Renal physiology (2023-2024) ---- Lecture-1 --------------- Prof. Dr.
Samir Sawadi
Renal physiology
Objectives:
1. What are the Main Functions of Kidney
2. What are the Functional anatomy of the kidney
Functions of kidney:
1. Excretion of metabolic waste products: The kidney eliminate
waste product of metabolism that are not needed by the body. These
products include urea (from the metabolism of amino acids),
creatinine (from muscle creatine), uric acid (from nucleic acids), and
bilirubin (from hemoglobin breakdown and metabolite of various
hormone). The kidneys eliminate most toxins and other substances
such as drugs.
2. Regulation of water and electrolyte balances: The capacity of the
kidneys to alter sodium excretion in response to change in sodium
intake is 10 fold than normal. This also true for water and other
electrolytes. The kidneys regulate the concentration of the following
ions in the plasma: sodium (Na+), potassium (K+), calcium (Ca2+),
magnesium (Mg2+), chloride (Cl -), bicarbonate (HCO3 -), hydrogen
(H+), and phosphates (HPO4 2- and H2PO4 -).
So the kidneys regulation of plasma osmolarity. Because the kidneys
vary the rate at which they excrete water relative to solutes, they have
the ability to regulate the osmolarity (solute concentration) of the
plasma.
3. Regulation arterial pressure: In increase the blood pressure, the
kidney was excreting variable amount of sodium and water and this
lead to decrease blood volume and restore the normal blood pressure.
While in case of decrease the blood pressure the kidney was secrete
vasoactive factors such as renin, that lead to formation of vasoactive
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Renal physiology (2023-2024) ---- Lecture-1 --------------- Prof. Dr. Samir Sawadi
products such as angiotensin II and this lead to vaso-concentriction
and increase the blood pressure.
4. Regulation acid-base balance: By excreting acid and by regulation
the body fluid buffer stores. Kidneys eliminate certain types of acid
such as sulfuric acid and phosphoric acid by metabolism of proteins.
5. Regulation of erythrocytes production: the kidneys secrete
erythropoietin which stimulates the production of red blood cells, one
important stimulus for erythropoietin secretion is hypoxia. So that the
people with severe kidney disease, severe anemia develops as result of
decreased erythropoietin production.
6. Regulation of 1,25-Dihydroxy vitamin D3 production: The
kidneys produce the active form of D3 (1,25-Dihydroxy vitamin D3)
also called Calcitriol, which is essential for normal calcium level in
blood through the following mechanisms.
A- Calcitriol interacts with vitamin D receptors in the small intestine
to enhance the intestinal calcium and phosphorous absorption.
B- Calcitriol stimulate the immature pre-osteoclasts, causing them to
become mature (bone-resorbing) osteoclasts. Such mature osteoclasts
function in removing calcium and phosphorus from bone to maintain
blood calcium and phosphorus levels.
C- Calcitriol also stimulates calcium reabsorption in the kidneys.
[Link]
7. Glucose synthesis: the kidneys synthesis glucose from amino acid
during prolonged fasting (gluconeogenesis).
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Renal physiology (2023-2024) ---- Lecture-1 --------------- Prof. Dr. Samir Sawadi
Functional anatomy of the kidney
General organization of the kidney and urinary tract: Two kidneys lie
on the posterior wall of the abdomen, outside the peritoneal cavity. Each
kidney of adult human weight about 150 grams. Through hilum pass the
renal artery, vein, lymphatic, nerve supply and ureter that carries the urine
from the kidney to the bladder where it is stored urine until it is emptied
by micturition. Kidney contain outer cortex and inner medulla. The
medulla is divided into multiple cone shaped masses of tissue called renal
pyramids, terminate into renal pelvis.
Macroscopic Anatomy of the Kidney
A cross section of a kidney reveals that it contains two regions: a reddish-
brown outer layer called the cortex, and an inner region called the
medulla, which is darker and has a striped appearance. The medulla is
subdivided into a number of conical sections called renal pyramids. At
the tips of the renal pyramids, in the areas known as papillae, tubules
called collecting ducts drain into minor calyces. It converge to form two
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Renal physiology (2023-2024) ---- Lecture-1 --------------- Prof. Dr. Samir Sawadi
or three larger passageways called major calyces, which drain into a
single funnel-shaped passage called the renal pelvis, the initial portion of
the ureter.
Renal blood flow: Blood flow to the two kidneys is normally about
22% of COP (1100 ml/ minute).
Renal Artery enters kidney
through the hilum
Renal Segmental Artery
Interlobar Arteries
Interlobular Arteries
Arcuate Arteries
Renal artery is a branch of abdominal aorta enter the kidney through the
hilum, then branching to give rise the renal segmental arteries, this
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Renal physiology (2023-2024) ---- Lecture-1 --------------- Prof. Dr. Samir Sawadi
divided to interlobar arteries, divided to arcuate arteries, and this
branched to give an interlobular arteries, to enter the glomerulus as an
afferent arterioles to forming a glomerulus capillary bed and exit as
efferent arterioles then peritubular capillaries, interlobular veins, arcuate
veins, interlobar veins, this veins drain in renal veins and this drain in to
the inferior vena cava.
Nerve supply:
The kidney has a rich adrenergic sympathetic nerve supply distributed to
the:
1. Vascular smooth muscle to cause vasoconstriction.
2. Juxtaglomerular cells to cause renin secretion.
3. Tubular cells to stimulate Na and water reabsorption.
Lymphatic:
The kidneys have an abundant lymphatic supply that drains via the
thoracic duct into the venous circulation in the thorax.
Quick Check
1. In renal failure develop anemia why?
2. In chronic renal failure need calcium supplement or not and why?
3. Describe the path of blood flow into and out of the kidneys.
References
1. Kim E. B, Susan M. B, Scott B, Heddwen L. B. (2016). Ganong’s Review of Medical
Physiology, (25th edition). By McGraw-Hill Education. China.
2. Arthur C. Guyton and John E. Hall. (2016 ). Textbook of Medical Physiology, (11 th
edition)
3. Cindyl, L. Stanfield. (2013). Chapter 18 and 19. Principles of human physiology, (5 th
edition): p: 504-563.
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