1

1502 504

CD

: Urinary

3

53010710065

53010710066

2

53010710069

53010710071

53010710072

53010710073

2

1 2554

CD

3

Urinary

nephron

3

4

Anatomy Review

2

Early filtrate processing

20

Glomerular filtration

29

Late filtrate processing

37

5

Anatomy Review

Urinary System

1. Anatomy

2. Nephron

3.

Tubular epithelium

6

4. Juxtaglomerular

apparatus

epithelial cells

Epithelial Cells

3 squamous, cuboidal columnar

ureter) ,

urinary bladder)

urethra)

urine)

7

retroperitoneal

peritoneal cavity)

upper abdomen

Adrenal gland)

Perirenal fat capsule

Renal vein ,Renal hilium Inferior vena cava

8

continuously filter)

Renal vein Renal artery

Abdominal aorta

Segmental arteries Interlobar

arteries

3

renal cortex, renal medulla pelvis

9

1. Renal cortex nephron

(Nephron) cortex cortical nephrons

Nephron cortex medulla juxtamedullary

nephrons

Cortical nephrons

nephrons cortex loop of Henle

medulla

Juxtamedullary nephrons

nephrons glomeruli cortical/medullary juction

loop of Henle medulla

10

2. Renal medulla

renal pyramids

Renal pyramids

medulla

capillaries

Renal columns

renal cortex renal

pyramids medulla

Renal pelvis

renal sinus

ureter)

Renal sinus

renal pelvis artery

vein

Nephron overview

nephron)

11

associated blood vessels)

Nephron)

glomerulus

(renal tubule)

Nephron overview: Associated blood vessels

Interlobar artery

renal colums

segmental artery

arcuate artery

Arcuate artery

12

medulla-cortex junction arcuate veins

renal pyramids

cortical radiate arteries

Cortical radiate artery

arcuate artery

afferent arterioles

Afferent arteriole

cortical radiate artery

glomerulus

autoregulation

Glomerulus

afferent arterioles

efferent arterioles

glomerular capsule (Bowman's capsule)

Efferent arteriole

glomerulus

peritubular capillaries

Peritubular capillaries

13

efferent arteriole

renal cortex

Vasa recta

medulla

Cortical radiate vein

peritubular capillaries vasa recta

arcuate vein

Arcuate vein

medulla-cortex junction arcuate

arteries

renal pyramids

Interlobar veins

Interlobar vein

arcuate vein renal vein

Nephron overview: Tubular segments

14

(nephron)

Glomerular (Bowman's) Capsule

glomerulus

(Proximal convoluted tubule (PCT))

glomorular capsule loop of

Henle

Active 65%

U (Loop of Henle)

U descending ascending

limbs.

Descending loop of Henle (

Ascending loop of Henle (

Distal convoluted tubule (DCT))

juxtaglomerular apparatus

cortical collecting duct

Cortical collecting duct

15

distal convoluted tubules

nephrons

cortex

Medullary collecting duct

cortical collecting ducts

medulla

16

renal corpuscle

Glomorulus

afferent efferent arterioles

glomerular (Bowman's) capsule

Afferent arteriole

cortical radiate artery

glomerulus

autoregulation

Efferent arteriole

glomerulus

peritubular capillaries

Glomerular (Bowman's) Capsule

nephron glomerulus

Renal corpuscle

nephron glomerulus

glomerular capsule

Parietal layer

17

glomerular capsule glomerulus

Visceral layer (podocytes)

glomerular capsule

glomerulus

Capsular space

glomerular capsule

18

Renal corpuscle

glomerular

longitude)

Capillary endothelium

simple squamous cells

Fenestrations

,

19

20

renal corpuscle

basement membrane capillary endothelium

Basement membrane

epithelial cells

basement membrane podocytes

Podocyte

visceral layer glomerulus

capsule

cell body

Pedicels

foot process podocyte basement membrane

glomerular capillary

filtration membrane

Filtrations slits

pedicels filtration

membrane

fenestrated capillary endothelium, basement

membrane podocyte

21

filtration membrane

Filtration membrane

3

fenestrated capillary endothelium, basement

membrane filtration slits

pedicels podocytes

filtration membrane cross-section

Photomicrograph filtration membrane cross-

section

Podocyte

visceral layer glomerulus

capsule

Nucleus

22

Pedicel

foot process podocyte basement membrane

glomerular capillary

filtration membrane

Capsular space

glomerular capsule

filtrate)

Filtrations slits

pedicels filtration

membrane

Basement membrane

epithelial cells connective

tisssue cells

Capillary endothelium

simple squamous cells

Capillary fenestration

23

filtration membrane

capsular space

Proximal convoluted tubule (PCT)

Simple cuboidal cells PCT brush border cells

microvilli

24

PCT

glomerular capsule loop of Henle

65%

Brush border cells

epithelial cells PCT microvilli

Microvilli

plasma membrane

Lumen

Luminal membrane

plasma membrane tubular lumen

Tight junctions

Intersititial space

interstitium

25

Basolateral membrane

plasma membrane

interstitial space

Mitochondrion

organell cytoplasm ATP

metabolism

:

Solutes

(solvent)

(solution)

Squamous cells Thin loop of Henle

thin segment loop of Henle

Simple squamous epithelial cells

:

26

Thick ascending loop of Henle DCT

Cuboidal epithelium thick ascending loop of Henle

DCT

:

ascending limb NaCl

DCT ascending limb

Cuboidal epithelia

(renal tubule)

Ascending loop of Henle

medulla

renal cortex

27

DCT

juxtaglomerular apparatus cortical

collect duct

Glycoprotein

Photomicrograph Glomerulus Adjacent tubules

Photomicrograph glomerulus

glomerular capsule

Glomerular capsule

glomerulus

28

Parietal layer

glomerular capsule glomerulus

Visceral layer

glomerular capsule basement

membrane glomerulus

Distal convoluted tubule (DCT)

juxtaglomerular apparatus

cortical collecting duct

Proximal convoluted tubules (PCT)

glomorular capsule loop of

Henle

Active 65%

29

30

Juxtaglomerular apparatus

thick ascending loop of Henle DCT

afferent efferent arterioles

Thick ascending loop of Henle

U filtrate medulla

cortex

Efferent and Afferent arteriole

juxtaglomerular apparatus (JGA)

macula densa granular cells

Juxtaglomerular apparatus (JGA)

31

ascending loop of Henle

afferent arteriole

glomerulus

Granular cells

smooth muscle cells (modified)

autoregulation GFR blood regulation

rennin juxtaglomerular (JG)

cells

Macula densa cells

loop of Henle

juxtaglomerular apparatus

filtrate

32

Cortical collecting duct

Cuboidal cells cortical collecting duct 2

Principal cells intercalated cells

Cuboidal cells

(renal tubule)

Principal cells

(collecting duct)

aldersterone antidiuratic hormone

Na K ions

Intercalated cells

acid-base

regulation

:

Principal cells:

2) Intercalated cells: H+

33

-

34

Medullary collecting duct

Medullary collecting duct principal cells

Medullary collecting duct

cortical collecting duct medulla

urine

Principal cells

(collecting duct)

aldersterone antidiuratic hormone

Na K ions

:

Urea

nitrogenous waste

(urine)

35

36

Photomicrograph collecting ducts

Photomicrograph

(collecting ducts)

1.

2. 3 renal cortex, renal medulla renal

pelvis

3. (nephron)

4.

epithelial cells

37

Early filtrate processing

filtrate)

filtrate

1. passive active

reabsorbtion) (secretion)

2. filtrate processing

38

3. countercurrent multiplier

medullary osmotic gradient

nephron

passive transport

primary active transport

secondary active transport

osmolarity

Passive Transport

Primary active transport

ATP carrier molecule

Secondary active transport

concentration gradient

concentration gradient

membrane

concentration gradient primary active

transport

39

cotransport

Osmolarity

reabsorption)

glomerulus

reabsorption)

(reabsorption pathways)

2 tubular cell barrier

Transcellular pathway

luminal basolateral membranes

Paracellular pathway

tight junctions

Transcellular pathway

40

Peritubular capillary

Tubular cell

Interstitial space

Basolateral membrane

Luminal membrane

Paracelluar pathway

Peritubular capillary

Tubular cell

Tight junction

Interstitial space

Lateral intercellular space

41

Reabsorption Overview:

lumen tight junctions

tubule interstitial space

Decrease the osmolarity of the interstitium

intersitium tubule

dehydration

Increase the osmolarity of the interstitium

tight junction

interstitium

plasma membrane

Reabsorption Overview: Interstitial Osmolarity

osmolarity interstitium

sodium ion interstitium

sodium interstitium

osmolarity

tubule tight junction plasma membrane

interstitium

osmolarity

42

interstitium

interstitial osmolarity

Reabsorption Overview: Membrane Activity

sodium ion

basolateral transport

luminal membrane?

sodium ions

filtrate lumial membrane

Sodium ions filtrate

intracellular

sodium ions basolateral membrane

reabsorption ions luminal membrane

43

Reabsorption Overview:

basolateral transport sodium ions

2

Interstitial osmolarity tubular

lumen

2. sodium ions

luminal membrane

Sodium ion transport

PCT Basalateral membrane: Active

2

Na+

Na+-K+ ion pumps Na+ K+

Interstitial fluid

1. Na+

44

2. osmolarity interstitial fluid

PCT Basolateral membrane: Diffusion

Potassium ion channel K+ interstitium

Diffusion

K+ K+

Glucose carrier molecules glucose

facilitated diffusion

Glucose

45

PCT Luminal membrane activity

Luminal membrane

Na+-H+ countertransport Na+-glucose cotransport

carrier carrier molecules

Na+-K+ ATPase

ion pumps Basolateral membrane

H+ countertransport molecule

Na+

Countertransport molecules

concentration gradient

primary active transport pumps basolateral

membrane

cotransport molecule

Na+ Cotransport

molecule concentration gradient

primary active transport pumps basolateral

membrane

transport

carriers

Transport maximum (Tm)

46

Hyperglycemia

Hyperglycemia

(diabetes mellitus)

cotransport molecules

filtrate

Cotransporters

cotransport molecules comformation

Glucose

glucose Tm

glucose

Glucose

PCT loop of Henle

Tubular cells cotransport carriers

cotransport carriers

glucose

Glucose reabsorption analogy

47

Normal sugar rate

PCT

glucose,

Increase sugar rate

hyperglycemia (diabetes

mellitus)

glucose transport maximum

Tm)

PCT Paracellular Pathway

tight junction PCT (tight)

PCT tight junction concentration

gradient

Na+ Cl- K+ solvent drag

Osmolarity filtrate interstitial fluid

equilibrium

48

PCT

PCT

1. Na+-K+ ATPase ion pumps

Na+ interstitium

2. H+ ions filtrate

3. transport molecules

filtrate cytosol

4. bulk flow interstitium

peritubular capillaries

:

65%

(filtrate)

glucose 100%

49

Thin Descending Loop of Henle

cuboidal epithelial cells simple

squamous epithelial cells

(membrane) NaCl

channels transporter molecules

:

osmolarity filtrate

Ascending Loop of Henle: Luminal

Membrane

tight junction glycoprotein

converting luminal membrane

Luminal membranes:

microvilli

2. ion channels secondary active

transport carriers

Carrier molecule K+, 2Cl- Na+

50

K+ K+

filtrate interstitium

Cl- Na+ basolateral membrane

interstitium

Ascending Loop of Henle: Basolateral

Membranes

Basolateral membranes ascending loop of Henle

Na+-K+ ATPase ion pumps K+

channels PCT

Chlorid channel Cl- Na+

equilibrium

luminal filtrate interstitial fluid

Osmotic gradient interstitial fluid tubular filtrate

200 mmole

Ascending Loop

ascending limb of loop of Henle

1. Filtrate

51

2. Interstitial osmolarity 200 mmole filtrate

3. osmolarity cortex

(medullary osmotic gradient)

Loop of Henle: A Countercurrent Multiplier

osmotic gradient countercurrent

multiplier loop of Henle 2

acending limbs descing limbs

interstitial osmolarity gradient

medulla

medullary gradient

ascending limb NaCl interstitium

interstitium

loop

52

descending limb loop

NaCl ascending limb

filtrate

Medullary interstitium

300-1200 mmole

cortical loop of Henle

100 mmole

200 mmole

interstitial fluid

53

The Vasa Recta: A Countercurrent Exchanger

Vasa recta medullary cells

medullary osmotic

gradient

vasa recta

countercurrent exchange

descending vasa recta loop

interstitium NaCl

2. ascending loop

NaCl interstitium

medulla

osmotic

gradient

-

1. 65% filtrate)

PCT Active Passive

2. filtrate descending loop of Henle

54

3. Filtrate ascending loop of Henle

4. NaCl ascending

descending limb loop of Henle osmotic gradient

medulla

5. Vasa recta medull

osmotic gradient

55

Glomerular filtration

3 :

(filtration) reabsorption)

(secretion)

(filtration membrane) glomerular capsule

1. 3

2. filtration membrane)

3.

glomerulus (glomerular filtrate)

4. glomerulue

(glomerular filtration)

1. nephron)

2. hydrostatic pressure

3. osmotic pressure

(nephron)

56

glomerulus

renal tubule)

Hydrostatic Pressure

Osmotic Pressure

(solution) (solute)

Renal Process

Filtration)

(solute) glomerulus capsular space

(Reabsorption)

(filtrate)

peritubular capillaries

(Secretion)

peritubular capillaries

tubular cells filtrate

57

1. (filtration membrane)

2.

3.

glomerulus

glomerular capsule

Filtration Membrane glomerulus (Glomerular

Filtration)

(filtration membrane) 3

1. Fenestred glomerular endothelium

2. Basement membrane

3. Filtration slits

Filtration slits pedicels podocyted

58

glomerulus bulk flow

hydrostatic pressure

(solute)

Glomerular filtrate

capsular space glomerular

filtrate

glomerular filtrate

59

Organic molecules = Glucose, Amino acids

Nitrogenous waste = Urea, Uric acids, Creatinine

Ions = Sodium, Potassium, Chloride

Water

glomerular filtrate

(Filtration Membrane)

(

60

filtrate

“hematuria”)

1. Glomerular hydrostatic pressure (blood pressure)

= 60 mmHg

2. Capsular hydrostatic pressure = 15 mmHg

3. Glomerular osmotic pressure = 28 mmHg

4. : 60 mmHg – (15 mmHg + 28 mmHg) =

17 mmHg

61

60) touchdown

2 (15 28)

60

glomerulus hydrostatic

pressure

Glomerulus (Glomerular Filtration Rate: GFR)

62

(net filtration pressure)

GFR

GFR

autoregulation

GFR

63

Autoregulation GFR

1. Systemic pressure : 120 mmHg

2. Glomerular hydrostatic pressure

3. afferent arteriole

4. : GFR = 125 ml/

autoregulation

1. Systemic pressure : 140 mmHg

2. Glomerular hydrostatic pressure

3. afferent arteriole

4. : GFR = 146 ml/

autoregulation (afferent arterilole

1. Systemic pressure : 140 mmHg

2. Glomerular hydrostatic pressure

3. afferent arteriole

4. : GFR = 125 ml/

autoregulation

1. Systemic pressure : 100 mmHg

2. Glomerular hydrostatic pressure

3. afferent arteriole

64

4. : GFR = 104 ml/

autoregulation (afferent arterilole

1. Systemic pressure : 100 mmHg

2. Glomerular hydrostatic pressure

3. afferent arteriole

4. : GFR = 125 ml/

65

GFR: Myogenic Mechanism

blood

flow

blood flow

autoregulation myogenic mechanism

arteriole reflexive

vasoconstriction

glomerular blood flow

GFR: Tubuloglomerular mechanism

66

macula densa cells juxtaglomerular

apparatus NaCl filtrate

terminal portion ascending loop of Henle

High Flow:

high filtrate flow rate macula densa

vasoconstrictor

afferent arteriole

vasoconstrictor:

1. GFR

2. Tubular filtrate flow

3. Na+ Cl-

Low Flow:

low flow rate macula densa:

1. vasoconstrictor

2. granular cells rennin

67

GFR: Sympathetic

sympathetic

sympathetic

autoregulation

sympathetic

1.

2. GFR

Emergency

sympathetic

arteriole

GFR filtrate flow

68

1. Glomerular filtrate

filtration

membreane

2. (net filtration pressure)

glomerular hydrostatic pressure capsular

hydrostatic pressure glomerular osmotic pressure

3.

autoregulation GFR

4.

sympathetic autoregulation

Late Filtrate Processing

filtrate DCT collecting duct

1. aldosterone

2. ADH

69

3. medullary osmotic gradient

1.

2.

3. osmolarity

4. medullary osmotic gradient

Late Filtrate Processing Analogy

early tubular segment

early tubular segment

later tubular segment

1.

2.

70

CCD: H+

cortical collecting duct principle cells

intercalated cells

Intercalated cells H+ filtrate

Principle cells

CCD: Aldosterone

Principal cells NaCl

aldosterone ADH

Aldosterone Na+-K+ ATPase ion pump

luminal Na+, K+ channels

71

Aldosterone: Adrenal gland

1. Aldosterone Na+-K+ ATPase ion pump

luminal Na+, K+ channels

2. basolateral K+ channels K+ filtrate

interstitium

3. Aldosterone DCT

4. interstitial osmolarity

72

CCD: Antidiuretic Hormone

Principle cells ADH

ADH: Pituitary gland

ADH (posterior pituitary)

Water channels

interstitial osmolarity

osmolarity

Dehydration Overhydration

Dehydration

dehydration

ADH

73

Overhydartion

overhydration ADH

medullary collecting duct

: Medullary Collecting Duct

74

medullary collecting duct

125 ml/ glomerular filtrate 6 ml/ (5%)

ADH collecting duct

Medullary osmotic gradient

75

Osmotic gradient filtrate

medullary collecting duct

ADH

ADH

Normal hydration

1. ADH Water channels

2. ADH urea medullary collecting

duct

3. Urea 40% interstitial osmolarity

4. Urea loop of Henle collecting

ducts

5. 2 body osmolarity

(600 mOsm)

Under hydration

1. ADH

2. filtrate

3. 1400

mOsm

Over hydration

76

1. ADH

2. Filtrate osmolarity

3.

4. osmolarity 100 mOsm

77

95% 125 ml/ filtrate

medullary collecting duct

Final volume of urine

Normal: ADH level Normal

0.9 % filtrate 1.10 ml/ 1.5

Dehydration: ADH level High

0.2 % filtrate 0.24 ml/ 0.4

Overhydration: ADH level Low

12.5 % filtrate 16.0 ml/ 22.5

78

1. Late filtrate processing

2. Late filtrate processing

aldosterone antidiuratic

3. Medullary osmotic gradient ADH

4. 99% glomerular filtrate