Chapter 02

Urinalysis and Body Fluids, 5th Edition
RENAL ANATOMY,
PHYSIOLOGY, AND
FUNCTION TESTING
CHAPTER 2
Copyright © 2008. F.A. Davis Company

Kidneys
 They maintain the body’s internal environment by:
 Regulating the total volume of water in the body and the total concentration
of solutes in that water (osmolality).
 Regulating the concentrations of the various ions in the extracellular fluids.
 Ensuring long-term acid-base balance.
 Excreting metabolic wastes and foreign substances.
 Producing erythropoietin and renin.
 Converting vitamin D to its active form.
 Carrying out gluconeogenesis during prolonged fasting.

Kidneys
 Location and External Anatomy
 The bean-shaped kidneys lie in a retroperitoneal position in the superior
lumbar region.
 The right kidney is crowded by the liver and lies slightly lower than the left.
 An adult’s kidney has a mass of about 150 g (5 ounces) and its average
dimensions are 11 cm long, 6 cm wide, and 3 cm thick

Kidneys
 Location and External Anatomy
 Three layers of supportive tissue surround each kidney.
 Renal fascia: anchors the kidney and the adrenal gland to surrounding
structures.
 Perirenal fat capsule: surrounds the kidney and cushions it against
blows.
 Fibrous capsule: prevents infections in surrounding regions from
spreading to the kidney
 Internal Gross Anatomy
 Frontal three distinct regions of the kidney
 Renal Cortex: Outermost
 Renal Medulla: Deep into the cortex
 Exhibits renal pyramids/medullary
 Renal columns


Nephrons
 Functional and structural unit of the kidney
 1 to 1.5 million per kidney
 Parts
 Renal Corpuscle
 Glomerulus
 The endothelium of the glomerular capillaries is fenestrated.
 The filtrate is the raw material that the renal tubules process to form
urine.
 Glomerular Capsule / Bowman’s Capsule
 Layers: (1) parietal layer, (2) visceral layer

Nephrons
 Functional and structural unit of the kidney
 1 to 1.5 million per kidney
 Parts
 Renal Tubule and Collecting Duct
 Proximal Convoluted Tubule
 Nephron Loop (formerly loop of Henle)
 Distal Convoluted Tubule


Nephrons
 Two types of nephrons
 Cortical
 Removal of waste products
 Reabsorption of filtered nutrients
 Juxtamedullary
 Longer loops of Henle
 Urine concentration

Nephrons
 Nephron Capillary Beds
 Glomerulus
 Specialized for filtration
 It differs from all other capillary beds in the body in that it is both fed and
drained by arterioles—the afferent arteriole and efferent arteriole,
respectively.
 Peritubular capillaries
 These low-pressure, porous capillaries readily absorb solutes and water
from the tubule cells.
 Vasa recta
 Plays an important role in forming concentrated urine

Nephrons
 Juxtaglomerular Complex
 Region where the most distal portion of the ascending limb of the
nephron loop lies against the afferent arteriole feeding the glomerulus
(and sometimes the efferent arteriole).
 Cells in the JGC
 Macula Densa
 Granular cells / Juxtaglomerular cells

Nephrons
 Juxtaglomerular Complex
 Cells in the JGC
 Extraglomerular mesangial cells
 These cells may pass regulatory signals between macula densa
and granular cells.

Kidney Physiology: Mechanisms of Urine

Formation
 Glomerular filtration
 takes place in the renal corpuscle and
produces a cell- and protein-free filtrate.
 Tubular reabsorption
 is the process of selectively moving
substances from the filtrate back into
the blood.
 Majority takes place in distal convulated
tubule
 Tubular secretion
 is the process of selectively moving
substances from the blood into the
filtrate.
 it occurs along the length of the tubule
and collecting duct.
Nephron Functions
 Renal blood flow
 Glomerular filtration
 Tubular reabsorption
 Tubular secretion

Renal Blood Flow
 Afferent arteriole (renal artery)
 Blood enters the glomerulus
 Efferent arteriole
 Blood leaves the glomerulus
 Peritubular capillaries
 Vasa recta/loops of Henle
 Renal vein
Blood flows through the nephron in the following
order: Afferent arteriole, peritubular capillaries,
vasa recta, efferent arteriole
Glomerular Filtration
 Definition: is a passive process in which hydrostatic pressure forces fluids and
solutes through a membrane.
 Filtration membrane
 lies between the blood and the interior of the glomerular capsule.
 allows free passage of water and solutes smaller than plasma proteins.
 Parts:
 Fenestrated endothelium: allow all blood components except blood
cells to pass through.
 Basement membrane: forms a physical barrier that blocks all but the
smallest proteins while still permitting most other solutes to pass.
 Foot processes of podocytes: If any macromolecules manage to
make it through the basement membrane, slit diaphragms—thin
membranes that extend across the filtration slits—prevent almost all of
them from traveling farther.

Glomerular Filtration
 Pressures That Affect Filtration
 Outward Pressures: promote filtrate formation.
 Hydrostatic pressure: It is the chief force pushing water and solutes out
of the blood and across the filtration membrane.
 Inward Pressures: Two inward forces inhibit filtrate formation by opposing
HPgc
 Hydrostatic pressure in the capsular space (HPcs) is the
 pressure exerted by filtrate in the glomerular capsule.

Renin-Angiotensin-Aldosterone
System (RAAS)
 Regulates blood flow
 Responds to blood pressure and plasma sodium
changes
 Juxtaglomerular apparatus
 Juxtaglomerular cells – afferent arteriole
 Macula densa – efferent arteriole
 Macula densa initiates RAAS in response to
blood pressure changes
Functions of Angiotensin II
 Dilates afferent arteriole
 Constricts efferent arteriole
 Stimulate sodium reabsorption in proximal convoluted
tubule (PCT)
 Trigger release of aldosterone
 Reabsorption of sodium in distal convoluted tubule (DCT)
and collecting duct (CD)
 Increase potassium excretion
 Trigger release of antidiuretic hormone (ADH)
 Stimulates water reabsorption in CD
Glomerular Filtrate
 Normal
 120 mL/min of filtrate
 Composition
 Ultrafiltrate of plasma
 Same composition minus plasma proteins,
protein-bound substances, and cells
 Ultrafiltrate specific gravity = 1.010

Tubular Reabsorption
 Active transport
 Cellular energy and carrier proteins needed for
transport back to blood
 Glucose, salts (Na is highest), amino acids in
proximal convoluted tubule
 Chloride in ascending loop of Henle
 Sodium in distal convoluted tubule

Tubular Reabsorption (cont’d)

 Passive transport
 Controlled by substance concentration gradients
on sides of a membrane
 Water reabsorption occurs throughout the
nephron
 Exceptionis ascending loop of Henle –
impermeable to water
 Urea in PCT and ascending loop of Henle
 Sodium in the ascending loop of Henle

Maximal Reabsorptive Capacity (Tm)

 Plasma level at which active transport ceases
 Renal threshold: plasma level causing active
transport to cease
 Normally reabsorbed substance appears in urine
 Glucose threshold = 160-180 mg/dL
 Normal blood sugar, urine glucose = tubular
damage

Tubular Concentration
 Descending loop of Henle
 Passive reabsorption of water into the highly
concentrated medulla
 Ascending loop of Henle
 Walls are impermeable to water
 Chloride actively reabsorbed
 Sodium passively reabsorbed

Tubular Concentration (cont’d)

 Countercurrent mechanism
 Maintains concentration in the medulla
 Medulla is diluted by the water from the
descending loop
 Reconcentrated by sodium and chloride from the
filtrate in the ascending loop
 DCT
 Aldosterone-controlled Na reabsorption if needed
by body
CD Reabsorption
 Final filtrate concentration
 Water reabsorption controlled by ADH in response
to body hydration
 ADH
 Controls permeability of DCT and CT walls to
water
 Amount of ADH produced by hypothalamus
determines permeability

↑Body Hydration = ↓ADH = ↑Urine
Volume ↓
↓ Body Hydration = ↑ADH = ↓Urine
Volume

Functions
 Reabsorption = filtrate to blood
 Secretion = blood to filtrate
 Eliminate nonfiltered wastes
 Protein-bound substances
 Regulate acid-base balance
 Secrete H+ ions to return filtered buffers to the blood
 Excretion of excess H+ ions

Urea and
creatinine
can be used
to determine
if the sample
is urine

↑Body Hydration = ↓ADH = ↑Urine
Volume ↓
↓ Body Hydration = ↑ADH = ↓Urine
Volume

The normal color of urine is attributed to UROCHROME


For general screening

the random urine
specimen is the most
common.
The first morning
specimen is more
concentrated than the
random.
If there is a test
request for routine
urinalysis and for
bacterial culture- 2
separate specimen
must be collected.


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Urinalysis and Body Fluids, 5th Edition

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Kidney Physiology: Mechanisms of Urine

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Tubular Reabsorption (cont’d)

Copyright © 2008. F.A. Davis Company

Maximal Reabsorptive Capacity (Tm)

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Tubular Concentration (cont’d)

Copyright © 2008. F.A. Davis Company

↑Body Hydration = ↓ADH = ↑Urine

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

↑Body Hydration = ↓ADH = ↑Urine

Copyright © 2008. F.A. Davis Company

The normal color of urine is attributed to UROCHROME

Copyright © 2008. F.A. Davis Company

For general screening

Copyright © 2008. F.A. Davis Company

Copyright © 2008. F.A. Davis Company

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