1. Glomerular filtration. Dr. Rida Shabbir DPT KMU

2. Functions of kidney: Excretion of metabolic waste products and foreign chemicals. Regulation of water and electrolyte balance. Regulation of body fluid osmolality and electrolyte concentration. Regulation of arterial pressure. Regulation of acid base balance. Secretion, metabolism and excretion of hormones. Gluconeogenesis.

3. Excretion of metabolic waste products, foreign chemicals, drugs and hormones: Urea: – From metabolism of amino acids. Creatinine: – from muscle creatine. Uric acid: – from nucleic acid. End products of hemoglobin breakdown: – bilirubin. Metabolites of various hormones. Toxic and foreign substances: – pesticides, drugs and food additives.

4. Urinary excretion rate: Filtration rate + secretion rate – reabsorption rate. Urine formation begins with filtration of protein free fluid from glomerular capillaries to bowman’s capsule. Same concentration of fluids in plasma and bowman’s capsule. Water and specific solutes reabsorbed. Secretion of other substances from peritubular capillaries into tubules.

6. Filtration, Reabsorption, and Secretion of Different Substances Tubular reabsorption > tubular secretion in urine formation. Secretion= Potassium and hydrogen ions and a few other substances that are excreted in the urine. Urea, creatinine, uric acid and urates=poorly reabsorbed Foreign substances and drugs= poorly reabsorbed, secreted from the blood into the tubules, so that their excretion rates are high. Sodium ions, chloride ions, and bicarbonate ions, are highly reabsorbed, so that only small amounts appear in the urine Amino acids and glucose, are completely reabsorbed from the tubules and do not appear in the urine. Glomerular filtration, tubular reabsorption, and tubular secretion—regulated according to the needs of the body

7. Large Amounts of Solutes Filtered and Then Reabsorbed GFR allows the kidneys to rapidly remove waste products from the body that depend primarily on glomerular filtration for their excretion. Most waste products are poorly reabsorbed by the tubules and depend on a high GFR for effective removal. Plasma volume is only about 3 liters, whereas the GFR is about 180 L/day, the entire plasma can be filtered and processed about 60 times each day. This high GFR allows the kidneys control the volume and composition of the body fluids.

8. Glomerular Filtration Composition of the Glomerular Filtrate Glomerular capillaries are relatively impermeable to proteins. Glomerular filtrate is protein-free and devoid of cellular elements, including red blood cells. Concentrations of most salts and organic molecules, are similar to the concentrations in the plasma. Low-molecular-weight substances, calcium and fatty acids are partially bound to the plasma proteins. One half of the plasma calcium and most of the plasma fatty acids are bound to proteins, are not filtered through the glomerular capillaries.

9. GFR Is About 20 Per Cent of the Renal Plasma Flow GFR is determined by – (1) the balance of hydrostatic and colloid osmotic forces acting across the capillary membrane and – (2) the capillary filtration coefficient (Kf), the product of the permeability and filtering surface area of the capillaries. The glomerular capillaries have a much higher rate of filtration than most other capillaries because of a high glomerular hydrostatic pressure and a large Kf. In the average adult human, the GFR is about 125 ml/min, or 180 L/day. The fraction of the renal plasma flow that is filtered (the filtration fraction) averages about 0.2; this means that about 20 per cent of the plasma flowing through the kidney is filtered through the glomerular capillaries. The filtration fraction is calculated as follows: Filtration fraction =GFR/Renal plasma flow

10. Glomerular Capillary Membrane Three major layers: – (1) the endothelium of the capillary, – (2) a basement membrane, and – (3) a layer of epithelial cells (podocytes) surrounding the outer surface of the capillary basement membrane. These layers make up the filtration barrier Filter several hundred times as much water and solutes as the usual capillary membrane. Prevents filtration of plasma proteins.

11. The capillary endothelium is perforated by thousands of small holes called fenestrae. Endothelial cells have fixed negative charges that hinder the passage of plasma proteins. Surrounding endothelium is the basement membrane that have large spaces through which large amounts of water and small solutes can filter. The final part of the glomerular membrane is a layer of epithelial cells that line the outer surface of the glomerulus. proteinuria albuminuria.

12. Determinants of the GFR The GFR is determined by (1) the sum of the hydrostatic and colloid osmotic forces across the glomerular membrane, which gives the net filtration pressure. (2) the glomerular capillary filtration coefficient, Kf. Expressed mathematically, GFR =Kf x Net filtration pressure

13. Determinants of the GFR GFR =Kf x Net filtration pressure. Increased glomerular capillary filtration coefficient increases GFR. Increased glomerular capillary colloid osmotic pressure decreases GFR. Increased bowman’s capsule hydrostatic pressure decreases GFR. Increased glomerular capillary hydrostatic pressure increases GFR.

14. Renal blood flow: In an average 70-kilogram man, the combined blood flow through both kidneys is about 1100 ml/min, or about 22 per cent of the cardiac output. The mechanisms that regulate renal blood flow are closely linked to the control of GFR and the excretory functions of the kidneys. On a per gram weight basis, the kidneys normally consume oxygen at twice the rate of the brain but have almost seven times the blood flow of the brain. Thus, the oxygen delivered to the kidneys far exceeds their metabolic needs, and the arterial-venous extraction of oxygen is relatively low compared with that of most other tissues. A large fraction of the oxygen consumed by the kidneys is related to the high rate of active sodium reabsorption by the renal tubules.

15. Physiologic Control of Glomerular Filtration and Renal Blood Flow Most of the renal vascular resistance resides in three major segments: interlobular arteries, afferent arterioles, and efferent arterioles. Resistance of these vessels is controlled by the sympathetic nervous system, various hormones, and local internal renal control mechanisms.