24112011,Thursday. With the name of Allah.

Lecture notes #22 : THE RENAL SYSTEM

Today we will talk about the renal system.The objective of the renal system is ; we do know that the renal system regulate homeostasis process.And that is the regulation of the level of fluid and salt in the body.In addition to other function that includes the regulation of blood pressure of course,stimulating of the red blood cells production. The renal system consist essentially of 2 kidneys,where the filtration and reabsorption take place.And then we have the conductive portion which is in the form of 2 ureters and they conduct the filtrate or the urine to the urinary bladder,which is the reservoir and to the urethra that is then accept throught duct.

You have taken in anatomy,that the kidney is a kidney shape,or bean shape.We have 2 kidneys that is present retroperitoneally ,that is behind the peritoneum in the posterior part of the upper portion of the abdomen.And we have the lateral border and medial border.In the medial border we have the hilum of the kidney,where the blood vessels enter and leaves.And the renal pelvis,which is form from the minor and major calyses.And they end up by forming the ureter.Of course we have the adrenal gland on top of the kidney. The structure of the kidney grossly 10-14 cm length.And is essentially made of 2 main portion,the outer cortex and the inner medulla.In many organs we can see this structure,for example the lymphoid system.And usually the functional aspects of the kidney which are the nephron usually are present within the cortical region.And the ureter region with the convey ducts of this filtrate from minor calyx to the major calyx and to the renal pelvis.

In each kidney within the cortex region we see this triangular projection,about 8-18 within each kidney,and this is what we call the medullary pyramid.In a while we can see this pyramid are form of radiating tubules moving up and down and they create what we call the medullary rays.

Now,if we look at the cortical region,we can see this picture.

(picture of nephron) Where we have large globular structure which are the glomeruli.And surrounding the glomeruli we can see the cross section of several tubules which are the renal tubules.Now this tubules will come across them moving fom the renal corpuscle,come across proximal convoluted tubule,thin & thick loops of Henles distal convoluted tubules and collecting tubules & ducts.

Now to understand this structure in the kidney we start by describing the circulation of blood supply.

Now we do know that the kidney is supply by the renal artery which is the branch from abdominal aorta.And this renal artery before it enters into the substance of the kidney it divides into several segmental branches.And this segmental branch will enter the substance of the kidney and gives me the interlobar arteries and the interlobar arteries will arches and give me arcuate arteries.And arcuate arteries usually perpendicular to the renal capsule that surrounds it.And then from there we can see the interlobular arteries will arise,and they will form the glomerulus. The final terminal branches which arise from this arcuate arteries,they enter into a bag like a balloon of two membranes.

Here is the balloons of two membranes.I want you to consider that you have a balloon which is slightly inflated,and then you bring the final terminal branches and try to push them within the balloon,right?Not inside the balloon but push them within the outer layer of the balloon.Eventually the two layers of the balloon will cover this final terminal branches. This branches which enter into this balloon we call them afferent arterioles.They have arterial blood which going to supply the substances of the kidney and after that they leave as efferent arterioles.They are called the vascular poles of renal corpuscle. Look,we have this 2 layers which we call them the inner visceral layer and the outer parietal layer,of the Bowmans capsule.We call this Bowmans capsule. The outer parietal layer is made of simple squamous epithelium.The inner visceral layer is actually stucked to this arterioles inside the lumen.What is this made of?It is made of podocytes. The podocytes sits on this arterioles and arise from them primary process.From the primary processes we have the secondary process and the secondary process are going to surrounds the arterioles and criss-cross (interdigitate) with the adjacent process.When they criss-cross with each other,they will form the filtration slit.

*picture shows the primary and secondary process.

*the filtration slits.

So,these are 3 components that will make up the renal filter.(important) 1. Fenestrated Capillaries. Remember we said that we have 3 types of capillaries.The continous,fenestrated and discontinous. The continous capillaries are present in the body where we doesnt expect to find any exchange.Like in the skeletal muscle. The fenestrated capillaries are capillaries that the endothelial cells are slightly apart and we have a diaphgram,which is made of basement membrane and acts as selective barrier.

2. Underlying Basement Membrane. It acts as diaphgram. 3. Slits created by Criss-Crossing of Secondary Processes of Podocytes surrounding the Capillaries The filtration slits.

The renal filter is very important.All of you have to know what is the component that made the renal filter.

So whats going to happen?

The blood that pass through the kidney enters the functional unit,which is the nephron and then it will be filter by this renal filters. As is said the renal corpuscle has 2 poles. 1. The vascular poles which the blood vessels enter and leaves. 2. The renal poles,where the proximal convoluted tubule begin.

Ok,how much of blood that pass through each kidney within a minute? Answer : Blood flow to kidneys is about 1.2-1.3 Liters/minute (All blood is filter every 45 minutes.) > to be filter.

Now lets see the other components.From the picture above you can see the vascular pole and the renal pole.As you can see over here the filter will pass through the tubule of the kidney starting from the proximal convoluted tubules and moving ascending and descending through the thin and thick limbs of Loop of Henles and then to the distal convoluted tubeles.The distal convoluted tubules will actually come back close to the glomerulus.And then from there to the collecting duct.The collecting duct will reach the renal papillae which passes through the minor calyx.The minor calyx joined each other to form the major calyx.And major calyx form the renal pelvis and renal pelvis will end up to form the ureter. Now lets see what are the characteristic features of these tubules that present. The proximal convoluted tubules are in the tubules that are in the close proximity to the glomerulus. This proximal convoluted tubule is longer than the distal convoluted tubule. The outer layer is the simple squamous epithelium.When it reach the proximal convoluted tubules it will undergoes transitional changes to become low columnar or tall cuboidal epithelial cells.

Now within this tubules whats going to happen? Answer: There will be selective reabsorption.

What are additional structure we need for reabsorption? Answer : Abundant microvilli have to be present.The ,microvilli form the brush border.

The cells in tubules also have elongated nuclei.And because these cells are large,when we look to the transverse section under the microscope we can see just only few of this nuclei in the proximal tubules.

Here we can see the picture which are the opposite one of them.See the difference between them.In loop of Henles we have the thin and thick descending and ascending part.Both of them is composed of simple cuboidal epithelial cells near the cortex and simple squamous epithelial cells when it is deeper to the medulla. Of course in the inner medulla the lumen is wider because it composed of simple squamous epithelial cell.I dont want you to remember the diameter and numbers over there,just remember the epithelial cell that lining them. Alright,the distal convoluted tubule is essentially have the simple cuboidal epithelium but they do not project any brush border or canaliculi like the proximal tubules.But the cells of distal tubules do have basal membrane invaginations and associated mitochondria similar like the proximal tubules,which gives the cells striated appearance also indicates their similar ion transporting function.Because the cell are smaller,within each section you will see more number of this tubule than the proximal. Now I was telling you that the distal convoluted tubule come back and approach the glomerulus again.And here we have a specific type of cells which approach the glomerulus.This type of cell play a very important role in the blood pressure regulation by secretion of some substances. Just imagine this situation like you move out from a city and went to another city such as Amman and you make a u-turn in case youve forgot something.

But how? The distal tubules come very close to the glomerulus because we have some specific sensory cells over there.This sensory cells are going to send the template ; how much of fluid are there,how much of salt are there and there are going to send messages to the filtration mechanism to filter more salts or absorb more fluid or etc.Here we can see the regulation of blood pressure in addition of the baroreceptor,mechanical receptor,which youve taken in physiology,right?But the histological aspect we will explain them in the next class. After that you can see the collecting ducts,which have the simple columnar epithelial cells.

Look at the picture,this is what I was telling you.The distal convoluted tubules are going back and approach the glomerulus,and approximate to become very close to the renal corpuscle and this is what we called the juxtaglomerular region.We have there the cells of macula densa.A very important mechanism that sense the ionic concentration and water volume in the filtrate.And base of that they are going to take part in the secretion of renin.In next class we will talk about them in more details.

Renin is a secretory product from the juxtaglomerular cells.it is an aspartyl protease and is secreted into the blood.They function to cleaves the plasma protein angiotensin into inactive decapeptide angiotensin 1.

Alright,so as you can see over here,this is the cortex and medulla.Here we have the nephron,and we have renal tubules radiating back and forth,and eventually what is going to filtrate come to the renal column to the renal papilla,and this renal papilla will form like a duct which we called the minor calyx.And the one minor calyx from here and one from there will form the major calyx.And the major calyx will form the renal pelvis,and from the renal pelvis the filtrate will pass into the ureter.After the collecting duct, there will be a collective portion system.Ya3ni,whatever filtrate pass through from the renal papilla to the ureter.

From the renal pelvis to the ureter,what is the structure? Its not very difficult to imagine.Naturally,its going to be lining by epithelial,9a7?The epithelial has to be able to adapt the pressure,so there will be transitional.It is a transitional type of epithelium.You also need something like peristalsis,so you have to have the smooth muscle. For example,look at the bladder.It have the similar structure like the ureter,but it is the reservoir one. So,in this class I want you to focus on ; The structure of glomerulus and the different component that make up the glomerulus. The structure of the renal filter and the different component that make up them. The proximal tubules,loop of Henle,the distal tubule and collecting duct;focus on the characteristic features for each component of these tubules.

So,if youre going to study that,try to integrate the information so that you can clearly understand it.

Thats all,thank you.

Look forward for your exams, instead of being depressed over them. Two reasons for that; first - exams are TRADEMARK of medical schools (they are here to stay!), secondly - they serve as signboards, telling you how close (or how far) you're to the destiny. Enjoy & cherish them! Never leave God behind in your pursuit to be the men/women of medicine. As healers, we are the INSTRUMENT of God's mercy. Continue your strive to be close to Him, for you will definitely need Him endlessly. It is through your hands, words, eyes and smiles that God is going to cure and care for the sick and fallen. May you deserve such honour Prof Dr. Harlina Siraj

By: izzati idris (: