CHAPTER 6 Located at the rear of the abdominal cavity in
ANATOMY AND PHYSIOLOGY the retroperitoneum, the kidneys receive blood from the
The body takes nutrients from food and converts them to
energy. After the body has taken the food that it needs, waste
products are left behind in the bowel and in the blood.
The kidney and urinary systems keep chemicals, such as
potassium and sodium, and water in balance and remove a
tyape of waste, called urea, from the blood. Urea is produced
when foods containing protein, such as meat, poultry, and
certain vegetables, are broken down in the body. Urea is
carried in the bloodstream to the kidneys.
Other important functions of the kidneys include blood
pressure regulation and the production of erythropoietin,
which controls red blood cell production in the bone marrow.
URINARY SYSTEM PARTS AND THEIR FUNCTIONS:
• Two kidneys - a pair of purplish-brown organs
located below the ribs toward the middle of the back.
Their function is to remove liquid waste from the
blood in the form of urine; keep a stable balance of
salts and other substances in the blood; and produce
erythropoietin, a hormone that aids the formation of
red blood cells.
The kidneys remove urea from the blood through tiny
filtering units called nephrons. Each nephron consists
of a ball formed of small blood capillaries, called a
glomerulus, and a small tube called a renal tubule.
Urea, together with water and other waste
substances, forms the urine as it passes through the
nephrons and down the renal tubules of the kidney.
• Two ureters - narrow tubes that carry urine from
the kidneys to the bladder. Muscles in the ureter
walls continually tighten and relax forcing urine
downward, away from the kidneys. If urine backs up,
or is allowed to stand still, a kidney infection can
develop. About every 10 to 15 seconds, small
amounts of urine are emptied into the bladder from
the ureters.
• Bladder - a triangle-shaped, hollow organ located in
the lower abdomen. It is held in place by ligaments
that are attached to other organs and the pelvic
bones. The bladder's walls relax and expand to store
urine, and contract and flatten to empty urine
through the urethra. The typical healthy adult
bladder can store up to two cups of urine for two to
five hours.
• Two sphincter muscles - circular muscles that help
keep urine from leaking by closing tightly like a
rubber band around the opening of the bladder.
• Nerves in the bladder - alert a person when it is
time to urinate, or empty the bladder.
• Urethra - the tube that allows urine to pass outside
the body. The brain signals the bladder muscles to
tighten, which squeezes urine out of the bladder. At
the same time, the brain signals the sphincter
muscles to relax to let urine exit the bladder through
the urethra. When all the signals occur in the correct
order, normal urination occurs.
THE KIDNEYS
The kidneys are organs with several functions. They are seen
in many types of animals, including vertebrates and
some invertebrates. They are an essential part of the urinary
system and also serve homeostatic functions such as the
regulation of electrolytes, maintenance of acid-base balance,
and regulation of blood pressure.
They serve the body as a natural filter of the blood, and
remove wastes which are diverted to the urinary bladder. In
producingurine, the kidneys excrete wastes such
as urea and ammonium; the kidneys also are responsible for
the reabsorption of water, glucose, and amino acids. The
kidneys also produce hormones including calcitriol, renin,
and erythropoietin.
paired renal arteries, and drain into the paired renal veins.
Each kidney excretes urine into a ureter, itself a paired
structure that empties into the urinary bladder.
Renal physiology is the study of kidney function,
while nephrology is the medical specialty concerned
with kidney diseases. Diseases of the kidney are diverse, but
individuals with kidney disease frequently display
characteristic clinical features. Common clinical conditions
involving the kidney include thenephritic and nephrotic
syndromes, renal cysts, acute kidney injury, chronic kidney
disease, urinary tract infection, nephrolithiasis, and urinary
tract obstruction.
ANATOMY
LOCATION
In humans the kidneys are located in the abdominal cavity,
more specifically in the paravertebral gutter and lie in
a retroperitoneal position at a slightly oblique angle. There are
two, one on each side of the spine. The asymmetry within the
abdominal cavity caused by the liver typically results in the
right kidney being slightly lower than the left, and left kidney
being located slightly more medial than the right. The right
kidney sits just below the diaphragm and posterior to
the liver, the left below the diaphragm and posterior to
thespleen. Resting on top of each kidney is an adrenal gland.
STRUCTURE
The kidney has a bean-shaped structure, each kidney has
concave and convex surfaces. The concave surface, the renal
hilum, is the point at which the renal artery enters the organ,
and the renal vein and ureterleave. The kidney is surrounded
by tough fibrous tissue, the renal capsule, which is itself
surrounded byperinephric fat, renal fascia (of Gerota)
and paranephric fat. The anterior (front) border of these
tissues is theperitoneum, while the posterior (rear) border is
the transversalis fascia.
The superior border of the right kidney is adjacent to the liver;
and the spleen, for the left border. Therefore, both move
down on inhalation.
BLOOD SUPPLY
The kidneys receive blood from the renal arteries, left and
right, which branch directly from the abdominal aorta. Despite
their relatively small size, the kidneys receive approximately
20% of the cardiac output.
PHYSIOLOGY
Excretion of wastes
The kidneys excrete a variety of waste products produced
by metabolism. These include the nitrogenous wastes urea,
from protein catabolism, and uric acid, from nucleic
acid metabolism.
Acid-base homeostasis
Two organ systems, the kidneys and lungs, maintain acid-
base homeostasis, which is the maintenance of pH around a
relatively stable value. The kidneys contribute to acid-base
homeostasis by regulating bicarbonate (HCO3-) concentration.
The kidneys have two important roles in the maintaining of
the acid-base balance: to reabsorb bicarbonate from and to
excrete hydrogen ions into urine
Osmolality regulation
Any significant rise in plasma osmolality is detected by
the hypothalamus, which communicates directly with
the posterior pituitary gland. An increase in osmolality causes
the gland to secreteantidiuretic hormone (ADH), resulting in
water reabsorption by the kidney and an increase in urine
concentration. The two factors work together to return the
plasma osmolality to its normal levels.
ADH binds to principal cells in the collecting duct that
translocate aquaporins to the membrane allowing water to
leave the normally impermeable membrane and be
reabsorbed into the body by the vasa recta, thus increasing
the plasma volume of the body.
There are two systems that create a hyperosmotic medulla
and thus increase the body plasma volume: Urea recycling
and the 'single effect.'
Urea is usually excreted as a waste product from the kidneys.
However, when plasma blood volume is low and ADH is
released the aquaporins that are opened are also permeable
to urea. This allows urea to leave the collecting duct into the
medulla creating a hyperosmotic solution that 'attracts' water.
Urea can then re-enter the nephron and be excreted or
recycled again depending on whether ADH is still present or
not.
The 'Single effect' describes the fact that the ascending thick
limb of the loop of Henle is not permeable to water but is
permeable to NaCl. This means that a countercurrent system
is created whereby the medulla becomes increasingly
concentrated setting up an osmotic gradient for water to
follow should the aquaporins of the collecting duct be opened
by ADH.
Blood pressure regulation
Long-term regulation of blood pressure predominantly
depends upon the kidney. This primarily occurs through
maintenance of the extracellular fluid compartment, the size
of which depends on the plasma sodium concentration.
Although the kidney cannot directly sense blood pressure,
changes in the delivery of sodium and chloride to the distal
part of the nephron alter the kidney's secretion of the
enzyme renin. When the extracellular fluid compartment is
expanded and blood pressure is high, the delivery of these
ions is increased and renin secretion is decreased. Similarly,
when the extracellular fluid compartment is contracted and
blood pressure is low, sodium and chloride delivery is
decreased and renin secretion is increased in response.
Renin is the first in a series of important chemical messengers
that comprise the renin-angiotensin system. Changes in renin
ultimately alter the output of this system, principally the
hormonesangiotensin II and aldosterone. Each hormone acts
via multiple mechanisms, but both increase the kidney's
absorption of sodium chloride, thereby expanding the
extracellular fluid compartment and raising blood pressure.
When renin levels are elevated, the concentrations of
angiotensin II and aldosterone increase, leading to increased
sodium chloride reabsorption, expansion of the extracellular
fluid compartment, and an increase in blood pressure.
Conversely, when renin levels are low, angiotensin II and
aldosterone levels decrease, contracting the extracellular fluid
compartment, and decreasing blood pressure.
Hormone secretion
The kidneys secrete a variety of hormones,
including erythropoietin, and the
enzyme renin. Erythropoietin is released in response
to hypoxia (low levels of oxygen at tissue level) in the renal
circulation. It stimulates erythropoiesis (production of red
blood cells) in the bone marrow. Calcitriol, the activated form
of vitamin D, promotes intestinal absorption of calcium and
the renal reabsorption ofphosphate. Part of the renin-
angiotensin-aldosterone system, renin is an enzyme involved
in the regulation of aldosterone levels.
THE NEPHRONS
Nephron is the basic structural and functional unit of
the kidney. Its chief function is to regulate the concentration
of water and soluble substances like sodium salts by filtering
the blood, reabsorbing what is needed and excreting the rest
asurine. A nephron eliminates wastes from the body,
regulates blood volume and blood pressure, controls levels
of electrolytes and metabolites, and regulates blood pH. Its
functions are vital to life and are regulated by the endocrine
system by hormones such as antidiuretic
hormone,aldosterone, and parathyroid hormone. In humans, a
normal kidney contains 800,000 to 1.5 million nephrons.
ANATOMY
Each nephron is composed of an initial filtering component
(the "renal corpuscle") and a tubule specialized for
reabsorption and secretion (the "renal tubule"). The renal
corpuscle filters out large solutes from the blood, delivering
water and small solutes to the renal tubule for modification.
Renal corpuscle
Composed of a glomerulus and the Bowman's capsule,
the renal corpuscle is the beginning of the nephron. It is the
nephron's initial filtering component.
The glomerulus is a capillary tuft that receives its blood
supply from an afferent arteriole of the renal circulation. The
glomerular blood pressure provides the driving force for water
and solutes to be filtered out of the blood and into the space
made by Bowman's capsule. The remainder of the blood (only
approximately 1/5 of all plasma passing through the kidney is
filtered through the glomerular wall into the Bowman's
capsule) passes into the narrower efferent arteriole. It then
moves into the vasa recta, which are collecting capillaries
intertwined with the convoluted tubules through the
interstitial space, in which the reabsorbed substances will also
enter. This then combines with efferent venules from other
nephrons into the renal vein, and rejoins the main
bloodstream.
The Bowman's capsule, also called the glomerular capsule,
surrounds the glomerulus. It is composed of a visceral inner
layer formed by specialized cells called podocytes, and a
parietal outer layer composed of a single layer of flat cells
called simple squamous epithelium. Fluids from blood in the
glomerulus are filtered through the visceral layer of
podocytes, and the resulting glomerular filtrate is further
processed along the nephron to form urine.
Renal tubule
The renal tubule is the portion of the nephron containing
the tubular fluid filtered through the glomerulus. After passing
through the renal tubule, the filtrate continues to
the collecting duct system, which is not part of the nephron.
The components of the renal tubule are:
Proximal convoluted tubule
Loop of Henle
Descending limb of loop of Henle
Ascending limb of loop of Henle
Thin ascending limb of loop of Henle
Thick ascending limb of loop of Henle
Distal convoluted tubule
PHYSIOLOGY
The nephron carries out nearly all of the kidney's functions.
Most of these functions concern
the reabsorption and secretion of various solutes such
as ions (e.g., sodium), carbohydrates (e.g., glucose),
and amino acids (e.g., glutamate). Properties of the cells that
line the nephron change dramatically along its length;
consequently, each segment of the nephron has highly
specialized functions.
The proximal tubule as a part of the nephron can be divided
into an initial convoluted portion and a following straight
(descending) portion.[5] Fluid in the filtrate entering the
proximal convoluted tubule is reabsorbed into the peritubular
capillaries, including approximately two-thirds of the filtered
salt and water and all filtered organic solutes
(primarily glucose and amino acids).
The loop of Henle, also called the nephron loop, is a U-shaped
tube that extends from the proximal tubule. It consists of a
descending limb and ascending limb. It begins in the cortex,
receiving filtrate from the proximal straight tubule, extends
into the medulla as the descending limb, and then returns to
the cortex as the ascending limb to empty into the distal
convoluted tubule. The primary role of the loop of Henle is to
concentrate the salt in the interstitium, the tissue surrounding
the loop.
Considerable differences distinguish the descending and
ascending limbs of the loop of Henle. The descending limb is
permeable to water and noticeably less impermeable to salt,
and thus only indirectly contributes to the concentration of
the interstitium. As the filtrate descends deeper into
the hypertonic interstitium of the renal medulla, water flows
freely out of the descending limb byosmosis until the tonicity
of the filtrate and interstitium equilibrate. Longer descending
limbs allow more time for water to flow out of the filtrate, so
longer limbs make the filtrate more hypertonic than shorter
limbs.
Unlike the descending limb, the ascending limb of Henle's
loop is impermeable to water, a critical feature of
the countercurrent exchange mechanism employed by the
loop. The ascending limb actively pumps sodium out of the
filtrate, generating the hypertonic interstitium that drives
countercurrent exchange. In passing through the ascending
limb, the filtrate grows hypotonic since it has lost much of its
sodium content. This hypotonic filtrate is passed to the distal
convoluted tubule in the renal cortex.
The distal convoluted tubule has a different structure and
function to that of the proximal convoluted tubule. Cells lining
the tubule have numerous mitochondria to produce enough
energy (ATP) for active transport to take place. Much of the
ion transport taking place in the distal convoluted tubule is
regulated by the endocrine system. In the presence
of parathyroid hormone, the distal convoluted tubule
reabsorbs more calcium and excretes more phosphate.
When aldosterone is present, more sodium is reabsorbed and
more potassium excreted. Atrial natriuretic peptide causes
the distal convoluted tubule to excrete more sodium. In
addition, the tubule also
secernates hydrogen and ammonium to regulate pH.
After traveling the length of the distal convoluted tubule, only
about 1% of water remains, and the remaining salt content is
negligible.
THE GLOMERULUS
A glomerulus is a capillary tuft that performs the first step in
filtering blood to form urine. It is surrounded by Bowman's
capsule in nephrons of the vertebrate kidney. It receives its
blood supply from an afferent arteriole of the renal circulation.
Unlike most other capillary beds, the glomerulus drains into
an efferent arteriole rather than a venule. The resistance of
the arterioles results in high pressure in the glomerulus,
aiding the process of ultrafiltration, where fluids and soluble
materials in the blood are forced out of the capillaries and
intoBowman's capsule.