds does the renal circulation have?
Glomerular capillaries = starts and ends as arteriole
Peritubular capillaries = starts as artery ends as venule
Location: glomerular vs peritubular capillaries
Glomerular = found within glomerulus
Peritubular = surround the renal tubules in the kidney cortex and medulla
Function: glomerular vs peritubular capillaries
Glomerular = specialized for filtration
Peritubular = involved in reabsorption and secretion
What is the GFR per day?
180L/day
What is the approximate urine volume?
1 - 1.5 L per day
What is excretion a sum of?
Excretion = glomerular filtration + tubular secretion - tubular reabsorption
What are the 4 methods of renal handling of substances?
- Filtration only
- Filtration and partial reabsorption
- Filtration and complete reabsorption
- Filtration and secretion
What substances are filtered only?
Inulin
What substances are filtered and partially reabsorbed?
Many electrolytes = Na, Cl
What substances are filtered and fully reabsorbed?
Amino acids and glucose
What substance are filtered then secreted?
Creatinine and certain drugs
What is tubular secretion?
Vital mechanism by which the kidneys selectively remove substances from the bloodstream and excrete them in the urine, contributing to the regulation of body fluid composition and overall homeostasis.
What is creatinine?
Waste product generated by the breakdown of creatine phosphate in muscles
What does tubular secretion regulate?
K+ and H+
What is the GFR per minute?
Volume of plasma ultrafiltrate formed each minute 125 mL/min
Slightly lower in females
What is renal plasma flow?
Amount of plasma that is delivered to the kidneys for filtration and processing = crucial to assess kidney function and renal blood flow
625 mL/min
Filtration fraction equation
Glomerular Filtration Rate / Renal Plasma Flow = 125 / 625 = 0.2
20% of plasma flowing though kidneys = filtered through the glomerular capillaries
What factors determines the GFR?
Surface area of capillary bed
Permeability of capillaries
Hydrostatic and osmotic pressure gradient across capillary wall
Glomerular ultrafiltration coefficient (Kf)
Kf = glomerular capillary permeability x filtration surface area
How does capillary bed surface area affect GFR?
Angiotensin II = vasoconstrictor
Contraction of mesangial cells = reduces area available for filtration
Changes diameter of blood vessels
What is special about glomerular capillaries?
More permeable than other capillary beds
What is the rule about filtration based on permeability?
Molecules less than 4nm = freely filtered
Intermediate size molecules filtered depending on CHARGE
The basal lamina = negative
So positive particles are readily filtered
What is capillary permeability for proteins?
Largely impermeable to protein
Example of a small plasma protein not being filtered
Albumin repelled because it is negatively charged so not filtered even though it is small
What happens in glomerulonephtitis?
Immune cells attack and damage glomerulus
Glomerular negative charge lost
Albumin can then enter urine
Define glomerular hydrostatic pressure
Pressure from blood in glomerular capillary wanting to enter nephron
Favours filtration = +55mmHg
Define colloid osmotic pressure
Proteins attracting water out of nephron
Opposes filtration = -30 mmHg
Define Bowman’s hydrostatic pressure
Pressure from fluids in capillaries against Bowman’s capsule
Opposes filtration = -15mmHg
What is the net filtration pressure?
Favours filtration = +10 mmHg
Difference between
What is the difference between gomerular capillaries and normal capillaries?
Glomerular capillaries = high pressure system
Others = low pressure system
What factors cause a decrease in GFR?
Age, Renal disease, Diabetes mellitus, hypertension, decrease in Kf
Difference in diameter of arterioles?
Afferent arterioles = smaller than efferent
Creates bottle-neck effect
What happens to GFR if there is in obstruction of the urinary tract?
Increase in Bowman’s capsule hydrostatic pressure = decrease GFR
What happens to GFR when sympathetic activity increases?
Increase sympathetic activity = increase vasoconstrictor hormones
Afferent arteriolar constriction
Reduce renal blood flow
Reduce glomerular hydrostatic pressure
Reduce GFR
What does increased Angiotenin II do to GFR?
Efferent arteriolar constriction = INCREASE GFR
Also causes mesangial contraction = reduction in GFR
BUT, the strong effect on efferent arteriole usually leads to the effect of overall increase in GFR
What effect does artieral pressure have on GFR?
Minimal affect since renal blood flow is autoregulated
What effect does high salt and protein intake have on GFR?
Increases GFR
How is renal blood flow autoregulated?
Myogenic mechanism and tubuloglomerular feeback
How does the myogenic mechanism work?
Muscle reflex to adjust blood flow into the kidneys based on changes in blood pressure = adjusts to stretch
What is tubuloglomerular feedback?
Feedback mechanism that links changes in NaCl conc at macula densa to renal arteriolar resisance and autoregulation of GFR
What do macula densa monitor?
NaCl concentration = part of tubuloglomerular feedback
What happens to afferent arteriolar resistance when arterial presure decreases?
Glomerular hydrostatic presure decreases -> GFR decreases -> Decrease in macula densa NaCl -> Decrease afferent arteriolar resistance
What happens to efferent arteriolar resistance when arterial pressure decreases?
Senses decrease in NaCl -> Increases renin -> Increases Angiotensin II leading to increase in efferent arteriolar resistance [ THIS IS TO MAINTAIN GFR ]
What is renal plasma clearance?
Voume of plasma that is completely cleared of a substance by the kidneys per unit of time. It represents the efficiency with which the kidneys remove a particular substance from the bloodstream through filtration and/or secretion
Units of renal plasma clearance
mL per min
How to calculate clearance rate?
Conc of substance in urine / concentration of substance in blood
When does the clearance of the substance = GFR?
For substances that are only filtered (not reabsorbed or secreted)
How do you calculate urine flow rate?
Urine volume / time in minutes
How to calculate GFR?
(Conc of substance in urine / concentration of substance in blood ) x urine flow rate = GFR [urine flow rate = urine volume / time in minutes ]
What criteria are needed to choose a substance to measure to calculate GFR?
Substances that are only filtered, not toxic and not metabolized by the body = creatinine and inulin
What is inulin?
Polysaccharide
Difference between measuring GFR with inulin and creatinine?
Creatinine does NOT need to be administered = endogenous susbstance UNLIKE inulin
What happens if you cannot use collect creatinine in the urine to measure creatinine clearance?
Use plasma creatinine concentrations
What is the relationship between plasma creatinine conc and GFR?
INVERSELY PROPORTIONAL