Chapter 26 (Urinary)

___% of blood supply goes there and circulates there many times during the day. (all blood goes there and circulates several times a day. I am assuming at any given moment, it is 25%) Blood ________ has a direct effect on how much blood gets _________ or how much gets filtered out of the blood.

25% of blood supply goes there and circulates there many times during the day. Blood pressure has a direct effect on how much blood gets filtered or how much gets filtered out of the blood.

Transport Maximum ___% of the water initially filtered through the glomerular filtration gets reabsorbed If you didn't, you would become _________ Why _________ gets reabsorbed too Glucose will act very similar in the blood for osmotic pressure to the ________. •Each type of symporter has an ________ limit on how fast it can work, called the ___________ maximum (Tm). •The mechanism for water reabsorption by the renal tubule and collecting duct is __________. •About ___% of the filtered water reabsorbed by the kidneys occurs together with the reabsorption of solutes such as Na+, Cl-, and glucose. •Water reabsorption together with solutes in tubular fluid is called ____________ water reabsorption. •Reabsorption of the final water, called __________ reabsorption, is based on need and occurs in the ___________ ducts and is regulated by _____.

90% of the water initially filtered through the glomerular filtration gets reabsorbed If you didn't, you would become dehydrated Why glucose gets reabsorbed too Glucose will act very similar in the blood for osmotic pressure to the sodium. •Each type of symporter has an upper limit on how fast it can work, called the transport maximum (Tm). •The mechanism for water reabsorption by the renal tubule and collecting duct is osmosis. •About 90% of the filtered water reabsorbed by the kidneys occurs together with the reabsorption of solutes such as Na+, Cl-, and glucose. •Water reabsorption together with solutes in tubular fluid is called obligatory water reabsorption. •Reabsorption of the final water, facultative reabsorption, is based on need and occurs in the collecting ducts and is regulated by ADH.

External Anatomy of Kidney LOOK AT PIC ON SLIDE 9 Adrenal gland above Kidney (known as the __________ gland) Sagittal slice

Adrenal gland above Kidney (known as the suprarenal gland) Sagittal slice

micturition reflex Allows urine to ______ Stretch __________ stretch triggering to release We ______ ourselves not to release unless there is a specific scenario. We urinate or we void or we micturish → all mean _______ Some patients do not have that control → urinary ____________ Can result from damage, aging, or UTI •Micturition or urination (voiding) •Stretch receptors signal spinal cord and _______ -when volume exceeds 200-400 mL •Impulses sent to ________ center in sacral spinal cord (S2 and S3) & reflex is triggered -parasympathetic fibers cause detrusor muscle to contract, external & internal sphincter muscles to ________. •Filling causes a sensation of fullness that initiates a desire to urinate before the reflex actually occurs -_________ control of external sphincter -cerebral cortex can initiate micturition or delay its occurrence for a limited period of time

Allows urine to flow Stretch receptors stretch triggering to release We train ourselves not to release unless there is a specific scenario. We urinate or we void or we micturish → all mean urinate Some patients do not have that control → urinary incontinence Can result from damage, aging, or UTI •Micturition or urination (voiding) •Stretch receptors signal spinal cord and brain -when volume exceeds 200-400 mL •Impulses sent to micturition center in sacral spinal cord (S2 and S3) & reflex is triggered -parasympathetic fibers cause detrusor muscle to contract, external & internal sphincter muscles to relax •Filling causes a sensation of fullness that initiates a desire to urinate before the reflex actually occurs -conscious control of external sphincter -cerebral cortex can initiate micturition or delay its occurrence for a limited period of time

Anatomy of Urinary Bladder Just look at diagram ON SLIDE 85

Anatomy of Urinary Bladder Just look at diagram ON SLIDE 85

Antidiuretic Hormone Typically the _____ hormone that affects the pores at the collecting duct and the distal convoluted tubule as far as _____ reabsorption Typically when you drink, you need to urinate more. When you drink alcohol, alcohol has a direct affect on the production of ADH Alcohol _________ production of ADH, this means the reabsorption of sodium (and water because water follows) is affected at the collecting duct. If you inhibit production of ADH, you _____ reabsorb as much sodium which decreases reabsorption of water which means you are forming more filtrate and thus more ______. THERE IS A FEEDBACK LOOP FOR ADH ON THIS SLIDE (SLIDE 66).

Antidiuretic Hormone Typically the last hormone that affects the pores at the collecting duct and the distal convoluted tubule as far as water reabsorption Typically when you drink, you need to urinate more. When you drink alcohol, alcohol has a direct affect on the production of ADH Alcohol inhibits production of ADH, this means the reabsorption of sodium (and water because water follows) is affected at the collecting duct. If you inhibit production of ADH, you won't reabsorb as much sodium which decreases reabsorption of water which means your forming more filtrate and thus more urine. There is a feedback loop for ADH on this slide

Renal Autoregulation of GFR Arterial blood ________ has a function on this Tubular feedback directly related to our ________ and water concentrations ________ is the number one electrolyte, sodium is what migrates through and _______ follows. water will change the ______ of these cells and that will affect the _________. -tubuloglomerular feedback •elevated systemic ___ raises the GFR so that fluid flows too ________ through the renal tubule & Na+, Cl- and water are not ____________. •macula densa detects that difference & releases a ___________ from the juxtaglomerular apparatus •afferent arterioles constrict & _______ GFR

Arterial blood pressure has a function on this Tubular feedback directly related to our sodium and water concentrations Sodium is the number one electrolyte, sodium is what migrates through and water follows. water will change the size of these cells and that will affect the pressure. -tubuloglomerular feedback •elevated systemic BP raises the GFR so that fluid flows too rapidly through the renal tubule & Na+, Cl- and water are not reabsorbed •macula densa detects that difference & releases a vasoconstrictor from the juxtaglomerular apparatus •afferent arterioles constrict & reduce GFR

Reabsorption of bicarbonate Bicarbonate also gets reabsorbed in _____ Bicarbonate H2CO3 Formed by taking water and combining it with CO2 When it breaks down, you can get hydrogen ions and monocarbon ions __________ ions can go back into blood and the _______ ions can get secreted back into the ____ Hydrogen ions getting reabsorbed into PCT (getting filtered out of blood) is why the urine will have a change of its ____ (________ pH) → hydrogen ions have a direct effect on pH level. (one of the metabolic occurrences to pH in the body) •For every ____ secreted into the tubular fluid, one filtered __________ eventually returns to the blood

Bicarbonate also gets reabsorbed in PCT Bicarbonate H2CO3 Formed by taking water and combining it with CO2 When it breaks down, you can get hydrogen ions and monocarbon ions Monocarbon ions can go back into blood and the hydrogen ions can get reabsorbed back into the tubule Hydrogen ions getting reabsorbed into tubule (getting filtered out of blood) is why the urine will have a change of its pH (lower pH) → hydrogen ions have a direct effect on pH level. (one of the metabolic occurrences to pH in the body) •For every H+ secreted into the tubular fluid, one filtered bicarbonate eventually returns to the blood

Histology of urinary bladder

Bladder is very strong and has ___________ epithelium

Chemical component of urinalysis Chemical and microscopic __________ Values are dependent on confirmation of all three parts (physical, chemical, and microscopic)

Chemical Chemical and microscopic overlap Values are dependent on confirmation of all three parts (physical, chemical, and microscopic)

Clinical Application Microscopic: look at different types of _________. Look at ______ blood cells, _____ blood cells, _______ → sometimes temporal damage or an indication of more severe damage Bacteria → ______ is usually in there because urine has exposure to the skin Patients who need to go on dialysis ______________: artificial kidney machine (hospital)--> takes a lot of time ____________ dialysis Draw off fluids from the abdominal cavity and give the patient an IV bag to infiltrate them with the fluids. You could do this with a dialysis center Patient comes in 2-3 times per week

Clinical Application Microscopic: look at different types of microbes. Look at white blood cells, red blood cells, castes → sometimes temporal damage or an indication of more severe damage Bacteria → yeast is usually in there because urine has exposure to the skin Patients who need to go on dialysis Hemodialysis: artificial kidney machine (hospital)--> takes a lot of time Peritoneal dialysis Draw off fluids from the abdominal cavity and give the patient an IV bag to infiltrate them with the fluids. You could do this with a dialysis center Patient comes in 2-3 times per week

countercurrent mechanism Countercurrent Mechanism Descending limb of loop of henle is very __________ to water Vasa recta blood vessels go across both ascending and descending limbs which allows for the levels of sodium to affect the water levels in the tissue spaces. •Descending limb is very permeable to water -higher osmolarity of interstitial fluid outside the descending limb causes ______ to move out of the tubule by osmosis •at hairpin turn, osmolarity can reach 1200 mOsm/liter •Ascending limb is ____________ to water, but symporters remove ____ and Cl- so osmolarity drops to 100 mOsm/liter, but less urine is left •Vasa recta blood flowing in opposite directions than the loop of Henle -- provides _________ & O2 without affecting osmolarity of interstitial fluid

Countercurrent Mechanism Descending limb is very permeable to water Changes at the loop of Henle Vasa recta blood vessels go across both ascending and descending limbs which allows for the levels of sodium to affect the water levels in the tissue spaces. •Descending limb is very permeable to water -higher osmolarity of interstitial fluid outside the descending limb causes water to move out of the tubule by osmosis •at hairpin turn, osmolarity can reach 1200 mOsm/liter •Ascending limb is impermeable to water, but symporters remove Na+ and Cl- so osmolarity drops to 100 mOsm/liter, but less urine is left •Vasa recta blood flowing in opposite directions than the loop of Henle -- provides nutrients & O2 without affecting osmolarity of interstitial fluid

KNOW DIAGRAM ON SLIDE 15 Diagram gives an overview of what happens to blood when it goes through the kidney. Realize: it starts a renal _______ and ends at renal _______. After renal artery, blood goes through different types of arteries then different types of arterioles (__________ arterioles, ___________ arterioles) then the ___________ capillaries and/or _______ _______ then different types of veins before it leaves the renal _______. One that is also very important is the ______________ capillaries (part of the nephron).

Diagram gives an overview of what happens to blood when it goes through the kidney. Realize: it starts a renal artery and ends at renal vein. After renal artery, blood goes through different types of arteries then different types of arterioles (afferent arterioles, efferent arterioles) then the peritubular capillaries and/or vasa recta then different types of veins before it leaves the renal vein. One that is also very important is the glomerular capillaries (part of the nephron).

Blood Supply to the Nephron Diagram showing blood flow Shows how _______ ______ looks with rest of nephron After filtrate gets reabsobred into the vasa recta, the ascedning limb of the loop of Henle goes near the _________ convoluted tubule which also is close to the arterioles Critical because that is part of the ___________ apparatus which is part of the controlling mechanism which is why the balance of electrolytes and water is so important. LOOK AT SLIDE 19

Diagram showing blood flow Shows how vasa recta looks with rest of nephron After it goes to vasa recta, it goes near the proximal convoluted tubule which also is clos to the arterioles Critical because that is part of the juxtaglomerular apparatus which is part of the controlling mechanism which is why the balance of electrolytes and water is so important. LOOK AT SLIDE 19

evaluation of kidney function Different types of other testing such as _____ (blood urea nitrogen blood test) to confirm what is going on in urinalysis. Plasma _________ How effective are the kidneys at clearing a substance from blood plasma. •Two blood screening tests can provide information about kidney function. -One screening test is the blood urea nitrogen (_____), which measures the level of nitrogen in blood that is part of urea. -Another test is measurement of plasma __________. •Renal plasma clearance expresses how effectively the kidneys remove (clear) a substance from blood _______.

Different types of other testing such as BUN (blood urea nitrogen blood test) to confirm what is going on in urinalysis. Plasma clearance How effective are the kidneys at clearing a substance from blood plasma. •Two blood screening tests can provide information about kidney function. -One screening test is the blood urea nitrogen (BUN), which measures the level of nitrogen in blood that is part of urea. -Another test is measurement of plasma creatinine. •Renal plasma clearance expresses how effectively the kidneys remove (clear) a substance from blood plasma.

Disruption to ________ balance and _________ balance can also create problems with Kidneys. Patients that have severe ________ (2nd or third degree), one of the major problems is __________ → losing moisture from burnt skin which then causes dehydration which then causes kidney damage or kidney _________. Thus kidneys can fail because you don't have the ________ of electrolytes or water thats normally found there. If it gets so severe, you may need a kidney __________. Not that challenging to do but the patient needs to be put on cyclosporine which is an immunosuppressive drug to prevent rejection of transplanted kidney. They have to live on that for the rest of their ________ making them vulnerable to other infections.

Disruption to fluid balance and electrolyte balance can also create problems with Kidneys. Patients that have severe burns (2nd or third degree), one of the major problems is dehydration → losing moisture from burnt skin which then causes dehydration which then causes kidney damage or kidney failure. Thus kidneys can fail because you don't have the balance of electrolytes or water thats normally found there. If it gets so severe, you may need a kidney transplant. Not that challenging to do but the patient needs to be put on cyclosporine which is an immunosuppressant drug to prevent rejection of transplanted kidney. They have to live on that for the rest of their lives making them vulnerable to other infections.

Diuretics Reabsorption of water will ________ the urine flow Caffeine inhibits _________ reabsorption Alcohol inhibits _____ Medications have other effects •Substances that slow renal reabsorption of water & cause diuresis (increased urine flow rate) -caffeine which inhibits Na+ reabsorption -alcohol which inhibits secretion of ADH -prescription medicines can act on the PCT, loop of Henle or DCT

Diuretics Reabsorption of water will increase the urine flow Caffeine inhibits sodium reabsorption Alcohol inhibits ADH Medications have other effects •Substances that slow renal reabsorption of water & cause diuresis (increased urine flow rate) -caffeine which inhibits Na+ reabsorption -alcohol which inhibits secretion of ADH -prescription medicines can act on the PCT, loop of Henle or DCT

Clinical Application Diuretics (coffee and tea) ________ the different cells that cause the effects of the mechanism. A lot of coffee and tea will concentrate the urine, you urinate a little differently than you would expect (increasing your urine flow) which means you __________ more quickly. Will inhibit the effects of the kidneys •Diuretics are drugs that ________ urine flow rate. They work by a variety of mechanisms. The most potent ones are the loop diuretics, such as furosemide, which _______ the symporters in the thick ascending limb of the loop of Henle.

Diuretics (coffee and tea) inhibit the different cells that cause the effects of the mechanism. A lot of coffee and tea will concentrate the urine, you urinate a little differently than you would expect (increasing your urine flow) which means you dehydrate more quickly. Will inhibit the effects of the kidneys •Diuretics are drugs that increase urine flow rate. They work by a variety of mechanisms. The most potent ones are the loop diuretics, such as furosemide, which inhibits the symporters in the thick ascending limb of the loop of Henle.

External Anatomy of the Kidney Do I want you to remember all these structures, NOT AT THIS TIME. Do realize that Kidney problems can be related to a lot of different factors. ________________ is a displacement of the kidneys. Happens with many thin people. •_______________ is an inferior displacement of the kidneys. It most often occurs in thin people. This condition is dangerous because the ureters may ________ and block urine flow (Clinical Application).

Do I want you to remember all these structures, NOT AT THIS TIME. Do realize that Kidney problems can be related to a lot of different factors. Nephroptosis is a displacement of the kidneys. Happens with many thin people. •Nephroptosis is an inferior displacement of the kidneys. It most often occurs in thin people. This condition is dangerous because the ureters may kink and block urine flow (Clinical Application).

Evaluation of Kidney Function Urinalysis → a means of analyzing kidney function We look at the _______ of the urine from different points How much ______ and how much ______ of fluids in a patient If a patient is consuming 2 pitchers of water, and only urinating a ____ of water,something is going on, water is going somewhere else Maybe kidneys aren't doing their jobs Foley __________ are used to obtain urine from patients with kidney problems. Urine is placed in a bag and then can check how much _________ of urine is formed.

Evaluation of Kidney Function Urinalysis → a means of analyzing kidney function We look at the volume of the urine from different points How much input and how much output of fluids in a patient If a patient is consuming 2 pitchers of water, and only urinating a cup of water,something is going on, water is going somewhere else Maybe kidneys aren't doing their jobs Full catheters are used to obtain urine from patients with kidney problems. Urine is placed in a bag and then can check how much volume of kidney is formed.

Filtration Membrane Filtration membrane of the glomerulus prevents certain things from going through such as _______, platelets, large plasma ________, medium-sized __________ Smaller _________ go through and other small things such as ________ Most of us don't see sugar in our urine because we _________ it. •#1 (endothelial cell) Stops all cells and platelets •#2 (basal lamina) Stops large plasma proteins •#3 (filtration slit) Stops medium-sized proteins, not small ones LOOK AT PIC ON SLIDE 36

Filtration membrane of the glomerulus prevents certain things from going through such as cells, platelets, large plasma proteins, medium-sized proteins Smaller proteins go through such as glucose Most of us don't see sugar in our urine because we reabsorb it. •#1 Stops all cells and platelets •#2 Stops large plasma proteins •#3 Stops medium-sized proteins, not small ones

Formation of Concentrated Urine Urine can be have up to ___ times the osmolarity of plasma which means your sodium levels in urine is much _______ than in your blood. ADH is very important to maintain the reabsorption of the ______ so you can keep that higher level of ________ leaving your body. •Cells in the collecting ducts reabsorb more water & urea when _____ is increased •Urea recycling causes a buildup of urea in the renal medulla •Figure 26.20 summarizes the processes of filtration, reabsorption, and secretion in each segment of the nephron and collecting ducts. Hormonal effects are also noted.

Formation of Concentrated Urine Four times the osmolarity of plasma which means your sodium in urine is much higher than in your blood. ADH is very important to maintain the reabsorption of the water so you can keep that higher level of sodium leaving your body. •Cells in the collecting ducts reabsorb more water & urea when ADH is increased •Urea recycling causes a buildup of urea in the renal medulla •Figure 26.20 summarizes the processes of filtration, reabsorption, and secretion in each segment of the nephron and collecting ducts. Hormonal effects are also noted.

Formation of Concentrated Urine Urine gets concentrated by... If you don't drink water and are out in the sun, your urine will be more yellow and more _______________. If you exercise, you will ____________ changing where the water comes out of your body affecting _____________ of urine. ADH also affects urine concentration in a ______________ mechanism The higher it is concentrated the more it allows for ________. to occur (higher concentration of water moves to a lower concentration of water). There is less water where there is ______ sodium and more water where there is ______ sodium. •Compensation for low water intake or heavy perspiration •When ADH level is ______, the kidneys secrete concentrated urine and conserve water; a large volume of water is reabsorbed from the tubular fluid into interstitial fluid, and the _______ concentration of urine is high. •Production of concentrated urine involves ascending limb cells of the loop of Henle establishing the osmotic gradient in the renal medulla, collecting ducts reabsorbing more water and urea, and urea recycling causing a build up of urea in the renal medulla (Figure 26.19). •The ______________ mechanism also contributes to the excretion of concentrated urine.

Formation of Concentrated Urine Urine gets concentrated by... If you don't drink water and are out in the sun, your urine will be more yellow 9more concentrated If you exercise, you will perspire changing where the water comes out of your body affecting concentration of urine. ADH also affects urine concentration in a countercurrent mechanism The higher it is concentrate the more it allows for osmosis to occur (higher concentration of water moves to a lower concentration of water). There is less water where there is more sodium and more water where there is less sodium •Compensation for low water intake or heavy perspiration •When ADH level is high, the kidneys secrete concentrated urine and conserve water; a large volume of water is reabsorbed from the tubular fluid into interstitial fluid, and the solute concentration of urine is high. •Production of concentrated urine involves ascending limb cells of the loop of Henle establishing the osmotic gradient in the renal medulla, collecting ducts reabsorbing more water and urea, and urea recycling causing a build up of urea in the renal medulla (Figure 26.19). •The countercurrent mechanism also contributes to the excretion of concentrated urine.

Formation of Dilute Urine This diagram give you a good illustration of the concentrations Numbers are looking at how concentrated/diluted the filtrate is at specific points in the nephron Loop of Henle - 900 (most __________ urine) → dilute urine = 65 DIAGRAM ON SLIDE 71

Formation of Dilute Urine This diagram give you a good illustration of the concentrations Numbers are looking at how concentrated/diluted the filtrate is at specific points in the nephron Loop of Henle - 900 (most urine produced) → dilute urine = 65 DIAGRAM ON SLIDE 71

Histology of the Nephron and Collecting Duct Glomerulus → just like we see in capillaries, the glomerulus has a lot of _______ _________ epithelium.

Glomerulus → just like we see in capillaries we have a lot of simple squamous epithelium.

External Anatomy of Kidney LOOK AT PIC ON SLIDE 8 Here is a transverse slice (look at it) Vertebrae surrounds spinal cord You can see right kidney and left kidney (the left is _______ than the right) They are encased in a ________ made of membrane with some possible fat to _______ kidneys.

Here is a transverse slice (look at it) Vertebrae surrounds spinal cord You can see right kidney and left kidney (one is higher than the other) They are encased in a capsule made of membrane with some possible fat to cushion kidneys.

Hormonal Regulation Hormonal controls will affect the ________ which will then affect chlorine. Sodium also affect water reabsorption and ____________ secretion Aldosterone and angiotensin II will cause ___________ of the afferent arteriole which decreases glomerular pressure and filtration (________ GFR). Helps as far as the sodium reabsorption Also causes the reabsorption of _____ sodium than chlorine and less water at the loop of henle and the distal convoluted tubule (DCT) Atrial natriuretic peptide (____) ________ reabsorption of sodium into the water at the proximal convoluted tubule which also suppresses _________ and antidiuretic hormone (_____).

Hormonal Regulation Hormonal controls will affect the sodium which will then affect chlorine. Sodium also affect water reabsorption and potassium secretion Aldosterone and angiotensin II will cause vasoconstriction of the afferent arteriole and which decreases glomerular pressure and filtration. Helps as far as the sodium reabsorption Also causes the reabsorption of more sodium than chlorine and less water at the loop of henle and the distal convoluted tubule Atrial natriuretic peptide (ANP) inhibits reabsorption of sodium into the water at the proximal convoluted tubule which also suppresses aldosterone and antidiuretic hormone (ADH).

Net Filtration Pressure Include ___________ pressure of glomerular _______ (GBHP), _________ _________ pressure (CHP), _______ _______ osmotic pressure (BCOP) Net filtration pressure is a little bit more ______ from the blood and into Bowman's capsule. NFP = total pressure that promotes filtration NFP = ______ - (______+_______) = 10 mm Hg LOOK AT PIC ON SLIDE 37

Include hydrostatic pressure of glomerular blood, scapular hydrostatic pressure, blood colloid osmotic pressure Net filtration pressure is a little bit more away from the blood and into Bowman's capsule. NFP = total pressure that promotes filtration NFP = GBHP - (CHP+BCOP) = 10 mm Hg

KNOW DIAGRAM ON SLIDE 17

KNOW DIAGRAM ON SLIDE 17

LOOK AT DIAGRAM ON SLIDE 70 FOR SUMMARY OF REABSORPTION AND SECRETION --> GREAT DIAGRAM

LOOK AT DIAGRAM ON SLIDE 70 FOR SUMMARY OF REABSORPTION AND SECRETION --> GREAT DIAGRAM

juxtamedullary nephrons DIAGRAM ON SLIDE 22 ______ of these These are deeper in the ________ Both cortical and juxtamedullary nephrons work together to create the _____ •___-___% of nephrons are juxtamedullary nephrons

Less of these These are deeper in the medulla Both cortical and juxtamedullary nephrons work together to create the urine •15-20% of nephrons are juxtamedullary nephrons

Location of Urinary Bladder Sagittal cross section of female Bladder and urethra is _________ to the pubic symphysis and _________ to the vagina and rectum. PIC ON SLIDE 84 •Posterior to pubic symphysis •In females is anterior to vagina & inferior to uterus •In males lies _________ to rectum

Location of Urinary Bladder Sagittal cross section of female Bladder and urethra is posterior to the pubic symphysis and anterior to the vagina and rectum. PIC ON SLIDE 84 •Posterior to pubic symphysis •In females is anterior to vagina & inferior to uterus •In males lies anterior to rectum

physical component of urinalysis Look at the physical contributing factors in the urine __________ of the urine (color should be between a light ______ to a medium ______). ________ = more concentrated urine could be related to biopigments If you were exercising and sweating a lot and not taking in enough fluids. If it is more ________, that means you took in a lot more volume of water Abnormal colored urine: ______ = bleeding such as from UTI Food coloring → saint patty's day → colorizes urine When trying to treat syphilis → use to give patients crystal violet → would cause _______ urine Medications can turn urine a different color Uristat causes _______ urine Green - _______ color is caused by liver damage related to breaking down blood cells in the liver too effectively which an also lead to the breaking down of proteins Specific _________: How many ________ are in that volume of fluid? __________ Want it to be fresh (at body temp) which is why you are supposed to urinate during your checkup as opposed to at home and then bringing it in. Once it becomes ______, it can start to break down. So it has to be a fresh sample. Some jobs require a urine sample (drug test) (urinalysis) Devices to keep urine ______ People bring in urine sample that is not there own → if it is 150 degrees, probably isn't there urine Some of these facilities now physically watch the person urinate into a cup to make sure they are not using someone else's. __________ of urine Urine will normally have a mild pungent odor because of the _________. Strong odor = more _______________ Sweet odor (bananas or fruity) = means you have _______ → can also represent things such as __________ mellitus.

Look at the physical contributing factors in the urine Color of the urine (color should be between a light straw to a medium amber). Darker = more concentrated urine could be related to biopigments If you were exercising and sweating a lot and not taking in enough fluids. If it is more clear that mean you took in a lot more volume of water Abnormal colored urine: Red = bleeding such as from UTI Food coloring → saint patty's day → clorizes urine When trying to treat syphilis → use to give patients crystal violet → would cause purple urine Medications can turn urine a different color Uristat causes orange urine Green - brown is caused by liver damage related to breaking down blood cells in the liver too effectively which an also lead to the breaking down of proteins Specific gravity How many particles are in that volume of fluid? Temperature Want it to be fresh (at body temp) which is why you are supposed to urinate during your checkup as opposed to at home and then bringing it in. Once it becomes cold, it can start to break down. So it has to be a fresh sample. Some jobs require a urine sample (drug test) (urinalysis) Devices to keep urine warm People bring in urine sample that is not there own → if it is 150 degrees, probably isn't there urine Some of these facilities now physically watch the person urinate into a cup to make sure they are not using someone else's. Fragrance of urine Urine will normally have a mild pungent odor because of the ammonia. Strong odor = more concentration Sweet odor (bananas or fruity) = means you have ketones → can also represent things such as diabetes mellitus

Symporters in the Loop of Henle May require more _______ regulation for reabsorption to occur. Reabsorbed into ______ _______ as opposed to peritubular capillary associated with PCT and DCT.

May require more energy regulation for reabsorption to occur. Reabsorbed into vasa recta as opposed to peritubular capillary associated with PCT and DCT.

Nephrons: __________ _________ tubule (PCT), _______ of ________, _________ ________ tubule (DCT) which then leads into the __________ duct Loop of Henle has ascending limb and descending limb, cells of each have different __________. 2 different types of nephrons: ________ nephrons and _____________ Both are in medulla and cortex, difference is how ________ they are located in both the medulla and cortex (where each is located more)

Nephrons: Proximal convoluted tubule, loop of Henle, distal convoluted tubule which then leads into the collecting duct Loop of Henle has ascending limb and descending limb, cells of each have different dimensions. 2 different types of nephrons: cortical nephrons and juxtamedullary Both are in medulla and cortex, difference is how much they are located in both the medulla and cortex (where each is located more)

Structure of Renal Corpuscle Nice image to show Bowman's capsule, proximal convoluted tubule, afferent arteriole, efferent arteriole, loop of henle, and macula densa which _______ or ________ in size which change the pressure on the afferent arteriole which then changes the ________ of the blood flow to the glomerulus. IMAGE ON SLIDE 26

Nice image to show Bowman's capsule, proximal convoluted tubule, afferent arteriole, efferent arteriole, loop of henle, and macula densa which increase or decrease in size which change the pressure on the afferent arteriole which then changes the pressure of the blood flow to the glomerulus.

Tubular Reabsorption and Secretion Occurs from the point of the proximal convoluted tubule (_____) all the way to the ___________ duct. Reabsorption of different things Most of _________ that got secreted get reabsorbed (why we don't normally see sugar in our urine) Filtration of _________, antibiotics gets filtered out of the blood at the _________, not the glomerulus. •Nephron must reabsorb ___% of the filtrate -_____ with their microvilli do most of work with rest of nephron doing just the fine-tuning •solutes reabsorbed by active & passive processes •water follows by _________ •small proteins by pinocytosis •Important function of nephron is tubular ________ -transfer of materials from blood into tubular fluid •helps control blood ___ because of secretion of ___ •helps _________ certain substances (NH4+, creatinine, K+)

Occurs from the point of the proximal convoluted tubule all the way to the collecting duct Reabsorption of different things Most of sugar that got secreted get reabsorbed (why we don't normally see sugar in our urine) Filtration of medications, antibiotics gets filtered out of the blood at the tubules, not the glomerulus. •Nephron must reabsorb 99% of the filtrate -PCT with their microvilli do most of work with rest of nephron doing just the fine-tuning •solutes reabsorbed by active & passive processes •water follows by osmosis •small proteins by pinocytosis •Important function of nephron is tubular secretion -transfer of materials from blood into tubular fluid •helps control blood pH because of secretion of H+ •helps eliminate certain substances (NH4+, creatinine, K+)

Ureters One ureter comes from each kidney to one bladder Ureters are same ______ for anybody relative to their body size Use ____________, hydrostatic pressure, and _________ to allow urine to migrate along. Kidney stones are formed in the renal ________ and they break up Stone gets trapped in the _______ → pain and discomfort ___________ and caffeine increase risk of kidney stones because you ________. More soda will also increase risk •The ureters are ___________ (behind abdominal cavity) and consist of a mucosa, muscularis, and fibrous coat.

One ureter comes from each kidney to the bladder Ureters are same size for anybody relative to their body size Use peristalsis, hydrostatic pressure, and gravity to allow urine to migrate along. Kidney stones are formed in the renal pelvis and they break up Stone gets trapped in the ureter → pain and discomfort Diuretics and caffeine increase risk of kidney stones because you dehydrate More soda will also increase risk •The ureters are retroperitoneal and consist of a mucosa, muscularis, and fibrous coat.

Over a __________ nephrons in kidney Why we can live with ____ kidney Why transplant exist and why we can live without one

Over a million nephrons in kidney Why we can live with one kidney Why transplant exist and why we can live without one

Overview of Kidney Functions •___________ of blood ionic composition -Na+, K+, Ca+2, Cl- and phosphate ions •Regulation of blood pH, osmolarity & glucose •Regulation of blood volume -conserving or ___________ water •___________ of blood pressure -secreting the enzyme renin -adjusting renal resistance •Release of erythropoietin & calcitriol •________ of wastes & foreign substances

Overview of Kidney Functions •Regulation of blood ionic composition -Na+, K+, Ca+2, Cl- and phosphate ions •Regulation of blood pH, osmolarity & glucose •Regulation of blood volume -conserving or eliminating water •Regulation of blood pressure -secreting the enzyme renin -adjusting renal resistance •Release of erythropoietin & calcitriol •Excretion of wastes & foreign substances

Passive Reabsorption in the 2nd half of PCT We also get chlorine, potassium, calcium, magnesium and urea __________ reabsorbed into the ___________ capillaries from the 2nd half of the PCT.

Passive Reabsorption in the 2nd half of PCT We also get chlorine, potassium, calcium, magnesium and urea passively reabsorbed into the peritubular capillaries.

Production of Dilute and Concentrated Urine ADH is very low usually but it does have an affect on the last portion of ______ reabsorption. Water gets reabsorbed primarily at the ________ cells of the collecting duct Once it passes the collecting duct towards the ______, you then have ______ (now it cant be reabsorbed). •The rate at which water is lost from the body depends mainly on ____, which controls water permeability of _______ cells in the collecting duct (and in the last portion of the distal convoluted tubule). When ADH level is very low, the kidneys produce ______ urine and excrete _______ water; in other words, renal tubules absorb more solutes than water

Production of Dilute and Concentrated Urine ADH is very low usually but it does have an affect on the last portion of water reabsorption. Gets reabsorbed primarily at the principal cells of the collecting duct Once it passes the collecting duct towards the calyx, you then have urine (now it cant be reabsorbed). •The rate at which water is lost from the body depends mainly on ADH, which controls water permeability of principal cells in the collecting duct (and in the last portion of the distal convoluted tubule). When ADH level is very low, the kidneys produce dilute urine and excrete excess water; in other words, renal tubules absorb more solutes than water

Reabsorption and Secretion in the Collecting Duct By the end of the DCT ___% of water has been reabsorbed Readjustments occur in the collecting duct Principal cells secrete _________ which leaks out and offsets the sodium charge.

Reabsorption and Secretion in the collecting Duct By the end of the DCT 95% of water has been reabsorbed Readjustments occur in the collecting duct Principal cells secrete potassium which leaks out and offsets the sodium charge.

Reabsorption Routes Reabsorption based on ______ levels _________ will affect chlorine, potassium, other electrolytes 2 location: ___________ reabsorption - fluid leakage between cells ____________ reabsorption - substance passes from the fluid in the tubule lumen through the apical membrane of a tubule cell, across the cytosol, and out into interstitial fluid through the basolateral membrane.

Reabsorption based on sodium levels Sodium will affect chlorine, potassium, other electrolytes 2 location: Paracellular reabsorption - fluid leakage between cells Transcellular reabsorption - substance passes from the fluid in the tubule lumen through the apical membrane of a tubule cell, across the cytosol, and out into interstitial fluid through the basolateral membrane.

Reabsorption in the DCT Reabsorption into the _________ capillaries _____________ hormone affecting the reabsorption of _________. •The DCT serves as the major site where _________ hormone stimulates reabsorption of ______. •DCT is not very permeable to _______ so the solutes are reabsorbed with _______ accompanying water.

Reabsorption in the DCT Reabsorption into the peritubular capillaries Parathyroid hormone affecting the reabsorption of calcium. •The DCT serves as the major site where parathyroid hormone stimulates reabsorption of Ca+2. •DCT is not very permeable to water so the solutes are reabsorbed with little accompanying water.

Reabsorption in the Loop of Henle Similar things are going on Now we only reabsorb about ___% of the filtered water at the _________ limb but little or none at the _________ limb. Because the sodium at levels are increasing as going up (water is not able to be reabsorbed) Cells are going from more of a squamous structure to _______ which is also harder for water to get through.

Reabsorption in the Loop of Henle Similar things are going Now we only reabsorb about 15% of the filtered water at the descending limb but little or none at the ascending limb. Because the sodium at levels are increasing as going up (not able to be reabsorbed) Cells are going from more of a squamous structure to cuboidal which is harder to get through.

Reabsorption in the PCT In diagram ON SLIDE 55, we see glucose and _______ getting through and out to the blood flow •Glucose, amino acids, lactic acid, water-soluble vitamins and other nutrients are completely reabsorbed in the first ____ of the proximal convoluted tubule •Intracellular sodium levels are kept low due to Na+/K+ pump

Reabsorption in the PCT In diagram we see glucose and sodium getting through and out to the blood flow •Glucose, amino acids, lactic acid, water-soluble vitamins and other nutrients are completely reabsorbed in the first half of the proximal convoluted tubule •Intracellular sodium levels are kept low due to Na+/K+ pump

Reabsorption in the Proximal Convoluted Tubule In PCT, we also use a certain type of reabsorption to actually affect _________ diffusion •Diffusion of Cl- into interstitial fluid via the paracellular route leaves tubular fluid more _______ than interstitial fluid. This electrical potential difference promotes passive ___________ reabsorption of Na+, K+, Ca+2, and Mg+2 (Figure 26.14). •Reabsorption of Na+ and other solutes creates an osmotic gradient that promotes reabsorption of ______ by osmosis (Figure 26.15).

Reabsorption in the Proximal Convoluted Tubule In PCT, we also use a certain type of reabsorption to actually affect chlorine diffusion •Diffusion of Cl- into interstitial fluid via the paracellular route leaves tubular fluid more positive than interstitial fluid. This electrical potential difference promotes passive paracellular reabsorption of Na+, K+, Ca+2, and Mg+2 (Figure 26.14). •Reabsorption of Na+ and other solutes creates an osmotic gradient that promotes reabsorption of water by osmosis (Figure 26.15).

Reabsorption within Loop of Henle Red arrows represent _______ levels Blue arrows = ______ for reabsorption (filtration) Notice levels are ________ as you go down the loop of henle and up Has an effect as far as what the levels are in the tissue spaces. DIAGRAM ON SLIDE 73

Reabsorption within Loop of Henle Red arrows represent sodium levels Blue arrows = water for reabsorption (filtration) Notice levels are changing as you go down the loop of henle and up Has an effect as far as what the levels are in the tissue spaces. DIAGRAM ON SLIDE 73

Regulation of GFR feedback loop ON SLIDE 41 Feedback loop diagram Related to ________ and water that affects the juxtaglomerular apparatus to create the ____________.

Regulation of GFR feedback loop ON SLIDE 41 Feedback loop diagram Related to sodium and water that affects the juxtaglomerular apparatus to create the autoregulation

Secretion of H+ and Absorption of Bicarbonate by Intercalated Cells Sodium potassium will also have an affect on the ____________ levels with ________ being the primary electrolyte. •Proton pumps (H+ATPases) secrete ___ into tubular fluid -can secrete against a concentration gradient so urine can be ______ times more acidic than blood •Cl-/HCO3- antiporters move _________ ions into the blood -intercalated cells help regulate ___ of body fluids •Urine is buffered by HPO4 2- and ________, both of which combine irreversibly with H+ and are excreted

Secretion of H+ and Absorption of Bicarbonate by Intercalated Cells Sodium potassium will also have an affect on the bicarbonate levels with chlorine being the primary electrolyte. •Proton pumps (H+ATPases) secrete H+ into tubular fluid -can secrete against a concentration gradient so urine can be 1000 times more acidic than blood •Cl-/HCO3- antiporters move bicarbonate ions into the blood -intercalated cells help regulate pH of body fluids •Urine is buffered by HPO4 2- and ammonia, both of which combine irreversibly with H+ and are excreted

Secretion of NH3 (ammonia) and NH4+ (ammonium) in the PCT Hydrogen ion may be substituted for ____________. Urine has a slightly pungent odor from the ammonia and ammonium which is derived from the __________ of amino acids.

Secretion of NH3 (ammonia) and NH4+ (ammonium) in the PCT Hydrogen ion may be substituted for ammonium Urine has a slightly pungent odor from the ammonia and ammonium which is derived from the breakdown of amino acids.

Reabsorption Routes LOOK AT IMAGE ON SLIDE 47 Shows both _____________ and _____________ routes Both routes lead to the reabsorbed particles going through the tissue ______ to get to the blood supply _________ in this tissue space will also have an effect on the reabsorption. 50% of reabsorption is ______________ for transcellular reabsorption, you may need _______ transport (ATP).

Shows both paracellular and transcellular routes Both routes lead to the reabsorbed particles going through the tissue space to get to the blood supply Sodium in this tissue space will also have an effect on the reabsorption. 50% of reabsorption is paracellular Transcellular, you may need active transport (ATP).

Blood Vessels around the Nephron Simple diagram good to know _________ arteriole going in creating the ___________ (a = affecting and e = effected) Capsule (_________ capsule) allows our initial filtration ___________ arteriole goes to the __________ capillaries and peritubular capillaries will also go into the ______ _______ which go ________ the nephron (not really shown in the diagram). 3 events going on at the nephron 1. Glomerular _________ 2. Tubular _________: water and other electrolytes can leave the nephron and go back into blood. 3. Tubular __________/filtration, sometimes referred to as urine formation Through this whole tube process it eventually leads to the ________ which at that point will be urine. But until it reaches calyx it is referred to as _________.

Simple diagram good to know afferent arteriole going in creating the glomerulus and the we have the efferent (a = affecting and e = effected) Capsule (Bowman's capsule) allows our initial filtration Efferent arteriole goes to the peritubular capillaries and peritubular capillaries will also go into the vasa erecta which go across the nephron (not really shown in the diagram). 3 events going on at the nephron 1. Glomerular filtration 2. Tubular reabsorption: water and other electrolytes can leave the nephron and go back into blood. 3. Tubular secretion/filtration, sometimes referred to as urine formation Through this whole tube process it eventually leads to the calyx which at that point will be urine. But until it reaches calyx it is referred to as filtrate

Transport Mechanism ____________ is the key electrolyte that affects the reabsorption mechanism Sodium also affects tubular __________ Where the sodium is, the _______ will follow •Solute reabsorption drives ________ reabsorption. The mechanisms that accomplish Na+ reabsorption in each portion of the renal ________ and collecting ______ recover not only filtered Na+ but also other electrolytes, nutrients, and ________.

Sodium is the key electrolyte that affects the reabsorption mechanism Sodium also affects tubular filtrations Where the sodium is, the water will follow •Solute reabsorption drives water reabsorption. The mechanisms that accomplish Na+ reabsorption in each portion of the renal tubule and collecting duct recover not only filtered Na+ but also other electrolytes, nutrients, and water.

Transport Mechanism ___________ _________ pump (active transport) requires ____ (energy) and is used for reabsorbing _________. water is only reabsorbed by _______

Sodium potassium pump (active transport) requires ATP (energy) and is used for reabsorbing sodium. water is only reabsorbed by osmosis.

Reabsorption and Secretion in the Collecting Duct Sodium potassium pump is going on where the _________ is being displaced with _______ using the energy of ATP Aldosterone will _________ sodium and water reabsorption here •Aldosterone increases Na+ and water reabsorption & K+ _________ by _________ cells by stimulating the synthesis of new pumps and channels.

Sodium potassium pump is going on where the sodium is being displaced with potassium using the energy of ATP Aldosterone will increase sodium and water reabsorption here •Aldosterone increases Na+ and water reabsorption & K+ secretion by principal cells by stimulating the synthesis of new pumps and channels.

Histology of the Nephron and Collecting Duct Some parts of nephron have __________ cells (large part of it (majority) is _______ making up the tubes) Still some _________ cells at inferior portion of loop of Henley •Distinctive features due to function of each region -microvilli -cuboidal versus simple -hormone receptors DIAGRAM ON SLIDE 24

Some parts of nephron have cuboidal cells (large part of it (majority) is cuboidal making up the tubes) Still some squamous cells at inferior portion of loop of Henley •Distinctive features due to function of each region -microvilli -cuboidal versus simple -hormone receptors DIAGRAM ON SLIDE 24

Anatomy and Histology of the Kidneys The paired kidneys are ____________ organs. (Not within the abdominal cavity)

The paired kidneys are retroperitoneal organs. (Not within the abdominal cavity)

Active and Passive Transport There is passive transport such as diffusion and facilitated transport Transport across membranes can be either ________ or _________ (See Chapter 3). In primary active transport, the energy derived from ____ is used to "______" a substance across a membrane. In secondary active transport the energy stored in an ion's electrochemical gradient drives another substance across the membrane.

There is passive transport such as diffusion and facilitated transport •Transport across membranes can be either active or passive (See Chapter 3). •In primary active transport the energy derived from ATP is used to "pump" a substance across a membrane. •In secondary active transport the energy stored in an ion's electrochemical gradient drives another substance across the membrane.

Nephrons (simple) Tubular structure where it starts to allow capillaries of the ________ to actually get ________ out of the blood. Has lots of tubes.

Tubular structure where it starts to allow capillaries of the glomerulus to actually get filtering out of the blood. Has lots of tubes.

Internal Anatomy of Kidney Upper picture is diagram model ON SLIDE 12 Lower picture is real kidney diagram ON SLIDE 12 Virtual Kidney dissection in Lab Kidney has _______ on the outside, then _______, then the ________ (the middle). In the medulla we have the _________ because they are triangular in shape They lead centrally towards white structure called minor _______ that leads to a major ______ (larger) which leads to the central portion of the Kidney known as the renal ________. The renal pelvis leads to where we develop the ________. Renal artery and renal vein come into the kidney through the renal ________ where blood will be circulated throughout the Kidney. Gets filtered through many ________. Millions of nephrons in one kidney. A lot of times people with heart problems, the second organ that gets affected after the heart is the ________ due to the blood circulation that occurs in them.

Upper picture is diagram model Lower picture is real kidney diagram Virtual Kidney dissection in Lab Kidney has capsule on the outside, then cortex, then the medulla (the middle). In the medulla we have the pyramids because they are triangular in shape They lead centrally towards white structure called minor calyx that leads to a major calyx (larger) which leads to the central portion of the Kidney known as the renal pelvis. The renal pelvis leads to where we develop the ureter. Renal artery and renal vein come into the kidney through the renal pelvis where blood will be circulated throughout the Kidney. Gets filtered through many nephrons. Millions of nephrons in one kidney. A lot of times people with heart problems, the second organ that gets affected after the heart is the kidney due to the blood circulation that occurs in them.

Ureters 10 to 12 in long IVP test used to check to see what the dimension of the ureters are and the function of the drainage of the kidneys

Ureters 10 to 12 in. long IVP test used to check to see what the dimension of the ureters are and the function of the drainage of the kidneys

Urinary Bladder Triangular shape allows for muscular structure to contain the urine ___________ muscles that prevents urine from passing into the urethra Pressure ___________ identify when the bladder feels full

Urinary Bladder Triangular shape allows for muscular structure to contain the urine Sphincter muscles that prevents urine from passing into the urethra Pressure receptors identify when the bladder feels full

Urine Storage, Transportation, and Elimination From _______ calyx into ______ calyx into the renal _______ then ________ then urinary _________ until it fills up and there is pressure and we have the feeling we have to go. •Urine drains through ________ ducts into minor _______, which joint to become major _________ that unite to form the _______ pelvis (Figure 26.3). From the renal pelvis, urine drains into the ________ and then into the urinary ________, and finally, out of the body by way of the _________ (Figure 26.1).

Urine Storage, Transportation, and Elimination From minor calyx into major calyx into the renal pelvis then ureters then urinary bladder until it fills up and there is pressure and we have the feeling we have to go. •Urine drains through papillary ducts into minor calyces, which joint to become major calyces that unite to form the renal pelvis (Figure 26.3). From the renal pelvis, urine drains into the ureters and then into the urinary bladder, and finally, out of the body by way of the urethra (Figure 26.1).

Urine is sterile when in the system, loses ________ when it comes in contact with skin.

Urine is sterile when in the system, loses sterility when it comes in contact with skin.

Waste referred to as ____________ waste (from the breakdown of food and nutrients). Not just what comes from the blood. Based on things that have been broken down. We also get a lot of electrolytes If you drank urine, you would notice the high concentration of water in it and the __________ to it because of the high levels of sodium, potassium, and chlorine. Also has slightly __________ like nature as a result of other components that get broken down. Kidney creates _____________: Important because it stimulates the bone marrow to produce new blood cells. A lot of the waste is also made up of products that come from the liver. We get rid of medical wastes in the urine as well. Any kind of _____________ will stay in your blood until it gets broken down and removed. (it is removed at the Kidneys).

Waste referred to as metabolic waste (from the breakdown of food and nutrients). Not just what comes from the blood. Based on things that have been broken down. We also get a lot of electrolytes If you drank urine, you would notice the high concentration of water in it and the saltiness to it becasue of the high levels of sodium, potassium, and chlorine. Also has slightly ammonia like nature as a result of other components that get broken down. Kidney creates erythropoietin. Important because it stimulates the bone marrow to produce new blood cells. A lot of the waste is also made up of products that come from the liver. We get rid of medical wastes in the urine as well. Any kind of medication will stay in your blood until it gets broken down and removed. (it is removed at the Kidneys).

Hormonal Regulation of GFR We have different hormones We have atrial natriuretic peptide (_____) which ___________ the filtration pressure ____________ II reduces the glomerular filtration by __________ and narrowing the afferent and efferent arterioles. •Atrial natriuretic peptide (ANP) _________ GFR -__________ of the atria that occurs with an increase in blood volume causes hormonal release •relaxes glomerular mesangial cells increasing capillary ________ area and increasing GFR •Angiotensin II reduces GFR -potent __________ that narrows both afferent & efferent arterioles reducing GFR

We have different hormones We have atrial natriuretic peptide (ANP) which increases the filtration pressure Angiotensin II reduces the glomerular filtration by vasoconstriction and narrowing the afferent and efferent arterioles. •Atrial natriuretic peptide (ANP) increases GFR -stretching of the atria that occurs with an increase in blood volume causes hormonal release •relaxes glomerular mesangial cells increasing capillary surface area and increasing GFR •Angiotensin II reduces GFR -potent vasoconstrictor that narrows both afferent & efferent arterioles reducing GFR

Regulation of GFR We look at how glomerular filtration pressure can be affected. There are three ways we can affect it: ____________: how kidney adjusts itself with using the _____________ apparatus ___________________: nerve controls ___________ regulation: how hormones affect it.

We look at how glomerular filtration pressure can be affected. There are three ways we can affect it: Autoregulation: how kidney adjusts itself with using the juxtaglomerular apparatus Neuroregulation: nerve controls Hormonal regulation: how hormones affect it.

net filtration pressure We need more pressure going ___ than coming ____. Not enough pressure will lead to ___________ with the glomerulus and kidneys and capillaries. When we look at patients who have kidney problems, we have to look at that ________ to see if it is normal or abnormal.

We need more pressure going in than coming out. Not enough pressure will lead to problems with the glomerulus and kidneys and capillaries. When we look at patients who have kidney problems we have to look at that pressure to see if it is normal or abnormal.

Reabsorption in the proximal convoluted tubule (PCT) We reabsorb ________ then water because ________ follows In the PCT, we get all the _______ type things such as glucose and amino acids back ___% of water gets reabsorbed and also ___% of the sodium •The ________ of solute and water reabsorption from filtered fluid occurs in the proximal convoluted tubules and most absorptive processes involve this electrolyte: ____. •Proximal convoluted tubule Na+ transporters promote reabsorption of 100% of most __________ solutes, such as glucose and amino acids; 80-90% of ___________ ions; 65% of _______, ____, and K+; 50% of Cl-; and a variable amount of Ca+2, Mg+2, and HPO4-2. •Normally, ____% of filtered glucose, amino acids, lactic acid, water-soluble vitamins, and other nutrients are reabsorbed in the first _____ of the PCT by _____ symporters. Figure 26.12 shows the operation of the main Na+-glucose symporters in PCT cells.

We reabsorb sodium then then water because water follows In the PCT, we get all the organic type things such as glucose and amino acids back 65% of water gets reabsorbed and also 65% of the sodium •The majority of solute and water reabsorption from filtered fluid occurs in the proximal convoluted tubules and most absorptive processes involve Na+. •Proximal convoluted tubule Na+ transporters promote reabsorption of 100% of most organic solutes, such as glucose and amino acids; 80-90% of bicarbonate ions; 65% of water, Na+, and K+; 50% of Cl-; and a variable amount of Ca+2, Mg+2, and HPO4-2. •Normally, 100% of filtered glucose, amino acids, lactic acid, water-soluble vitamins, and other nutrients are reabsorbed in the first half of the PCT by Na+ symporters. Figure 26.12 shows the operation of the main Na+-glucose symporters in PCT cells.

We use term urinary system as opposed to __________ because excretory can include respiratory system (CO2), integumentary system (perspiration), and digestive system (feces). The urinary system and reproductive system merge together in _______ and are separate in _________. Males go to a urologist for reproductive issues where as women go to ___________ instead (since their reproductive system is separate from urinary).

We use term urinary system as opposed to excretory because excretory can include respiratory system (CO2), integumentary system (perspiration), and digestive system (feces). The urinary system and reproductive system merge together in males and are separate in females Males go to a urologist for reproductive issues where as women go to gynecologists instead (since their reproductive system is separate from urinary).

What you do in life can affect the kidneys Boxers, not allowed to kidney punch. Because if you cause damage to kidneys or disrupt balance of electrolytes, the kidneys may no longer function. Certain occupation may also do this (heavy jostling of the body such as construction (someone who uses jackhammer → jackhammer may jostle kidneys causing damage.)) The kidney does not just have urine in it. It also has _______ in it (what forms the urine later on). Fluid in Kidney not initially referred to as urine, it is actually _______. Functional unit of the kidney is the nephron. Nephron has different parts, we get the ________ of it.

What you do in life can affect the kidneys Boxers, not allowed to kidney punch. Because if you cause damage to kidneys or disrupt balance of electrolytes, the kidneys may no longer function. Certain occupation may also do this (heavy jostling of the body such as construction (someone who uses jackhammer → jackhammer may jostle kidneys causing damage.)) The kidney does not just have urine in it. It also has filtrates in it (what forms the urine later on). Fluid in Kidney not initially referred to as urine, it is actually filtrates. Functional unit of the kidney is the nephron. Nephron has different parts, we get the filtrate of it.

When looking at juxtaglomerular apparatus, we notice juxtaglomerular cells of an _________ arteriole and cells known as macula densa cells of an __________ loop of henle. Macula densa: cells that can change _________ based on amount of water and _________. More _______ goes into location and draws more ______ causing cells to ______ Less _______ causes cells to _______ Macula densa actually swells or shrinks affecting the ________ arteriole changing the amount of _________ in the glomerulus Critical to glomerular filtration You have the same number of nephrons from the time you are born (they grow in size but not in number). We also use antidiuretic hormone (ADH)

When looking at juxtaglomerular apparatus, we notice juxtaglomerular cells of an afferent arteriole and cells known as macula densa. Macula densa: cells that can change shape based on amount of water and sodium. More sodium goes into location and draws more water causing cells to swell Less sodium causes cells to shrink Macula densa actually swells or shrinks affecting the afferent arteriole changing the amount of pressure in the glomerulus Critical to glomerular filtration You have the same number of nephrons from the time you are born (they grow in size but not in number). We also use antidiuretic hormone (ADH)

Juxtaglomerular apparatus When we look at the juxtaglomerular apparatus, we look at the macula densa cells and the juxtaglomerular cells which are along the afferent arteriole which are important for affecting the ________ filtration or _________ filtration.

When we look at the juxtaglomerular apparatus, we look at the macula densa cells and the juxtaglomerular cells which are along the afferent arteriole which are important for affecting the pressure filtration or glomerular filtration.

Glucosuria Where we _____ reabsorb enough of the ___________. Common cause = if we are _______, this is where we have ______ activity of insulin and extra high levels of blood _____. Other rare genetic disorder can also cause this If we have a blood test or urine test within ___ minutes of having a high amount of ______, chances are that the sugar levels would be so high that it may be suspected that you have a problem with your metabolism even though that is not the case. Why they use a _______ test for urine. •Renal symporters can ____ reabsorb glucose fast enough if blood glucose level is above 200 mg/mL -some glucose remains in the _______ (glucosuria) •Common cause is _______ mellitis because insulin activity is deficient and blood sugar is too ______. •Rare genetic disorder produces defect in __________ that reduces its effectiveness

Where we dont reabsorb enough of the glucose Common cause = if we are diabetic, this is where we have less activity of insulin and extra high levels of sugar. Other rare genetic disorder can also cause this If we have a blood test or urine test within 20 minutes of having a high amount of sugar, chances are that the sugar levels would be so high that it may be suspected that you have a problem with your metabolism even though that is not the case. Why they use a fasting test for urine. •Renal symporters can not reabsorb glucose fast enough if blood glucose level is above 200 mg/mL -some glucose remains in the urine (glucosuria) •Common cause is diabetes mellitis because insulin activity is deficient and blood sugar is too high •Rare genetic disorder produces defect in symporter that reduces its effectiveness

three ways GFR can be affected:

autoregulation (JGA) neuroregulation hormonal regulation

glomerular filtration - a portion of the blood ________ is filtered into the kidney. Blood ___________ has a direct effect on it. Over ____% of what gets filtered here gets reabsorbed. Otherwise ____________ would occur. You only form about a _____ or two of urine a day yet you filter ____ gallons of blood per day at the glomerulus

glomerular filtration - a portion of the blood plasma is filtered into the kidney. Blood pressure has a direct effect on it. Over 90% of what gets filtered here gets reabsorbed. Otherwise dehydration would occur. You only form about a quart or two of urine a day yet you filter 48 gallons per day at the glomerulus

3 basic functions of nephron

glomerular filtration, tubular reabsorption, and tubular secretion.

Overview of Renal Physiology Nephrons and collecting ducts perform three basic processes while producing urine:

glomerular filtration, tubular secretion, and tubular reabsorption

males have _________ urethra than females •Females -length of 1.5 in., orifice between clitoris & vagina -histology •transitional changing to nonkeratinized stratified squamous epithelium, lamina propria with elastic fibers & circular smooth muscle •Males -tube passes through ________, UG diaphragm & penis -3 regions of urethra •prostatic urethra, membranous urethra & spongy urethra •circular smooth muscle forms internal urethral sphincter & UG diaphragm forms external urethral sphincter

males have longer urethra than females •Females -length of 1.5 in., orifice between clitoris & vagina -histology •transitional changing to nonkeratinized stratified squamous epithelium, lamina propria with elastic fibers & circular smooth muscle •Males -tube passes through prostate, UG diaphragm & penis -3 regions of urethra •prostatic urethra, membranous urethra & spongy urethra •circular smooth muscle forms internal urethral sphincter & UG diaphragm forms external urethral sphincter

3 components of urinalysis

physical, chemical, microscopic

Cortical Nephron DIAGRAM ON SLIDE 21 ___-___% of nephrons are cortical nephrons but the majority of it is located in the _______

•80-85% of nephrons are cortical nephrons cortex

Nephrons •A nephron consists of a renal __________ where fluid is filtered, and a renal ________ into which the filtered fluid passes (Figure 26.5). •Nephrons perform three basic functions: glomerular __________, tubular ____________, and tubular _____________. •A renal tubule consists of a _________ _________ tubule (PCT), ______ of ________ (nephron loop), and _________ ________ tubule (DCT). •Distal convoluted tubules of several nephrons drain into a single ___________ duct and many collecting ducts drain into a small number of __________ ducts.

•A nephron consists of a renal corpuscle where fluid is filtered, and a renal tubule into which the filtered fluid passes (Figure 26.5). •Nephrons perform three basic functions: glomerular filtration, tubular reabsorption, and tubular secretion. •A renal tubule consists of a proximal convoluted tubule (PCT), loop of Henle (nephron loop), and distal convoluted tubule (DCT). •Distal convoluted tubules of several nephrons drain into to a single collecting duct and many collecting ducts drain into a small number of papillary ducts.

Blood and Nerve Supply of Kidney •Abundantly supplied with blood vessels -receive ___% of resting cardiac output via renal ________ •Functions of different capillary beds -__________ capillaries are where filtration of blood occurs •vasoconstriction & vasodilation of afferent & efferent __________ produce large changes in renal filtration -_____________ capillaries that carry away reabsorbed substances from filtrate -_______ _______ supplies nutrients to medulla without disrupting its osmolarity form

•Abundantly supplied with blood vessels -receive 25% of resting cardiac output via renal arteries •Functions of different capillary beds -glomerular capillaries where filtration of blood occurs •vasoconstriction & vasodilation of afferent & efferent arterioles produce large changes in renal filtration -peritubular capillaries that carry away reabsorbed substances from filtrate -vasa recta supplies nutrients to medulla without disrupting its osmolarity form

Blood and Nerve Supply of the Kidneys •Blood enters the kidney through the renal _______ and exits via the renal _______. -Figures 26.4 and 26.5 show the branching pattern of renal blood vessels and the path of blood flow through the kidneys. •In a kidney transplant a donor kidney is placed in the _______ of the recipient through an abdominal incision. The renal _______, renal _______, and _______ of the donor kidney are connected to the corresponding structure in the recipient. The patient is then placed on ______________ drugs to prevent _________ of the transplanted kidney.

•Blood enters the kidney through the renal artery and exits via the renal vein. -Figures 26.4 and 26.5 show the branching pattern of renal blood vessels and the path of blood flow through the kidneys. •In a kidney transplant a donor kidney is placed in the pelvis of the recipient through an abdominal incision. The renal artery, renal vein, and ureter of the donor kidney are connected to the corresponding structure in the recipient. The patient is then placed on immunosuppressive drugs to prevent rejection of the transplanted kidney.

Neural Regulation of GFR •Blood vessels of the kidney are supplied by ___________ fibers that cause __________ of afferent arterioles •At rest, renal BV are maximally _________ because sympathetic activity is minimal -renal ___________ prevails at rest •With moderate _________ stimulation, both afferent & efferent arterioles _________ equally -__________ GFR equally •With extreme __________ stimulation (exercise or hemorrhage), __________ of afferent arterioles reduces ____. -lowers urine ______ & permits blood flow to other tissues What is the sympathetic and parasympathetic nerves doing In most case, we look at the sympathetic nerves such as looking at what happens when you ________ or you have bleeding. Causes _____________ of afferent arterioles through the _________ nerve fibers.

•Blood vessels of the kidney are supplied by sympathetic fibers that cause vasoconstriction of afferent arterioles •At rest, renal BV are maximally dilated because sympathetic activity is minimal -renal autoregulation prevails •With moderate sympathetic stimulation, both afferent & efferent arterioles constrict equally -decreasing GFR equally •With extreme sympathetic stimulation (exercise or hemorrhage), vasoconstriction of afferent arterioles reduces GFR -lowers urine output & permits blood flow to other tissues What is the sympathetic and parasympathetic nerves doing In most case, we look at the sympathetic nerves such as looking at what happens when you exercise or you have bleeding. Causes vasoconstriction of afferent arterioles through the sympathetic nerve fibers.

•Dialysis is the separation of ________ solutes from _______ ones through use of a selectively permeable _________. •Filtering blood through an artificial kidney machine is called __________. This procedure filters the blood of wastes and adds nutrients. •A portable method of dialysis is called continuous ambulatory __________ dialysis.

•Dialysis is the separation of large solutes from smaller ones through use of a selectively permeable membrane. •Filtering blood through an artificial kidney machine is called hemodialysis. This procedure filters the blood of wastes and adds nutrients. •A portable method of dialysis is called continuous ambulatory peritoneal dialysis.

The Filtration Membrane •Filtered substances move from the blood stream through three barriers: a glomerular endothelial cell, the basal lamina, and a filtration _____ formed by a podocyte (Figure 26.8). •The principle of filtration - to force fluids and ______ through a membrane by ________ - is the same in glomerular capillaries as in capillaries elsewhere in the body.

•Filtered substances move from the blood stream through three barriers: a glomerular endothelial cell, the basal lamina, and a filtration slit formed by a podocyte (Figure 26.8). •The principle of filtration - to force fluids and solutes through a membrane by pressure - is the same in glomerular capillaries as in capillaries elsewhere in the body.

Net Filtration Pressure •Glomerular filtration depends on three main pressures, one that _________ and two that _______ filtration (Figure 26.9). •Filtration of blood is __________ by glomerular blood hydrostatic pressure (GBHP) and ________ by capsular hydrostatic pressure (CHP) and blood colloid osmotic pressure (BCOP). -The net filtration pressure (NFP) is about ___ mm Hg. •In some kidney diseases, damaged glomerular capillaries become so ________ that plasma ________ enter the filtrate, causing an increase in _____ and GFR and a decrease in BCOP. (Clinical Application)

•Glomerular filtration depends on three main pressures, one that promotes and two that oppose filtration (Figure 26.9). •Filtration of blood is promoted by glomerular blood hydrostatic pressure (BGHP) and opposed by capsular hydrostatic pressure (CHP) and blood colloid osmotic pressure (BCOP). -The net filtration pressure (NFP) is about 10 mm Hg. •In some kidney diseases, damaged glomerular capillaries become so permeable that plasma proteins enter the filtrate, causing an increase in NFP and GFR and a decrease in BCOP. (Clinical Application)

Internal Anatomy of the Kidney •Internally, the kidneys consist of __________, medulla, ________, papillae, columns, ________, and _________ (Figure 26.3). •The renal ________ and renal ________ constitute the functional portion or parenchyma of the kidney. •The __________ is the functional unit of the kidney.

•Internally, the kidneys consist of cortex, medulla, pyramids, papillae, columns, calyces, and pelves (Figure 26.3). •The renal cortex and renal pyramids constitute the functional portion or parenchyma of the kidney. •The nephron is the functional unit of the kidney.

The Nephron •Kidney has over 1 __________ nephrons composed of a corpuscle and tubule •Renal corpuscle = site of ________ filtration -glomerulus is capillaries where ________ occurs -glomerular (__________) capsule is double-walled epithelial cup that _________ filtrate •Renal tubule -________ __________tubule (PCT) -______ of _______ dips down into medulla -________ ________ tubule (DCT) •Collecting ducts and papillary ducts drain urine to the renal pelvis and ureter.

•Kidney has over 1 million nephrons composed of a corpuscle and tubule •Renal corpuscle = site of plasma filtration -glomerulus is capillaries where filtration occurs -glomerular (Bowman's) capsule is double-walled epithelial cup that collects filtrate •Renal tubule -proximal convoluted tubule -loop of Henle dips down into medulla -distal convoluted tubule •Collecting ducts and papillary ducts drain urine to the renal pelvis and ureter.

KNOW URINARY SYSTEM DIAGRAM ON SLIDE 3 •Kidneys, ureters, urinary bladder & urethra •Urine flows from each kidney, down its ________ to the bladder and to the outside via the ________ • Kidneys ________ the blood and return most of water and solutes to the bloodstream

•Kidneys, ureters, urinary bladder & urethra •Urine flows from each kidney, down its ureter to the bladder and to the outside via the urethra •Filter the blood and return most of water and solutes to the bloodstream

Overview of Renal Physiology •Nephrons and collecting ducts perform 3 basic processes -glomerular filtration •a portion of the blood _______ is filtered into the kidney -tubular reabsorption •________ & useful substances are reabsorbed into the ________ -tubular secretion •_________ are removed from the blood & secreted into ______ •Rate of excretion of any substance is its rate of _________, plus its rate of ________, minus its rate of _________.

•Nephrons and collecting ducts perform 3 basic processes -glomerular filtration •a portion of the blood plasma is filtered into the kidney -tubular reabsorption •water & useful substances are reabsorbed into the blood -tubular secretion •wastes are removed from the blood & secreted into urine •Rate of excretion of any substance is its rate of filtration, plus its rate of secretion, minus its rate of reabsorption

External Anatomy of Kidney •Paired kidney-_________-shaped organ •4-5 in long, 2-3 in wide,1 in thick •Found just above the waist __________ the peritoneum & posterior wall of abdomen -retroperitoneal (along with adrenal _________ & _________) •Protected by ___th & ___th ribs with right kidney lower Kidneys function to get rid of ________ The kidneys you can find at the supermarket would be similar to our kidneys are ___ kindeys. Kidneys are very high up in abdomen (11th or 12th rib)

•Paired kidney-bean-shaped organ •4-5 in long, 2-3 in wide,1 in thick •Found just above the waist between the peritoneum & posterior wall of abdomen -retroperitoneal (along with adrenal glands & ureters) •Protected by 11th & 12th ribs with right kidney lower Kidneys function to get rid of waste The kidneys you can find at the supermarket would be similar to our kidneys are pig kindeys. Kidneys are very high up in abdomen (11th or 12th rib)

juxtaglomerular apparatus •Structure where __________ arteriole makes contact with _________ limb of loop of Henle -macula densa is _________ part of __________ limb -juxtaglomerular cells are modified muscle cells in __________

•Structure where afferent arteriole makes contact with ascending limb of loop of Henle -macula densa is thickened part of ascending limb -juxtaglomerular cells are modified muscle cells in arteriole

renal tubule and Collecting Duct •Table 26.1 illustrates the histology of the cells that form the renal tubule and collecting duct. •The ____________ apparatus (JGA) consists of the __________ cells of an afferent arteriole and the _______ _______ cells of the ascending loop of Henle. The JGA helps __________ blood _________ and the _____ of blood filtration by the kidneys (Figure 26.6). •Most of the cells of the distal convoluted tubule are _________ cells that have receptors for ____ and _________. A smaller number are _____________ cells which play a role in the homeostasis of blood ____. •The number of nephrons is ________ from birth. They may increase in size, but not in number (Clinical Application).

•Table 26.1 illustrates the histology of the cells that form the renal tubule and collecting duct. •The juxtaglomerular apparatus (JGA) consists of the juxtaglomerular cells of an afferent arteriole and the macula densa. The JGA helps regulate blood pressure and the rate of blood filtration by the kidneys (Figure 26.6). •Most of the cells of the distal convoluted tubule are principal cells that have receptors for ADH and aldosterone. A smaller number are intercalated cells which play a role in the homeostasis of blood pH. •The number of nephrons is constant from birth. They may increase in size, but not in number (Clinical Application).

Nephrons •The loop of Henle consists of a _________ limb, a thin __________ limb, and a thick _________ limb (Figure 26.5). •There are two types of nephrons that have differing structure and function. -A _________ nephron usually has its glomerulus in the outer portion of the ________ and a ______ loop of Henle that penetrates only into the outer region of the medulla (Figure 26.5a). -A _______________ nephron usually has its glomerulus deep in the cortex close to the _______; its ______ loop of Henle stretches through the ________ and almost reaches the renal _______. (Figure 26.5b).

•The loop of Henle consists of a descending limb, a thin ascending limb, and a thick ascending limb (Figure 26.5). •There are two types of nephrons that have differing structure and function. -A cortical nephron usually has its glomerulus in the outer portion of the cortex and a short loop of Henle that penetrates only into the outer region of the medulla (Figure 26.5a). -A juxtamedullary nephron usually has its glomerulus deep in the cortex close to the medulla; its long loop of Henle stretches through the medulla and almost reaches the renal papilla (Figure 26.5b).

Regulation of GFR •The mechanisms that regulate GFR _______ blood flow into and out of the glomerulus and alter the glomerular capillary surface area available for filtration. •The three principal mechanisms that control GFR are renal ___________, _________ regulation, and __________ regulation.

•The mechanisms that regulate GFR adjust blood flow into and out of the glomerulus and alter the glomerular capillary surface area available for filtration. •The three principal mechanisms that control GFR are renal autoregulation, neural regulation, and hormonal regulation.

•The urinary system consists of two _________, two ________, one urinary _____________, and one __________ (Figure 26.1). •Urine is __________ from each kidney through its ________ and is stored in the urinary __________ until it is expelled from the body through the ___________. •The specialized branch of medicine that deals with structure, function, and diseases of the male and female urinary systems and the male reproductive system is known as nephrology. The branch of surgery related to male and female urinary systems and the male reproductive system is called _________.

•The urinary system consists of two kidneys, two ureters, one urinary bladder, and one urethra (Figure 26.1). •Urine is excreted from each kidney through its ureter and is stored in the urinary bladder until it is expelled from the body through the urethra. •The specialized branch of medicine that deals with structure, function, and diseases of the male and female urinary systems and the male reproductive system is known as nephrology. The branch of surgery related to male and female urinary systems and the male reproductive system is called urology.