1. Renal Physiology Overview
Jeff Kaufhold, MD FACP

2. Renal Physiology Structure Clearance Water Balance Electrolytes
Acid-Base Balance
Hormonal Functions

3. Renal Anatomy Renal Artery and Vein Cortex – filtering Glomeruli
Medulla – Tubules, regulates water/ lytes
Ureters
Bladder
Urethra and Sphincter control

4. Anatomy of Urinary Tract

6. Glomerular Physiology
Filtration
Filtration membrane
Endothlial cell layer
Basement membrane
Epithelial cell layer
Electrical charge – negative
Clearance = waste product removal
Ultrafiltration = water removal

7. Filtration Membrane

10. Glomerular Blood Flow

11. Glomerular Physiology Blood flow determinants
Systemic
Efferent
Afferent
Filtration

12. Effect of Angiotensin on Glomerular Blood Flow

13. Glomerular Physiology Blood flow determinants
Efferent
Afferent
PG's
Local
TGF
Filtration

14. Glomerular Physiology Blood flow determinants
Systemic
Efferent
Afferent
PG's
Local
TGF
Filtration

15. Glomerular filtration

16. Glomerular Physiology
Pathologic conditions:
Renal Artery Stenosis
Hypertension / Medication effects
Membrane problems
Lead to blood in urine – hematuria
-Loss of negative charge leads to protein in urine – proteinuria
-Diabetes, Glomerulonephritis

17. Blood Flow to Tubules

18. Renal Tubule Physiology Overview
Prox. tubule
Distal Tubule
reabsorption
Collecting duct
Loop of Henle

19. Proximal Tubule Function: Reabsorption Features:
Brush border with cilia
Carbonic Anhydrase for reclaiming Bicarb
Filtration Fraction
Pathology: Renal tubular Acidosis

20. Renal Tubule Physiology Overview
Prox. tubule
Distal Tubule
blood
Tubule membrane
reabsorption
Collecting duct
Ultrafiltrate
Tubule lumen
Loop of Henle
Tubule membrane

21. Renal Tubule Physiology Overview
Prox. tubule
Distal Tubule
Collecting duct
Loop of Henle

22. Renal Tubule Physiology Overview
Prox. tubule
Distal Tubule
Collecting duct
impermeable to
imperm. to
H2O
solute
Loop of Henle

23. Renal Tubule Physiology Overview
Prox. tubule
Distal Tubule
Collecting duct
Loop of Henle

24. Renal Tubule Physiology Overview
Ion Exchange
Sodium for
Potassium/Hydro
Prox. tubule
Distal Tubule
Collecting duct
Loop of Henle

25. Renal Tubule Physiology Overview
Prox. tubule
Distal Tubule
Collecting duct
Loop of Henle

26. Renal Tubule Physiology Overview
Prox. tubule
Distal Tubule
Collecting duct
ADH +
permeable to H2O
Loop of Henle
ADH -
impermeable

27. Function of Nephron Tubules

28. Renal Tubule Physiology Overview
Prox. tubule
Distal Tubule
solute exchange
reabsorption
Collecting duct
impermeable to
imperm. to
H2O
solute
ADH +
permeable to H2O
Loop of Henle
ADH -
impermeable

29. Interstitium The tissue in between the tubules Function:
Ammoniagenesis
Countercurrent multiplier
Pathology:
RTA, Loss of concentrating ability, AIN

30. Countercurrent Multiplier
Way to keep the concentrating ability of the kidney isolated from the rest of the body
Components:
Urine flow with sodium chloride pump
Blood flow from Vasa Recta
Pathology:
Sickle Cell /Trait, bladder obstruction

31. Countercurrent Multiplier

32. Countercurrent Multiplier

33. Countercurrent Multiplier
WARM
COLD

34. Renal Physiology Endocrine Functions
Renin – control of BP
Erythropoietin – turns on bone marrow to make red blood cells
Vitamin D activation – regulates bone metabolism, Calcium, Phosphorus and Parathyroid Gland.

35. Volume regulation Active Sensors Passive system Renal Autonomic nerves
Like a system of lakes and spillways

36. Renal Structure C
Artery P
Vein M
Ureter

37. Renal Structure U Cortex U osmotic Vascular 300 gradient bundle
Medulla
collecting tubule
Glomerulus
1200 U

38. Renal Physiology Sensing of Volume
Effective Arterial Blood Volume (EABV)
Pathology:
Congestive Heart Failure
Cirrhosis
Pregnancy
Nephrotic Syndrome
Aldosteronoma

39. Pathologic States
CHF
Renal Artery Stenosis
Low Blood Flow

40. Pathologic States Cirrhosis Pregnancy Nephrotic Syndrome
Leaky capillaries

41. Pathologic States Aldosteronoma Tumor which Produces too much
Aldosterone, causing
Fluid retention

42. Pathologic States Aldosteronoma causes Fluid retention Hypertension
Perfusion of outer glomeruli sets upper limit on how much fluid can be retained.

43. Pathologic States Removal of Aldosteronoma causes
Diuresis until volume is normal again, and
Hypertension improves

45. Why Kidney Patients will Come to Physical Therapists
Hip Fractures
Strokes
Heart attacks and heart surgery
Deconditioning
Neuropathy

46. Glomerular Physiology
Afferent. Art
AT II constrict
ACE-i dilate
PG's NET dilate
TGF NET constrict
NSAID's constrict
Aminophylline dilate
Diltiazem dilate
Filt Press
maintained
reduced
increase
parallels
reduce
Efferent Art.
constrict
dilate
no effect