functional morphology of kidneys clearance
TRANSCRIPT
![Page 1: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/1.jpg)
Department of PhysiologyFaculty of Medicine, Masaryk University
Functional morphologyof kidneysClearance
Assoc. Prof. MUDr. Markéta Bébarová, Ph.D.
![Page 2: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/2.jpg)
This presentation includes only the most important terms and facts. Its content by itself is not a sufficient source of information required to
pass the Physiology exam.
![Page 3: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/3.jpg)
Renal FunctionsExcretion of Waste Products and Toxins
Control of Volume and Composition of Body Fluids, Osmolality
Regulation of Acid-Base Balance
Regulation of Blood Pressure
Secretion, Metabolism and Excretion of Hormones
Glukoneogenesis
![Page 4: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/4.jpg)
http://classes.midlandstech.edu/carterp/Courses/bio211/chap25/chap25.htm
Structure of Kidney
![Page 5: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/5.jpg)
Structure of Kidney
http://classes.midlandstech.edu/carterp/Courses/bio211/chap25/chap25.htm
![Page 6: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/6.jpg)
Structure of Nephron
Ganong´s Review of Medical Physiology, 23rd edition
![Page 7: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/7.jpg)
mesangial cells
Guyton Hall. Textbook of Medical Physiology
Structure of Nephron - Glomerulus
![Page 8: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/8.jpg)
mesangial cells
Guyton Hall. Textbook of Medical Physiology
Structure of Nephron - Glomerulus
![Page 9: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/9.jpg)
High filtration rate in glomeruli
Protein passage barrier
provided by high permeability of glomerular membrane
negative charge of all layers of glomerular membrane
Ganong´s Review of Medical Physiology
Structure of Nephron - Glomerulus
![Page 10: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/10.jpg)
Structure of Nephron - Tubulus
proximal convoluted tubule
glomerulus
Ganong´s Review of Medical Physiology, 23rd edition
![Page 11: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/11.jpg)
Structure of Nephron - Tubulus
loop of Henle
Ganong´s Review of Medical Physiology, 23rd edition
proximal convoluted tubule
glomerulus
![Page 12: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/12.jpg)
Structure of Nephron - Tubulus
loop of Henle
Ganong´s Review of Medical Physiology, 23rd edition
proximal convoluted tubule
glomerulus
![Page 13: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/13.jpg)
http://classes.midlandstech.edu/carterp/Courses/bio211/chap25/chap25.htm
Structure of Nephron - Tubulus
![Page 14: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/14.jpg)
Structure of Nephron - Tubulus
distal convoluted tubule
Ganong´s Review of Medical Physiology, 23rd edition
loop of Henle
proximal convoluted tubule
glomerulus
![Page 15: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/15.jpg)
Structure of Nephron - Tubulus
Ganong´s Review of Medical Physiology, 23rd edition
collecting duct
distal convoluted tubule
loop of Henle
proximal convoluted tubule
glomerulus
![Page 16: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/16.jpg)
Guyton Hall. Textbook of Medical Physiology
1) Glomerular filtration2) Tubular reabsorption3) Tubular secretion4) Urine excretion
Urine Formation
![Page 17: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/17.jpg)
Urine Formation
creatinine other waste
products
Guyton Hall. Textbook of Medical Physiology
electrolytes amino acids glucose
PAH toxins organic base
and acids
![Page 18: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/18.jpg)
Urine Formation
creatinine other waste
products
Guyton Hall. Textbook of Medical Physiology
electrolytes amino acids glucose
PAH toxins organic base
and acids
![Page 19: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/19.jpg)
Guyton Hall. Textbook of Medical Physiology
GFR = 125 ml/min = 180 l/day
FF = 0.2 20% of plasma filtered!
Urine Formation - Glomerular Filtration
Ganong´s Review of MedicalPhysiology, 23rd edition
![Page 20: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/20.jpg)
Glomerular filtration rate (GFR) depends on:
2) Balance of hydrostatic and coloid osmotic forces
1) Capillary filtration coefficient Kf(permeability and area of glomerular membrane; mesangial cells)
GFR = Kf net filtration pressure
Urine Formation - Glomerular Filtration
![Page 21: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/21.jpg)
Glomerular filtration rate (GFR) depends on:
2) Balance of hydrostatic and coloid osmotic forces
1) Capillary filtration coefficient Kf(permeability and area of glomerular membrane; mesangial cells)
GFR = Kf net filtration pressure
Urine Formation - Glomerular Filtration
![Page 22: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/22.jpg)
Guyton Hall. Textbook of Medical Physiology
PG πG
PBπB
πB = 0
Under physiological conditions:net filtration pressure = PG + πB – PB - πG = 60 + 0 – 18 - 32 = 10 mmHg
GFR = Kf net filtration pressureUrine Formation - Glomerular Filtration
GFR = Kf (PG + πB – PB – πG)
Ganong´s Review of MedicalPhysiology, 23rd edition
![Page 23: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/23.jpg)
Vas afferens, vas efferens• input and output of high-pressure glomerular capillary net
• control the glomerular filtration pressure:
• glomerular blood flow =Pv.a. – Pv.e.
Rv.a. + Rv.e. + Rg.k.
• ↑ resistance of vas aff. or vas eff. ↓ renal blood flow(if the arterial pressure is stable)
constriction of vas aff. glomerular pressure filtrationconstriction of vas eff. glomerular pressure filtration
Urine Formation - Glomerular Filtration
![Page 24: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/24.jpg)
Aktivní transportní mechanismy
Guyton Hall. Textbook of Medical Physiology
Urine Formation – Tubular Processes
![Page 25: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/25.jpg)
1) Primary active transport2) Secondary active transport3) Pinocytosis
(big molecules, e.g. proteins, namely in the proximal tubule)
Active Transport Mechanisms
Urine Formation – Tubular Processes
![Page 26: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/26.jpg)
Guyton Hall. Textbook of Medical Physiology
1) Primary active transport
Urine Formation – Tubular ProcessesActive Transport Mechanisms
![Page 27: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/27.jpg)
- Na+/K+ ATPase- H+ ATPase- H+/K+ ATPase- Ca2+ ATPase
1) Primary active transport
Urine Formation – Tubular ProcessesActive Transport Mechanisms
![Page 28: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/28.jpg)
2) Secondary active transport
Guyton Hall. Textbook of Medical Physiology
symport
antiport
Urine Formation – Tubular ProcessesActive Transport Mechanisms
![Page 29: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/29.jpg)
Substances using active transport show the so calledtransport maximum (given by saturation of the transporter).
for example glucosetransport maximum: 320 mg/min
Guyton Hall. Textbook of Medical Physiology
diabetes mellitus
Urine Formation – Tubular ProcessesActive Transport Mechanisms
![Page 30: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/30.jpg)
reabsorption
secretion
Guyton Hall. Textbook of Medical Physiology
Urine Formation – Tubular ProcessesActive Transport Mechanisms
Substances using active transport show the so calledtransport maximum (given by saturation of the transporter).
![Page 31: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/31.jpg)
1) Primary active transport2) Secondary active transport3) Pinocytosis
(big molecules, e.g. proteins, namely in the proximal tubule)
1) Reabsorption of H2O by osmosis
2) Reabsorption of solutes by diffusion
in the proximal tubule (highly permeable for H2O) active reabsorption of solutes lumen-intersticium
concentration gradient H2O osmosis into intersticium
Cl- (Na+ into intersticium, reabsorption of H2O by osmosis) urea (reabsorption of H2O by osmosis)
Urine Formation – Tubular ProcessesActive Transport Mechanisms
Passive Transport Mechanisms
![Page 32: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/32.jpg)
Guyton Hall. Textbook of Medical Physiology
Urine Formation – Tubular Processes
![Page 33: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/33.jpg)
Aktivní transportní mechanismy
Guyton Hall. Textbook of Medical Physiology
Urine Formation – Tubular Processes
![Page 34: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/34.jpg)
Physical Forces in Peritubular Capillaries and in Renal Intersticium- tubular reabsorption is controlled by hydrostatic and
coloid osmotic forces (similary to GFR)
GFR = Kf net filtration pressure
TRR = Kf net reabsorptive force
Urine Formation – Tubular Processes
![Page 35: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/35.jpg)
Guyton Hall. Textbook ofMedical Physiology
Urine Formation – Tubular ProcessesPhysical Forces in Peritubular Capillaries and in Renal Intersticium
![Page 36: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/36.jpg)
Tubuloglomerularfeedback
Glomerulotubularbalance
Ganong´s Review of Medical Physiology, 23rd edition
Urine Formation – Tubular Processes
![Page 37: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/37.jpg)
Guyton Hall. Textbook of Medical Physiology
Proximal Tubule1) complete reabsorption of substances playing key roles for
the organism (glucose, amino acids)2) partial reabsorption of substances important for the
organism (ions – Na+, K+, Cl-, etc.)
3) reabsorption of water
Result: isoosmotic fluid, notably decreasedvolume
4) secretion of H+
Urine Formation – Tubular Processes
5) reabsorption of HCO3-
![Page 38: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/38.jpg)
Loop of Henle1) thin descending part - passive reabsorption of water (osmosis)2) thick ascending part - active reabsorption of ions (Na+/K+/2Cl-
symport), secretion of H+, reabsorption of HCO3-
counter-current multiplier
Result: hypotonic fluid, volume further decreased
Urine Formation – Tubular Processes
![Page 39: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/39.jpg)
Loop of HenleUrine Formation – Tubular Processes
1) thin descending part - passive reabsorption of water (osmosis)2) thick ascending part - active reabsorption of ions (Na+/K+/2Cl-
symport), secretion of H+, reabsorption of HCO3-
![Page 40: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/40.jpg)
Distal tubule1) juxtaglomerular apparatus
2) active reabsorption of solutes similar to the thick ascendingloop of Henle, also no permeability for urea and water –the so called dilution segment (dilutes the tubular fluid)
Result: hypotonic fluid
Urine Formation – Tubular Processes
![Page 41: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/41.jpg)
Collecting duct (+ end of distal tubule)1) principal cells – reabsorption of Na+ and water (ADH),
secretion of K+
Urine Formation – Tubular Processes
![Page 42: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/42.jpg)
1) principal cells – reabsorption of Na+ and water (ADH), secretion of K+
Collecting duct (+ end of distal tubule)
2) intercalated cells – secretion of H+, reabsorption of HCO3-
and K+
Urine Formation – Tubular Processes
![Page 43: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/43.jpg)
Collecting duct – medullar part1) reabsorption of Na+ and Cl-, water (ADH), urea2) secretion of H+, reabsorption of HCO3
-
Urine Formation – Tubular Processes
![Page 44: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/44.jpg)
Guyton Hall. Textbook of Medical Physiology
pronouncedsecretion in comparisonwith H2O
pronouncedreabsorptionin comparisonwith H2O
Urine Formation – Tubular Processes
![Page 45: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/45.jpg)
a) Examination of concentration ability of kidneys
a) Examination of dilution ability of kidneys
Examination of renal function Renal clearance
- Concentration test using thirstiness
Examination of function of renal tubules
- Adiuretin test
(very unpleasant; 12 hours of thirstiness, urine sample every 4 hours – urine density and osmolality; also a blood sample)
(more pleasant for patient; no drinks and food during night, ADH application in the morning through the nasal mucosa –urine density and osmolality)
(test of reaction on increased water intake – decreased ADH production + increased diuresis in healthy people)
![Page 46: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/46.jpg)
Renal Clearance= the volume of plasma that is cleared of thesubstance by kidneys per unit time
Using clearance, we can quantified the excretion ability ofkidneys, the velocity of renal blood flow and even basic functions of kidneys (GFR, tubular reabsorption and secretion).
CS PS = V US CS =V US
PS[ml/min]
![Page 47: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/47.jpg)
Guyton Hall. Textbook of Medical Physiology
RPF = 5.85 x 1 mg/min
0.01 mg/ml = 585 ml/min
Correction to the extraction ratio of PAH (EPAH):
RPF = 585 ml/min
0.9= 650 ml/min EPAH =
PPAH - VPAH
PPAH
= 0.9
Renal Clearance
Clearance of a substance that is fully cleared from plasma in glomerulotubular apparatus.
Determination of renal plasma flow velocity (RPF)
PAH (paraaminohippuric acid)cleared by 90%
![Page 48: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/48.jpg)
Clearance of a substance that is fully filtered in the glomerulus and is not reabsorbed/secretedin tubules.
Determination of glomerular filtration rate (GFR)
Creatinine
Inulin
Guyton Hall. Textbook of Medical Physiology
Renal Clearance
![Page 49: Functional morphology of kidneys Clearance](https://reader030.vdocuments.net/reader030/viewer/2022040905/624e18005fa3e36f25384553/html5/thumbnails/49.jpg)
FF is the fraction of plasma filtered through the glomerularmembrane.
Calculation of Filtration Fraction (FF)
FF = GFRRPF
= 0.19125 ml/min650 ml/min
= ~20% of plasma is filteredin the glomerulus
Calculation of Tubular Reabsorption/Secretion
A. GFR PS > V US
B. GFR PS < V US
substance reabsorbed
substance secreted
Renal Clearance