05/06/2018

Identify?

ANATOMY and
FUNCTIONS OF THE KIDNEY Kidney

Renal artery

Renal vein

Hilum

Ureters

Urinary bladder
Urethra

Location and Basic Structure of the Kidneys

• The KIDNEYS lie on either side of
the vertebral column

• Positioned RETROPERITONEALLY

• Enclosed in a tough, fibrous capsule

• UPPER POLE/BORDER is at the level of

the TWELFTH THORACIC VERTEBRA
(T12)

• LOWER POLE/BORDER is at the level of

the THIRD LUMBAR VERTEBRA (L3)

Location and Basic Structure of the Kidneys Location and Basic Structure of the Kidneys

NEPHROPTOSIS •The RIGHT KIDNEY is usually slightly more

caudal in position OR
also known as a
floating kidney and • The LEFT KIDNEY is usually 1.5 – 2.0 cm
renal ptosis higher than the right.

is a condition in which the

kidney descends
> 2 vertebral bodies (or >5 cm)
during a position change • the WEIGHT of each kidney:
from supine to upright
• ranges from 125 – 170 g in the adult male
from 115 – 155 g in the adult female

Treatment: Nephropexy

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Location and Basic Structure of the Kidneys
• the kidney SIZE:
Length 11- 12 cm
Width 5 – 7.5 cm
Thickness 2.5 – 3 cm
• IMPORTANCE of kidney size?
Finding of bilaterally small kidneys supports the
diagnosis of
CKD of long-standing duration,
with an irreversible component of scarring
If the kidney size is normal, it is possible that the
renal disease is acute or subacute
Location and Basic Structure of the Kidneys
Finding of bilaterally small kidneys supports the
diagnosis of
CKD of long-standing duration,
with an irreversible component of scarring
If the kidney size is normal, it is possible that the
renal disease is acute or subacute, EXCEPT
1. diabetic nephropathy
2. Amyloidosis
3. HIV nephropathy
4. Polycystic Kidney disease

Kidney Structure Kidney Structure

HILUS
- is a slit located on the medial or concave surface of each
kidney
The lateral surface of each kidney is convex
- Structures that pass through the sinus:
- RENAL PELVIS
- RENAL ARTERY and VEIN
but the MEDIAL side is deeply CONCAVE - LYMPHATIC VESSELS
- NERVE PLEXUS

This medial depression leads into a hollow

chamber, RENAL SINUS, and the entrance to
this sinus is the HILUM

Kidney Structure Kidney Structure

TWO DISTINCT REGIONS can be identified on each  MEDULLA

kidney - the inner region
- is composed of striated
 CORTEX conical masses (8 to 18) of tissue, RENAL PYRAMIDS
- pale outer region
 RENAL PYRAMIDS
 MEDULLA
- consist of multiple NEPHRONS
- darker inner region

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Kidney Structure Kidney Structure

 MEDULLA  MEDULLA
- the inner region - the inner region
- is composed of striated - is composed of striated
conical masses (8 to 18) of tissue, RENAL PYRAMIDS conical masses (8 to 18) of tissue, RENAL PYRAMIDS

 RENAL PYRAMIDS  RENAL PYRAMIDS

- consist of multiple NEPHRONS
 NEPHRON
- functional unit of the kidney
- consist of multiple NEPHRONS
- the base of each pyramid is positioned at
the corticomedullary boundary
- the apex extends toward the renal pelvis
to form a papilla (RENAL PAPILLA)

Kidney Structure Kidney Structure

 CORTEX
- is about 1 cm in thickness

- forms a cap around the medulla (over the base of each

 RENAL PAPILLA
- ON THE TIP of each papilla are small
openings (10-25) that represent the distal
ends of the collecting ducts
renal pyramid) and dips into the medulla between renal
pyramids, forming renal columns of Bertin
- the granular appearance of the cortex is due to the
random organization of tiny tubules associated with the
nephrons

Kidney Structure Kidney Structure

RENAL PELVIS RENAL PELVIS

- the expanded superior end of the ureter - subdivided into 2 or 3 tubes,

forming a funnel-shaped sac inside the MAJOR CALYCES
renal sinus
- collects the urine and passes it to the ureter - Major calyces are subdivided into several
MINOR CALYCES – drain the urine formed
by each pyramidal unit

- A series of small elevations project into the

renal sinus , RENAL PAPILLAE

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Kidney Structure Kidney Structure

URETERS
BLOOD SUPPLY
- originate from the lower portion of the renal pelvis
at the ureteropelvic junction - supplied normally by a
SINGLE RENAL ARTERY

- presence of one or more accessory renal

arteries is not uncommon

- renal artery enters the hilar region and usually

divides to form an anterior and a posterior
branch

Kidney Structure Kidney Structure

RENAL ARTERIES
interlobar arteries
RENAL ARTERY
 arcuate arteries
- which arise from the abdominal aorta, transport a  interlobular arteries
large volume of blood
 afferent arterioles
- carry 15-30% of the total cardiac output into the
kidneys (when a person is at rest)

- enter the kidneys through the hilum

Kidney Structure Kidney Structure

interlobular veins
 arcuate veins
 interlobar veins
 RENAL VEIN  RENAL VEIN – joins the inferior vena cava

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FUNCTIONS OF THE KIDNEY FUNCTIONS OF THE KIDNEY

Primary Function: To help maintain homeostasis by regulating the composition, volume, and the Several other important functions:
pH of the extracellular fluid.
PRODUCTION AND SECRETION OF HORMONE ERYTHROPOIETIN
REGULATION OF BODY FLUID VOLUME and OSMOLALITY
REGULATION OF ELECTROLYTE BALANCE ACTIVATION OF VITAMIN D
REGULATION OF ACID-BASE BALANCE converts Vit D to active form 1,25(OH) 2Vit D.
Involved in calcium homeostasis.
- This is accomplished by removing metabolic wastes from the blood and formation of URINE
MAINTAIN BLOOD VOLUME AND BLOOD PRESSURE BY SECRETING RENIN
EXCRETION OF WASTE PRODUCTS (Urea, Ammonia, drugs, toxins)

THE NEPHRON THE NEPHRON

o functional unit of the kidney • Responsible for the urine formation:

o each kidney contains about 1 million nephrons
Glomerular filtration
o consists of a renal corpuscle and a renal tubule
Tubular secretion
A renal corpuscle is composed of a tangled cluster of blood capillaries , Tubular reabsorption
GLOMERULUS
Glomerulus - surrounded by a thin-walled, sac-like structure,
GLOMERULAR CAPSULE

Overview of nephron function Urine Formation

Urine formation begins with filtration of plasma by the glomerular capillaries
GLOMERULAR FILTRATION

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Hydrostatic / Oncotic Pressure Urine Formation

GLOMERULAR FILTRATION
REVIEW:

The force of blood pressure causes

filtration to occur at capillaries throughout
the body

Most of the fluid is reabsorbed into the

blood stream by the colloid pressure of
the plasma

Urine Formation Urine Formation

GLOMERULAR FILTRATION GLOMERULAR FILTRATION

REVIEW:

In kidney, 2 capillaries work in series.

The first capillary bed is specialized only Water + disolved substances are
to filter filtered out of glomerular capillaries

Instead of forming interstitial fluid, the glomerular capsules

filtered fluid (filtrate) moves into the renal
tubule, where much of it is destined to
become urine

Urine Formation Urine Formation

GLOMERULAR FILTRATION GLOMERULAR FILTRATION

• Glomerular filtrate cross the three layers of

the glomerular barrier during filtration •Capillary endothelium

• Capillary endothelium • Basement membrane

• Basement membrane • Epithelium of Bowman’s Capsule

(Podocytes –filtration slits allow size
• Epithelium of Bowman’s Capsule (Podocytes – <60kD)
filtration slits allow size <60kD)

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Urine Formation Urine Formation

GLOMERULAR FILTRATION GLOMERULAR FILTRATION

• The ability of a molecule to cross the • produces a180 liters of fluid per day
membrane depends on size, charge, and • could not continue unless most of this filtered
shape fluid is returned or reabsorbed
• Glomerular filtrate therefore contains all
molecules not contained by the glomerular 2 additional process contribute to urine formation
barrier - it is NOT URINE YET! Tubular reabsorption
Tubular secretion

Urine Formation Urine Formation

GLOMERULAR FILTRATION GLOMERULAR FILTRATION

• FILTRATION PRESSURE
• produces a180 liters of fluid per day
Hydrostatic pressure of blood forces substances
• could not continue unless most of this filtered
through the glomerular capillary wall.
fluid is returned or reabsorbed
Consider:

• Urine output is about 1 -2 L per day Osmotic pressure of plasma in the glomerulus
Hydrostatic pressure inside glomerular capsule
• About 99% of filtrate is reabsorbed

NET FILTRATION PRESSURE

Urine Formation Urine Formation

GLOMERULAR FILTRATION REGULATION OF FILTRATION RATE

• FILTRATION RATE / GFR
directly proportional to net filtration pressure • GFR is usually relatively constant
• To help maintain homeostasis,

Factors affecting glomerular hydrostatic pressure, GFR may increase when body fluids are in excess and
glomerular plasma osmotic pressure or hydrostatic GFR may decrease when the body must conserve fluid
pressure in the glomerular capsule also affect filtration.

• ex: changes in diameters of arterioles = alter GFR

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GFR depends on diameters of afferent and efferent arterioles

Urine Formation
Glomerulus
REGULATION OF FILTRATION RATE
Afferent arteriole Efferent arteriole

• Sympathetic Nervous system reflexes

- respond to changes in blood pressure and blood volume, can alter
the GFR Glomerular filtrate

- If BP or blood volume drops sufficiently, the afferent arterioles

vasoconstrict, DECREASING GFR - less urine, conserve water Aff. Art. dilatation Eff. Art. constriction
- Afferent arteriolar vasodilation increases GFR – to counter GFR
increased blood volume or pressure

Prostaglandins, Angiotensin II (low

Kinins, Dopamine dose)
(low dose), ANP,
NO

GFR depends on diameters of afferent and efferent arterioles

Urine Formation
Glomerulus
TUBULAR REABSORPTION
Afferent arteriole Efferent arteriole

Glomerular
filtrate

GFR Eff. Art. dilatation

Aff. Art. constriction

Ang II (high dose), Angiotensin II

Noradrenaline (Symp blockade
nerves), Endothelin,
ADH, Prost. Blockade)

Urine Formation Urine Formation

TUBULAR REABSORPTION TUBULAR REABSORPTION

• occurs throughout the renal tubule,
• Peritubular capillaries provide nutrients for the
but most of it takes place in the
tubules and retrieve the fluid and substances
PROXIMAL CONVOLUTED TUBULE
the tubules reabsorb
• Peritubular capillary blood is under relatively Water
low pressure Glucose
• Plasma protein concentration is relatively high Amino Acids
Others: creatine, lactic, citric, uric and ascorbic acids;
phosphate, sulfate, calcium, potassium, sodium

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Urine Formation

TUBULAR SECRETION
• certain substances move from the plasma of blood in
the peritubular capillary into the fluid of the renal tubule.
• As a result, the amount of a particular substance
excreted in the urine may exceed the amount filtered
from the plasma in the glomerulus
•Penicillin, histamine, creatinine, phenobarbital,
hydrogen ions, ammonia, potassium

Regulation of Urine Concentration and Volume Regulation of Urine Concentration and Volume

ALDOSTERONE and ALDOSTERONE

ANTI-DIURETIC HORMONE • Secreted by the adrenal glands in response to angiotensin II or high
potassium
- stimulate additional reabsorption of sodium and water,
respectively • Acts in distal nephron to increase resorption of Na+ and Cl- and the
secretion of K+ and H+

• NaCl resorption causes passive retention of H2O

Regulation of Urine Concentration and Volume Urine Elimination

ANTI-DIURETIC HORMONE (ADH) After urine forms in the nephrons, it passes from the collecting ducts through the
openings in the renal papillae and enters the calyces of the kidney.
• Osmoreceptors in the brain (hypothalamus) sense Na+ concentration
of blood.
• High Na+ (blood is highly concentrated) stimulates posterior pituitary
to secrete ADH.
• ADH upregulates water channels on the collecting ducts of the
nephrons in the kidneys.
• This leads to increased water resorption and decrease in Na +
concentration by dilution

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Urine Elimination

Urine passes through the renal pelvis, the ureter conveys urine to the urinary bladder.
The urethra passes urine to the…

Ureters Urinary bladder

- about 25 cm long - may hold as much
as 600 ml before
stimulating pain
receptors;
-150 ml
-(urge to urinate)

Urethra is about 4 cm long in females

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