I.

ANATOMY AND PHYSIOLOGY

Kidney
The kidneys are bean-shaped organs, each about the size of tightly clenched fist.
They lie on the posterior abdominal wall behind the peritoneum to either side of the
vertebral column. A connective tissue renal capsule surrounds each kidney. Around the
renal capsule is a thick layer of fat called the renal fat pad, which protects the kidney
from mechanical shock.
On the medial side of each kidney is the hilum (hilum; a small amount), where
the renal artery and nerves enter the renal vein and ureter exit the kidney. The hilum
opens into a cavity called the renal sinus, which is filled with fat and connective tissue.).
Within the renal sinus the urinary channel is enlarged to form the renal pelvis (basin)
several funnel-shaped structures called calyses (flower petals; singular calyx) extend
from the renal pelvis to the kidney tissue. At the hilum the renal pelvis narrows to form
the ureter (ur-reter).
The kidney is divided into an outer cortex and inner medulla. The medulla
consists of a number of cone-shaped renal pyramids. The base of each renal pyramid
extends into the cortex, and the apex of each pyramid projects into the medulla, where a
calyx surrounds its tip.
The functional unit of the kidney is the nephron (nefron)), which consists of an
enlarged terminal end called renal corpuscle, a proximal convulated tubule, a loop of
Henle and a distal convoluted ubule. The distal convoluted tubule empties into a
collecting duct, which carries urine from the cortex of the kidney to a calyx. The renal
corpuscle and both convoluted tubules are in the renal cortex. The collecting tubule and
loop of Henle enter the medulla. About one third of the 1.3 million nephrons in each
kidney must be functional to ensure survival.
The renal corpuscle of the nephron consists of Bowmans capsule and the
glomerulus (glo-meru-lus). The wall of Bowmans capsule is indented to form a double-
walled chamber. A tuft of capillaries called the glomerulus, which resembles a ball of
yarn, occupies the indentation. The cavity of Bowmans capsule opens into a proximal
convoluted tubule, which carries away fluid from the capsule. The inner layer of
Bowmans capsule surrounds the glomerulus and consists of specialized cells called
podocytes (podo-sitz).
The glomerular capillaries have pores in their walls, and the podocytes have gaps
between them. The walls of the glomerular capillaries, the podocytes and the basement
membrane between them form a filtration membrane.
In the first step of urine formation, fluid called filtrate is filtered from the
glomerular capillaries into Bowmans capsule through the filtration membrane. After
entering the Bowmans capsule, filtrate flows into the proximal convoluted tubule. From
there, filtrate flows into the loop of Henle, which is a continuation of the proximal
convoluted tubules. Each loop has a descending limb, which extends forward the renal
sinus and an ascending limb, which extends back towards the cortex.
The ascending limb of Henles loop gives rise to the distal convoluted tubule,
which joins a collecting duct. The collecting duct extends from the cortex to the medulla
and empties its contents into the calyx. A large portion of the descending limb has very
thin walls, as it is made up of simple squamous epithelium. The remainder of the nephron
and collecting duct is made up of simple cuboidal epithelium.
Arteries and Veins
The kidney is highly vascularized organ. The artery supplies the two kidneys.
They process the blood passing through them before returning to the circulation. 20%-
25% of the total cardiac output goes to the kidney. 90% of which circulate through the
cortex and 20% goes to the medulla.

Abdominal Artery Renal Artery Lobar Artery Interlobar Artery

Arcuate Artery Interlobular Artery Afferent Arterioles
Glomerular Capillary Loop Efferent Arteriole Peritubule Capillary
Renal Veins Renal Sinuses Juxtaglomerular apparatus

The renal arteries branch off the abdominal aorta and enter the renal sinus of
each kidney. The renal arteries give rise to branches to several interlobar arteries, which
pass between the renal pyramids. The interlobar arteries, in turn, give rise to arteries that
turn and project between the cortex and medulla, the arcuate arteries. Interlobular
arteries branch off the arcuate arteries to project into the cortex. The afferent arterioles
arise from the branches of the interlobular arteries and extend to glomerular capillaries.
Efferent arteries extend from glomerular capillaries to the peritubular capillaries,
which surround the proximal and distal convoluted tubules and the loop o Henle. Blood
from the peritubular capillaries enters the renal veins into the renal sinus. The veins of the
kidney run parallel to the arteries and have similar names.
A specialized structure called the juxtaglomerular apparatus is formed where
the distal convoluted tubule and the afferent arteriole and the efferent arteriole of a
nephron. The specialized walls of the afferent arteriole and the distal convoluted tubule
come into contact to form the juxtaglomerular apparatus

URINE PRODUCTION
The chief functions of the kidney are to process blood plasma and excrete urine,
which are life-preserving functions because homeostasis depends on it. For example, the
kidneys are the most important organs in the body for maintaining fluid-electrolyte and
acid-base balance. They do this by varying the amount of water and electrolytes leaving
the blood in the urine so that they equal the amounts of these substances entering the
blood from other various avenues.
Urine is mostly water and contains organic waste products such as urea, uric acid
and creatinine. Here are just a few of the blood constituents that cannot be held within
their normal concentration ranges if the kidneys fail:
Sodium
Potassium
Chloride
Nitrogenous waste (especially urea)
In short, kidney failure means homeostatic failure and if not relieved, inevitable
death may occur.
In addition to processing blood plasma and forming urine, the kidney also
performs other important functions. They influence the rate of secretion of the hormone
ADH (anti-diuretic hormone) and aldosterone and synthesize the hormone erythropoietin,
the active form of Vitamin D and certain prostaglandin.
The three processes critical to the formation of urine are filtration, reabsorption,
and secretion.
1. Filtration is the movement of plasma across the filtration membrane of the
renal corpuscle. Blood cells and large molecules such as proteins cannot cross the
filtration membrane. The portion of the plasma entering the nephron becomes the
filtrate.
2. Tubular reabsorption is the movements of substances from the filtrate back
into the blood of the peritubular capillaries. In general, the useful substances that
enter the filtrate are reabsorbed, and metabolic waste products remain in the
filtrate and are eliminated. For example, when proteins are metabolized, ammonia
is a by-product. The ammonia is converted into urea by the liver. The urea forms
part of the filtrate and is eliminated in the urine.
3. Tubular secretion is the transport of substances, usually waste products, into
the filtrate. Therefore, urine produced by the nephrons consists of the substances
that are filtered and secreted into the nephron minus those substances that are
reabsorbed.
These three mechanisms are used in concert to process blood plasma and form urine.
First, a hydrostatic pressure gradient drives the filtration of much plasma into the
nephron. Since the filtrate contains the materials that the body must conserve (save), the
walls of tubules starts to reabsorbed those materials back in the blood. As the filtrate
(urine) begins to leave nephron, the kidney may secrete a few last minute items into the
urine for secretion. In short, the kidney does not selectively filter out much of the plasma,
and then reabsorbs what should not be thrown out before the filtrate reaches the end of
the tubules and become urine. This mechanism allows very fine adjustment to blood
homeostasis.