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Structure and Function of
the Renal and Urologic
Systems
Chapter 35


                            1
Structures of the Kidney
        Kidneys
                 Retroperitoneal
                 Renal capsule
                 Renal fascia
                 Hilum




                                                      2
Mosby items and derived items © 2006 by Mosby, Inc.
Structures of the Kidney




                                                      3
Mosby items and derived items © 2006 by Mosby, Inc.
Structures of the Kidney
        Renal cortex
        Renal medulla
        Renal pyramids
        Renal columns
        Minor calyx
        Major calyx
        Renal pelvis
                                                      4
Mosby items and derived items © 2006 by Mosby, Inc.
Structures of the Kidney




                                                      5
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Nephron
        1.2 million nephrons per kidney
        Functional unit of the kidney
                 Superficial cortical nephrons
                 Midcortical nephrons
                 Juxtamedullary nephrons




                                                      6
Mosby items and derived items © 2006 by Mosby, Inc.
Nephron
        Renal corpuscle
                 Glomerulus
                 Bowman capsule
                 Mesangial cells
        Bowman space



                                                      7
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Nephron
        Glomerular filtration membrane
                 Glomerular endothelium
                 Basement membrane
                 Capillary epithelium
                           Also referred to as podocytes or visceral epithelium
                           Filtration slits




                                                                                  8
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Nephron
        Juxtaglomerular apparatus
                 Juxtaglomerular cells
                 Macula densa




                                                      9
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Juxtaglomerular Apparatus




                                                      10
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Nephron
        Renal tubules
                 Proximal tubule
                 Loop of Henle
                 Distal tubule
                 Collecting duct
                 Principal cells
                 Intercalated cells

                                                      11
Mosby items and derived items © 2006 by Mosby, Inc.
Structures of the Kidney




                                                      12
Mosby items and derived items © 2006 by Mosby, Inc.
Structures of the Kidney




                                                      13
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Blood Vessels
        Renal arteries
        Interlobar arteries
        Arcuate arteries
        Interlobular arteries
        Afferent arterioles
        Glomerular capillaries
        Efferent arterioles
        Peritubular capillaries and vasa recta
                                                      14
Mosby items and derived items © 2006 by Mosby, Inc.
Structures of the Kidney




                                                      15
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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


                                                                 16
Mosby items and derived items © 2006 by Mosby, Inc.
Structures of the Kidney
        Bladder
                 Detrusor muscle
                 Transitional epithelium
                 Trigone
                 Micturition reflex
        Urethra
                 Internal and external sphincters
                 3 to 4 cm in females
                 18 to 20 cm in males

                                                      17
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Bladder and Urethra




                                                      18
Mosby items and derived items © 2006 by Mosby, Inc.
Renal Blood Flow
        Receive 1000 to 1200 mL of blood per minute
        Glomerular filtration rate (GFR)
        Autoregulation
                 Myogenic mechanism
                 Tubuloglomerular feedback
        Neural regulation
        Hormones
                 Renin-angiotensin system
                 Natriuretic peptides

                                                      19
Mosby items and derived items © 2006 by Mosby, Inc.
Renal Blood Flow




                                                      20
Mosby items and derived items © 2006 by Mosby, Inc.
Nephron Function
        Glomerular filtration
                 Net filtration pressure
                           Glomerular hydrostatic pressure
                           Capsular hydrostatic pressure
                           Blood oncotic pressure
                 Filtration rate




                                                             21
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Glomerular Filtration




                                                      22
Mosby items and derived items © 2006 by Mosby, Inc.
Nephron Function
        Tubular reabsorption
        Tubular secretion
        Excretion
        Tubular transport
                 Proximal tubule
                 Loop of Henle and distal tubule
                 Glomerulotubular balance

                                                      23
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Nephron Function




                                                      24
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Nephron Function




                                                      25
Mosby items and derived items © 2006 by Mosby, Inc.
Nephron Function




                                                      26
Mosby items and derived items © 2006 by Mosby, Inc.
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

                                                                  27
Mosby items and derived items © 2006 by Mosby, Inc.
Countercurrent Exchange System




                                                      28
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Concentration and Dilution of
Urine
        Urea
        Catecholamines
        Antidiuretic hormone (ADH)
        Urodilantin
        Natriuretic peptide
        Diuretics


                                                      29
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Renal Hormones
        Vitamin D
        Erythropoietin




                                                      30
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Tests of Renal Function
        Clearance and glomerular filtration rate
                 Inulin
                 Creatinine
        Clearance and renal blood flow
        Blood tests
                 Plasma creatinine concentration
                 Plasma cystatin C concentration
                 Blood urea nitrogen (BUN)

                                                      31
Mosby items and derived items © 2006 by Mosby, Inc.
Tests of Renal Function
        Urinalysis
                 Urine color
                 Urine pH
                 Specific gravity
                 Urine sediment
                           RBCs
                           Casts
                           Crystals
                           WBCs

                                                      32
Mosby items and derived items © 2006 by Mosby, Inc.
Tests of Renal Function
        Urinalysis
                 Reagent strips (dipsticks)
                           Glucose
                           Bilirubin
                           Urobilinogen
                           Leukocyte esterase
                           Nitrates
                           Ketones
                           Proteins
                           RBCs, hemoglobin, and myoglobin
                                                             33
Mosby items and derived items © 2006 by Mosby, Inc.
Aging and Renal Function
        Decrease in kidney size
        Decrease in renal blood flow and GFR
        Number of nephrons decrease due to renal
        vascular and perfusion changes
        Glomerular capillaries atrophy
        Tubular transport response decreases
        Increased bladder symptoms
                 Urgency, frequency, and nocturia
                                                      34
Mosby items and derived items © 2006 by Mosby, Inc.

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Review Anatomy And Physiology Kidney

  • 1. Structure and Function of the Renal and Urologic Systems Chapter 35 1
  • 2. Structures of the Kidney Kidneys Retroperitoneal Renal capsule Renal fascia Hilum 2 Mosby items and derived items © 2006 by Mosby, Inc.
  • 3. Structures of the Kidney 3 Mosby items and derived items © 2006 by Mosby, Inc.
  • 4. Structures of the Kidney Renal cortex Renal medulla Renal pyramids Renal columns Minor calyx Major calyx Renal pelvis 4 Mosby items and derived items © 2006 by Mosby, Inc.
  • 5. Structures of the Kidney 5 Mosby items and derived items © 2006 by Mosby, Inc.
  • 6. Nephron 1.2 million nephrons per kidney Functional unit of the kidney Superficial cortical nephrons Midcortical nephrons Juxtamedullary nephrons 6 Mosby items and derived items © 2006 by Mosby, Inc.
  • 7. Nephron Renal corpuscle Glomerulus Bowman capsule Mesangial cells Bowman space 7 Mosby items and derived items © 2006 by Mosby, Inc.
  • 8. Nephron Glomerular filtration membrane Glomerular endothelium Basement membrane Capillary epithelium Also referred to as podocytes or visceral epithelium Filtration slits 8 Mosby items and derived items © 2006 by Mosby, Inc.
  • 9. Nephron Juxtaglomerular apparatus Juxtaglomerular cells Macula densa 9 Mosby items and derived items © 2006 by Mosby, Inc.
  • 10. Juxtaglomerular Apparatus 10 Mosby items and derived items © 2006 by Mosby, Inc.
  • 11. Nephron Renal tubules Proximal tubule Loop of Henle Distal tubule Collecting duct Principal cells Intercalated cells 11 Mosby items and derived items © 2006 by Mosby, Inc.
  • 12. Structures of the Kidney 12 Mosby items and derived items © 2006 by Mosby, Inc.
  • 13. Structures of the Kidney 13 Mosby items and derived items © 2006 by Mosby, Inc.
  • 14. Blood Vessels Renal arteries Interlobar arteries Arcuate arteries Interlobular arteries Afferent arterioles Glomerular capillaries Efferent arterioles Peritubular capillaries and vasa recta 14 Mosby items and derived items © 2006 by Mosby, Inc.
  • 15. Structures of the Kidney 15 Mosby items and derived items © 2006 by Mosby, Inc.
  • 16. 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 16 Mosby items and derived items © 2006 by Mosby, Inc.
  • 17. Structures of the Kidney Bladder Detrusor muscle Transitional epithelium Trigone Micturition reflex Urethra Internal and external sphincters 3 to 4 cm in females 18 to 20 cm in males 17 Mosby items and derived items © 2006 by Mosby, Inc.
  • 18. Bladder and Urethra 18 Mosby items and derived items © 2006 by Mosby, Inc.
  • 19. Renal Blood Flow Receive 1000 to 1200 mL of blood per minute Glomerular filtration rate (GFR) Autoregulation Myogenic mechanism Tubuloglomerular feedback Neural regulation Hormones Renin-angiotensin system Natriuretic peptides 19 Mosby items and derived items © 2006 by Mosby, Inc.
  • 20. Renal Blood Flow 20 Mosby items and derived items © 2006 by Mosby, Inc.
  • 21. Nephron Function Glomerular filtration Net filtration pressure Glomerular hydrostatic pressure Capsular hydrostatic pressure Blood oncotic pressure Filtration rate 21 Mosby items and derived items © 2006 by Mosby, Inc.
  • 22. Glomerular Filtration 22 Mosby items and derived items © 2006 by Mosby, Inc.
  • 23. Nephron Function Tubular reabsorption Tubular secretion Excretion Tubular transport Proximal tubule Loop of Henle and distal tubule Glomerulotubular balance 23 Mosby items and derived items © 2006 by Mosby, Inc.
  • 24. Nephron Function 24 Mosby items and derived items © 2006 by Mosby, Inc.
  • 25. Nephron Function 25 Mosby items and derived items © 2006 by Mosby, Inc.
  • 26. Nephron Function 26 Mosby items and derived items © 2006 by Mosby, Inc.
  • 27. 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 27 Mosby items and derived items © 2006 by Mosby, Inc.
  • 28. Countercurrent Exchange System 28 Mosby items and derived items © 2006 by Mosby, Inc.
  • 29. Concentration and Dilution of Urine Urea Catecholamines Antidiuretic hormone (ADH) Urodilantin Natriuretic peptide Diuretics 29 Mosby items and derived items © 2006 by Mosby, Inc.
  • 30. Renal Hormones Vitamin D Erythropoietin 30 Mosby items and derived items © 2006 by Mosby, Inc.
  • 31. Tests of Renal Function Clearance and glomerular filtration rate Inulin Creatinine Clearance and renal blood flow Blood tests Plasma creatinine concentration Plasma cystatin C concentration Blood urea nitrogen (BUN) 31 Mosby items and derived items © 2006 by Mosby, Inc.
  • 32. Tests of Renal Function Urinalysis Urine color Urine pH Specific gravity Urine sediment RBCs Casts Crystals WBCs 32 Mosby items and derived items © 2006 by Mosby, Inc.
  • 33. Tests of Renal Function Urinalysis Reagent strips (dipsticks) Glucose Bilirubin Urobilinogen Leukocyte esterase Nitrates Ketones Proteins RBCs, hemoglobin, and myoglobin 33 Mosby items and derived items © 2006 by Mosby, Inc.
  • 34. Aging and Renal Function Decrease in kidney size Decrease in renal blood flow and GFR Number of nephrons decrease due to renal vascular and perfusion changes Glomerular capillaries atrophy Tubular transport response decreases Increased bladder symptoms Urgency, frequency, and nocturia 34 Mosby items and derived items © 2006 by Mosby, Inc.