​ANALYSIS OF URINE & BODY FLUIDS LECTURE ​| S​ ISON 

1 

UNIT #1: RENAL FUNCTION THE KIDNEY ANATOMY

Frontal section

NEPHROLOGY VS. UROLOGY

● Nephrology
○ Anything that pertains to the function of the kidney
itself (glomerulus, nephrons)
● Urology
○ Refers to the lower urinary tract and male
reproductive system

URINARY SYSTEM
What consists of your urinary system?
● Refers to:
a. Two kidneys
● Reddish in color
b. Two ureters
● Located above the waist
c. One urinary bladder
● Renal hilus
d. One urethra
○ Concave medial border of each kidney faces the
● Why is the right kidney lower than the left?
vertebral column
○ The right kidney is usually lower than the left
● Layers of the kidney (inside going outside)
kidney because of the location of the liver
○ Renal capsule​: barrier against trauma and
OVERVIEW OF KIDNEY FUNCTIONS maintains the shape of the kidney
○ Adipose capsule​: fatty tissue surrounding the
● Regulation of blood ionic composition renal capsule and holds it in place in the abdominal
○ Compositions that have charges (cations or cavity
anions) ○ Renal fascia​: anchors the kidney to the abdominal
○ Ions are solutes which are regulated in the kidney wall
● Maintenance of blood osmolarity ● Renal medulla
○ Osmolality: the number of particles of solute per kg ○ Renal pyramid​: inverted triangular structures
of water ■ Roughly 8-12 in each kidney
○ Osmolarity: the number of particles of solute per L ■ The broader base of the renal pyramids is
of solution the border between cortex and medulla
● Regulation of blood volume and blood pressure ■ Renal papilla:​ apex of the triangle
○ Wherever the sodium is, water will follow ■ Renal column​: structure between the
■ When ​salt (+/-) is increased in the body, pyramid
there is an increase of water in the body ● Nephron​: functional unit of the kidney
→ ​increased blood volume → more ○ Present in the renal papilla
difficult to pump blood → ​higher BP ○ After the glomerulus, urine passes through the
○ Enzyme renin papillary duct (in renal papilla) → minor calyx →
○ Renal resistance major calyx → renal pelvis → ureter → urinary
● Regulation of blood pH bladder → urethra
○ Normal pH of the body: 7.35 - 7.45 ○ Each kidney contains approximately 1 to 1.5
● Release of hormones nephrons
○ Calcitriol: active form of calcium which regulates ○ In human kidney, contains two types of nephrons
calcium homeostasis ■ Cortical nephrons- make up approx. 85%
○ Erythropoietin (EPO): promotes the formation of of nephrons and primarily situated in the
RBCs cortex of the kidney
● Regulation of blood glucose levels ● Responsible for removal of
○ Amino acid (glutamine) will be deaminated in the waste products and reabsorption
kidneys → used for gluconeogenesis of nutrients.
● Excretion of wastes and foreign substances

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 ​ANALYSIS OF URINE & BODY FLUIDS LECTURE ​| S​ ISON  2 

■ Juxtamedullary nephrons- have longer

loops of Henle that extend deep into the
medulla of the kidney
● Primary function is concentration
of the urine
○ The ability of the kidneys to clear waste products
selectively from the blood and simultaneously to
maintain the body’s essential water and electrolyte
balances is controlled in the nephron by the
following renal functions
■ Renal blood flow
■ Glomerular filtration ● The human kidneys receive approximately 25% of the blood
■ Tubular reabsorption pumped through the heart at all times
■ Tubular secretion ○ Blood enters the capillaries of the nephron through
THE KIDNEY BLOOD SUPPLY the ​afferent arteriole
○ It then flows through the glomerulus and into the
efferent arteriole
■ The varying sizes of these arterioles help
to create the hydrostatic pressure
differential important for glomerular
filtration
■ These maintain the consistency of
glomerular capillary pressure and renal
blood flow within the glomerulus
○ The blood from the efferent arteriole enters the
peritubular capillaries​ and the ​vasa recta​ and
flows slowly through the cortex and medulla of the
kidney close to the tubules before returning to the
renal vein
○ Peritubular capillaries
■ Surrounds proximal and distal convoluted
tubules
● Renal blood flow (RBF) ■ Provide for immediate absorption of
○ Blood going to the kidney to be filtered essential substances from the fluid in the
○ Renal artery → segmental arteries → interlobar proximal convoluted tubule and final
arteries → arcuate arteries → interlobular arteries adjustment of the urinary composition in
→ afferent arterioles → glomerular capillaries → the distal convoluted tubule
efferent arterioles ○ Vassa recta
■ AGE (inside interlobular artery) ■ Located adjacent to the ascending and
■ (Afferent → Glomerulus → Efferent) descending loops of Henle in
■ Glomerulus​: where filtration takes place juxtamedullary nephrons
■ Interlobar artery: present in the renal ● Area where major exchanges of
column between 2 pyramids water and salts take place
○ Peritubular capillaries → vasa recta → interlobular between the blood and the
veins → arcuate veins → interlobar veins → medullary interstitium.
segmental veins → renal vein ● The exchange maintains the
osmotic gradient (salt conc.) in
the medulla, which is necessary
for renal concentration
○ Total renal blood flow is approx. 1200mL/min.
■ Total renal plasma flow ranges from 600
to 700 mL/min.

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 ​ANALYSIS OF URINE & BODY FLUIDS LECTURE ​| S​ ISON  3 

■ Normal values for renal blood flow and

renal function tests depend on body size

NEPHRONS
● Functional unit of the kidney
● After being filtered by the glomerulus, the blood goes to the
Bowman’s capsule
○ Filtrate goes to PCT → Thick descending loop of
Henle → Thin descending loop of Henle → Thin
ascending loop of Henle → Thick ascending loop
of Henle → DCT → Collecting duct → Papillary
duct → Renal papule → Minor calyx → major calyx
→ renal pelvis → ureter → urinary bladder →
urethra BASIC FUNCTIONS OF A NEPHRON
CORTICAL NEPHRON
● Function: Filtration
● Appearance: Shorter loop of Henle

URINE FORMATION
1. Glomerular filtration
2. Tubular reabsorption
3. Tubular secretion

GLOMERULAR FILTRATION

JUXTAMEDULLARY NEPHRON
● Function: Concentration
● Appearance: Longer loop of Henle
○ The longer, the deeper it is in the medulla, more
salt → higher concentration
■ Cannot concentrate urine if it is short
○ Presence of DCT, thick & thin descending loop of
Henle since it is stretched out and modified

● AGE: ​Afferent - Glomerulus - Efferent

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 ​ANALYSIS OF URINE & BODY FLUIDS LECTURE ​| S​ ISON  4 

■ Albumin and protein in blood = 7.1 nm

● Proteinuria or albuminuria
(presence of protein in urine)
● Any pressure or damage in the
kidney → bigger pore size →
presence of protein in urine
(hypertension, high BP)
■ Pedicel
● Creeping finger-like projections)
comprised of cells (podocytes)
● Slit membrane: spaces between
the projections
● Visceral portion of the Bowman’s
● The glomerulus consists of a coil of approximately​ ​eight capsule
capillary lobes​, ​the walls of which are referred to as the ○ Glomerular filtration barrier contains a​ shield of
glomerular filtration barrier negativit​y that repels molecules with a positive
○ Located within Bowman’s capsule, which forms the charge
beginning of the renal tubule ■ Very important because albumin (the
○ Glomerulus serves as a nonselective filter of primary protein associated with renal
plasma substances with molecular weights of disease) has a positive charge and would
<70,000 easily pass through the barrier
● Factors influencing the actual filtration process ■ If it were not for the shield of negativity,
○ Cellular structure of the capillary walls and ■ all routine urines would have positive
Bowman’s capsule reagent strip readings for protein/albumin
○ Hydrostatic pressure and oncotic pressure ● Reasons why the glomerulus is the site for filtration:
○ Feedback mechanisms of the A. Difference of the size of the lumen
renin-angiotensin-aldosterone system ​(RAAS) ● Lumen (width) of afferent arteriole is
● Layers of the glomerulus (inside going outside) bigger than efferent arteriole
○ Endothelial fenestrations ● The difference of the size of the lumen
■ Fenestrations = pore creates a pressure → causes blood to be
■ Each pore is around 70 - 100 nm filtered in the glomerulus
therefore RBCs, WBCs, and other ● The pressure is necessary to overcome
elements cannot pass through the opposition of pressures from the fluid
● These pores increase capillary within Bowman’s capsule and the oncotic
permeability but do not allow the pressure of unfiltered plasma proteins in
passage of large molecules and the glomerular capillaries
blood cells ● Increase and decrease of size of afferent
■ Further restriction of large molecules and efferent arterioles causes an
occurs as the filtrate passes through the autoregulatory mechanism​ within the
basement membrane and the thin juxtaglomerular apparatus which
membranes covering the filtration slits maintains the glomerular blood pressure
formed by the intertwining foot processes at a ​relatively constant rate​ regardless
of the ​podocytes​ of the inner layer of of fluctuations in systemic blood pressure
Bowman’s capsule ○ Dilation of the arterioles when
○ Basal lamina blood pressure drops prevent the
■ Acellular decrease of blood flow to the
■ Prevents filtration of larger plasma kidney, thus preventing an
proteins increase in the blood level toxic
waste production
○ Slit membrane B. Tuft of capillaries: “Kumpol-kumpol”
■ Contains pores (6-7 nm) which allows ● Increases the surface area for filtration
water, glucose, vitamins, and amino acids ● Higher surface area = blood is readily
to be filtered filtered

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 ​ANALYSIS OF URINE & BODY FLUIDS LECTURE ​| S​ ISON  5 

C. Thin and porous

D. Pressure passing through the glomerulus should
be high to filter the blood

Electron microscopy image of the glomerulus ● RAAS: Renin- Angiotensin - Aldosterone System
○ Regulates the flow of blood to and within the
TUBULAR REABSORPTION
glomerulus
Active Transport vs. Passive Transport ■ Responds to changes in blood pressure
● Active Transport and plasma sodium content
○ Energy is used and ATP is necessary for the ■ Monitored by ​juxtaglomerular apparatus
transport of solutes ● Consists of juxtaglomerular cells
○ Responsible for the reabsorption of glucose, amino in the afferent arteriole and the
acids, and salts in the proximal convoluted tubule, macula densa of the distal
chloride in the ascending loop of Henle, and convoluted tubule
sodium in the distal convoluted tubule ● High sodium = Water retention = High BP
○ When the plasma concentration of a substance ● Low sodium​ = Water elimination = Low water volume =
that is normally completely reabsorbed reaches an Low blood volume =​ Low BP ​= Renin = Angiotensinogen =
abnormally high level, the filtrate concentration Angiotensin I = ​Angiotensin II
exceeds the Maximal Reabsorptive Capacity ( T m ) ○ Juxtaglomerular apparatus detects low blood
of the tubules pressure and produces Renin (enzyme)
■ Appears in the urine ○ Angiotensinogen (blood-borne substrate) reacts
■ Renal threshold- ​The plasma with renin to form Angiotensin I
concentration at which active transport ○ Angiotensin I (Inert hormone)
stop ■ Goes to the lungs with the help of
■ Threshold for glucose (160 to 180mg/dL) Angiotensin Converting Enzyme (ACE)
● Passive transport:​ transport of solutes are based on ○ Angiotensin II (active form)
concentration from higher → lower concentration ■ Corrects the low blood pressure by:
○ Physical differences are called ​gradients ● Vasodilation of afferent and
○ Occur in all parts of the nephron except the vasoconstriction of efferent
ascending loop of Henle, which are impermeable to increases pressure in glomerulus
water ● PCT will reabsorb sodium to
● Tubular Reabsorption: ​small essential solutes are filtered promote water retention
in the glomerulus → goes back to blood circulation ● Release sodium retaining
○ Most of these solutes are essential hormone (aldosterone) from
○ Must go back to the blood from renal tubules adrenal cortex to promote water
■ Energy is needed from tubules to the retention
blood (Active transport) ● Production of antidiuretic
hormone promotes water
retention and less urine excretion

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 ​ANALYSIS OF URINE & BODY FLUIDS LECTURE ​| S​ ISON  6 

TUBULAR SECRETION
Tubular Secretion
● Two major functions:
○ Eliminating waste products not filtered by the
glomerulus
○ Regulating the acid–base balance in the body
through the secretion of hydrogen ions
● Many foreign substances, such as medications, cannot be
filtered by the glomerulus
○ Bound to plasma proteins
○ When they enter the peritubular capillaries, they
develop stronger affinity for the tubular cells and
dissociate from their carrier proteins
■ Results in their transport into the filtrate by
● Water, glucose, sodium, amino acids are reabsorbed in the
the tubular cells
PCT then go to peritubular arteries
■ The major site for removal of these non
○ Descending loop of Henle: water is reabsorbed
filtered substances is the ​proximal
through the vasa recta to the blood
convoluted tubule
○ Ascending loop of Henle: sodium and chloride is
Acid-Base Balance Mechanisms
reabsorbed through vasa recta to the blood
● The removal of H​+​ from body fluids & subsequent
■ Prevent dilution of the medullary
elimination form the body depend on the following
interstitium by the water reabsorbed from
mechanisms:
the descending loop.
1. Buffer systems
■ Only area where water is blocked and not
2. Exhalation of CO​2
reabsorbed
3. Kidney excretion of H​+
■ This selective reabsorption process is
● More Hydrogen ions we have in our body, the more acidic
called the​ countercurrent mechanism
○ If you are in a relaxed state, breathing is slow then
● Serves to maintain the osmotic
there is a slower exchange of oxygen and carbon
gradient of the medulla
dioxide (higher CO​2 ​in the lungs)
○ Collecting duct: water is reabsorbed again
■ CO​2​+ H​+ ​= Carbonic acid will be formed
■ Reabsorption depends on the osmotic
■ Decreased pH = acidosis
gradient in the medulla and the hormone
■ Higher CO​2 = ​ yawning while awake
vasopressin​ (ADH)
■ Pulmonary compensatory mechanism
■ Renders the walls of the distal convoluted
tubule and collecting duct permeable or
impermeable to water
■ ↑ ADH = ↑ Permeability = ↑ Reabsorption
of water = ↓ volume concentrated urine
■ Absence of ADH = Impermeability = ↑
volume of dilute urine
■ Production of ADH is determined by the
state of body hydration
● To maintain the normal blood pH of 7.4, the blood must
buffer and eliminate the excess acid formed by dietary
● In summary:
intake and body metabolism
○ ↑Body Hydration = ↓ADH = ↑Urine Volume
○ Buffering capacity depend on bicarbonate ions,
○ ↓Body Hydration = ↑ADH = ↓Urine Volume
which are readily filtered by the glomerulus and
must be expediently returned to the blood to
● Active transport: glucose, amino acids, salts, Chloride, maintain the proper pH
Sodium ○ This process provides for almost 100%
● Passive transport: water, urea, Sodium reabsorption of filtered bicarbonate and occurs
● Both active and passive: Sodium primarily in the proximal convoluted tubule

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 ​ANALYSIS OF URINE & BODY FLUIDS LECTURE ​| S​ ISON  7 

● Metabolic compensatory mechanism (by the kidneys)

○ Urine passes through the tubular lumen
○ Bicarbonate makes blood alkaline to neutralize
decreased pH caused by hydrogen in our sleep
○ Almost all bicarbonate is filtered out in the
glomerulus → binds to hydrogen = carbonic acid
○ Carbonic acid goes to tubular cell with the help of
carbonic anhydrase​ = carbonic acid going to blood

○ Same mechanism happens with phosphate

(left picture)
○ Same mechanism happens with ammonium
■ Ammonia filtered in glomerulus
■ Binds to hydrogen = ammonium
■ Part of the final product of urine therefore
urine is ammoniacal in odor
● All three of these processes occur simultaneously at rates
determined by the acid–base balance in the body
○ A disruption in these secretory functions can result
in ​metabolic acidosis​ or ​renal tubular acidosis​,
the inability to produce an acid urine

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