RESPIRATION

The lungs, ventilation &

its control

ALTERATIONS IN PREGNANCY

URINARY SYSTEM

MICROANATOMY

RENAL CLEARANCE
Substance such as creatinin or urea which are excreted by the kidney
have a lower concentration in the renal vein than the artery; they are
therefore said to be cleared by the kidney.
Serum creatinine= 70 mol/L
Urine creatinine = 6 mmol/L
24-h urine volume = 2 L/24 h
Then:
24-h urine creatinine excretion= 2x6 mmol = 2x6x100 mol
Excretion of creatinine in 1 min
= 2x6 mmol mol
60x24
= 8,3 mol
1 mol of creatinine occupies 1000 = 14,3 mL
70
Creatinine clearance = 8,3 x 14,3 = 119 mL/min

Glomerular Fitration Rate

GFR : The clearance of a substance that is neither
reabsorbed from the renal tubule nor secreted
into the tubule
The plasma constituent that most closely
approaches this is creatinine, and the creatinine
clearance is therefore the usual measurement for
estimation of the GFR.
The normal GFR = 120 mL/min

Renal Blood Flow

Healthy renal blood flow + 1,2 L/min
The renal blood blood vessels are innervated by
the autonomic nervous system via renal nerves
Stimulation of the renal nerves cause
vasoconstriction and a decrease in renal blood
flow. This occurs via the vasomotor center in
systemic hypotension & also in severe hypoxia.
Renal blood flow is also decreased by the direct
action of catecholamines & both neural & humoral
mechanisms are likely to be involved in the
reduction of renal blood flow associated with
exercise.

Handling of Individual Substances

Glucose & Amino Acids
Reabsorbed by active transport at the proximal tubule
If the filtered load of glucose is too great for the proximal tubule
to be able to reabsorb all the filtered glucose, it is excreted in
the urine Glycosuria DM
Some pregnant women have glycosuria at lower blood glucose
concentrations Gestational Diabetes

Sodium & Chloride

The majority of Na is reabsorbed actively in the proximal tubule.
In addition, sodium is reabsorbed actively in the distal
convoluted tubule, collecting duct & bladder under the control of
mineralocorticoids. Na is also reabsorbed passively in the thick
assending loop of Henle in exchange for chloride ions, which are
themselves actively reabsorbed.
Cl is usually reabsorbed passively, following Na & K reabsorption
in the proximal convoluted tubule. It is also actively reabsorbed
in the thick ascending loop of Henle.

 Bicarbonate
Reabsorbed passively following Na reabsorption; it is also
reabsorbed by buffering hydrogen ions
In the renal tubule HCO3 + H Carbonic acid broke down by
carbonic anhidrase CO2 & H2O
CO2 reabsorbed accross the tubular cell, & in the proximal
tubular cell reacts again with H2O HCO3 reabsorbed as CO2
This mechanism occurs so long as the plasma HCO3
concentration is < 28 mmol/L. Once the HCO3 concentration >
28 mmol HCO3 appears in the urine, which becomes alkaline.

Potassium
Reabsorbed actively in the proximal convulated tubule, iin
exchange for chloride ions. It is also secreted into the distal
convulated tubule, in exchange for Na ions, & this is under the
control of aldosterone & other mineralocorticoids.

 Hydrogen ions
Actively excreted in the proximal & distal tubules in exchange for sodium. In the
tubule the hydrogen ions are buffered by bicarbonate, phosphate & ammonia,
which keep the pH of tubular fluid >4,5, the minimum for hydrogen ion secretion.

Water
Of the 170 L of water that is filtered per day, all but 1,5 L is reabsorbed under
normal curcumstances. In extreme hydration the total amount of water excreted
may be as high as 50% of the GFR.
This control of water reabsorption depends on the level of ADH, the GFR, & the
solute load.
Concentration of the urine occurs because of the high osmotic pressure achieved
by reabsorption of Cl followed by Na in the thick ascending limb of the loop of
Henle in the medulla of the kidney.
ADH is secreted from the posterior pituitary gland, under the influence of the
hypothalamus. Its secretion is increased by stress, hypovolemia, & increase in
plasma osmolarity, adrenaline & certain drugs such as morphine. Its secretion
decreased by an increase in circulating blood volume, by a fall in plasma
osmolarity & by alcohol.
During pregnancy, 4 times as much ADH is produced in order to counter act the
effects of placentally derived vasopressinase.

 Urea
Accumulates in high concentration in the renal
medulla.
The kidney tubular cells are freely permeable to
urea.
When urine flows are low only 10-20% of the filtered
urea is excreted, while at high urine flow rates 5070% is excreted.

Endocrine Function of The Kidney

Kidney Increase production of renin,
erythropoeitin (EPO) & the active hydroxylation of
vit D.