The Kidneys and Adrenals

 One of the most complex, beautifully

“engineered” organs of the human body,
the kidneys perform several essential
tasks including the excretion of waste
products, the maintenance of homeostatic
balance in the body and the release of
important hormones. To achieve this,
human kidneys have a highly developed,
superbly refined anatomy and physiology.
 Location and Basic Structure of the
Kidneys
 The kidneys are located near the vertebral
column at the small of the back; the left kidney
lying a little higher than the right. Each is
identical in structure and function. They are bean-
shaped, about 10 cm long and 6.5 cm wide. Each
kidney comprises an outer cortex and an inner
medulla. The kidney is supplied with oxygenated
blood via the renal artery and drained of
deoxygenated blood by the renal vein. In
addition, urine produced by the kidney as part of
its excretory function, drains out via narrow
“tubules” and the ureter, in turn connected to the
bladder.
 The Nephron

 The main functional unit of the kidney is the nephron. There

are approximately one million nephrons per kidney. The
role of nephrons is to make urine by:
 Filtering blood of small molecules and ions such as water,
salt, glucose and other solutes including urea. Large
“macromolecules” like proteins are untouched.
 Recycling the required quantities of useful solutes which
then re-enter the bloodstream. (A process called
reabsorption)
 Allowing surplus or waste molecules/ions to flow from the
tubules/ureter as urine.
 Filtration and Reabsorbtion in the Kidneys
 The kidneys also perform the following
functions:
 Detoxify harmful substances (e.g., free
radicals, drugs)
 Increase the absorption of calcium by
producing calcitriol (form of vitamin D)
 Produce erythropoietin (hormone that
stimulates red blood cell production in the
bone marrow)
 Secrete renin (hormone that regulates
blood pressure and electrolyte balance)
 During progress through the nephron, some solutes like sodium
chloride, potassium and glucose are reabsorbed, along with water,
back into the bloodstream. This maintains a correct balance of
these chemicals within the blood, assisting blood pressure
regulation, for example. The filtration and reabsorbtion of glucose
within the kidneys also helps to maintain correct levels of vital
blood sugars. When this regulation breaks down very serious
health consequences can follow.

 Urea and uric acid are nitrogen containing waste products from
metabolic processes in the body. These substances are potentially
toxic and are partially excreted by the kidneys to maintain good
health. Interestingly, of the filtrate which enters each nephron
from the blood, only about 1% actually leaves the body as urine
because of the various reabsorbtion mechanisms driven by
osmosis, diffusion, and active transport.
 Another, less familiar, mechanism for urine production in
the kidneys is tubular secretion. Specialised cells move
solutes directly from the blood into the tubular fluid. For
example, hydrogen and potassium ions are secreted
directly into the tubular fluid. This process is “coupled” or
balanced by the re-uptake of sodium ions back into the
blood.

 Tubular secretion of hydrogen ions, augmented by control

of bicarbonate levels, is important in maintaining correct
blood pH. When the blood is too acidic (acidosis) more
hydrogen ions are secreted. If the blood becomes too
alkaline (alkalosis), hydrogen secretion is reduced. In
maintaining blood pH within normal limits (about 7.35–7.45)
the kidney can produce urine with pH as low as that of acid
rain or as alkaline as baking soda!
 In addition to its excretory and homeostatic roles,
the kidneys also release two important hormones
into the blood. These are:
 Erythropoietin which acts on bone marrow to
increase the production of red blood cells
 Calcitriol which promotes the absorption of
calcium from food in the intestine and acts
directly on bones to shift calcium into the
bloodstream.

 Finally the kidney produces the enzyme renin, an

important regulator of blood pressure.
 The kidneys are a pair of bean-shaped
organs located below the ribs near the
middle of the back. They are protected by
three layers of connective tissue: the renal
fascia (fibrous membrane) surrounds the
kidney and binds the organ to the
abdominal wall; the adipose capsule (layer
of fat) cushions the kidney; and the renal
capsule (fibrous sac) surrounds the kidney
and protects it from trauma and infection.
 The formation of urine occurs in the basic units of the
kidney, called nephrons. Each human kidney contains over
1 million nephrons. Nephrons consist of a network of
capillaries (called a glomerulus), a renal tubule, and a
membrane that surrounds the glomerulus and functions as
a filter (called Bowman's capsule). The glomeruli are where
urine production begins. Urine formation occurs in the renal
tubules, which travel from the outer tissue of the kidney
(called the cortex), to the inner tissue (called the medulla),
and return to the cortex.

 Extensions of the cortex project into the medulla and divide

the tissue into renal pyramids. The renal pyramids extend
into funnel-like extensions (called calyces), where the
collection of urine occurs. Minor calyces merge to form
major calyces and major calyces merge to form the renal
pelvis, the upper portion of the ureter.
 Each section of the renal tubule performs a different
function. As the tube leads away from Bowman's capsule
into the cortex, it forms the proximal convoluted (highly
coiled) tubule. In this section, waste products and toxic
substances (e.g., ammonia, nicotine) are forced out of the
blood through a permeable membrane and useful
substances (e.g., glucose, amino acids, vitamins, minerals)
are reabsorbed.

 Urine then travels through the loop of Henle, a long U-

shaped extension of the proximal convoluted tubule. It
consists of a descending limb and an ascending limb. Some
sections of the loop are permeable to water and
impermeable to substances in the urine (e.g., salt,
ammonia), and some sections are impermeable to water
and permeable to other substances.
 The next section is the distal convoluted tubule. Normally,
this section is water permeable. Substances that remain in
the urine are reabsorbed, increasing the concentration of
the urine. After passing through the distal convoluted
tubule, the urine consists almost entirely of waste products.
Most of the water and other useful substances have been
reabsorbed.

 Next, urine enters the collecting tubule. Urine from several

nephrons empties into each collecting tubule. These
tubules form the calyces, and the calyces form the renal
pelvis (upper portion of the ureter). Urine travels from the
kidneys through the ureters to the bladder, where it is
stored until it is eliminated from the body through the
urethra.
 The hypothalamus in the brain detects the level of
substances in the blood and controls the secretion of
hormones. Antidiuretic hormone, aldosterone, and atrial
natriuretic factor are hormones that change the
permeability of the distal convoluted tubule and the
collecting tubule, regulating urine volume and helping to
maintain blood pressure.

 For example, when water content in the blood is low (called

dehydration), the secretion of antidiuretic hormone (ADH)
increases and the kidneys reabsorb more water. This
increases the concentration of the urine and decreases
urine output. When water content in the blood is high, ADH
production ceases and the kidneys reabsorb less water.
This decreases the concentration of the urine and increases
urine output.
 is a bean-shaped organ invested by a
tough fibrous capsule. The hilum,
found in the centre of the medially-
directed concave face, is the site of
entry and exit of its major vessels
and the renal pelvis, the distended
initial portion of the ureter.
 is organised into 10-18 lobes with an outer
cortex and an inner medulla. Each lobe
consists of a medullary pyramid (conical in
shape) that is capped by the cortical
components of each lobe. The pointed,
centrally-oriented part of the medullary
pyramid (the renal papilla) is surrounded
by a branch of the renal pelvis called a
calyx (pl. calyces; Gr. kalyx- cup of a
flower), which form the initial portions of
the lower urinary tract.
 Nephrons, the functional units of the
kidney, originate in the cortex and loop
down into the medulla for variable
distances before returning to the cortex
and draining provisional urine into the
collecting duct system. The collecting
ducts then extend back into the medulla
merging successively to form the largest
ducts (papillary ducts or ducts of Bellini)
that open into the calyces.
 The renal cortex contains the renal
corpuscles where ultrafiltration of plasma
occurs and the tortuous or convoluted
portions of the renal tubule system. Some
collecting ducts are visible in the cortex
and are called 'medullary rays'.
 The renal medulla contains the straight
looping portions of the tubule system as
well as the collecting ducts.
 The blood supply of the kidney is central to its
function.
 The main renal artery sequentially divides into:
 posterior and anterior branches
 interlobar arteries that run between the medullary
pyramids
 arcuate arteries that run laterally where the renal cortex
abuts the medulla (the corticomedullary junction)
 interlobular arteries running upwards into the cortical
tissue
 afferent arterioles
 the glomeruli, tufts of capillary loops within the renal
corpuscle where plasma filtration occurs
 efferent arterioles
 two secondary capillary plexuses which provide
the blood supply to the parenchyma of the
kidney:
 The vasa recta. Arising from efferent arterioles of
juxtamedullary glomeruli (in the cortex near the
medulla), this capillary system runs straight down
into the medulla and loops back on itself
ultimately draining into the veins at the
corticomedullary junction. As well as providing
the blood supply to the medulla, the vasa recta,
help to generate the high osmotic pressure in the
medulla necessary for concentration of urine.
 The cortical capillary network. Arising
from the efferent arterioles in the
rest of the cortex, these capillaries
allow the exchange of materials
between the blood and cortical
tubules (eg. oxygen to tubular cells;
molecules reabsorbed from the
provisional urine to blood).
 The renal corpuscle
 consists of Bowman's capsule and
the renal glomerulus
 is the site of filtration of the blood:
 Bowman's capsule
 consists of two contiguous layers of epithelial
cells with a space between them (the urinary
space)
 The outer, capsular epithelium (the parietal wall)
is simple squamous epithelium and may be
thought of as the funnel portion of the renal
tubule.
 The inner, podocyte layer (the visceral wall) forms
part of the filtration barrier -or filter paper within
the funnel- between blood plasma and provisional
urine formed in the urinary space. The podocytes
(meaning cells with feet!) are so-named because
they have interdigitating cytoplasmic extensions
or 'foot processes' apposed to the basement
membrane surrounding the glomerular
capillaries.
 The glomerulus
 is a tuft of capillary loops enclosed by the
visceral layer of Bowman's capsule. The
capillaries have a fenestrated endothelium
which lacks diaphragms.
 is supported by mesangial cells. These cells
synthesise a connective tissue matrix
(mesangium).
 phagocytise any particles trapped on the
endothelial side of the glomerular filtration
barrier and maintain its basement membrane
(see below).
 control glomerular blood flow by contracting or
relaxing to make the glomerular capillaries
narrower or wider.
 Renal Tubule
 proximal convoluted tubule, the loop of
Henlé, the distal convoluted tubule and
the collecting tubule.
 The proximal and distal convoluted
segments are found exclusively in the
cortex and can be distinguished. In the
medulla, we will find thick and thin
segments of the loop of Henlé
intermingled with collecting ducts and the
vasa recta.
 PCT
 begins at the urinary pole of the renal
corpuscle
 is continuous with the parietal layer of
Bowman's capsule
 is the longest, most convoluted portion of
the tubule
 is lined by simple cuboidal epithelial cells
with abundant mitochondria, a prominent
brush border of microvilli and basolateral
interdigitations of the plasma membrane
which increase surface area.
 Loop of Henle
 extends for varying lengths into the medulla. Juxtamedullary
nephrons may have long Loops of Henle reaching far into the inner
medulla whereas other nephrons generally only extend a short
distance in the medulla.
 has four segments:
 the pars recta (straight portion) of the proximal tubule extends
into the outer medulla and is similar in morphology and function to
the rest of the proximal tubule.
 the thin descending limb, lined by simple squamous epithelium,
travels a variable distance into the medulla.
 the thin ascending limb, also lined by simple squamous
epithelium, begins immediately after the tubule loops back on
itself. This segment may be quite short.
 the thick ascending limb is similar in structure to the distal
convoluted tubule being simple cuboidal with basolateral
interdigitations and abundant mitochondria reflecting its ability to
actively transport ions. It extends back to the cortex and is
continuous with the distal convoluted tubule.
 DCT
 is lined by simple cuboidal epithelium
with basolateral interdigitations and
abundant mitochondria.
 lacks the extensive brush border of
the proximal tubule.
 forms part of the juxtaglomerular
apparatus found at the vascular pole
of the renal corpuscle.
 Collecting Tubule
 is the final segment of the nephron.
It is lined by simple cuboidal
epithelium of varied functions and
morphologies that overlap with those
of distal tubules and collecting ducts.
 begin in the renal cortex as medullary rays
(portions of cortex resembling the
medulla).
 merge to form larger ducts in the medulla
and ultimately the papillary ducts that
empty urine into the renal calyces.
 are lined by simple columnar cells with
distinct lateral plasma membranes due to
reduced interdigitation of these
membranes with neighbouring cells.
 The adrenal medulla is the central core of the
adrenal gland, surrounded by the adrenal cortex.
The chromaffin cells of the medulla are the body's
main source of the catecholamine hormones
adrenaline (epinephrine) and noradrenaline
(norepinephrine). These water-soluble hormones,
derived from the amino acid tyrosine, are part of
the fight-or-flight response initiated by the
sympathetic nervous system. The adrenal
medulla can be considered specialized ganglia of
the sympathetic nervous system, lacking distinct
synapses, instead releasing secretions directly
into the blood.
 The adrenal cortex is devoted to the synthesis of
corticosteroid hormones from cholesterol. Some cells
belong to the hypothalamic-pituitary-adrenal axis and are
the source of cortisol and corticosterone synthesis. Under
normal unstressed conditions, the human adrenal glands
produce the equivalent of 35–40 mg of cortisone acetate
per day.[1] Other cortical cells produce androgens such as
testosterone, while some regulate water and electrolyte
concentrations by secreting aldosterone. In contrast to the
direct innervation of the medulla, the cortex is regulated by
neuroendocrine hormones secreted by the pituitary gland
and hypothalamus, as well as by the renin-angiotensin
system.
 Zona glomerulosa
 The zona glomerulosa is the main site for production of
mineralocorticoids, namely aldosterone, which plays an important
role in the body's sodium homeostasis.

 Zona fasciculata
 The zona fasciculata is responsible for producing glucocorticoids,
chiefly cortisol in humans. Cortisol secretion is stimulated by
adrenocorticotropic hormone (ACTH) from the anterior pituitary,
by binding to a cell surface receptor and in turn increasing
intracellular cAMP. In the absence of ACTH, the zona fasciculata
secretes a basal level of cortisol.

 Zona reticularis
 The zona reticularis produces androgens, mainly
dehydroepiandrosterone (DHEA) and DHEA sulfate in humans.
 Although variations of the blood supply to
the adrenal glands (and indeed the
kidneys themselves) are common, there
are usually three arteries that supply each
adrenal gland:
 The superior suprarenal artery is provided
by the inferior phrenic
 The middle suprarenal artery is provided
by the abdominal aorta
 The inferior suprarenal artery is provided
by the renal artery
 Venous drainage of the adrenal
glands is achieved via the suprarenal
veins:
 The right suprarenal vein drains into
the inferior vena cava
 The left suprarenal vein drains into
the left renal vein or the left inferior
phrenic vein.