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1
Basic Mechanisms of Urine Formation
Filtration, secretion, reabsorption and excretion.
How do we determine these rates?
Master formula
Renal Physiology- Chapter 27
2
For any substance,
The rate of = rate of + rate of – rate of excretion filtration secretion reabsorption
Renal Equations (for lab exercise)
Other terms that are used to express these ideas:
•For “Rate of excretion” we often use the term “urinary output”
•For “Rate of filtration,” when referring to filtered fluid, we often use the term GFR
if referring to filtered solute, we use Tubular Load
3
Calculating Tubular Load of a Substance (any solute, “s”)
At the glomerulus, fluid and solutes are constantly being filtered and enter the tubule.
GFR is the term for the volume of plasma fluid filtered each minute.
Once in the tubule, it is “tubular fluid” and no longer plasma, but not yet urine
Tubular Load (TLs): the amount of any substance (s) entering the tubule, each minute.
TL depends on two things: the plasma concentration and the rate of filtration of that solute
TL s = Ps x GFR
4
Tubular Filtrate Resembles Plasma
By far, filtered fluid is mainly NaCl and water.
It contains other salts and electrolytes, amino acids, small sugars, vitamins and other small molecules, such as wastes.
Na+ and Cl- are present in such large amts; they are over 99% reabsorbed along the length of the tubule. (Why? Remember that plasma volume affects blood pressure)
Reabsorption of other solutes, like amino acids and sugars, is often linked to the transport of Na+
5
Tubular Lumen
Tubular Cells
Luminal MembraneNote: this side contains microvilli in PCT.
Basolateral Membranes
Filtrate arriving from Bowman’s Capsule
Peritubular Capillaries
The PCT has an extensively amplified apical membrane called the brush border and its basolateral membrane is highly invaginated and contains many mitochondria
6
Tubular ReabsorptionTransport: Active (primary or secondary) and Diffusion
Many different solutes are reabsorbed by various transport methods
As a result of solute reabsorption, osmosis will occur
As a result, water movement from the tubule will affect the gradients of other solutes still in the tubule, and if they are permeable, their reabsorption.
Figure 27-1;Guyton and Hall
7
Primary Active Transport of Na+3 modes of net reabsorption of sodium
Sodium/Potassium ATPase
Facilitated diffusion/ Secondary active transport on apical membrane
Simple diffusionBulk flow into
peritubular capillary
Figure 27-2;Guyton and Hall
8Figure 27-3;Guyton and Hall
Mechanisms of Secondary Active Transport
Across the luminal membrane:
Co-transport of Na+ Glucose Na+ Amino Acids. Na+ H+ Counter-transport
(Exchange)
• Across the basolateral membranes:glucose and amino acids diffuse out to peritubular capillaries (they are permeable there) but Na must be actively transported out of the cell by Na/K pump.
9
Transport Maximum
Some substances have a maximum rate of tubular transport due to saturation of carriers, limited ATP, etc.
• Transport Maximum (Tm): Once the transport maximum is reached for all nephrons, further increases in tubular load are not reabsorbed, but are then excreted.
• Threshold is the plasma concentration at which tubular load just exceeds the transport maximum (Tm) for reabsorption, where below threshold all solute molecules are reabsorbed, and above threshold, some solutes are not
Examples: glucose, amino acids, phosphate, sulfate
Figure 27-4;Guyton and Hall
10
1
2
3
4
5
=solute= transporter
Transport maximum is reached when carriers are saturated.
5/min
11
1
2
3
4
5
=solute= transporter
Saturation is reached, Maximum speed, Tm
Excretion
5/min
12
A patient with uncontrolled diabetes has aGFR of 90 ml/min, a plasma glucose of 200 mg/dl (2mg/ml), and a transport max (Tm) shown in the figure. What is the glucose excretion for this patient?
.
Reabsorbed
Excreted
TransportMaximum(150 mg/min)
Threshold
250
200
150
100
50
0
Glu
cose
(m
g/m
in)
a. 0 mg/minb. 30 mg/minc. 60 mg/mind. 90 mg/mine. 120 mg/min
50 100 150 200 250 300 350Filtered Load of Glucose
(mg/min)Copyright © 2006 by Elsevier, Inc.
13
Answer: Filt Glu = Reabs Glu = Excret Glu =
.
Reabsorbed
Excreted
Threshold
250
200
150
100
50
0
Glu
cose
(m
g/m
in)
Filtered Load of Glucose(mg/min)
a. 0 mg/minb. 30 mg/minc. 60 mg/mind. 90 mg/mine. 120 mg/min
GFR = 90 ml/min PGlu = 2 mg/mlTmax = 150 mg/min
50 100 150 200 250 300 350
TransportMaximum(150 mg/min)
(GFR x PGlu) = (90 x 2) = 180 mg/min Tmax = 150 mg/min
30 mg/min
Copyright © 2006 by Elsevier, Inc.
14
Interstitial Fluid
TubularLumen
Tubular Cells
Make sure you understand that Reabsorption of Water and Solutes is Coupled to Na+ Reabsorption
in the PCT
Na +
K+ATP
Na +
K+ATP Na +
- 3 mV0 mv
H20
Cl-
Urea
Na +
H +
glucose, amino acidsNa +
- 70 mV
Copyright © 2006 by Elsevier, Inc.
15Figure 27-7;Guyton and Hall
Changes in Concentration in Proximal Tubule
Special feature of PCT: is freely permeable to water
As a result of solute reabsorption, osmosis will occur
Isosmotic reabsorption…what does that mean? Define. (300mOsm)
As a result, water movement from the tubule will affect the gradients of other solutes still in the tubule, and if they are permeable, their reabsorption.
~100% Glucose and Amino Acids 67% of Filtered Sodium 65% of Filtered Water
What happens to a solute concentration in the tubule if it is reabsorbed more than water? or less than water?
16
Before we move onto the other nephron segments be mindful of the following:
The kidneys must be able to excrete urine that is either hypo-osmotic or hyper-osmotic with respect to bodily fluids
This means that the varying osmolality requires that solute be separated from water at some point along the nephron!
The loop of Henle, in particular the thick ascending limb, is the MAJOR site where solute and water are separated.
Thus the excretion of both dilute and concentrated urine requires normal function of the loop of Henle
17
LOH- Thin Descending limb
permeable to water AQP-1 water channels ??? of filtered water
reabsorbed here No active sodium
transport minimal permeability to
sodium and urea (simple diffusion
INTO the tubule only -110% of urea)
18
Thick- Ascending limb—Diluting Segment!!!!
Impermeable to water About ??? of sodium
reabsorption Fluid leaving thick
ascending limb is hypo-osmotic
Actively pumps sodium out of tubule to surrounding interstitial fluid (Na+/K+ ATPase)Na+/2 Cl-/K+ co-transporter on luminal side
Na+/H+ counter-transport (H+ secretion)Also, Ca+2, HCO3-, Mg+2, K+, and Na+ paracellularly due to positive net charge in lumen from backflow of K+
19Figure 27-9;Guyton and Hall
Sodium Chloride and Potassium Transport in Thick Ascending Loop of Henle
20
Look at properties of cells along tubule:
Cells of tubules are NOT permeable to water. Water can’t go in or out.
Cells of tubules actively reabsorb Na+ and Cl-(out of tubule and into surrounding area). Salt is removed but NOT water.
Interstitial space becomes highly concentrated!
This makes filtrate more dilute and osmolality decreases.
400
21
Purpose of the LOH- Counter Current Multiplier
to create an osmotic gradient deep in medulla of kidney, not for its own benefit, but to benefit the collecting duct that sits adjacent to it.
Creates “salt gradient.” If Loop is disabled, then collecting
duct adjacent to it cannot give concentrated urine.
Concentration and volume of urine is determined by concentration gradient produced in Loop of Henle and by the presence of certain hormones.
Urine concentration can then range from 50 mOsmolal to 1400 mOsmolal.
Let’s write in the osmolalities for the filtrate in the descending and ascending tubules
300
700
1000
12000
300
700
1000
22
Factors That Contribute to Buildup of Solute in Renal Medulla -Countercurrent Multiplier
Active transport of Na+, Cl-, K+ and other ions from thick ascending loop of Henle into medullary interstitium
Active transport of ions from medullary collecting ducts into interstitium
Passive diffusion of urea from medullary collecting ducts into interstitium
Diffusion of only small amounts of water into medullary interstitium– most absorbed in PCT.
“sluggish blood”
23Figure 27-11; Guyton and Hall
Characteristics of Early and Late Distal Tubules and Collecting Tubules Characteristics of Early and Late Distal Tubules and Collecting Tubules
• not permeable to H2O• not permeable to ureaJuxtaglomerular apparatus
• permeability to H2O depends on hormones• not permeable to urea
24
DCT- early
associated with Juxtaglomerular apparatus (helps in tubuloglomerular feedback mechanism for GFR) Mesangial cells: smooth muscle
like properties, structural support, phagocytic activity, secrete prostaglandins
Granular cells of the afferent arteriole- makes renin
Macula densa of DCT- chemoreceptors
Functionally similar to thick ascending loop
Not permeable to water (still diluting segment) nor urea
Active reabsorption of Na+, Cl-, K+, Mg++
Thiazide diuretics affect Na/Cl co-transporter
25
Late DCT, connecting tubule
Principal cells: what do they do?
No urea permeabilityK+ sparing diuretics
work here Antagonists to
aldosterone binding sites Sodium channel blockers
(reduces K+)Water reabsorption
dependent on hormones
26
Tubular LumenIntercalated Cells
Na +
ATP
Cl -
K+H+
ATP
H20 (depends on
hormones)
H +
ATPK+
ATP
ATP
K+
Copyright © 2006 by Elsevier, Inc.
Intercalated Cells what do they do?
27
Medullary Collecting Ducts-
Permeable to urea goes back to ALOH
Can reabsorb more water (ADH dependent)- to be discussed later!
important for determining final urine output
Can secrete hydrogen ions.
28
Concentration of DifferentSubstances in Tubular System
• Concentrations of solutes depend on relative reabsorption of the solutes compared to water.
• if water is reabsorbed to a greater extent than the solute, the solute will become more concentrated in the tubule (e.g., creatinine, inulin)
• if water is reabsorbed to a lesser extent than the solute, the solute will become less concentrated in the tubule (e.g., glucose, amino acids) Figure 27-14;
Guyton and Hall
29Figure 27-15; Guyton and Hall
Peritubular Capillary Net reabsorption forces
30
Determinants of PeritubularCapillary Hydrostatic Pressure
Peritubular Capillary
Glomerular CapillaryRa Re
ArterialPressure
Arterial Pressure PcRa Pc
Re Pc
31
We’ve covered filtration and reabsorption….Now, it’s time for Tubular Secretion
First step is simple diffusion from peritubular capillaries to interstitial fluid
Enter to tubular cell can be active or passive
Exit from tubular cell to lumen can be active or passive
Examples: potassium, hydrogen, organic acids, organic bases, NH3
H+, K+, NH3
Organic acids and bases
Secretion = Excretion – Filtration+ reabsorption (0)