body fluids and renal physiology - bums.ac.ir 1234.pdf · body fluids and renal physiology by: dr....
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Body fluids and
Renal physiology
By: Dr. FoadoddiniDepartment of Physiology & PharmacologyBirjand University of Medical Sciences
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Volume and Osmolality of Extracellular and Intracellular Fluids in Abnormal States
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Fluids in the "Potential Spaces" of the Body
Edema
Pc
Kf πC
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Safety factor
Low compliance in IF
3 mmHg
"Washdown“of IF Protein
7mmHg
LymphFlow
7mmHg
Safety Factors That Normally Prevent Edema
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Blood Supply to the Kidneys• Blood travels from afferent arteriole to capillaries in the nephron called glomerulus • Blood leaves the nephron via the efferent arteriole• Blood travels from efferent arteriole to peritubular capillaries and vasa recta
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Internal Anatomy
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• Blood is filtered in the nephrons
• The cortex of each kidney contains ± 1,2 million nephrons
• The nephron consists of a renal corpuscle and a renal tubule
• The renal tubule consists of the convoluted tubule and the loop of Henle
• The main filter of the nephron is glomerulus which is located within the Bowman's capsule
Function of the Kidney• Terminology
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Micturation
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Bowman’s capsules - with glomerulus
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The filtration barrier - podocytes
fenestratedendothelium
fenestratedendothelium
primaryprocess
podocytecell bodysecondary
process(pedicel)
filtrationslit
basallamina
podocyte
pedicel filtration slitbasal
lamina
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Detailed structure of the filtration system
Capillary
CapillaryBasementmembrane
Basementmembrane
Fenestrations
Fenestrations
Podocyte process
Capillary
BM
Endothcell nucleus
Endothcell nucleus
E
F
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The filtration barrier - pedicels
Bowman’s space
capillary
pedicel
filtration slit
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Control of Kf• Mesangial cells have contractile properties, influence capillary
filtration by closing some of the capillaries – effects surface area
• Podocytes change size of filtration slits
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GLOMERULAR FILTRATION
The first step in the formation of urine is the production of a plasma ultrafiltrate.The ultrafiltrate is cell and protein-free and the concentration of small solutes are
the same as in plasma.The filtration barrier restricts movement of solutes on a basis of size and charge. Molecules < 1.8 nm freely filtered; >3.6 nm not filteredCations are more readily filtered than anions for the same molecular radius.Serum albumin has a radius if about 3.5 nm but its negative charge prevents its
filtration
In many disease processes the negative charge on the filtration barrier is lost so that proteins are more readily filtered - a condition called proteinuria
The glomerular filtration rate (GFR) is about 125 ml/min in a normal adult
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10mmHg
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Glomerular hydrostatic pressure, PGC, is high and relatively constant ≈45 mmHg.This is offset by a pressure in Bowman’s capsule PBC ≈10 mm Hg
Net filtrative force is:≈ 35 mm Hg
PGC-PBC40
30
20
10
0
mm Hg
aff. art eff. art.
THE GLOMERULUS - THE STARLING EQUILIBRIUM
The glomerulus is unusual with respect to most capillary beds.
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Glomerular hydrostatic pressure, PGC, is high and constant ≈45 mmHg.This is offset by a pressure in Bowman’s capsule PBC ≈10mmHgNet filtrative force is:≈ 35 mm Hg
Osmotic pressure, ΠGS, ≈25 mm Hg.Due to the large net filtration of fluid ΠGS increases along the capillary to 35
mm Hg to achieve a balance of forces.
PGC-PBC40
30
20
10
0
mm Hg
Net filtrationforce
ΠGS
THE GLOMERULUS - THE STARLING EQUILIBRIUM
aff. art eff. art.
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FILTRATION FRACTION
Filtration fraction is an important expression of the extent of glomerular filtration.
It is the ratio: Filtration fraction = Glomerular filtration rate
Renal plasma flow
It is the fraction of renal plasma flow that is filtered at the glomerulus
RPF750 ml/min
GFR125 ml/min
Renal blood flow1250 ml/min
EfferentArteriole
625 ml/min
Urine 1 ml/min
124 ml/min
renal
vein
glomerulus
tubule
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Thus, in this example filtration fraction is: 125750 ≈ 0.17
GFR and RPF can be measured separately using clearance methods
Glomerular filtration rate (GFR)is about: 125 ml/min
Renal blood flowis about: 1250 ml/min
Renal plasma flow (RPF)is about: 750 ml/min
FILTRATION FRACTIONan example
Remember: plasma volume is about 60% of total blood volume
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RENAL BLOOD FLOW (RBF)
Renal blood flow is ≈1.25 l/min -i.e. about 25% of the cardiac outputThis is a very large flow relative to the weight of the kidneys (≈350 g)
Renal blood flow
GFR
0 100 200
Arterial blood pressure, mm Hg
1.5
1.0
0.5
0
Flow, l/minRBF determines GFR
RBF also modifies solute and water reabsorption and delivers nutrients to nephron cells.
Renal blood flow is autoregulatedbetween 90 and 180 mm Hg by varying renal vascular resistance (RVR)
i.e. the resistances of the interlobular artery, afferent arteriole and efferent arteriole
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RENAL BLOOD FLOW - AUTOREGULATION
Two hypotheses have been proposed to explain autoregulation
1. Myogenic hypothesisWhen arterial pressure increases the renal afferent arteriole is stretched
Autoregulation effectively uncouples renal function from arterial blood pressure and ensures that fluid and solute excretion is constant.
Increase of arterial pressure
Flow increases
Remember:
Flow α 1r4
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RENAL BLOOD FLOW - AUTOREGULATION
1. Myogenic hypothesisWhen arterial pressure increases the renal afferent arteriole is stretched
Vascular smooth muscle responds by contracting thus increasing resistance
Increase of arterial pressure
Increase of vascular tone
Flow increases
Flow returns to normal
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RENAL BLOOD FLOW - AUTOREGULATION
2. Tubuloglomerular feedback
Alteration of tubular flow (or a factor in the filtrate) is sensed by the macula densa of the juxtaglomerular apparatus (JGA) and produces a signal that alters GFR.
It is unclear what is the factor (NaCl reabsorption?) or the nature of the signal (renin?).
4. ↑Ra↓GFR
1. ↑GFR
2. ↑filtrate
3.signal from JGA
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27: Tubular Processing of theGlomerular Filtrate
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10mmHg
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First Defense line: TGF GFR regulation
Second Defanse line: GTB Reabsorption regulation
ΔP ΔUOAgII
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Use of ClearanceMethods to Quantify Kidney Function
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C = U * V/ P
GFR = Cinulin FF= GFR / RPF
RPF= CPAH