Physiology of the excretion system

120. General description of the excretion system. The role of the kidneys in the process of selection. Features of the
blood supply to the kidneys?
The urinary system consists of two kidneys, two ureters, one urinary bladder and one urethra. After the kidneys
filters blood plasma, they return most of the water and solutes to the blood stream. The remaining water and
solutes constitutes urine which passes through the ureters and is stored in the urinary bladder until it is excreted
from the body through the urethra.

Functions of the kidneys:

1. Regulation of blood ionic composition: the kidneys help regulate the blood levels of several ions most
importantly sodium, potassium, calcium, chloride and phosphate ions
2. Regulation of blood pH: the kidneys excrete a variable amount of H+ into the urine and conserve
bicarbonates ions which is an important buffer in pH of blood. This help in regulating blood pH
3. Regulation of blood volume: the kidneys adjust blood volume by conserving or eliminating water in urine.
An increase in blood volume increases blood pressure while a decrease in blood volume decreases blood
pressure.
4. Regulation of blood pressure: the kidneys also help regulate blood pressure br secreting enzyme Renin
which activates the Renin-Angiotensin-Aldosterone pathway. Increased Renin causes an increased blood
pressure
5. Maintenance of blood osmolarity: by separately regulating loss of water and loss of solutes in urine the
kidneys maintain a relatively constant blood osmolarity close to 300millimol/liter (mOsm.Litre)
6. Production of hormones: the kidney produces three hormones :
a. Erythropoietin: produced by peritubular capillary endothelial cells in response to hypoxia and it
stimulates the bone marrow in red blood cell production
b. Renin: produced by Juxtaglomular apparatus of kidney due to decrease arterial pressure or sodium
chloride content in blood. Renin plays an important role in conversion of angiotensin to angiotensin I
c. Calcitriol: the active form of vitamin D, stimulates calcium absorption in the intestine and calcium
and phosphate reabsorption in the kidneys
7. Regulation of blood glucose level: like the liver, the kidney can use amino acid Glutamine
in Gluconeogenesis for the synthesis of glucose during starvation
8. Excretion of wastes and foreign substances: by forming urine, the kidneys help in
excreting wastes such as ammonia and urea from deamination of amino acids. Bilirubin
from the catabolism of hemoglobin, creatinine from creatine phosphate break down in
muscle fibers. Uric acid from catabolism of nucleic acid. Drugs etc..

Blood Supply to the Kidneys:

The kidneys receive 20-25% of resting cardiac output through the right and left renal artery. Renal
blood flow in adult kidneys is about 1200mL per minute. Renal arteries branch from aorta and then
divide into:
1. Left renal artery is longer than right renal artery
2. Renal artery
3. Interlobar arteries
4. Arcuate arteries
5. Afferent Arterioles
6. Glomerulus
7. Efferent Arteriole
8. Efferent arterioles divide into Peritubular capillaries and Vasa recta (supply tubular portion
of nephrona dn renal medulla)
9. Peritubular arteries eventually reunite to from peritubular venules and then interlobular
veins. The blood drains to the Arcuate veins to the interlobar veins running between the
renal pyramids.
Innervation of kidney: many renal nerves originate in the renal ganglion and pass through the renal plexus into the
kidneys along with the renal arteries. Renal nerves are part of the sympathetic division of the autonomic nervous
system. Most are vasomotor nerves that regulate the flow of blood through the kidney by causing vasodilation or
vasoconstriction of renal arterioles.

Functional unit of kidney is: Nephron which is made up of many cells

Each nephron consists of two parts:
1. Renal corpuscle: made up of glomerulus and Bowman’s capsule where blood is filtered
2. Renal tubule: consists of proximal convoluted tubule, loop of Henle and distal convoluted tubule.

121. Mechanisms of urine formation. Filtration in the glomeruli and factors on which it depends?
Urine formation occurs in 3 steps:
1. Glomerular filtration: takes place in Bowman capsule, water and most solutes in blood plasma move across
the wall of glomular capillaries into the glomerular capsule and then into the renal tubule
2. Tubular re-absorption and secretion: occurs in the renal tubule, as filtered fluid flows along the renal tubule
and through the collecting duct, tubule cells reabsorb about 99% of the filtered water and many useful
solutes. The water and solutes return to the blood as it flows through the peritubular capillaries and vasa
recta. Note that reabsorption refers to the return of a substance to the blood stream. The term absorption
by contrast, refers to entry of new substance to the body as in the GI tract.
3. Water conservation: happens in the collecting duct, as fluid flows along the renal tubule and through the
collecting duct, the tubule and duct cells secrete other materials such as wastes, drugs and excess ions into
the fluid. Tubular secretion removes a substance from the blood.
For filtration in the Glomerular capsule, the blood plasma has to cross 3 barriers:
1. Glomerular Endothelial cells
2. Basal Lamina
3. Filtration slit formed by podocytes

Principle of filtration: the use of pressure to force fluids through a membrane (i.e. Starlings law of capillaries
Hydrostatic pressure (push) and oncotic pressure i.e. colloid osmotic pressure (pull)). The volume of fluid filtered by
renal corpuscle is much larger than in other capillaries of the body for 3 reasons:
1. Glomerular capillaries have a large surface area as they are long and extensive. Mesangial cells regulate
surface area available for filtration (relaxed ↑SA, contracted ↓SA)
2. Filtration membrane have large fenestrations/pores
 3. Glomerular capillary blood pressure is high because efferent arteriole is thinner than afferent arteriole
Net Filtration Pressure: Glomerular filtration depends on 3 main pressure, one pressure promotes filtration and two
pressures oppose filtration:
1. Glomerular blood hydrostatic pressure GBHP - 55mmHg
2. Capsular hydrostatic pressure CHP – 15mmHg
3. Blood colloid osmotic pressure BCOP – 30mmHg
Net Filtration pressure = GBHP – CHP – BCOP = 55 – 15 – 30 = 10 mmHg

Glomerular Filtration Rate GFR: depends on arterial pressure. The mechanisms that regulate glomerular filtration
rate operate in two ways:
1. By adjusting blood flow into and out of the glomerulus
2. Altering the glomerular capillary surface area available for filtration
There are 3 mechanism to control GFR:
1. Renal autoregulation: consists of 2 mechanisms, myogenic mechanism and tubuloglomerular feedback
working together, they can maintain nearly constant GFR over a wide range of systemic blood pressures.
a. Myogenic mechanism: when blood pressure rises, it stretched the walls of the afferent arterioles , in
response smooth muscle fibers contract which narrows the walls of the afferent arterioles hence
maintaining constant blood pressure and vice versa if blood pressure drops. Hence this maintains a
constant GFR
b. Tubuloglomerular Feedback: Macula densa cells of Juxtaglomerular apparatus detect changes in Na,
Cl and water delivery and sends an input to the control center (the Juxta Glomerular Apparatus)
which either cause the constriction or dilation of the afferent arteriole hence regulating blood flow
to glomerulus and hence the GFR
2. Neural regulation: Sympathetic stimulation vaso-constricts the afferent arterioles reducing GFR
 3. Hormonal regulation: Angiotensin II – potent vasoconstrictor reducing GFR and atrial natriuretic peptide
ANP increases GFR by relaxing the glomerular Mesangial cells hence increasing surface area available for
filtration
122. Reabsorption and secretion in the nephron, their physiological mechanisms reabsorption of water?
Reabsorption: movement of water and solutes from nephron tubule back into circulation
Secretion: movement of solutes and water from circulation into the nephron tubule

The afferent arteriole brings plasma to the head of the nephron where the vessels will form the glomerulus, the
vessels will then exit the head of the nephron via the efferent arterioles. The efferent arterioles will then form the
vasa recta which are capillaries that will follow the tubule of the nephron. The vasa recta allow for reabsorption of
things back into circulation while at the same time allow the secretion of things from circulation back inside the
nephron.
Parts of the nephron:
1. Head of nephron: bowman’s capsule
2. PCT: proximal convoluted tubules
3. Loop of Henle
4. DCT: distal convoluted tubule
5. Collecting duct
Different sections of the nephron may absorb the same thing but in different amounts.
Reabsorption:
1. PCT: reabsorption of Na, Cl, K, Glucose, amino acids, urine, HCO3 and water
2. Descending part of loop of Henle: water reabsorption takes place
3. Ascending part of loop of Henle: Na, Cl, K, reabsorption occurs
4. DCT: responsible for reabsorption of Na, Cl, K, Ca, Mg, HCO3
5. Collecting duct: responsible for reabsorption of Na, Cl, Urea and water
Different segments of nephron also allow for the secretion of things back inside the tubule from the circulation
specifically from the vasa recta
PCT is important in acid base regulation
Loop of Henle is important in absorption of electrolytes

DCT: Mg and Ca get reabsorbed para cellular i.e. between the cells
Collecting duct: have special channels called aquaporins which allow for reabsorption of water concentrating the
urine for excretion. The number of aquaporins is controlled by ADH of pituitary gland, hence more aquaporins more
water retained in circulation

123. Countercurrent mechanism reabsorption of water?

Bowman capsule, PCT, DCT and collecting duct are in the cortex of the kidney while the loop of Henle is in the Kidney
medulla. The kidney Medulla is salty.
Countercurrent: because the descending and ascending part of the loop of Henle flow in opposite direction.
 Descending Limp of loop oh Henle: water is reabsorbed passively
 Ascending limb of loop of Henle: ions are reabsorbed actively. Note that Urea is sometimes reabsorbed to
maintain osmolarity of medulla (urea recycling)
124. Regulation reabsorption of sodium and glucose in the tubule nephrons?
Insulin increases glucose absorption in urine by increasing the PCT permeability (passive transport), sometimes
glucose can exists in urine after a meal with carbohydrate, after hard exercise
125. Regulation reabsorption of amino acids in the tubules of nephrons?

Amino acid is 100% absorbed in the PCT by sodium symporter pump

Reabsorption is a 2 step process:

1. Step 1: passive or active movement of water and dissolved solutes from the fluid inside the tubule through
the tubule wall into the space inside
2. Step 2: water and solutes move through the capillary walls back into your bloodstream again by passive or
active transport
Nephron Overview