Download Urine formation by kidney.

Glomerular filtration.
Dr. Rida Shabbir
DPT KMU
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.
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.
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.
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
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.
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.
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
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.
•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.
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
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.
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.
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.