BA Ww The Kidney ¥ Where are the kidneys found? + Found retroperitoneally bjw T12 ~L3 vertebral level + Size approx 10 x6.5x3.ms, Weighs around 195-150 grams ¥ What are the functions ofthe kidney? 1. Regulates and maintains composition and volume of extracellular fui. 2. Maintains acid base balance by excreting H+ ions or HCO3- ions. 3. Endocrine organ 2} Synthesis of acid protease Renin — enzyme involved in control of blood pressure {and blood volume, Angiotensinogen mam Angiotensin b) Erythropoietin synthesis ~ *+ glycoprotein hormone *+ regulates RBCs formation in response to decrease 02 concentration. + erythropoietin acts on specific receptors expressed on surface of CFU for erythrocytes in bone marrow ©) Hydroxylation of 25-OH vi + a steroid precursor produced in liver. min D3 ~ *+ converted to 1,25 (OH)2 vitamin D3, hormonally active. ¥ What does the urinary tract consist of? 1. ureter ~runs on transverse process of spine 2. bladder 3. urethra 4, kidneysss '¥ What is the location of the kidneys? ‘+ The kidneys are located retroperitoneally ying against the posterior abdominal wall and extend from 112 to L3 vertebrae. ‘+ Thy are situated on either side ofthe vertebral column. "¥ Whatis the size of the kidneys? + Each kidney is typically about 10-12 cm in length, 5-7 em in width, and 3-4 om in thickness, ‘+ They have a bean-lke shape.‘¥ What is found anteriorly and posterioly? ‘+ Anteriorly: Adjacent to liver, spleen, pancreas, duodenum, and colon. + Posteriorly: Covered by diaphragm and muscles of back (e.g,, psoas major, quadratus lumborum). conston of reer '¥ Describe the internal structure of the kidney: + Onalongituginal section, the kidney reveals three distinct regions visible to the naked eye, arranged from outer to inner: the cortex , ‘the medulla, and the renal sinus. ‘+ Renal parenchyma : The cortex and medulla tagether form the renal parenchyma (the substance of the kidney) and contain millions ‘of nephrons, the kidney's functional uits.. ‘+ Renal sinus : a large cavity situated beneath the renal parenchyma, connects to the outside through the hilum, ‘+ Contains the renal pelvis, major and minor calyces , renal arteries and veins , nerves , and adipose (fat) tissue ‘+ Acts as a conduit forthe flow of urine and entryfext of blood vessels and nerves into the kidney. ‘¥ What is the cortex? + Cortex: The outer layer, containing renal corpuscles and convoluted tubules. ‘+The cortex is a 7-10 mm thick granular layer located just beneath the capsule.+ Itis organised into two distinct regions: + Cortical labyrinth + Medullary rays (oriented radially toward the capsule but do not extend all the way to it) + The thin zone between the tips of the medullary rays and the capsule is called the cortex corticis + Arenal lobule is formed by: + Amedullary ray. + Half ofthe adjacent cortical labyrinth on either side, + The borders of each renal lobule are defined by interlobular blood vessels ¥ What is the medulla? Medulla: The inner region, consisting of renal pyramids, + Each pyramid has: + Abase facing the cortex. + An apex (renal papilla) pointing toward the renal pelvis and projecting into a minor calyx. + The human kidney is a mult papillary type, with the medulla divided into 8 to 18 renalfmedullary pyramids. + Renal pyramids are separated by inward extensions of cortical tissue called renal columns or columns of Bertin. + The strated appearance of the pyramids is due to straight tubular structures of the nephrons, + Arenal lobe consists of a medullary pyramid and the cortical tissue overlying its base and sides. 1, Renal capsule 2. Renal cortex. Renal columns: extensions of cortical tissue between the pyramids. 1, Renal medulla 1. Renal pyramids: contain loops of Henle and collecting ducts. 2. Minor calyx: collects urine from the renal papillae. 3 Major ealyx: formed by the union of minor calyces. 4, Renal pelvis: A funnel-shaped structure that collects urine from the major calyces and channels it into the ureter. '¥ What is the Gerota's fascia? + Encases the kidneys and adrenal glands, separating them from the surrounding peritoneal structures. Dy rion, ¥¥ Whore are the upper pole and lower pole ofthe kidney found? + Upper Poles: © Extend trom TM to Lt vertebrae. + Lower Poles: © Extend from L2 to Lé vertebrae, The lower pole of the right Kidney is often in proximity tothe liver. ¥ What are the dimensions of the kidneys? + Mem x6 emx3.em ‘¥ Which kidnoy is lower than what? + right is lower than lett ¥ What isthe relation ofthe left and right kidney?“+ Right Kidney: © Anteriorly related to the liver, duodenum, and ascending colon, + Left Kidney: © Anteriorly related to the spleen, stomach, pancreas, and descending colon, © Mth and 12th ribs provide some protection. Fight -¥ How will we palpate the kidney? + Kidney Palpation: Anterior + Suprerena land + Spleen + stomach + Pancreas + Lett coi lee = junum + Suprarenal gland * Liver = Duodenum Fight colic lame Posterior * Diaphragm 3 and 12 ibs + Psoas major quadratus Jumborum and tranaversus abdominis + Subcosta iiohypogsstic and lisinguinal nerves + Diaphragm 12h ib + Psoas major quadratus Jumborum and tensversus abdominis + Subcosta liohypogsstiic and tsinguinel nerves © Generally not palpable unless enlarged or diseased. Palpation is usually done through the flank or costovertebral angle (CVA). © Ultrasound, CT, and MRI are used to assess kidney structure and pathology, with knowledge of renal topography aiding in ‘accurate interpretation. ¥ Anatomy of the kidney: ¥ What is found at the hilum of the kidney going from anterior to posterior? 4. Renal v 2. Renala 3. Renal pelvis'¥ Why should we know the relations of the 3 vessels? 1. During Bifid renal pelvis > if there is a carcinoma present inthe renel pelv's, then we will clamp the renal artery to access it by ‘making a mine incison in the front of the body 2. However, if there is a stone in the ureter, its closer to the renal pelvis hence, we will make an incision from the posterior section of the body ‘¥ What covers each kidney? ‘+ a renal capsule made of fibroconnective tissue capsule ‘¥ What cushions the kidney? + perrenal fat + and pararenal fat '¥ What surrounds the kidney and perireal fat? + ronal fascia + also known as Gerota’ fascia ‘Y Which structures isthe kidney mede up of? 1. Renal capsule . Cortex = contains nephrons and tubules Medulla = contains tubules and COs 2 3 4, Major calyx 5. Minor calyx 6. . Renal poles ‘¥ Anatomy ofthe kidney: Blood supply of kidney:¥ Descrie the anterior relations ofthe kidney + Right kidney -ityou want to access the hilum, then we will have to dissect the duodenum + Lott kidney -it you want access it, dissect descending colon and jejunum ¥ Describe the posterior relations ofthe kidney: + Ribs found bjw 11 and 72th ribs Which incision is better when it comes to doing surgery on the kidney? + Retroperitoneal incision is better than midline + Bec in midline, we have to dissect duodenum which causes lots of pain everytime they breathe ¥ Imaging: saggital view of the left kidney ‘¥ Imaging: saggital view ofthe right kidney '¥ Where does the testicular vin drain into? 1. left testicular v drains into gonadal v 2. Fight testicular v drains into IVC Which renal artery is longer? + ight renal a + asitis next to IVC away from aorta ¥ Which 5 segments does the renal vein divide into?Apical Superior Midale Inferior Posterior (back) ¥ Name the branches of the renal artery tnertr Abdominal Leterenl one rgnrenal ie gh ren ary Lefer wn, Renal Artery: Branches from the abdominal aorta atthe level of L1-L2 vertebrae. + Position: Each kidney receives blood from its own renal artery left and right renal arteries). Branches of the Renal Artery: ‘Segmental Arteries: The renal artery divides into several segmental arteries (usually 5) that supply different segments of the kidney. Within the renal sinus, segmental arteries divide into interlobar arteries. Interlobar Arteries: Branch from the segmental arteries and travel between the renal pyramids. Arcuate arteries branch into interlobular arteries, which: + Travel between medullary rays towards the capsule. Intralobar Arteries:These enter the renal parenchyma near the renal papillae and ascend between the medullary pyramids in the renal columns of Bertin. ‘Arcuate Arteries: arcuate pattern, ranches of the interlobar arteries that run along the border between the cortex and medulla, forming an + At the corticomedullary junction, interlobar arteries give rise to arcuate arteries, which: © Run parallel to the capsule. © Form arches over the medullary pyramids. Cortical Radiate (Interlobular) Arteries: Branch from the arcuate arteries and extend into the renal cortex, supplying the nephrons.‘The segmental branches of the renal undergo further divisions to supply the renal parenchyma: @ Each segmental artery divides to form interlobar arteries. They are situated on either side of every renal pyramid. © These interlobar arteries undergo further division to form the arcuate arteries. (@ At 90 degrees to the arcuate arteries, the interlobular arteries arise. (@ The interlobular arteries pass through the cortex, dividing one last time to form afferent arterioles. © The afferent arterioles form a capilary network, the glomerulus, where filtration takes place. The capillaries come together to form the different arterioles. ‘¥ Name the segments of real artery: Five segmental arteries originate from these two divisions: + Apical + Upper + Midate + Lower + Posterior '¥ Describe the two branches of the renal artery: ‘+ The anterior branch splits into four segmental arteries to supply the ventral halt. ‘+ The posterior branch supplies the dorsal half witha single segmental artery. Interlobuler artery. Anterior branches— renal artery Posterior branch— renal artery Interlobular arteries Ureteral artery '¥ The branches of the renal artery supplies?+ The anterior branch supplies the ventral half of the kidney and divides into four segmental arteries. + The poster branch supplies the dorsal part of the kidney and continues as a single segmental branch into the renal cortex. + The anterior and posterior branches run infront of and behind the renal pelvis, respectively, ¥ Name the diferent types of arterioles: Subcapsular Capillary Plexus + Inthe superficial cortex, interlobular arteries form a subcapsular capillary plexus. © Some enter the kidney capsule for its arterial supply. Afferent Arterioles + Interlobular arteries give off short lateral branches called afferent arterioles, leading toa glomerular capillary network Efferent arterioles + Blood exits the glomerulus through efferent arterioles, which branch into two capillary networks: © Peritubular Capillaries: + Associated with superficial and mideortical nephrons, supplying the cortex. © Vasa Recta: + Associated with juxtamedullary nephrons. + Descend in the medulla, forming long, thin vessels that run parallel to renal tubules. Juxtamedullary efferent Artrioles + Some supply small branches to the cortical peritubular capillary network. + Vasa recta loop back towards the eorticomedullary junction, ¥¥ Which branching method leads tothe kidney recelving the most blood? + when superior renal ais at the top ofthe kidney + least when inferior renal ais atthe bottom ¥¥ Which renal vein is longer? + lofts 3x times longer than right ¥ Which vein drains into left renal vein? + left gonadal v ¥ Describe the venous drainage: \Venous blood follows the arterial paths in reverse. In the cortex, bload returns through stellate veins or directly into interlobular veins, while in the medulla, the vasa recta drains into arcuate veins. Eventually, blood is carried by the renal vein to the inferior vena cava, There are no segmental veins.Subcapsular Plexus + Inthe superficial cortex, capilaries ofthe subcapsular plexus converge to form smal veins known as stellate veins, Interiobular Veins + Stellate veins unite to form the superior aspect of intertobular vein. Mid-Cortex + Capilaries of the peritubular network converge into venules that drain into interlobular veins. © Interlobular veins then flow into arcuate veins. Meduila + Ascending vasa recta return blood to arcuate veins or occasionally tothe basal parts of interlobular veins. Drainage Pathway + Arcuate veins into interlobar veins, which converge to form the renal vein. Renal Vein ‘+The renal vein carries blood away from the kidney to the inferior vena cava. ‘+ Note: There are no segmental veins in the renal venous system. © Function: Drain blood from the renal cortex into the arcuate veins. © arcu Veins © Function: Collect blood from the cortical radiate veins and drain into the interlobar veins. + Interlobar Veins: © Function: Drain blood from the arcuate veins and empty into the renal vin + Renal Ve ‘© Function: Collects blood from the interlobar veins and drains into the inferior vena cava. © Position: The right renal vein is typically shorter than the left and passes anterior to the inferior vena cava,ie Abdominal ven va nora Left renal ‘artery, Right renal Right renal artery ¥ Why do left sided varicocoele occur? ‘+ bec spermatic vein opens at a sharp angle into the let renal vein ¥ Describe the lymphatic drainage of kidneys: ‘+ Lymph from the kidney drains into the lateral aortic (or para-aortic) lymph nodes, which are located at the origin of the renal arteries. ‘+ Renal lymphatic vessels begin in three plexuses: © Around the renal tubules. © Under the renal capsule. © Inthe perirenal fat. ' The latter two plexuses connect freely. ‘+ Collecting vessels from the intrarenal plexus form four or five trunks. © These trunks follow the renal vein to end in the lateral aortic nodes, “+ The subcapsular collecting vessels join them as they leave ‘he hilum. ‘+ The perirenal plexus drains directly into the same nodes. = hnomal se SS Etemal ae FIGURE 5.5. Lymphates of the kidneys and suprarenal lands, The tymphatic vessels of the Kidneys form three Plexuses: one inthe substance of the ides, ape under the Abrous capsule, and one in the peritenal fot Four ot five Iymphatic trunks lave the renal hikim and are fined by veszels from the capsule (arrows). The lymphatic vessels follow the renal vento the lumbar caval and aortic) Imp nodes. Lymph '¥ Describe the innervation of kidneys:+ The kidney is densely innervated by sympathetic nerves from: © Thoracic spinal nerves X, XI, and XIt © Lumbar spinal nerve + Sympathetic nerves: © Enter at the hilus alongside blood vessels, © Extend along arteries to reach tubules, juxtaglomerular cells, and smooth muscle cells. + Efferent sympathetic renal nerves innervate all segments of renal vasculature in: © The cortex. © The outer medulla, © Including: ' Interlobar arteries. + Arcuate arteries. + Intertobular arter * Afferent and efferent glomerular arterioles. + Few sympathetic nerves are found in the inner medulla, © Highest innervation isin afferent glomerular arterioles, followed by efferent arterioles. + Sympathetic activation: © Causes vasoconstriction, leading to decreased renal blood flow (RBF) and glomerular filtration rate (GFR). + There is no parasympathetic innervation of renal vessels, + All segments of renal tubules are also innervated by sympathetic nerves: © Synaptic contacts occur at basolateral membranes of tubular epithelial cells. + Neuroettector junctions: © The greatest number is found in the proximal tubule. © Followed by: ‘The thick ascending limb, + The distal convoluted tubule. + The collecting duct. + Renal innervation shows regional variation © Highest at the corticomedullary border. © Decreasing in the superficial cortex and deeper medulla. +The kidney has abundant afferent sensory innervation, primarily in the renal pelvic wall ‘¥ What is a nephron? + functional unit ofthe kidney + components: bowmans capsule - proximal tubule - loop of henle - distal tubule - callecting duct ¥¥ Each kidney contains about one milion nephrons, composed of two main parts: (a) Renal Corpuscle Bowman's Capsule + Location: Cortex + Components: © Glomerulus: A tuft of cavillaries where blood filtration begins. © Bowman's Capsule: A double-walled structure surrounding the glomerulus, which collects the filtrate (pre-urine)(b) Renal Tubule ‘+ Responsible for modifying the fitrate ¥ What does the renal tubule consist of? i. Proximal Convoluted Tubule (PCT) + Location: Cortex of the kidney. ‘+ Structure: Lined with simple cuboidal epithelial cells with microvll forming a brush border, which increases surface area for reabsorption. + Function: 8, Reabsorbs about 65-70% of the filtrate, including water, sodium, potassium, bicarbonate, glucose, and amino acids. b. Secretes hydrogen ions, ammonia, and certain organic compounds. Loop of Henle + Location: Extends from the cortex into the medulla + Structure: © Descending Limb: Lined with simple squamous epithelium; permeable to water. © Thin Ascending Limb: Lined with simple squamous epithelium but impermeable to water. © Thick Ascending Limb: Lined with cuboidal epithelium; actively reabsorbs sodium, potassium, and chloride ion. + Function: 2. Establishes a medulary osmotic gradient, which is essential for concentrating urine. '. The descending limb allows water to leave the tubule, while the ascending limb actively transports salts out, leaving the filtrate more ailut. iil, Distal Convoluted Tubule (CT) + Location: Cortex of the kidney. + Structure: Lined with simple cuboidal cells with fewer microvilli than the PCT. + Function: ‘2. Regulates ion balance, primarily through the reabsorption of sodium and the secretion of potassium and hydrogen. », Regulated by hormones such as aldosterone (increases sodium reabsorption) and parathyroid hormone (increases calcium reabsorption). iv. Collecting Duct + Location: Extends from the cortex through the medulla + Structure: Lined with two types of cas © Principal Cells: Regulate water and sodium reabsorption (ADH and aldosterone sensitive). © intercalated Cel Wolved in the secretion of hydrogen ions and bicarbonate, aiding in acid-base balance.‘+ Function: Final site for water and sodium reabsorption, playing a key role in concentrating urine, depending on the body's hydration status (regulated by ADH). ¥¥ Which blood vessels supply the nephron? 1. Afferent Arteriole: Supplies blood to the glomerulus, where filtration occurs. Blood pressure in the afferent arteriole is tightly regulated to maintain filtration rates. 2. Glomerular Capillaries: Fenestrated capillaries within the glomerulus allow water, ions, and small molecules to pass into Bowman's, capsule, forming the filtrate, 3. Efferent Arteriole: Blood exits the glomerulus through this vessel. The efferent arteriole leads to diferent capilary networks, depending on the type of nephron. '¥ Deseribe the renal microvasculature: 1. Glomerular Capillary Bed + Located in the glomerulus. ‘+ Glomerular capillaries are ‘nested! between the afferent and efferent arterioles, © This configuration maintains a high, relatively constant pressure of 50-60 mmHg, ‘+ High pressure is crucial for ultrafiltration of plasma into Bowman's space. © This process leads to the formation of primary filtrate, 2. Peritubular Capillary Bed ‘+ Surrounds the renal tubules. ‘+ Transports reabsorbed water and solutes. ‘+ Returns substances to systemic circulation, © Peritubular capillaries and vasa recta share properties with other capillary beds (e.g., skin, muscle, adipose tissue). © They operate within a low pressure system, with pressures dropping to 5-10 mmHg. + Low hydrostatic pressure in peritubular capillaries allows plasma colloid osmotic pressure to dominate. © This creates a strong reabsorptive force, facilitating the return of absorbed molecules from interstitial fluid to circulation,'¥ Name the two types of nephrons: 1. Cortical Nephrons: In nephrons located primarily in the cortex, the efferent arteriole forms the peritubular capilaries. These capillaries surround the PCT and DCT, allowing the exchange of reabsorbed substances back into the bloodstream. a. Have a glomerulus located nearer to the outer parts of the cortex. ». Their loops of Henle are short. 2. Juxtamedullary Nephrons: These nephrons extend deep into the medulla, and their efferent arterioles form the vasa recta, a series of long, stright capillaries that run alongside the loop of Henle. The vasa recta help maintain the osmotic gradient in the medulla, Which is eritical for concentrating urine, ‘2, Have a glomerulus near the junction of the cortex and medulla. b. They have loops of Henle that penetrate deep into the medulla, ¥ Describe the glomerulus in detail + Itisa high-pressure capillary network, which is supplied by the afferent a and is drained by the ‘+ There are around 10 to 20 loops in the network. + The high pressure is required to cary out ultrafiltration, whereby part of the plasma is filtered into the Bowman's capsule space. + The vascular pole ofthe corpuscleis where: © Arterioles enter. © The urinary pole is where the PCT (Proximal Convoluted Tubule) begins.opty endabalien Seremeat emmbvene Proximal tubule, glomeralay eels Parietal layer ial Bowman’ space ADIMU Mesoogits How + Mesangial cells aro © Irregularly shaped cells embedded in their own extracellular matrix. © Situated between the glomerular capillary loops. © This area, defined as the juxta mesangial portion of the capillary wall, consists of: + Afenestrated endothelium. + Here, water, small solutes, and uncharged macromolecules in the blood freely pass through the endothelium to the mesangial cells. + The mesangial cells within the glomerulus communicate with mesangial cells outside the glomerulus (extraglomerular mesangial colls), and its the later cells that form part of the juxtaglomerular apparatus. ¥ Describe the bowmans capsule in deta + It surrounds the glomerulus. +t consists of visceral (nner) and parietal (outer) epithelial layers. Visceral Layer +The visceral layer i intimataly associated with the glomerular capillary loops. + tis ceflected to become continuous with the parietal layer at the vascular pole of the renal corpuscle. Bowman's Space +The space between the visceral and parietal Inings is known a: © Bowman's space. © Also called urinary space as it collects the filtrate of blood emanating trom the glomerular iter. + Bowman's space is continuous with the lumen of the proximal convoluted tubule, Parietal Lining + The cells of the parietal © Simple squamous epithelium. © Itmerges with the simple cuboidal epithelium lining the proximal convoluted tubule at the urinary pole. Visceral Layer + The visceral layer of Bowman's capsule is @ mocified simple squamous epithelium. + tis composed of large stellate epithelial cells called podocytes. Podocytes + Podocytes have: © Avoluminous body. © Long cytoplasmic extensions called primary processes, which give rise to numerous secondary processes calle! + Pedicels or foot processes. © Only the foot processes directly rest on the outer surface of the glomerular capillaries.© The cell bodies and primary processes are usually not found in extensive contact with the outer surface of the capillaries, standing off by 1-2 um. “+ The foot processes of neighboring podocytes regularly interdigitate, leaving between them narrow spaces of © ~30-40 nm wide caled filtration slits Podeeye ce body - Primary toot proeas Filtration Slits + Filtration sits are spanned by a thin electron-dense membrane: © anm wide. © Known as the slit diaphragm or filtration slit membrane. © tis through these fine slits that the primary urine emanating from the glomerular capillaries filters towards Bowman's space. ¥ What is polycystic kidney disease? Polycystic Kidney Disease (PKD) affects the nephron by causing cyst formation, which distorts normal renal tissue. Cysts often form from segments of the renal tubule, especially inthe proximal convoluted tubule (PCT), loop of Henle, and collecting ducts. ‘+ These cysts enlarge and disrupt the normal architecture of the tubule, impairing its ability to reabsorb water, electrolytes, and other essential solutes. + Glomerulus and Bowman's Capsule may not be directly affected by cyst formation in the early stages of PKO. ‘+ However, a cysts grow in other parts of the nephron, pressure on nearby structures can impair glomerular filtration. + Compression of blood vessels by expanding cysts reduces blood low and increases resistance in the renal vasculature. + Reduced blood flow to the kidney activates the renin-angiotensin-aldosterone system (RAAS) ‘+The juxtaglomerular apparatus (JGA) detects reduced perfusion and triggers the release of renin, leading tothe formation of angiotensin i, causing vasoconstriction and aldosterone release, increasing blood pressure, and leading to hypertension. ‘¥ What isthe peritubular network? In the outer two-thirds ofthe renal corte, the efferent arterioles form what is known as a Peritubular Network, supplying the nephron tubules with oxygen and nutrients, The inner ‘third ofthe cortex and the medulla are supplied by long, straight arteries called vasa recta.Interbar anery ert Cortical nephron Juxtamedullary nephron '¥ Whatis the glomerular capillaries? + Positioned between the afferent and efferent arteriole, glomerular capillaries maintain a high pressure (around 60-60 mma), driving plasma ultratitration into Bowman's space, forming the primary firate. ‘+ The glomerular capillaries are ‘nested! between the afferent and the efferent arterioles. This unique configuration allows the maintenance of a high and relatively constant pressure at around 50-60 mmHg within the glomerular capilaries.‘+ This high pressure is primarily responsible for the ultrafiltration of the plasma into the Bowman's space and the formation of primary filtrate. '¥ What is the peritubular capilaries? + Both peritubular capillaries and vasa recta operate under low pressure (as low as 5-10 mmHg), similar to other capillaries in the body. Ths low pressure allows for reabsorption, driven by the high plasma colloid osmotic pressure, facilitating the return of molecules absorbed by the tubules into circulation. + Both peritubular capillaries and vasa recta have similar properties to other capillary beds found in the organism (skin, muscle, adipose tissue, ete. + They are characterised by a low pressure system with a progressive and continuous drop in pressure reaching pressures as low as 5-10 mmHg, ‘+ The low hydrostatic pressure within the peritubular capillaries allows the elevated plasma colloid osmotic pressure to predominate and establish a predominant reabsorptive force responsible for returning the molecules absorbed by the tubules from ‘he interstitial fluid tothe circulation. ‘Describe the histological structure ofthe kidney: 1. Renal Capsule + Outer layer - Fibroblasts and collagen fibers. + nner layer - Myofibroblass.2. Renal Cortex The renal cortex consists of: ‘+ Tissue lying between the bases of the pyramids and the surface of the kidney, forming the cortical arches or lobules. Light and dark striations (medullary rays), ‘+ Tissue lying between adjacent pyramids (renal columns}. ‘+ Each pyramid surrounded by cortex forms a lobe, ‘+ Renal Corpuscles - Form ultrafitrate from blood. + Cortical Labyrinths ~ Contain proximal and distal convoluted tubules. ‘+ Medullary Rays — Contain straight tubules and collecting ducts. 3, Renal Medulla ‘The medulla is made up of renal pyramids. Each pyramid has a base directed towards the cortex and an apex (papilla) directed ‘owards the renal pelvis, fitting into a minor calyx. Pyramids show radial striations towards the apex. A pyramid with the surrounding cortex forms a renal lobe. “+ Pyramids ~ Base towards the cortex, apex forms renal papilla. Urine passes through the minor calyx into the renal pelvis. + Renal Pelvis - Funnel-shaped origin of the ureter. “+ Arcuate Arteries - Branches over pyramids at cortex-medull junction, ‘+ Hilum - Vessels enter and ext. "¥ What are the uriniferous tubules? The kidney consists of numerous uriniferous tubules specialized for urine excretion. Each tubule consists of a nephron and a collecting ‘tubule. Collecting tubules join to form larger papillary ducts (of Bell), which open into a minor calyx at the renal papilla.URINIFEROUS TUBULE Soren NEPHRON + COLLECTING DUCTS = 4, NEPHRON + distributed throughout cortex and —— ‘ors ones of medulla 2) RENAL CORPUSCLE by PROXIMAL TUBULE 9 MEERA FETE dy oistat TUBULE ‘STRAIGHT AND CONVOLUTED PORTIONS COLLECTING DUCTS ¥ Describe the renal corpuscle in detal!: ‘The renal corpuscle is an assemblage of a vascular structure, the glomerulus, and an epithelial structure, Bowrnan's capsule. ‘+The glomerulus is a high-pressure capillary network (fenestrated), which is responsible for fitration of plasma. Each glomerulus consists of a compact tuft of arterial capillaries composed of 10-20 loops, which is supplied by an afferent arteriole and drained by an efferent arteriole. ‘+ Bowman's capsule, or glomerular capsule, isa blind, double-walled epithelial cup, which surrounds the glomerulus, lke a baseball glove around a ball. it has two layers: an inner wall, which fits closely over the glomerular capillaries, and an outer wall, which is. Continuous with the renal tubule. The two layers are separated from each other by a smal space, Bowman's space, which collects the fluid forced out of the glomerular capillaries. © The inner layer (visceral layer) is made up of specialized epithelial cels called podocytes. © The outer layer (parietal layer) consists of simple squamous epithelium, Renal Corpuscle ey SS row of boos > Flow of titvate ‘Astoron. ‘eric ftow '¥ Briefly describe the proximal convoluted tubule: Found near the renal corpuscles, these tubules are lined with cuboidal epithelial cells that have a brush border of microvilito increase surface area for reabsorption. They are involved in reabsorbing water, glucose, amino acids, and electrolytes from the filtrate, Lumen: sualy star-like.PROXIMAL CONVOLUTED TUBULE (PCT) ‘* REABSORBS ORGANIC NUTRIENTS, PROTEINS, WATER, & ELECTROLYTES SECRETES AMIONS & CATIONS (e3. HYDROGEN & AMMONIUM) SIMPLE CUBOIDAL o COLUMNAR EPITHELIAL CELLS LONG MICROVILLI CYTOPLASM ic MORE EOSINOPHILIC than DISTAL CONVOLUTED TUBULES © COLLECTING DUCT + Itextends off of Bowman's capsule. + It's located in the cortical labyrinth where it follows a convoluted course in the proximity of its parent renal corpuscle. + It terminates as the tubule straightens and enters the medullary tissue: © Forjuxtamedullary nephrons - it enters the outer medulla. © For cortical nephrons - it enters the nearest medullary ray. '¥ Which cells are found here? + The simple eosinophilic cuboidal epithelial cells are © Sealed together at their apices by tight junctions. © The tight junctions are shallow, with only a few junctional strands. + The apical side of the cells: © Is covered with 9 well-developed luminal brush border. “+ The basal side of the cells: © Shows prominent processes, beginning just below the tight junctions. ‘+ The lateral cellular processes: © Spread racially from the cell body. © Interdgitate tightly with similar processes of adjacent cells, forming a basal membrane labyrinth ‘+ Both the apical brush border and basal membrane labyrinth increase the surface area ofthe cell and are characteristic of cells, involved in extensive transcellular transport. ‘+ Epithelial cells of the proximal tubule are characterized by: © Avery extensive endoc} fysosomal machinery inthe apical cytoplasm. «This correlates wel withthe reabsorption of filtered proteins and peptides by this nephron segment. '¥ What are the basal features of PCT? + Inthe basal part ofthe ces, there are vertical striations that represent numerous elongated mitechondria: © They are predominantly located within compartments of the basal labyrinth + These morphologic features are consistent with large active fon transport inthis segment. + The PCT also has 2 non-motile primary cilium. ¥¥ What does the straight portion of the PCT have? + Moving towards the straight portion of the PCT: ©The cells are less complex, correlating with a gradual decrease in reabsorptve rates along the tubule. © The cells ofthe straight potion are shorter. © Their brush border and basolateral infoldings are less well-defined than inthe convoluted part © They have fewer apical endocytic vesicles and fewer mitochondria.¥ Briefly describe the distal convoluted tubule: These tubules are also located in the cortex but have fewer microvill compared to the proximal convoluted tubules (PCT). They are involved in the fine regulation of electrolyte balance and are hormonally regulated (e.g. by aldosterone) DISTAL CONVOLUTED TUBULE * LIGHTER STAIN * SHORTER MICROVILLI ‘+ REABSORB Nat & Cl- 4 MAKES URINE HYPOTONIC. +The distal convoluted tubule (DCT) is continuous with the thick ascending limb of the loop of Henle. + tis defined as the tubular segment interposed between the macula densa region and the connecting tubule. + tis located inthe cortical labyrinth, where it forms tightly condensed loops near to its parent glomerulus. '¥ What isthe proximal det! vs lato? 4. Proximal DCT1 * tis tined by a simple layer of cuboidal epithelial cells resting on a basal membrane, © Unlike in the proximal tubule, these epithelial cals: * Lack apical vacuoles. + Do not have a brush border but only smal and irregular microvilli with a primary non-motile + Asin proximal tubules, the cells show: © Deep, elaborate infoldings of the basolateral cell membrane. © Numerous elongated mitochondria that le parallel to the long axis of the cell, indicative of active reabsorption of ions in this part of the nephron, + Mitochondria are: © More numerous and longar inthe distal tubule, reflecting intense active ion transport. + Inthe straight part of the distal tubule (corresponding to the thick ascending limb): © The tight junctions are more complex than those of the proximal tubule © They are not as permeable but still permit the permeation of small monovalent and divalent cations (e.g,, Nat, Ca2+) 2.Late DcT2 + tis. transitional portion characterized by a mixture of cell types from DCT1 and the contiguous collecting tubule segment. ¥ Briefly describe the Loop of Henle + The descending limb has an intial thick portion, called the thick descending limb or proximal straight tubule, which is continuous with the PCT. + Italso has a terminal thin portion, known as the thin descending limb. + The ascending limb is composed of: 1. Aninitial thin segment, called the thin ascending limb. 2. Aterminal thick segment, termed the thick ascending limb or di‘+ Thin Descending Limb: Lined by simple squamous epithelium, this ib is highly permeable to water but not to solutes. + Thin Ascending reabsorbed. Also lined by simple squamous epithelium, but impermeable to water. Solutes like sodium and chloride are ‘+ Thick Ascending Limb: Lined by cuboidal epithelial cells, this segment is actively involved inthe reabsorption of sodium, potassium, and chloride, contributing to the kidney's ability to concentrate urine. rn. sane sume Re ncn cre mana acer Tapesconone CSE Us: ~ DRAINS URINE from the NEPHRON —> MINOR CALYX ~ SIMPLE CUBOIDAL 2. COLUMNAR EPITHELIAL CELLS hat have WELL DEFINED BORDERS = UGHTLY STAINED ~ REABSORS WATER ~ SECRETE w ABSORB VARIOUS ELECTROLYTES ‘¥ What is the collecting tubule? ‘+ The connecting tubule (CNT) isthe short straight terminal portion of the renal tubule that connects the DCT to the collecting duct system. ‘+ The epithet lining of the DCT consists of two distinct cell types: © Connecting tubule cell: + Responsiole for Na+ and water reabsorption. © Intercalated cel: Responsible for H+ secretion or HCO3- secretion, ‘+ Both of these cells have only very few apical microvi ¥ Describe the Ultrastructure of Connecting Tubule Cells ‘+ The connecting tubule cells: © Have an ultrastructure intermediate between that of the typical DCT and CD principal cells. © They have fewer mitochondria and basolateral plasma membrane infoldings than the DCT cells but are: Considerably taller, ‘+ Have more mitochondria than the principal cells of the cortical collecting duct (CD).