1. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structure and Function of the Renal and Urologic Systems Chapter 28

2. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney  Kidneys  Retroperitoneal  Renal capsule  Renal fascia  Hilum

3. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney

4. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney  Cortex  Medullary  Pyramids  Calyces  Minor and major  Renal pelvis  Lobe

5. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney

6. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron  1.2 million nephrons per kidney  Functional unit of the kidney  Cortical nephrons  Juxtamedullary nephrons

7. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron  Renal corpuscle  Glomerulus  Bowman capsule  Mesangial cells  Bowman space

8. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Nephron

9. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Glomerulus

10. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron  Glomerular filtration membrane  Inner capillary endothelium  Basement membrane  Outer capillary epithelium Also referred to as podocytes or visceral epithelium Also referred to as podocytes or visceral epithelium Filtration slits Filtration slits  Filtrate passes through the three layers and forms the primary urine

11. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron  Juxtaglomerular apparatus  Juxtaglomerular cells  Macula densa

12. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Juxtaglomerular Apparatus

13. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron  Renal tubules  Proximal tubule  Loop of Henle  Distal tubule  Collecting duct  Principal cells : water & ECV…reabsorb NA+  Intercalated cells : acid-base…reabsorb K+ & HCO3-,secrete H+

14. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney

15. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Tubule

16. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Blood Vessels  Renal arteries  Interlobar arteries  Arcuate arteries  Glomerular capillaries  Peritubular capillaries and vasa recta  Vasa recta  Renal veins

17. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney

18. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney  Ureters  30 cm long  Long, intertwining muscle bundles  Pass obliquely though posterior aspect of bladder  Peristaltic activity  Micturition compresses the lower end of the ureter to avoid urine reflux

19. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Structures of the Kidney  Bladder  Detrusor muscle  Trigone  Micturition reflex  Urethra  Internal and external sphincters  3 to 4 cm in females  18 to 20 cm in males

20. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Bladder and Urethra

21. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Renal Blood Flow  Receive 1000 to 1200 mL of blood per minute  Glomerular filtration rate (GFR)  Autoregulation ( MAP 80-180mmHg)  Tubuloglomerular feedback

22. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Renal Autoregulation Renal Autoregulation

23. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Renal Blood Flow  Neural regulation  Celiac ganglion and splanchnic nerve  Hormones  Renin-angiotensin system  Aldosterone

24. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.  RAAS “Must understand”

25. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Function  Filters plasma  Reabsorbs and secretes  Tubular reabsorption and secretion  Forms a filtrate of protein-free fluid  Regulates the filtrate to maintain fluid volume, electrolytes, and pH

26. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Function  Glomerular filtration  Net filtration pressure (Table 28-1) Glomerular capillary oncotic/hydrostatic pressure Glomerular capillary oncotic/hydrostatic pressure Bowman capsule oncotic/hydrostatic pressure Bowman capsule oncotic/hydrostatic pressure  Filtration rate 180 L/day 180 L/day

27. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Glomerular Filtration

28. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Function  Tubular transport (Box 28-1)  Proximal tubule Active reabsorption of sodium Active reabsorption of sodium  Loop of Henle and distal tubule Concentration or dilution of urine Concentration or dilution of urine  Glomerulotubular balance Adjustment of reabsorption of sodium and water Adjustment of reabsorption of sodium and water

29. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Nephron Function

30. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Concentration and Dilution of Urine  Countercurrent exchange system  Contributes to production of concentrated urine  Fluid flows in opposite direction through parallel tubes  Fluid moves up and down the parallel limbs of the loop of Henle  The longer the loop, the greater the concentration gradient

31. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Countercurrent Exchange System

32. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Concentration and Dilution of Urine  Urea  Aldosterone  Antidiuretic hormone (ADH)  Atrial natriuretic peptide  Diuretics

33. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Acidification of urine  Hydrogen excretionAmmonia excretion excretion

34. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Renal Hormones  Urodilatin (natriuretic peptide)  Inhibits sodium and water reabsorption  Vitamin D  Necessary for the absorption of calcium and phosphate  Erythropoietin  Released when decreased oxygen to the kidney

35. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Tests of Renal Function  Clearance and glomerular filtration rate  Inulin  Creatinine  Clearance and renal blood flow  Blood tests  Plasma creatinine concentration  Blood urea nitrogen (BUN)

36. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Tests of Renal Function  Urodynamic tests  Cystometry, uroflowmetry, postvoid residual, electromyography, video urodynamics  Direct visualization tests  Cystoscopy, ureteroscopy

37. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Pediatric Renal Function  Decreased ability to remove excess water and solutes  Decreased concentrating ability  Narrow margin for fluid and electrolyte balance  Increased risk of drug toxicity

38. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Aging and Renal Function  Decrease in renal blood flow and GFR  Altered sodium and water balance  Number of nephrons decrease due to renal vascular and perfusion changes  Response to acid-base changes delayed  Increased risk for drug toxicity  Alterations in thirst and water intake