5/28/2014

1
Chapter 26
The
Urinary System
Diaphragm
Esophagus
Left adrenal
(suprarenal) gland
Left renal vein
LEFT KIDNEY
Abdominal aorta
Inferior vena cava
LEFT URETER
Rectum
Left ovary
Uterus
RIGHT KIDNEY
RIGHT URETER
URINARY
BLADDER
URETHRA
Right renal artery
I. QUICK ANATOMY
Transverse
plane
POSTERIOR
ANTERIOR
Pancreas
Body of
L2
Liver
View
RIGHT KIDNEY
Large intestine
LEFT KIDNEY
Spleen
Rib
Stomach
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(b) Parasagittal section through right kidney
POSTERIOR ANTERIOR
Lung
SUPERIOR
Liver
Adrenal (suprarenal)
gland
Peritoneum
RENAL CAPSULE
Large intestine
Diaphragm
Right kidney
Hip bone
Parasagittal
plane
23-5





II. FUNCTIONS

A. Filter blood plasma

B. regulate blood pressure and
volume

C. regulate osmolarity of body fluids

D. renin, EPO, and calcitriol

E. regulate P
CO2
and acid-base
balance of blood

F. detoxify drugs/toxins


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III. KIDNEY
A. Cortex - filtration to form urine;

B. Medulla - collect and excrete urine

Renal capsule
Collecting duct
Minor
calyx
Nephron Renal
cortex
Renal
medulla
Renal
papilla
(a) Anterior view of dissection of right kidney
Renal cortex
Renal medulla
Renal column
Renal pyramid
in renal medulla
Renal papilla
Renal capsule
Renal artery
Renal vein
Nephron
Collecting duct
PATH OF URINE DRAINAGE:
Minor calyx
Major calyx
Renal pelvis
Ureter
Urinary bladder
Renal
hilum
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Adrenal (suprarenal) gland
(b) Anterior view
LATERAL MEDIAL
Inferior vena cava
Suprarenal arteries
Renal artery
Renal vein
KIDNEY
URETER
Renal capsule
Renal cortex
Minor calyx
Major calyx
Renal artery
Renal vein
Renal pelvis
Ureter
LATERAL MEDIAL
(b) Posterior view of dissection of left kidney
SUPERIOR
Glomerular (Bowman's) capsule
Glomerulus
Distal convoluted
tubule
Interstitial fluid
in renal cortex
Collecting duct
Interstitial fluid in
renal medulla
Papillary
duct
Dilute
urine
Loop of
Henle
Proximal convoluted tubule
Afferent arteriole
Efferent arteriole
IV. NEPHRON
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The real story:
PCT
DCT
Renal corpuscle
(external view)
Afferent
arteriole
Efferent
arteriole
Endothelium of
glomerulus
(a) Renal corpuscle (internal view)
Capsular space
Glomerular capsule
Proximal
convoluted
tubule
Glomerulus
Renal Corpuscle:
A. renal corpuscle - filters blood plasma;
consists of:

1. glomerulus

-_______________capillaries

-blood enters glomerulus via _______

-blood leaves glomerulus via _______

-no venule


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Filtration slit
1
Pedicel
Fenestration (pore) of glomerular
endothelial cell: prevents filtration of
blood cells but allows all
components of blood plasma to
pass through
Basal lamina of glomerulus:
prevents filtration of larger
proteins
Slit membrane between pedicels:
prevents filtration of medium-sized
proteins
2
3
Renal corpuscle
(external view)
Afferent
arteriole
Efferent
arteriole
Endothelium of
glomerulus
(a) Renal corpuscle (internal view)
Capsular space
Glomerular capsule
Proximal
convoluted
tubule
Glomerulus
Renal Corpuscle:


2. Bowmans (glomerular) capsule -
encloses glomerulus


3. capsular space
-separates the two layers of the capsule
-


filtrate - everything that gets pushed through the capillary
walls into the capsule










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Glomerular capsule:
(b) Renal corpuscle
1380x LM
Afferent arteriole
Efferent arteriole
Proximal convoluted
tubule
Glomerulus
Capsular
space
Simple squamous
epithelial cells
DCT
Interstitial fluid
in renal cortex
Interstitial fluid in
renal medulla
Papillary
duct
Dilute
urine
Loop of
Henle
PCT
A. renal corpuscle
B. renal tubule
B. renal tubule - adjusts solute/fluid concentrations

1. anatomy

a. starts at glomerular capsule;
ends at collecting duct
b. 3 parts:
i. proximal convoluted tubule (PCT)
ii. loop of Henle
iii. distal convoluted tubule (DCT)



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DCT
Interstitial fluid
in renal cortex
Interstitial fluid in
renal medulla
Papillary
duct
Dilute
urine
Loop of
Henle
PCT
i. PCT - simple cuboidal epithelium





ii. Loop of Henle
- thin segments:
*simple squamous epithelium
*








- thick segments:
*simple cuboidal epithelium
*



iii. DCT
-cuboidal epithelium without
microvilli;
-







ii. Loop of Henle
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B. renal tubule
1. anatomy
2. function -
a. Secretion: body into tubule

b. Reabsorption: tubule back into body
How substances move:
-- across tubular epithelium

-- into peritubular fluid

-- into peritubular vessels that surround renal tubule


tubular epithelium
peritubular
capillaries
peritubular fluid
Afferent
arteriole
Renal corpuscle Renal tubule and collecting duct
Efferent
arteriole
Reabsorption:
tubular fluid into
blood
Secretion: blood
into tubular fluid
1
2
3
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I. Quick Anatomy
II. Functions
III. Kidney
IV. Nephron
A. Renal corpuscle and glomerulus
B. Renal tubule

V. URINE FORMATION 3 steps

A. Glomerular filtration
B. Tubular reabsorption and secretion
C. Water conservation

1
2
3
Glomerular Filtration
(Interactions Animation)
Renal Filtration

You must be connected to the internet to run this animation
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The daily composition of plasma, filtrate, and urine are compared.
Glomerular Filtration
Total
Amount in
Plasma
Amount in 180 L
of filtrate (/day)
Amount
returned to
blood/d
(Reabsorbed)
Amount in
Urine (/day)
Water (passive) 3 L 180 L 178-179 L 1-2 L
Protein (active) 200 g 2 g 1.9 g 0.1 g
Glucose (active) 3 g 162 g 162 g 0 g
Urea (passive) 1 g 54 g
24 g
(about 1/2)
30 g
(about 1/2)
Creatinine 0.03 g 1.6 g
0 g
(all filtered)
1.6 g
(none reabsorbed)
1. filtration only in renal corpuscle
--

--


A. Glomerular Filtration
2. filtration pressure

a. hydrostatic pressure -

i.glomerular blood hydrostatic pressure
GBHP





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GLOMERULAR BLOOD
HYDROSTATIC
PRESSURE
(GBHP) = 55 mmHg
Proximal convoluted tubule
Capsular
space
Glomerular
(Bowman's)
capsule
Efferent arteriole
Afferent arteriole
1
2. filtration pressure

a. hydrostatic pressure -

` i.glomerular blood hydrostatic pressure
GBHP
fluid pushing through wall of glomerulus 55 mm Hg


ii. capsular hydrostatic pressure
CHP



GLOMERULAR
BLOOD
HYDROSTATIC
PRESSURE
(GBHP) = 55 mmHg
CAPSULAR
HYDROSTATIC
PRESSURE
(CHP) = 15 mmHg
Proximal convoluted tubule
Capsular
space
Glomerular
(Bowman's)
capsule
Efferent arteriole
Afferent arteriole
1 2
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b. blood colloid osmotic pressure
BCOP-




GLOMERULAR
BLOOD
HYDROSTATIC
PRESSURE
(GBHP) = 55 mmHg
CAPSULAR
HYDROSTATIC
PRESSURE
(CHP) = 15 mmHg
BLOOD COLLOID
OSMOTIC
PRESSURE
(BCOP) = 30 mmHg
NET FILTRATION PRESSURE (NFP)
= GBHP CHP BCOP
= 55 mmHg 15 mmHg 30 mmHg
= 10 mmHg
Glomerular
(Bowman's)
capsule
Efferent arteriole
Afferent arteriole
1
2
3


3. glomerular filtration rate (GFR) -
amount of filtrate produced every minute


GFR is regulated 3 ways:
a. renal autoregulation
b. neural regulation
c. hormonal regulation



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a. renal autoregulation - nephrons adjust their
own blood flow and GFR without hormonal or nervous
control



two ways:

i. muscular
I. HOW IT WORKS:

increased arterial blood pressure stretches the
afferent arteriole

arteriole constricts (reflex) and


decreased arterial blood pressure,

the afferent arteriole relaxes and

RESULT: filtration rate remains stable

ii. tubuloglomerular feedback
mechanism:

--glomerulus receives feedback from the
___________________on the status of the downstream
tubular fluid

--glomerulus adjusts filtration to regulate the
composition of the fluid and systemic blood pressure


-- juxtaglomerular apparatus
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Renal corpuscle
(external view)
Afferent arteriole
Juxtaglomerular cell
Macula densa
DCT
Mesangial cell
Efferent arteriole
Endothelium of
glomerulus
(a) Renal corpuscle (internal view)
Podocyte of visceral layer of
glomerular (Bowmans) capsule
Pedicel
Mesangial cell
Capsular space
Parietal layer of glomerular
(Bowmans) capsule
Proximal
convoluted
tubule
ii. tubuloglomerular feedback mechanism:
I. The Juxtaglomerular Apparatus
two cell types involved:

1. macula densa
--epithelial cells at end of the nephron loop and
beginning of DCT
--senses variations in flow or fluid composition and

2. juxtaglomerular (JG) cells
--smooth muscle cells in the
--respond to paracrine by
HOW IT WORKS:

If GFR rises :
1. the flow of tubular fluid increases and
less NaCl is reabsorbed so macula densa senses

2. macula densa signals JG cells to contract
which constricts afferent arteriole which


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PCT
DCT
Some stimulus
disrupts
homeostasis by
Glomerular
filtration rate
(GFR)
Receptors
Macula densa
cells of JGA
detect increased
delivery of Na+,
Cl , and water
Control center
Juxtaglomerular
apparatus
Effectors
Decrease in
GFR
Return to
homeostasis when
response brings
GFR back to normal
Increasing
Decreased
secretion
of nitric oxide
Afferent arteriole
constricts, which
decreases blood
flow through
glomerulus
Output
Input
Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
High GFR Reduced GFR
Rapid flow of
filtrate in renal tubules
Sensed by
macula densa
Constriction of
afferent arteriole
Paracrine
secretion
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If GFR falls :

1. the flow of tubular fluid decreases and
more NaCl is reabsorbed so macula densa senses


2. macula triggers afferent arterioles to
relax (dilate) which increases blood flow which
b. nervous system control of GFR -
ANS - sympathetic division

i. sympathetic nervous system
cause constriction of

reduce GFR

redirect blood to






c. hormonal regulation

i. atrial natriuretic peptide (ANP) -
hormone

--high BP in heart triggers release
--inhibits
--dilates

bottom line: ________in blood pressure


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ii. juxtaglomerular apparatus

low blood pressure triggers JG cells to release

renin catalyzes a series of chemical reactions:
result is




Renal corpuscle
(external view)
Afferent arteriole
Juxtaglomerular cell
Macula densa
Ascending limb
of loop of Henle
Mesangial cell
Efferent arteriole
Endothelium of
glomerulus
(a) Renal corpuscle (internal view)
Podocyte of visceral layer of
glomerular (Bowmans) capsule
Pedicel
Mesangial cell
Capsular space
Parietal layer of glomerular
(Bowmans) capsule
Proximal
convoluted
tubule
ii. juxtaglomerular apparatus
Angiotensin II functions:
(bottom line: restores systemic fluid volume and BP)

--system-wide vasoconstriction

--constriction of

--in PCT, increase

-- trigger production of

--increase sense of thirst



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1
2
3
Peritubular capillaries
Afferent
arteriole
Renal corpuscle Renal tubule and collecting duct
Glomerular filtration (filtration
of blood plasma by glomerulus)
Efferent
arteriole
Tubular reabsorption
from glomerular
filtrate into blood
Tubular secretion
from blood into
glomerular filtrate
Urine
(contains
excreted
substances)
Glomerulus
Glomerular
capsule
Blood
(contains
reabsorbed
substances)
1
2 3
Glomerular filtrate
in renal tubule
Fluid in
tubule
lumen
Na
+
Paracellular
reabsorption
Na
+
Transcellular
reabsorption
Apical
membrane
Na
+
Na
+
Na
+
Na
+
Na
+
ATP
ADP
Tubule
cell
Tight junction
Basolateral
membrane
Interstitial
fluid
Diffusion
Active transport
Sodiumpotassium
pump (Na
+
/K
+
ATPase)
Peritubular
capillary
Key:
5/28/2014
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DCT
Interstitial fluid
in renal cortex
Interstitial fluid in
renal medulla
Papillary
duct
Dilute
urine
Loop of
Henle
PCT
Collecting
Duct
B. Tubular Reabsorption and Secretion

1. PCT - 65% of glomerular filtrate and
100% of glucose reabsorbed here

a. microvilli

b. lots of mitochondria for transporters

c. reabsorption starts with


d. water follows solutes

e. solvent drag -

f. water and nutrients taken up by


g. 100% of _______ reabsorbed here

i. ___________________

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Fluid in
tubule
lumen
Cl

K
+
Ca
2+
Mg
2+
Urea

Peritubular
capillary
Proximal
convoluted
tubule cell
Diffusion
Osmosis
H
2
O
H
2
O
Cl

K
+
Ca
2+
Mg
2+
Urea

Fluid in
tubule
lumen
Na
+
Na
+
Na
+
Proximal
convoluted
tubule cell
Tight junction
Interstitial
fluid
Peritubular
capillary
2 Na
+
Glucose Glucose Glucose
ATP
ADP
Na
+
glucose symporter
Glucose facilitated diffusion transporter
Diffusion
Sodiumpotassium
pump
Key:
Brush border (microvilli)
Total
Amount in
Plasma
Amount in 180 L
of filtrate (/day)
Amount
returned to
blood/d
(Reabsorbed)
Amount in
Urine (/day)
Water (passive) 3 L 180 L 178-179 L 1-2 L
Protein (active) 200 g 2 g 1.9 g 0.1 g
Glucose (active) 3 g 162 g 162 g 0 g
Urea (passive) 1 g 54 g
24 g
(about 1/2)
30 g
(about 1/2)
Creatinine 0.03 g 1.6 g
0 g
(all filtered)
1.6 g
(none reabsorbed)
5/28/2014
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DCT
Interstitial fluid
in renal cortex
Interstitial fluid in
renal medulla
Papillary
duct
Dilute
urine
Loop of
Henle
PCT
Collecting
Duct
2. Loop of Henle -

-- another 25% of original filtrate volume
reabsorbed

--loop generates ____________ for water
conservation

a. thick = cuboidal actively transports
sodium and chloride out of tubule


Fluid in
tubule
lumen
Na
+
Na
+
K
+
2Cl

symporter
Diffusion
Leakage channels
Sodiumpotassium pump
Key:
Thick
ascending limb
cell
Vasa recta
Na
+
Na
+
Na
+ Na
+
ATP
ADP
Cations:
Na
+
K
+
Ca
2+
Mg
2+
Apical
membrane
(impermeable to
water)
Interstitial fluid is
more negative than
fluid in tubule lumen
Cations

2Cl

2Cl

2Cl

2Cl

K
+ K
+
5/28/2014
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b. thin squamous very permeable to
water



c. tubular fluid becomes very dilute




Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
300
400
200
100
1,200
700
900
400
600
Na
+
K
+
Cl

H2O
1
2
3
5
4
The more salt that
is pumpedout of the
ascending limb, the
saltier the ECF is in
the renal medulla.
Na
+
K
+
Cl

Na
+
K
+
Cl

Na
+
K
+
Cl

Na
+
K
+
Cl

Na
+
K
+
Cl

H2O
The saltier the fluid in the
ascending limb, the more
salt the tubule pumps into
the ECF.
The more water that leaves
the descendinglimb, the
saltier the fluid is that
remains in the tubule.
H2O
H2O
H2O
The higher the osmolarity
of the ECF, the morewater
leaves the descending limb
by osmosis.
More salt is continually
added by the PCT.
Countercurrent Multiplier
(b) Recycling of salts and urea in the vasa recta (a) Reabsorption of Na+CI and water in a long-loop juxtamedullary nephron

Glomerular (Bowmans) capsule
Afferent
arteriole
Efferent
arteriole
Glomerulus
Distal convoluted tubule
Proximal
convoluted
tubule
Symporters in thick
ascending limb cause
buildup of Na+ and Cl
Interstitial fluid
in renal medulla
300
1200
1000
800
Osmotic
gradient
600
400
H
2
O
H
2
O
H2O
200
1200
980
600 780
400 580
200 380
300
100
Loop of Henle
1200 Concentrated urine
300
300
320
400
600
800
1000
1200
800
H2O
Urea
Papillary
duct
Collecting
duct
300
500
700
900
1100
1200
400
800
1000
600
Na+CI
Blood flow
Flow of tubular fluid
Presense of Na+-K+-2CI
symporters
Interstitial
fluid in
renal cortex
320
Juxtamedullary nephron
and its blood supply
together
Vasa
recta
Loop of
Henle
H2O
H2O
H2O
H2O
H2O
H2O
H2O
1
H2O
H2O
Na+CI
Na+CI
H2O
Na+CI
H2O
Na+CI
(b) Recycling of salts and urea in the vasa recta (a) Reabsorption of Na+CI and water in a long-loop juxtamedullary nephron

Glomerular (Bowmans) capsule
Afferent
arteriole
Efferent
arteriole
Glomerulus
Distal convoluted tubule
Proximal
convoluted
tubule
Symporters in thick
ascending limb cause
buildup of Na+ and Cl
Interstitial fluid
in renal medulla
300
1200
1000
800
Osmotic
gradient
600
400
H
2
O
H
2
O
H2O
200
1200
980
600 780
400 580
200 380
300
100
Loop of Henle
1200 Concentrated urine
300
300
320
400
600
800
1000
1200
800
H2O
Urea
Papillary
duct
Collecting
duct
Countercurrent flow
through loop of Henle
establishes an osmotic
gradient
300
500
700
900
1100
1200
400
800
1000
600
Na+CI
Blood flow
Flow of tubular fluid
Presense of Na+-K+-2CI
symporters
Interstitial
fluid in
renal cortex
320
Juxtamedullary nephron
and its blood supply
together
Vasa
recta
Loop of
Henle
H2O
H2O
H2O
H2O
H2O
H2O
H2O
1
2
H2O
H2O
Na+CI
Na+CI
H2O
Na+CI
H2O
Na+CI
(b) Recycling of salts and urea in the vasa recta (a) Reabsorption of Na+CI and water in a long-loop juxtamedullary nephron

Glomerular (Bowmans) capsule
Afferent
arteriole
Efferent
arteriole
Glomerulus
Distal convoluted tubule
Proximal
convoluted
tubule
Symporters in thick
ascending limb cause
buildup of Na+ and Cl
Interstitial fluid
in renal medulla
300
1200
1000
800
Osmotic
gradient
600
400
H
2
O
H
2
O
H2O
200
1200
980
600 780
400 580
200 380
300
100
Loop of Henle
1200 Concentrated urine
300
300
320
400
600
800
1000
1200
800
H2O
Urea
Papillary
duct
Collecting
duct
Countercurrent flow
through loop of Henle
establishes an osmotic
gradient
Principal cells in
collecting duct
reabsorb more
water when ADH
is present
300
500
700
900
1100
1200
400
800
1000
600
Na+CI
Blood flow
Flow of tubular fluid
Presense of Na+-K+-2CI
symporters
Interstitial
fluid in
renal cortex
320
Juxtamedullary nephron
and its blood supply
together
Vasa
recta
Loop of
Henle
H2O
H2O
H2O
H2O
H2O
H2O
H2O
1
2
3
H2O
H2O
Na+CI
Na+CI
H2O
Na+CI
H2O
Na+CI
(b) Recycling of salts and urea in the vasa recta (a) Reabsorption of Na+CI and water in a long-loop juxtamedullary nephron

Distal convoluted tubule
300
1200
1000
800
Osmotic
gradient
600
400
H
2
O
H
2
O
H2O
200
1200
980
600 780
400 580
200 380
300
100
1200 Concentrated urine
300
300
320
400
600
800
1000
1200
800
H2O
Urea
Papillary
duct
Urea recycling
causes buildup
of urea in the
renal medulla
Collecting
duct
Principal cells in
collecting duct
reabsorb more
water when ADH
is present
300
500
700
900
1100
1200
400
800
1000
600
Na+CI
Blood flow
Flow of tubular fluid
Presense of Na+-K+-2CI
symporters
Interstitial
fluid in
renal cortex
320
H2O
H2O
H2O
H2O
H2O
H2O
H2O
3
4
H2O
H2O
Na+CI
Na+CI
H2O
Na+CI
H2O
Na+CI
5/28/2014
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d. countercurrent multiplier

i. fluid flowing in opposite directions in


ii. positive feedback loop

iii. increases salinity of medulla

iv. increases water reabsorption
Glomerular (Bowman's) capsule
Glomerulus
Distal convoluted
tubule
Interstitial
fluid in
renal
cortex
Collecting
duct
Interstitial
fluid in
renal
medulla
Papillary
duct
Dilute
urine
Loop of
Henle
Proximal
convoluted
tubule
Afferent
arteriole
300
300
350
550
750
900
750 750 550
550 350 550
300
350 150 350
100
90
80
70
65
65
Efferent
arteriole
Bottom line: beginning of DCT is very dilute urine
DCT
Papillary
duct
Dilute
urine
Loop of
Henle
PCT
Collecting
Duct
5/28/2014
25
3. DCT and collecting duct - fluid arriving contains
about 20% of original filtrate fluid

a. more water reabsorption needed


b. hormone regulation

i. aldosterone

released when systemic blood pressure is low
--
--



ii. ADH -
released when systemic blood pressure is _____

-- DCT and collecting duct become

iii. atrial natriuretic peptide -
released when systemic blood pressure is _____

--
--inhibits production of aldosterone and
ADH
--result =

PROXIMAL CONVOLUTED TUBULE
Reabsorption (into blood) of filtered:
Water 65% (osmosis)
Na+ 65% (sodiumpotassium pumps, symporters,
antiporters)
K+ 65% (diffusion)
Glucose 100% (symporters and facilitated diffusion)
Amino acids 100% (symporters and facilitated diffusion)
Cl 50% (diffusion)
HCO3
8090% (facilitated diffusion)
Urea 50% (diffusion)
Ca2+, Mg2+ variable (diffusion)
Secretion (into urine) of:
H+ variable (antiporters)
NH4
+ variable, increases in acidosis (antiporters)
Urea variable (diffusion)
Creatinine small amount
At end of PCT, tubular fluid is still isotonic to blood (300
mOsm/liter).
LOOP OF HENLE
Reabsorption (into blood) of:
Water 15% (osmosis in descending limb)
Na+ 2030% (symporters in ascending limb)
K+ 2030% (symporters in ascending limb)
CI 35% (symporters in ascending limb)
HCO3
1020% (facilitated diffusion)
Ca2+, Mg2+ variable (diffusion)
Secretion (into urine) of:
Urea variable (recycling from collecting duct)
At end of loop of Henle, tubular fluid is hypotonic (100150
mOsm/liter).
RENAL CORPUSCLE
Glomerular filtration rate: 105125
mL/min of fluid that is isotonic to
blood
Filtered substances: water and all
solutes present in blood (except
proteins) including ions, glucose,
amino acids, creatinine, uric acid
EARLY DISTAL CONVOLUTED TUBULE
Reabsorption (into blood) of:
Water 1015% (osmosis)
Na+ 5% (symporters)
CI 5% (symporters)
Ca2+ variable (stimulated by parathyroid
hormone)
LATE DISTAL CONVOLUTED TUBULE AND
COLLECTING DUCT
Reabsorption (into blood) of:
Water 59% (insertion of water channels
stimulated by ADH)
Na+ 14% (sodiumpotassium pumps
and sodium channels stimulated by
aldosterone)
HCO3
variable amount, depends on H+
secretion (antiporters)
Urea variable (recycling to loop of Henle)
Secretion (into urine) of:
K+ variable amount to adjust for dietary
intake (leakage channels)
H+ variable amounts to maintain acid
base homeostasis (H+ pumps)
Tubular fluid leaving the collecting duct is
dilute when ADH level is low and
concentrated when ADH level is
high.
Urine
5/28/2014
26
c. primary site for Ca
++
reabsorption

i. parathyroid hormone -
increases calcium reabsorption in DCT


d. secretion -






e. acid-base balance secrete H
+
or CO
2


H
2
O + CO
2
H
2
CO
3
HCO
3
-
+ H
+

Fluid in
tubule
lumen
Na
+
Na
+
Proximal
convoluted
tubule cell
Interstitial
fluid
Peritubular
capillary
Na
+
/H
+
antiporter
HCO3

facilitated diffusion transporter

Diffusion
Sodiumpotassium pump
Key:
Na
+ CA
ATP
ADP
HCO3

HCO3

HCO3

H2CO3
CO2
Na
+
H
+
H
+
Na
+
Metabolic reactions

CO2
CO2
(a) Na
+
reabsorption and H
+
secretion
H2O

DCT
Interstitial fluid
in renal cortex
Interstitial fluid in
renal medulla
Dilute
urine
Collecting
Duct
5/28/2014
27
C. Water Conservation -

1. collecting duct starts in cortex and leads
into medulla
a. many nephrons are dumping into
collecting duct
b. cd reabsorbs water and
concentrates urine

2. medulla of kidney
a. very high solute concentration;
b. water leaves collecting duct to
follow those solutes (osmosis)





Vasa
recta
300
Loop of
Henle
Juxtamedullary
nephron and its
blood supply
together
380
580
780
980
1200
800
600
400
200
100
H2O
H2O
H2O
200
300
300
320
400
600
800
1000
1200
1200
Glomerular (Bowmans) capsule
Glomerulus
Distal convoluted
tubule
Efferent
arteriole
Afferent
arteriole
Proximal
convoluted
tubule
Interstitial fluid
in renal medulla
Osmotic
gradient
Symporters in
thick ascending
limb cause
buildup of
Na+ and Cl in
renal medulla
Countercurrent
flow through loop
of Henle
establishes
osmotic gradient
300
400
600
800
1000
1200
300 320
400
600
800
1000
1200
1100
900
700
500
Principal cells in
collecting duct
reabsorb more
water when ADH
is present
Urea recycling
causes buildup
of urea in renal
medulla
Papillary duct
Concentrated urine
Collecting duct
Loop of Henle
Urea
Na+Cl
H2O
Na+Cl
H2O
Na+Cl
H2O
Na+Cl
H2O
Na+Cl
Interstitial
fluid in
renal cortex
H2O
Na+Cl
Blood flow
Presence of Na+K+2Cl
symporters
Flow of tubular fluid
1
2
3
4
H2O
H2O
H2O
H2O
H2O
H2O
H2O
(a) Reabsorption of Na+, Cl, and water in
long-loop juxtamedullary nephron
(b) Recycling of salts and urea in vasa
recta
PROXIMAL CONVOLUTED TUBULE
Reabsorption (into blood) of filtered:
Water 65% (osmosis)
Na+ 65% (sodiumpotassium pumps, symporters,
antiporters)
K+ 65% (diffusion)
Glucose 100% (symporters and facilitated diffusion)
Amino acids 100% (symporters and facilitated diffusion)
Cl 50% (diffusion)
HCO3
8090% (facilitated diffusion)
Urea 50% (diffusion)
Ca2+, Mg2+ variable (diffusion)
Secretion (into urine) of:
H+ variable (antiporters)
NH4
+ variable, increases in acidosis (antiporters)
Urea variable (diffusion)
Creatinine small amount
At end of PCT, tubular fluid is still isotonic to blood (300
mOsm/liter).
LOOP OF HENLE
Reabsorption (into blood) of:
Water 15% (osmosis in descending limb)
Na+ 2030% (symporters in ascending limb)
K+ 2030% (symporters in ascending limb)
CI 35% (symporters in ascending limb)
HCO3
1020% (facilitated diffusion)
Ca2+, Mg2+ variable (diffusion)
Secretion (into urine) of:
Urea variable (recycling from collecting duct)
At end of loop of Henle, tubular fluid is hypotonic (100150
mOsm/liter).
RENAL CORPUSCLE
Glomerular filtration rate: 105125
mL/min of fluid that is isotonic to
blood
Filtered substances: water and all
solutes present in blood (except
proteins) including ions, glucose,
amino acids, creatinine, uric acid
EARLY DISTAL CONVOLUTED TUBULE
Reabsorption (into blood) of:
Water 1015% (osmosis)
Na+ 5% (symporters)
CI 5% (symporters)
Ca2+ variable (stimulated by parathyroid
hormone)
LATE DISTAL CONVOLUTED TUBULE AND
COLLECTING DUCT
Reabsorption (into blood) of:
Water 59% (insertion of water channels
stimulated by ADH)
Na+ 14% (sodiumpotassium pumps
and sodium channels stimulated by
aldosterone)
HCO3
variable amount, depends on H+
secretion (antiporters)
Urea variable (recycling to loop of Henle)
Secretion (into urine) of:
K+ variable amount to adjust for dietary
intake (leakage channels)
H+ variable amounts to maintain acid
base homeostasis (H+ pumps)
Tubular fluid leaving the collecting duct is
dilute when ADH level is low and
concentrated when ADH level is
high.
Urine
5/28/2014
28
VI. URINE EXCRETION -

--urine is produced continually
-- storage possible thanks to

A. route:

collecting duct renal pelvis ureter bladder
urethra

1. ureter -



Frontal
plane
Anterior view of frontal section
Rugae of mucosa
Peritoneum
Trigone
Internal urethral sphincter
(involuntary)
External urethral sphincter
in deep muscles of
perineum (voluntary)
External urethral orifice
Detrusor
muscle
Internal urethral orifice
Urethra
Hip bone
(pubis)
Ureters
Ureteral openings
Sagittal
plane
Uterus
Urinary bladder
Pubic symphysis
Urethra
External urethral
orifice
Rectum
Vagina
(a) Sagittal section, female
5/28/2014
29
Sagittal
plane
Urinary bladder
(b) Sagittal section, male
Pubic symphysis
Prostate
Deep muscles of
perineum
Penis
Spongy urethra
External urethral
orifice
Testis
Scrotum
Rectum
Prostatic urethra
Membranous
urethra
2. urinary bladder - holds about 500 mL

a. detrusor muscle - contracts to
expel urine into urethra
b. internal urethral sphincter

c. external urethral sphincter


3. urethra - shorter in female;



Fig. 23.24
Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
Stretch receptors
From pons
Pelvic nerve
Urethra
S2
S3
S4
5 6 7
2
3
4
8
1
1
2
3
4
5
6
7
8
Involuntary micturition reflex
Stretch receptors detect filling
of bladder, transmit afferent
signals to spinal cord.
Signals return to bladder from
spinal cord segments S2 and S3
via parasympathetic fibers in
pelvic nerve.
Efferent signals excite
detrusor muscle.
Efferent signals relax internal
urethral sphincter. Urine is
involuntarily voided if not
inhibited by brain.
Voluntary control
For voluntary control, micturition
center in pons receives signals
from stretch receptors.
If it is timely to urinate,
pons returns signals to
spinal interneurons that
excite detrusor and relax
internal urethral sphincter.
Urine is voided.
If it is untimely to urinate,
signals from pons excite
spinal interneurons that
keep external urethral
sphincter contracted. Urine
is retained in bladder.
If it is timely to urinate, signals
from pons cease and external
urethral sphincter relaxes. Urine
is voided.
Sacral segments
of spinal cord
To pons
Motor
fiber
Sensory
fiber
Full
urinary bladder
Para-
sympathetic
ganglion in
bladder wall
Somatic motor fiber
of pudendal nerve
External urethral
sphincter (voluntary)
Internal urethral
sphincter (involuntary)
Motor fibers to
detrusor muscle
B. micturition - urination
5/28/2014
30
1. involuntary micturition reflex

a. stretch receptors in bladder sense
when bladder is full communicate with spinal cord

b. spinal cord issues a command from S2 and S3

c. detrusor muscle

d. internal urethral sphincter
2. voluntary micturition reflex

a. stretch receptors in bladder signal pons

b. if brain OKs urination detrusor muscle is
and
internal urethral sphincter is

c. if brain NOT in favor of urination
pons excites external urethral sphincter
which constricts and holds urine in bladder
until it is time to urinate