Renal Extra Notes

Osmolarity (mOsm/L) = concentration (mmol/L) x number of dissociable particles (particles/mol)

Osmolarity refers to the number of solute particles per 1L of solvent, whereas osmolality is the number of
solute particles by 1kg of solvent.
*osmolality is temperature independent
Total body
water (TBW)
0.6 x body
weight

Tonicity: Hypotonic solution causes a cell to swell, and

hypertonic solution causes a cell to shrink.
*Plasma and Interstitial fluid of ECF is separated only by capillary
epithelium so compositions are similar.
Differences
Plasma
Interstitial fluid
Found within vascular system
Body cells are surrounded by
of body
it
Higher [protein]
Lesser [protein]
Erythrocytes, leucocytes,
Some leucocytes
platelets
Higher [glucose]
Lesser [glucose]
Higher [AA] and [O2]
Lesser [AA] and [O2]

Extracellular
Fluid (ECF)
0.2 x body
weight

Interstitial
Fluid
3/4 of ECF

Intracellular
Fluid (ICF)
0.4 x body
weight

Plasma
1/4 of ECF

Na+ is the major cation of ECF and Cl- and HCO3- is the major anions.
K+ is the predominant cation of ICF and organic molecules and negatively charged proteins are major
anions.
Na+ / K+ concentration across the plasma membrane is maintained by the Na+-K+-ATPase (Na+ extruded
from cells in exchange for K+)
Oncotic pressure is the osmotic pressure generated by large molecules (esp. proteins) in solution.
Gross Anatomy of Kidneys: Base of the renal
pyramid originates at the corticomedullary border and
apex terminates in papilla, which lies within the minor
calyx.
Blood flow to kidneys is about 25% of cardiac output.
Macula Densa is the segment of the thick ascending
limb that touches the glomerulus.
Proximal Tubule cells have brush border and basolateral
membrane is highly invaginated containing many
mitochondria.
Collecting Duct is composed of 2 types of cells:
principal cells (few mitochondria important role in
NaCl reabsorption) and intercalated cells (regulating
acid-base balance by secreting H+ and HCO3-)
*difference between juxtaglomerular nephron (15%)
and superficial (cortical, 85%) nephron = loop of Henle
is longer in first one and efferent arterioles also from a
series of vascular called vasa recta.
Juxtaglomerular apparatus one component of
feedback mechanism
1. Macula sense of thick ascending limb
2. Extraglomerular mesangial cells
3. Renin- and angiotensin II-producing granular
cells of afferent arteriole
Glomerular Filtration Rate: equal of the sum of filtration rates of all function nephrons (index of kidney
function)
*Creatinine (by-product of skeletal muscle creatine phosphate metabolism) and inulin can be used to
measure GFR (not perfect because it is secreted to a small extent in proximal tubule)
Ranges from 90-140mL/min for M and 80-125L/min for FM. *In 24 hours, as much as 180L of plasma is
filtered by glomeruli.
For a substance to be used as an appropriate marker for GFR, it must
Be freely filtered across the filtration barrier into Bowmans space
Not be reabsorbed or secreted by nephron

Not be metabolized or produced by the kidney

Not alter GFR

Filtration Fraction (portion of filtered plasma) = GFR/RPF (renal plasma flow)

Plasma ultrafiltrate is devoid of cellular elements (RBC, WBC and platelets) and has a very low
concentration of proteins.
In healthy people, GFR is regulated by alterations in the glomerular capillary pressure which is affected by
1. Changes in afferent arteriolar R: Decrease in R Increases PGC and Increases GFR
2. Changes in efferent arteriolar R: Decrease in R decreases P GC and decreases GFR
3. Changes in renal artery pressure: Increase in pressure transiently Increases P GC and GFR
Renal

Blood Flow
Indirectly determines GFR
Modifies the rate of solute and water reabsorption by proximal tubule
Participates in concentration and dilution of urine
Delivers oxygen, nutrients, and hormones to the cells of nephron and returns CO 2 and reabsorbed
fluid and solutes to the general circulation
Delivers substrates for excretion in the urine

Two mechanisms for autoregulation of RBF and GFR

1. Myogenic mechanism: depends on the tendency of the muscle to contract when it is stretched;
when the arterial pressure rises and afferent arteriole is stretched, smooth muscle contracts =
increase in pressure is offset by increase in pressure.
2. When GFR increases and causes [NaCl] of tubular fluid at the macula densa to rise, more NaCl
enters the macula densa. This leads to formation and release of ATP and adenosine, which causes
vasoconstriction of afferent arteriole.
Note: autoregulation is absent when arterial pressure is below 90mmHg and can be altered by certain
hormones and changes in sympathetic nerve activity.
Vasoconstrictors: Sympathetic Nerves, Angiotensin II*, Endothelin
Vasodilators: Prostaglandins**, NO, Bradykinin***
*efferent arteriole is more sensitive to angiotensin II than afferent arteriole. At low concentrations,
constriction of efferent arterioles predominates GFR increases and RBF decreases. BUT at high
concentrations, constriction of both arterioles occurs and both GFR and RBF decreases.
**no effect in healthy people, but works in people with pathopsychologic conditions such as haemorrhage
***stimulates release of prostaglandins and NO
Histamine: decreases the R of afferent and efferent arterioles and so increases RBF without elevating GFR

Formation of urine involves

1. Ultrafiltration of plasma by glomerular
apparatus
2. Reabsorption of water and solutes from
the ultrafiltrate
3. Secretion of selected solutes into the
tubular fluid
Glucose, AA, proteins, blood, ketones,
leucocytes and bilirubin are NOT components of
urine from a healthy individual.
Uniport: movement of a single molecule across
the membrane using a transport protein
Symport*: movement of two or more molecules
across the membrane in the same direction
Antiport*: movement of two or more molecules
across the membrane in different directions
*at least one of the solutes is transported
against its electrochemical gradient; energy for
this is derived from the passive downhill
movement of the other molecule.
Endocytosis: movement of membrane across
the plasma membrane by a process involving
the invagination of a piece of membrane until it
completely pinches off and forms a vesicle in
the cytoplasm (form of active transport)
Picture explained
Transcellular Na+ reabsorption in proximal tubule
is in 2 steps:
1. Movement across apical membrane into
the cell down a chemical concentration
gradient
2. Movement across basolateral membrane into blood by Na+-K+-ATPase
Some of the water is reabsorbed across the paracellular pathway, dragging K+ and Ca2+ with it (solvent
drag)
Proximal Tubule: reabsorbs virtually all glucose and AA
Key element: Na+-K+-ATPase pump in basolateral membrane
In the first , Na+ reabsorbed primarily with HCO3- and other solutes and in the distal , its reabsorbed
mainly with Cl-.
Reabsorbs 67% of filtered water
Loop of Henle
Water reabsorption occurs exclusively in the descending thin limb through aquaporin-1 water channels.
Salt reabsorption across thick ascending limb occurs by both transcellular and paracellular pathways. It
does NOT reabsorb water thus reabsorption of NaCl and other solutes reduces the osmolality of tubular
fluid.
*ASCENDING LIMB is known as diluting segment
Distal Tubule and Collecting Duct
Reabsorb NaCl and water, secrete K+ and H+
Late DT and CD are composed of 2 cell types: principal cells (reabsorb Na + and secrete K+) and
intercalated cells ( - secrete H+ and reabsorbs HCO3- and K+, - secrete HCO3- and reabsorb H+ and Cl-)
Angiotensin II has a stimulatory effect on NaCl and water reabsorption.
Aldosterone stimulates NaCl reabsorption in the thick ascending limb of loop of Henle, late DT and CD. It
also stimulates K+ secretion.
Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) inhibit NaCl and water reabsorption
because the peptides are produced by a rise in blood pressure.