ANATOMY AND PHYSIOLOGY

The KIDNEYS are known as

MASTER CHEMIST. Actually, they
are pair of bean shaped, brownish-
red structures located
retroperitoneally on the posterior
wall of the abdomen-from the 12th
thoracic vertebra to the third lumbar
vertebra in the adult.

The average adult kidney

weighs approximately 13 to 170 g (about 4.5 oz) and is 10 to 12 cm of the long, 6
cm wide and 2.5 cm thick. The right kidney is slightly lower than the left due to
the location f the liver. An adrenal gland lies on top of each kidney. The kidneys
and adrenals are independent in function, blood supply and innervation.

NEPHRONS
- from Greek word nephros, meaning "kidney". It is the basic structural and
functional unit of the kidney. Its functions are vital to life and are regulated by the
endocrine system by hormones such as antidiuretic hormone, aldosterone, and
parathyroid hormone. In humans, a normal kidney contains 800,000 to one
million nephrons. Its chief function is to regulate the concentration of water and
soluble substances like sodium salts by filtering the blood, reabsorbing what is
needed and excreting the rest as urine.
TWO PARTS OF RENAL PARENCHYMA:
Medulla
- (latin renes medulla = kidney middle) which is approximately 5 cm wide.
It contains the structures of the nephrons responsible for maintaining the salt
and water balance of the blood. These
structures include the vasa rectae (both
spuria and vera), the venulae rectae, the
medullary capillary plexus, the loop of
Henle, and the collecting tubulle. The renal
medulla is hypertonic to the filtrate in the
nephron and aids in the reabsorption of
water.

Cortex
- is the outer portion of the kidney
between the renal capsule and the renal medulla. In the adult, it forms a
continuous smooth outer zone with a number of projections (cortical columns)
that extend down between the pyramids. It contains the renal corpuscles and
the renal tubules except for parts of the loop of Henle which descend into the
renal medulla. It also contains blood vessels and cortical collecting ducts. The
renal cortex is the part of the kidney where ultrafiltration occurs.

MAJOR FUNCTIONS OF KIDNEY:

Regulation of water excretion

A person normally ingests about 1300 mL of oral fluids and 1000 mL of
water in food per day. Of the fluid ingested, approximately 900 mL is lost through
the skin and lungs (called insensible loss), 50 mL through sweat and 200 mL
through feces.

Regulation of electrolyte excretion

When the kidneys are functioning normally, the volume of electrolytes
excreted per day is equal to the amount ingested. The regulation of sodium
volume excreted depends on aldosterone, a hormone synthesized and released
from the adrenal cortex. With increased aldosterone in the blood, less sodium is
excreted in the urine, because aldosterone fosters renal absorption of sodium.

Regulation of acid-base balance

The kidney performs two major functions to assist in this balance. 1.) To
reabsorb and return to the bodys circulation any bicarbonate from the urinary
filtrate; 2.) To excrete acid in the urine.

Autoregulation of blood pressure

Rennin converts angiotensinogen to angiotensin I, which is then converted
to angiotensin II, the most powerful vasoconstrictor known; angiotensin II causes
the blood pressure to increase.
The adrenal cortex secretes aldosterone in response to poor perfusion or
increasing serum osmolality. The result is an increase in blood pressure.

Renal clearance
It is the ability of the kidneys to clear solutes from the plasma.

Regulation of red blood cell production

When the kidneys detect to decrease in the oxygen tension in renal bllod
flow, they release erythropoietin that stimulates the bone marrow to produce RBC
and carry oxygen throughout the body.

Vitamin D synthesis
Secretion of prostaglandins
Excretion of waste products
The kidneys eliminate the bodys metabolic waste products which is the
urea that excreted daily for about 25 to 30 mg.

Urine storage
Bladder emptying

Parts of the Kidney:

Renal Vein -This has a large diameter and a thin wall. It carries blood away
from the kidney and back to the right hand side of the heart. Blood in the
kidney has had all its urea removed. Urea is produced by your liver to get rid
of excess amino-acids. Blood in the renal vein also has exactly the right
amount of water and salts. This is because the kidney gets rid of excess
 water and salts. The kidney is controlled by the brain. A hormone in our blood
called Anti-Diuretic Hormone (ADH for short) is used to control exactly how
much water is excreted.

Renal Artery - This blood vessel supplies blood to the kidney from the left
hand side of the heart. This blood must contain glucose and oxygen because
the kidney has to work hard producing urine. Blood in the renal artery must
have sufficient pressure or the kidney will not be able to filter the blood.

Medulla - The medulla is the inside part of the kidney. This is where the
amount of salt and water in your urine is controlled. It consists of billions of
loops of Henl. These work very hard pumping sodium ions. ADH makes the
loops work harder to pump more sodium ions. The result of this is that very
concentrated urine is produced.

Cortex - The cortex is the outer part of the kidney. This is where blood is
filtered. We call this process "ultra-filtration" or "high pressure filtration"
because it only works if the blood entering the kidney in the renal artery is at
high pressure.

Billions of glomeruli are found in the cortex. A glomerulus is a tiny ball of

capillaries. Each glomerulus is surrounded by a "Bowman's Capsule".
Glomeruli leak. Things like red blood cells, white blood cells, platelets and
fibrinogen stay in the blood vessels. Most of the plasma leaks out into the
Bowman's capsules. This is about 160 litres of liquid every 24 hours.

Most of this liquid, which we call "ultra-filtrate" is re-absorbed in the medulla

and put back into the blood. Blood supplied to the kidney contains a toxic
product called urea which must be removed from the blood. It may have too
much salt and too much water. The kidney removes these excess materials.

Glomerulus and Bowman's Capsule - This is where ultra-filtration takes place.

Blood from the renal artery is forced into the glomerulus under high pressure.
Most of the liquid is forced out of the glomerulus into the Bowman's capsule
which surrounds it.
 Proximal Convoluted Tubules - Proximal means "near to" and convoluted
means "coiled up" so this is the coiled up tube near to the Bowman's capsule.
This is the place where all that useful glucose is re-absorbed from the ultra-
filtrate and put back into the blood. If the glucose was not absorbed it would
end up in your urine. This happens in people who are suffering from diabetes.

Loop of Henl - This part of the nephron is where water is reabsorbed. Kidney
cells in this region spend
all their time pumping
sodium ions. This makes
the medulla very salty; you
could say that this is a
region of very low water
concentration. If you
remember the definition of
osmosis, you will realize
that water will pass from a region of high water concentration (the ultra-filtrate
and urine) into a region of low water concentration (the medulla) through cell
membranes which are semi-permeable.

Distal Convoluted Tubules - Distal means "distant" so it is at the other end of

the nephron from the
Bowman's capsule. This is
where most of the salts in
the ultra-filtrate are re-
absorbed.

Collecting Duct - Collecting

ducts run through the
medulla and are
surrounded by loops of
Henl. The liquid in the
 collecting ducts (ultra-filtrate) is turned into urine as water and salts are
removed from it. Although our kidneys make about 160 litres of urine every 24
hours, we only produce about litre of urine. It is called a collecting duct
because it collects the liquid produced by lots of nephrons.

URETERS
Each ureter is a small tube, about 25 cm long that carries urine from the renal
pelvis to the urinary bladder. It descends from the renal pelvis, along the
posterior abdominal wall, behind the parietal peritoneum, and enters the
urinary bladder on the posterior inferior surface.

The wall of the ureter consists of three layers. The outer layer, the fibrous
coat, is a supporting layer of fibrous connective tissue. The middle layer, the
muscular coat, consists of inner circular and outer longitudinal smooth
muscle. The main function of this layer is peristalsis to propel the urine. The
inner layer, the mucosa, is transitional epithelium that is continuous with the
lining of the renal pelvis and the urinary bladder. This layer secretes mucus
which coats and protects the surface of the cells.
URINARY BLADDER

The urinary bladder is a temporary storage reservoir for urine. It is located in

the pelvic cavity, posterior
to the symphysis pubis,
and below the parietal
peritoneum. The size and
shape of the urinary
bladder varies with the
amount of urine it contains
and with pressure it
receives from surrounding organs.

The inner lining of the urinary bladder is a mucous membrane of transitional

epithelium that is continuous with that in the ureters. When the bladder is
 empty, the mucosa has numerous folds called rugae. The rugae and
transitional epithelium allow the bladder to expand as it fills.

The second layer in the walls is the submucosa that supports the mucous
membrane. It is composed of connective tissue with elastic fibers.

The next layer is the muscularis, which is composed of smooth muscle. The
smooth muscle fibers are interwoven in all directions and collectively these
are called the detrusor muscle. Contraction of this muscle expels urine from
the bladder. On the superior surface, the outer layer of the bladder wall is
parietal peritoneum. In all other regions, the outer layer is fibrous connective
tissue.

There is a triangular area, called the trigone, formed by three openings in the
floor of the urinary bladder. Two of the openings are from the ureters and form
the base of the trigone. Small flaps of mucosa cover these openings and act
as valves that allow urine to enter the bladder but prevent it from backing up
from the bladder into the ureters. The third opening, at the apex of the trigone,
is the opening into the urethra. A band of the detrusor muscle encircles this
opening to form the internal urethral sphincter.

URETHRA
The final passageway for the flow of urine is the urethra, a thin-walled tube
that conveys urine from the floor of the
urinary bladder to the outside. The opening
to the outside is the external urethral orifice.
The mucosal lining of the urethra is
transitional epithelium. The wall also
contains smooth muscle fibers and is
supported by connective tissue.

The internal urethral sphincter surrounds the

beginning of the urethra, where it leaves the
urinary bladder. This sphincter is smooth (involuntary) muscle. Another
 sphincter, the external urethral sphincter, is skeletal (voluntary) muscle and
encircles the urethra where it goes through the pelvic floor. These two
sphincters control the flow of urine through the urethra.

In females, the urethra is short, only 3 to 4 cm (about 1.5 inches) long. The
external urethral orifice opens to the outside just anterior to the opening for
the vagina.

In males, the urethra is much longer, about 20 cm (7 to 8 inches) in length,

and transports both urine and semen. The first part, next to the urinary
bladder, passes through the prostate gland and is called the prostatic urethra.
The second part, a short region that penetrates the pelvic floor and enters the
penis, is called the membranous urethra. The third part, the spongy urethra, is
the longest region. This portion of the urethra extends the entire length of the
penis, and the external urethral orifice opens to the outside at the tip of the
penis.

LIVER
The liver is the largest internal organ in the body, and weighs about 3
pounds in an adult. The liver is located in the right upper quadrant of the
abdomen, just below the diaphragm. A thick capsule of connective tissue called
Glisson's capsule covers the entire surface of the liver. The liver is divided into a
large right lobe and a smaller left lobe. The falciform ligament divides the two
lobes of the liver.

Each lobe is further divided into lobules that are approximately 2 mm high
and 1 mm in circumference.

These hepatic lobules are the functioning units of the liver. Each of the
approximately 1 million lobules consists of a hexagonal row of hepatic cells
called hepatocytes. The hepatocytes secrete bile into the bile channels and also
perform a variety of metabolic functions. Between each row of hepatocytes are
small cavities called sinusoids. Each sinusoid is lined with Kupffer cells,
phagocytic cells that remove amino acids, nutrients, sugar, old red blood cells,
bacteria and debris from the blood that flows through the sinusoids. The main
functions of the sinusoids are to destroy old or defective red blood cells, to
remove bacteria and foreign particles from the blood, and to detoxify toxins and
other harmful substances. Approximately 1500 ml of blood enters the liver each
minute, making it one of the most vascular organs in the body. Seventy-five
percent of the blood flowing to the liver comes through the portal vein; the
remaining 25% is oxygenated blood that is carried by the hepatic artery.

Central Role of Liver in Metabolism

The liver is vitally important in helping to maintain blood glucose levels

within normal range. After a carbohydrate-rich meal, thousands of glucose
molecules are removed from the blood and combined to form the large
polysaccharide molecules called glycogen, which are then stored in the liver. This
process is glycogenesis, literally, glycogen formation. Later, as body cells
continue to remove glucose from the blood to meet their needs, blood glucose
levels begin to drop. At this time, liver cells break down the stored glycogen, by a
process called glycogenolysis, which means glycogen splitting. The liver cells
then release glucose bit by bit t the blood to maintain homeostasis of blood
glucose levels. If necessary, the liver can also make glucose from
noncarbohydrate substances such as fats and proteins. This process is
gluconeogenesis, which means formation of new sugar.

PANCREAS

The hormones administered by the pancreas are responsible for

controlling and manipulating blood glucose levels. The pancreas houses islets
responsible for production and secretion of the hormones, glucagon and insulin.
Because of this, the pancreas falls under both the endocrine glandular system as
well as the exocrine glandular system. The islets which produce these hormones
are semi scattered throughout the pancreas and are known as the islets of
Langerhans. These particular endocrine functioning structures are typically able
to be located in the body and along the tail of the pancreas. Alpha cells and Beta
cells are the cells that are known to secrete the hormones within the islets.
Glucagon is administered from the Alpha cells and insulin comes from the Beta
cells. Gulcagon has an affect on insulin by providing the appropriate stimulus for
the liver to convert glycogen into glucose. The Alpha cells are able to respond
appropriately to the feedback provided and thus are able to self monitor. High
blood sugar, which is also known as hypoglycemia, can be the result of
continuous output of glucagon.