Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structure and Function of the Renal and Urologic Systems Chapter 28

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney  Kidneys  Retroperitoneal  Renal capsule  Renal fascia  Hilum

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney  Cortex  Medullary  Pyramids  Calyces  Minor and major  Renal pelvis  Lobe

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron  1.2 million nephrons per kidney  Functional unit of the kidney  Cortical nephrons  Juxtamedullary nephrons

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron  Renal corpuscle  Glomerulus  Bowman capsule  Mesangial cells  Bowman space

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Nephron

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Glomerulus

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron  Glomerular filtration membrane  Inner capillary endothelium  Basement membrane  Outer capillary epithelium Also referred to as podocytes or visceral epithelium Also referred to as podocytes or visceral epithelium Filtration slits Filtration slits  Filtrate passes through the three layers and forms the primary urine

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron  Juxtaglomerular apparatus  Juxtaglomerular cells  Macula densa

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Juxtaglomerular Apparatus

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron  Renal tubules  Proximal tubule  Loop of Henle  Distal tubule  Collecting duct  Principal cells : water & ECV…reabsorb NA+  Intercalated cells : acid-base…reabsorb K+ & HCO3-,secrete H+

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Tubule

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Blood Vessels  Renal arteries  Interlobar arteries  Arcuate arteries  Glomerular capillaries  Peritubular capillaries and vasa recta  Vasa recta  Renal veins

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney  Ureters  30 cm long  Long, intertwining muscle bundles  Pass obliquely though posterior aspect of bladder  Peristaltic activity  Micturition compresses the lower end of the ureter to avoid urine reflux

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney  Bladder  Detrusor muscle  Trigone  Micturition reflex  Urethra  Internal and external sphincters  3 to 4 cm in females  18 to 20 cm in males

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Bladder and Urethra

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Renal Blood Flow  Receive 1000 to 1200 mL of blood per minute  Glomerular filtration rate (GFR)  Autoregulation ( MAP mmHg)  Tubuloglomerular feedback

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Renal Autoregulation Renal Autoregulation

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Renal Blood Flow  Neural regulation  Celiac ganglion and splanchnic nerve  Hormones  Renin-angiotensin system  Aldosterone

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.  RAAS “Must understand”

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Function  Filters plasma  Reabsorbs and secretes  Tubular reabsorption and secretion  Forms a filtrate of protein-free fluid  Regulates the filtrate to maintain fluid volume, electrolytes, and pH

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Function  Glomerular filtration  Net filtration pressure (Table 28-1) Glomerular capillary oncotic/hydrostatic pressure Glomerular capillary oncotic/hydrostatic pressure Bowman capsule oncotic/hydrostatic pressure Bowman capsule oncotic/hydrostatic pressure  Filtration rate 180 L/day 180 L/day

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Glomerular Filtration

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Function  Tubular transport (Box 28-1)  Proximal tubule Active reabsorption of sodium Active reabsorption of sodium  Loop of Henle and distal tubule Concentration or dilution of urine Concentration or dilution of urine  Glomerulotubular balance Adjustment of reabsorption of sodium and water Adjustment of reabsorption of sodium and water

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Function

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Concentration and Dilution of Urine  Countercurrent exchange system  Contributes to production of concentrated urine  Fluid flows in opposite direction through parallel tubes  Fluid moves up and down the parallel limbs of the loop of Henle  The longer the loop, the greater the concentration gradient

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Countercurrent Exchange System

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Concentration and Dilution of Urine  Urea  Aldosterone  Antidiuretic hormone (ADH)  Atrial natriuretic peptide  Diuretics

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Acidification of urine  Hydrogen excretionAmmonia excretion excretion

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Renal Hormones  Urodilatin (natriuretic peptide)  Inhibits sodium and water reabsorption  Vitamin D  Necessary for the absorption of calcium and phosphate  Erythropoietin  Released when decreased oxygen to the kidney

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Tests of Renal Function  Clearance and glomerular filtration rate  Inulin  Creatinine  Clearance and renal blood flow  Blood tests  Plasma creatinine concentration  Blood urea nitrogen (BUN)

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Tests of Renal Function  Urodynamic tests  Cystometry, uroflowmetry, postvoid residual, electromyography, video urodynamics  Direct visualization tests  Cystoscopy, ureteroscopy

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Pediatric Renal Function  Decreased ability to remove excess water and solutes  Decreased concentrating ability  Narrow margin for fluid and electrolyte balance  Increased risk of drug toxicity

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Aging and Renal Function  Decrease in renal blood flow and GFR  Altered sodium and water balance  Number of nephrons decrease due to renal vascular and perfusion changes  Response to acid-base changes delayed  Increased risk for drug toxicity  Alterations in thirst and water intake