The kidney

medical encyclopedia (www.aviva.co.uk)

The kidneys remove from blood substances that are in excess (water and salts) or
toxic (nitrogenous wastes=urea resulted from the degradation of proteins amino
groups from amino acids or drugs)
The kidneys filter off

1
5

of the volume of blood plasma per minute. The filtrate is

mainly a deproteinized plasma (everything goes to the filtrate except for proteins).
Blood cells are too big and do not cross. If in the urine there is blood that means the
nephrons are not functioning normally since red blood cells or haemoglobin passed
through) Most of the substances are reabsorbed so very few remain to be excreted
into the final urine.
Kidney structure: an exterior capsule , underneath there is the external zone called
cortex and as we move inwards the medulla (the inner core). In the medulla there
are 6-12 Malpighi pyramids (renal pyramids) that form urine. This flows into the

papilla-the space at the tip of a pyramid that opens into a minor calyx (many) that
converge into 2-3 major calyces that at their turn empty into the renal pelvis. From
here, into the ureters (one for each kdney), urinary bladder and then through
urethra, out. (see the picture above and try to identify the structures)
The kidneys have approx 2 million nephrons=functional unit of kidney localized in
the cortex-just the loop descends into the medulla.
structure of nephrons: Bowmans capsule. The afferent arteriole, part of the renal
artery, goes into the capsule, make 4-18 loops that form a glomerulus-capillary bed
of high-pressure and exits as an efferent arteriole that recapillarizes around the
convoluted tubules-low pressure capillary bed to absorb fluids from the filtrate.
Bowmans capsule together with the glomerulus are known as the Malpighi
corpuscle.
Malpighi corpuscle together with the excretory tubules=convoluted tubules and the
loop of Henle. make the nephron. Malpighi corpuscle narrows to form the proximal
convoluted tubule, loop of Henle hairpin with a descending limb and an ascending
limb, the distal convoluted tubule that empty into the collecting duct=Bertin. Vasa
recta are unbranched capillaries that are parallel to the loop of Henle and venules
carry blood into the renal vein.
So the nephron is made of excretory structures (capsule + tubules) that collects the
blood filtrate=urine and blood vessels (glomerulus+ peritubular capillaries). Mind
that the flow of blood runs from renal artery to afferent arteriole, glomerulus,
efferent arteriole, peritubular capillaries proximal, vasa recta, peritubular capillaries
distal venules renal vein.Tthe initial filtrate forms at the level of the glomerulus and
then runs down the tubules for needful substances to be reabsorbed back into the
blood into peritubular capillaries and excess or toxic substances are allowed to be
excreted along with the final urine. So, urine formation has three stages:
ultrafiltration inside the glomerulus, reabsorbtion and secretion at the levels of
excretory tubules. (see image below to get an idea how the blood vessels are
distributed outside the yellow ducts that contain the filtrate=urine)

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I.

Ultrafiltration:

The process through which all molecules with a mass <65, 000 daltons can pass
from the blood inside the glomerular capillaries into the capsule through the wall of
the capillaries that is very permeable. The pressure inside the glomerulus is 100
times greater than in other tissues and this forces plasma out of the blood. In the
blood, only proteins (mass greater than 65,000 D) and cells remain. Everything else
goes into the filtrate (primary urine)
The structure of the wall of capillaries in the glomerulus is adapted for ultrafiltration:
1. There are pores=100 nm between the cells that mak the epithelium of the
capillaries. One layer of cells only. These pores , holes, allow the fluid to
escape but not proteins and cells just like a sieve.
2. The glomerular basement membrane GBM on which cells are placed is made
from a mesh of negatively charged glycoproteins (heparan sulfate) that
blocks proteins inside because of their charge but also collagen that blocks
proteins due to their size not to their charge.
3. Podocytes are cells that have extensions that wrap around the capillaries
(extensions from adjacent podocytes) of the glomerulus and finger-like
projections called foot processes of the same podocyte. The gaps between
foot processes called slits are narrow enough to leave small molecules like
water or ions or glucose to be filtered out of blood into the glomerulus but not
large molecules like proteins. (See fig 4 in your book)
II.
A) Reabsorbtion in the proximal convoluted tubule

180 dm-3 (liters) of glomerular filtrate is formed per day but just 1.5 L is excreted
as urine. In the filtrate there is glucose and salts but no glucose is found in the
final urine and just a few of the salts filtrated. So, at the level of the proximal
convoluted tubule (it is convoluted to create the high pressure that allows for
reabsorbtion-the reverse process of the glomerulus). All glucose, amino acids
and 80% of the water, and ions such as Na + (sodium) are reabosorbed by the
time the filtrate reach the end of the proximal convoluted tubule. Na ions are
pumped out of the filtrate by proteins located in the outer membrane of the
tubule cells (active transport) and reabsorbed into the peritubular capillaries.
The active transport of Na+ out triggers the Cl- (chloride ions) out of the filtrate
due to the charge gradient created by pozitively charged sodium ions. Glucose is
co-transported into the filtrate along with Na + that move down their
concentration gradient. Once in the cells, glucose diffuse out of the filtrate and
into the peritubular capillaries (passive transport down the gradient) and sodium
ions are pumped out by proteins (against the gradient). So, glucose couples with
sodium at the glomerular level to enter the filtrate and diffuses out of the filtrate
at the level of the convoluted tubule not to be lost along with urine. If glucose is
found in urine (sweet taste of urine) a condition called glucosuria occurs that is a
symptom of diabetes mellitus. Water diffuses out of the filtrate through osmosis
and back to the blood capillaries because so many solutes have been removed
from the filtrate (sodium, chloride ions, glucose are all solutes that left so water
remained too much) and a solute gradient has been created.
III.

B) Reabsorbtion of water at the level of the loop of Henle

The loop of Henle creates a gradient of solute concentration in the medulla.

In the ascending limb Na+ are pumped out of the filtrate into the fluid surrounding
the limb called interstitial fluid. The walls of the ascending limb are IMPERMEABLE to
water so water is retained in the fluid even if in the interstitial fluid the solute
concentration is greater than in the filtrate. (water tends through osmosis to get out
of the filtrate into the fluid of the medulla but it cannot). Body fluids usually have a
concentration of 300 mOsm. The pump proteins that pump Na + out of the filtrate
can create a concentration of up to 200 mOsm so the concentration of 500 mOsm is
achievable by the functioning of the pump proteins. The cells in the walls of the
descending limb are permeable to water but impermeable to Na+(sodium ions
cannot enter down their concentration gradient only water leaves the filtrate) . As
filtrate flows down the descending limb , the increased solute concentration in the
interstitial fluid in the medulla causes water to be drawn out of the filtrate until it
reaches the same concentration as the interstitial fluid. If the concentration of the
interstitial fluid surrounding the descending limb is 500 mOsm this would also be
the concentration of the filtrate at the beginning of the limb but pumps inside the
tubular cells of the descending limb pump out Na + cause a further increase of 200
mOSm so now the solute concentration of the interstitial fluid will be 700 mOsm.
This triggers an increase in the filtrate up to 700 mOsm. Again pumps increase

concentration with other 200 mOsm so 900 mOsm are achieved...in humans the
further increase can go up to 1200 mOsm at the trough of the loop. This system
for raising solute concentration is a countercurrent multiplier system.
Countercurrent because fluids flow in opposite directions and multiplier because
progressively steeper gradients of solute concentration develop in the interstitial
fluid in the medulla. Another countercurrent happens in the vasa recta to prevent th
e blood from this vessel to dilute the concentration of the solute in the interstitial
fluid in the medulla but this vessel still carries away water removed from the filtrate
in the descending limb and some of the sodium ions in excess.

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ADH and osmoregulation

Because progressively more solutes have passed out of the filtrate along the loop of
Henle , when the filtrate enters the distal convoluted tubule, the filtrate is very
diluted (the concentration of the solute is lower than that of body fluids-it is
hypotonic)
If the solute concentration of the blood is too low (blood has much water) then a
large volume of diluted urine will be produced to get rid of the excess water and
concentrate the blood. That is because the walls of the distal convoluted tubule and
those of collecting ducts have low permeability to water so water cannot leave the
filtrate and remains to be excreted through urine.
If the solute concentration of the blood is too high (thick blood) , the blood passing
through the hypothalamus alarms sensors that order the pituitary gland to secrete a
hormone called anti-diuretic hormone or ADH. This hormone increases the
permeability of distal and collecting ducts to water so water in the filtrate is allowed
to diffuse out of the filtrate into the interstitial fluid in the medulla and then back
into the blood (vasa recta) As the filtrate passes down the collecting duct, it flows
again deep in the medulla where the concentration of the solute is high so water will
go out of the filtrate through osmosis. Water is reabsorbed along the whole length of
the collecting duct. The body produces a small amount of concentrated urine but
the blood is diluted by the water that has been reabsorbed.
Osmoregulation-=water and solute are kept in balance (a parameter of
homeostasis) achived in the kidney. See fig 8 in the book.
Aldosterone is a hormone that helps with the reabsorbtion of Na +