Abnormalities of Micturition

Atonic Bladder Caused by Destruction of Sensory

Nerve Fibers. Micturition reflex contraction cannot occur if the sensory nerve fibers from the bladder to the spinal cord are destroyed. When this happens, a person loses bladder control, despite intact efferent fibers from the cord to the bladder and despite intact neurogenic connections within the brain. Instead of emptying periodically, the bladder fills to capacity and overflows a few drops at a time through the urethra. This is called overflow incontinence. A common cause of atonic bladder is crush injury to the sacral region of the spinal cord

Abnormalities of Micturition
Automatic Bladder Caused by Spinal Cord Damage Above the Sacral Region. If the spinal

cord is damaged above the sacral region but the sacral cord segments are still intact, typical micturition reflexes can still occur. However, they are no longer controlled by the brain. If the bladder is emptied periodically by catheterization to prevent bladder injury caused by overstretching of the bladder, the excitability of the micturition reflex gradually increases until typical micturition reflexes return; then, periodic bladder emptying occurs

Reabsorption and Secretion by the Renal Tubules

Urine that is formed and all the substances in

the urine represent the sum of three basic renal processes-glomerular filtration, tubular reabsorption, and tubular secretion-as follows: Urinary excretion = glomerular filtration tubular reabsorption + tubular secretion

Filtration, Reabsorption, and Excretion Rates of Different Substances by the Kidneys

Amount Filtered
Glucose (g/day) Bicarbonate (mEq/day) 180 4,320

Amount Reabsorbed
180 4,318

Amount Excreted
0 2

% of Filtered Load Reabsorbed 100 >99.9

Sodium (mEq/day)
Chloride (mEq/day) Potassium (mEq/day) Urea (g/day) Creatinine (g/day)

25,560
19,440 756 46.8 1.8

25,410
19,260 664 23.4 0

150
180 92 23.4 1.8

99.4
99.1 87.8 50 0

tubular reabsorption is highly selective

For a substance to be reabsorbed, it must first be transported (1) across the tubular epithelial membranes into the renal interstitial fluid and then (2) through the peritubular capillary membrane back into the blood

Active Transport
Can move a solute against an electrochemical gradient Transport that is coupled directly to an energy source, primary

active transport. Sodium-potassium ATPase pump that functions throughout most parts of the renal tubule. Transport that is coupled indirectly to an energy source, such as that due to an ion gradient, is referred to as secondary active transport. Reabsorption of glucose by the renal tubule is an example of secondary active transport. Solutes can be reabsorbed by active and/or passive mechanisms by the tubule Water is always reabsorbed by a passive physical mechanism called osmosis, which means water diffusion from a region of high water concentration to one of low water concentration

Solutes Can Be Transported Through Epithelial Cells or Between Cells

Solutes can be reabsorbed or secreted across

the cells by way of the transcellular pathway or between the cells by moving across the tight junctions and intercellular spaces by way of the paracellular pathway. Water is also reabsorbed across the paracellular pathway, and substances dissolved in the water, especially potassium, magnesium, and chloride ions, are carried with the reabsorbed fluid between the cells

Basic mechanism for active transport of sodium through the tubular epithelial cell. The sodium-potassium pump transports sodium from the interior of the cell across the basolateral membrane. The low intracellular sodium concentration and the negative electrical potential cause sodium ions to diffuse from the tubular lumen into the cell through the brush border.

1. Sodium diffuses across the luminal membrane into the cell down an electrochemical gradient established by the sodium-potassium ATPase pump on the basolateral side of the membrane.
2. Sodium is transported across the basolateral membrane against an electrochemical gradient by the sodium-potassium ATPase pump. 3. Sodium, water, and other substances are reabsorbed from the interstitial fluid into the peritubular capillaries by ultrafiltration, a

passive process driven by the hydrostatic and colloid osmotic pressure gradients.

Secondary active transport

Two or more substances interact a carrier

protein and are transported together across the membrane

Secondary active transport does not require

energy directly from ATP. Rather, the direct source of the energy is that liberated by the simultaneous facilitated diffusion of another transported substance down its own electrochemical gradient

Mechanisms of secondary active transport

co-transport of glucose and amino acids along with sodium ions through the tubular epithelial cells, followed by facilitated diffusion through the basolateral membranes. counter-transport of hydrogen ions from the interior of the cell and into the tubular lumen; movement of sodium ions into the cell, down an electrochemical gradient established by the sodium-potassium pump on the basolateral membrane, provides the energy for transport of the hydrogen ions from inside the cell into the tubular lumen.

Transport Maximum for Substances That Are Actively Reabsorbed

For most substances that are actively

reabsorbed or secreted, there is a limit to the rate at which the solute can be transported, often referred to as the transport maximum This limit is due to saturation of the specific transport systems involved when the amount of solute delivered to the tubule exceeds the capacity of the carrier proteins that involved in the transport process.

 In the adult human, the transport maximum

for glucose averages about 375 mg/min The filtered load of glucose is only about 125 mg/min (GFR plasma glucose = 125 ml/min 1 mg/ml). With large increases in GFR and/or plasma glucose concentration that increase the filtered load of glucose above 375 mg/min, the excess glucose filtered is not reabsorbed and passes into the urine

 Substances that are passively reabsorbed do

not demonstrate a transport maximum

Transport of this type is referred to as

gradient-time transport because the rate of transport depends on the electrochemical gradient and the time that the substance is in the tubule, which in turn depends on the tubular flow rate.

 Some actively transported substances (e.g. sodium

reabsorption in the proximal tubule ) also have characteristics of gradient-time transport the maximum transport capacity of the basolateral sodium-potassium ATPase pump is usually far greater than the actual rate of net sodium reabsorption. This means that the greater the concentration of sodium in the proximal tubules, the greater its reabsorption rate. Also, the slower the flow rate of tubular fluid, the greater the percentage of sodium that can be reabsorbed from the proximal tubules