What is glomerular filtration?

Unless things go wrong, most of us dont spend much time thinking about what it takes to
urinate, but in fact, your kidneys and urinary system are quite amazing. Together they receive
over a liter of blood each minute, and eliminate around 1.5 litres of urine per day, efficiently
getting rid of excess water and waste products that would otherwise cause you some serious
problems.

Glomerular filtration is the first step in making urine. It is the process that your kidneys use to
filter excess fluid and waste products out of the blood into the urine collecting tubules of the
kidney, so they may be eliminated from your body.How glomerular filtration works

The first step in making urine is to separate the liquid part of your blood (plasma), which
contains all the dissolved solutes, from your blood cells. Each nephron in your kidneys has a
microscopic filter, called a glomerulus that is constantly filtering your blood.

Blood that is about to be filtered enters a glomerulus, which is a tuft of blood capillaries (the
smallest of blood vessels). The glomerulus is nestled inside a cup-like sac located at the end of
each nephron, called a glomerular capsule. Glomerular capillaries have small pores in their walls,
just like a very fine mesh sieve. Most capillary beds are sandwiched between arterioles and
venules (the small vessels delivering blood too and collecting blood from capillary beds), and the
hydrostatic pressure drops as blood travels through the capillary bed into the venules and
veins.The glomerulus, on the other hand, is sandwiched between two arterioles - afferent
arterioles deliver blood to the glomerulus, while efferent arterioles carry it away. Constriction of
efferent arterioles as blood exits the glomerulus provides resistance to blood flow, preventing a
pressure drop, which could not be achieved if blood were to flow into venules, which do not
really constrict. The two arterioles change in size to increase or decrease blood pressure in the
glomerulus. In addition, efferent arterioles are smaller in diameter than afferent arterioles. As a
result, pressurized blood enters the glomerulus through a relatively wide tube, but is forced to
exit through a narrower tube. Together, these unique features plus the fact that your heart is
supplying your kidneys with over a liter of blood per minute (around 20% of its output) maintain
a high glomerular capillary pressure capillary pressure and the filtration function of the kidney,
regardless of fluctuations in blood flow. For example, the sympathetic nervous system can
stimulate the efferent arteriole to constrict during exercise when blood flow to the kidney is
reduced.

The physical characteristics of the glomerular capillary wall determine what is filtered and how
much is filtered into the glomerular capsule. Working from the inside out, the capillary walls are
made up of three layers:

Endothelium - this has relatively large pores (70-100 nanometers in diameter), which solutes,
plasma proteins and fluid can pass through, but not blood cells.
Basement membrane - this membrane is also made up of three layers, and is fused to the
endothelial layer. Its job is to prevent plasma proteins from being filtered out of the bloodstream.

Epithelium - this layer consists of specialized cells called podocytes. These cells are attached to
the basement membrane by foot processes (pedicels). They wrap around the capillaries, but leave
slits between them, known as filtration slits. A thin diaphtagm between the slits acts as a final
filtration barrier before the fluid enters the glomerular space.

Together the glomerulus and glomerular capsule filtering unit are known as a renal corpuscle.

In addition to the unique glomerular capillary bed, the kidneys have other
specialized capillaries, called peritubular capillaries that are tiny blood
vessels that run parallel to and surround the proximal and distal tubules of the
nephron, as well as the loop of Henle, where they are known as the vasa
recta. The vasa recta is important for countercurrent exchange, the process
that concentrates urine.

The glomerular filtration rate

The rate at which kidneys filter blood is called the glomerular filtration rate.
The main driving force for the filtering process, or outward pressure is the
blood pressure as it enters the glomerulus. This is counteracted to some
extent by inward pressure due to the hydrostatic pressure of the fluid within
the urinary space, and the pressure generated by the proteins left in the
capillaries that tend to pull water back into the circulatory system (colloidal
osmotic pressure). The net filtration pressure is the outward pressure minus
the inward pressure.

Figure of a glomerular capsule with glomerular hydrostatic pressure, blood

colloid osmotic pressure, and capsular hydrostatic pressure
 How is the glomerular filtration rate regulated?
It is perfectly normal for your blood pressure to fluctuate throughout the day;
however, perhaps surprisingly, this has no effect on your glomerular filtration
rate. This is because under normal circumstances, your body can precisely
control it:

Intrinsic mechanisms:

Renal autoregulation - the kidney itself can adjust the dilation or constriction
of the afferent arterioles, which counteracts changes in blood pressure.
This intrinsic mechanism works over a large range of blood pressure, but can
malfunction if you have kidney disease.

Graph of renal autoregulation occurring between 80 and 160mm Hg mean

arterial pressures

Extrinsic mechanisms:

Neural (nervous system) control and hormonal control -

these extrinsicmechanisms can override renal autoregulation and decrease the
glomerular filtration rate when necessary. For example if you have a large
drop in blood pressure, which can happen if you lose a lot of blood, your
nervous system will stimulate contraction of the afferent arteriole, reducing
urine production. If further measures are needed your nervous system can
also activate the renin-angiotensin-aldosterone system, a hormone system that
regulates blood pressure and fluid balance.

Hormonal control - atrial natriuretic peptide is a hormone that

can increasethe glomerular filtration rate. This hormone is produced in your
heart and is secreted when your plasma volume increases, which increases
urine production.