ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

Chapter 26: Urinary System

1st Semester l Finals l University of San Agustin l

Outline: o lie on posterior abdominal

26.1 Functions of the Urinary System wall on either side of vertebral
26.2 Kidney Anatomy and Histology column
26.3 Urine Production o lumbar vertebrae and rib cage
26.4 Regulation of Urine partially protect
Concentration and Volume o right kidney slightly lower than
26.5 Plasma Clearance and Tubular left
Maximum
26.6 Urine Movement Location and External Anatomy of the
26.7 Effects of Aging on the Kidneys Kidneys

26.1 FUNCTIONS OF THE URINARY  External anatomy:

SYSTEM  Renal Capsule: fibrous connective
tissues which surrounds each kidney
 Urinary system is a major excretory  Adipose tissue: engulfs renal capsule
system of the body and acts as cushion
 Two kidneys produce excretory  Renal fascia: thin layer loose
products, carried by ureters to urinary connective tissue which anchors
bladder which is emptied via urethra kidneys and surrounding adipose to
abdominal wall
 Functions of kidneys:
 Hilum: renal artery and nerves enter
o excretion of waste products
and renal vein and ureter exit kidneys
from the blood
o opens into renal sinus (cavity
o regulation of blood volume and
filled with fat and loose
pressure
connective tissue)
o regulation of blood solute
concentrations
o regulation of extracellular fluid
pH
o regulation of red blood cell
synthesis
o regulation of vitamin D
synthesis

26.2 KIDNEY ANATOMY AND HISTOLOGY

 Location:
o kidneys are bean-shaped organs
that are retroperitoneal
(behind peritoneum)

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 1

2 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

Internal Anatomy and Histology of the  Path of urine produced by nephron:

Kidneys o collecting duct
o toward renal papilla
 Cortex: outer area o papillary duct
o renal columns: part of cortical o minor calyx and beyond
tissue thatextends into medulla
 Medulla: inner area which surrounds Types of Nephrons
renal sinus
o renal pyramids: cone-shaped  Juxtamedullary nephrons
o (1) base is boundary between o renal corpuscle near the cortical
cortex andmedulla medullary border
o (2) apex of pyramid is renal o loops of henle extend deep into
papilla whichpoints toward sinus the medulla
 Cortical nephrons
 Calyces o renal corpuscle nearer to the
o minor calyx: papillae extend periphery of the cortex
into funnel ofminor calyx o loops of henle do not extend
o major calyx: converge to form deep into the medulla
renal pelvis  The filtration part of a nephron is called
a renal corpuscle (glomerulus)
 Renal pelvis: enlarged chamber
formed bymajor calyces Renal Corpuscle
 Ureter: exits at the hilum and
connects tourinary bladder  Bowman capsule: outer parietal
o simple squamous epithelium
o visceral layers (cells called
podocytes)
 Glomerulus: network of capillaries
o blood enters through afferent
arteriole and exits through
efferent arteriole

Structure of a Nephron

 Nephron: functional and histological

unit of the kidney
 Regions:
 Parietal layer: outer
o renal corpuscle
o simple squamous epithelium
o proximal convoluted tubule
that becomes cube-shaped
o loop of henle
where bowman’s capsule ends
o distal convoluted tubule
and proximal tubule begins
 Visceral layer: inner

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 2

3 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

o specialized podocytes that wrap

around the glomerular
capillaries

Fenestrae and Filtration Slits

 Fenestrae: window-like openings in

the endothelial cells of the glomerular
capillaries
 Filtration slits: gaps between cell
processes of the podocytes
o basement membrane  Fluid passes from the capillary through
sandwiched between the the filtration membrane into the
endothelial cells of the bowman capsule
glomerular capillaries and
podocytes Arterioles and the Juxtaglomerular
Apparatus

 Afferent arteriole: supplies blood to

glomerulus
 Efferent arteriole: drains blood from
glomerulus
 Glomerular capillaries have high
pressure because efferent arterioles
have small diameter compared to
afferent
 Juxtaglomerular apparatus:
specialized structure near glomerulus
o site of renin production
o juxtaglomerular cells: ring of
 Glomerulus is composed of smooth muscle in the afferent
fenestrated capillaries arteriole where the latter enters
 Visceral layer of bowman capsule bowman’s capsule
consists of specialized cells called o macula densa: specialized
podocytes tubule cells of the distal tubule
 Spaces between the podocyte cell (lies between afferent and
processes are called filtration slits efferent arterioles)

Filtration Membrane Renal Tubule

 Consists of capillary endothelium,  Proximal tubule: simple cuboidal

basement membrane, and epithelium with many microvilli
podocytes  Loops of henle
 First stage of urine formation o descending limb: first part
occurs here when fluid from blood in similar top proximal tubule and
capillaries moves across filtration latter part simple squamous
membrane into the lumen inside epithelium and thinner
bowman capsule o ascending limb: first part
simple squamous epithelium
and thin, distal part thicker and
simple cuboidal
 Distal tubule: shorter than proximal
tubule
TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 3
4 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

o simple cuboidal but smaller cells

and very few microvilli
 Collecting ducts: form where many
distal tubules come together
o larger in diameter
o simple cuboidal epithelium
o form medullary rays and lead to
papillary ducts

Arteries and Veins of the Kidney

1. Renal Arteries branch from abdominal

aorta
2. Segmental arteries branch from renal
3. Interlobar arteries ascend within
renal columns toward cortex
4. Arcuate arteries branch and arch
over the base of the pyramids
5. Interlobular arteries project into
cortex and give rise to afferent
arterioles 26.3 URINE PRODUCTION
6. Afferent arterioles supply blood to
glomerulus  Nephrons serve as the major
7. Glomerulus functional units as they regulate body
8. Efferent arterioles exit the renal fluid composition
corpuscle  Three major steps in urine
9. Peritubular capillaries form a plexus formation:
around the proximal and distal tubules o Filtration
10. Vasa recta: specialized parts of o tubular reabsorption
peritubular capillaries that course into o tubular secretion
medulla along loops of henle, then  Filtration
back towards cortex o movement of materials across
the filtration membrane into the
bowman capsule to form filtrate
 Tubular reabsorption
o solutes are reabsorbed across
the wall of the renal tubule into
the interstitial fluid by transport
processes (active transport and
co-transport)
o water is reabsorbed across renal
tubule by osmosis. Water and
solutes pass from the in-
terstitial fluid into the
peritubular capillaries
 Tubular secretion
o solutes are secreted across the
wall of the renal tubule into the
filtrate

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 4

5 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

these are reabsorbed and metabolized

by the cells of the proximal tubule

Filtration Pressure

 Filtration pressure: pressure gradient

responsible for filtration
o forces fluid from glomerular
capillary across membrane into
Filtration
lumen of Bowman’s capsules
 Movement of blood fluid through the
Pressures that contribute to filtration
glomerulus across filtration membrane
 Filtrate: water, small molecules, ions pressure:
that can pass through membrane
 Glomerular capillary pressure
 Renal fraction: part of total cardiac
(GCP):blood pressure inside capillary
output that passes through the kidneys
o varies from 12 to 30%’; tends to move fluid out of capillary into
Bowman’s capsule
averages 21%
 Renal blood flow rate: rate of whole  Capsule hydrostatic pressure
(CHP): pressure of filtrate already in
blood flow through kidneys
the lumen
 Renal plasma flow rate: renal blood
 Blood colloid osmotic pressure
flow rate X fraction of blood that is
plasma: 650mL/min (BCOP):osmotic pressure caused by
proteins in blood
 Glomerular filtration rate (GFR):
o favors fluid movement into the
amount of filtrate produced each
minute capillary from the lumen
o 180 L/day  Filtration pressure: 10 mm Hg(GCP)
50 mm Hg - (CHP) 10 mm Hg)- (BCOP)
 Filtration fraction: part of plasma
that is filtered into lumen of bowman’s 30 mm Hg
capsules
Filtration Pressure
o average 19%
 Average urine production per day: 1
 Colloid osmotic pressure in
to 2 L
Bowman’s capsule normally close to
o most of filtrate must be
reabsorbed zero
 High glomerular capillary pressure
results from:
Filtration Membrane
o low resistance to blood flow in
 Filtration membrane: filtration afferent arterioles
o low resistance to blood flow in
barrier
glomerular capillaries
o prevents blood cells and
o high resistance to blood flow in
proteins from entering lumen of
efferent arterioles: small
Bowman’s capsule
diamater vessels
 Components:
o fenestrated glomerular  Filtrate is forced across filtration
membrane
capillaries
o fluid moves into peritubular
o basement membrane
capillares from interstitial fluid
o podocytes of visceral layer of
 Hyper tension can damage
Bowman capsule
glomerular capillaries
 Some albumin and small protein
hormones enter the filtrate, but

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 5

6 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

Visual Representation Tubular Reabsorption

 Transport of water and solutes from

filtrate into the blood
o occurs as filtrate flows
through the lumens of the
renal tubule
 Substances transported to interstitial
fluid and reabsorbed into peritubular
capillaries
o sodium, potassium, calcium,
bicarbonate ,and chloride
 Portion not reabsorbed ends up in
urine
o contains urea, uric acid,
Regulation of Glomerular Filtration Rate creatinine, potassium, and other
(Intrinsic) substances

 Intrinsic mechanisms: Reabsorption in the Proximal Convoluted

autoregulation Tubule
o involves changes in degree of
constriction in afferent arterioles  Site of majority of reabsorption
 Myogenic mechanism: as systemic  Substances pass through cells of tubule
BP increases, afferent arterioles wall where each cell has:
constrict and prevent increase in renal o apical membrane: surface
blood blow that faces filtrate
o basal membrane: faces
 Tubuloglomerular feedback: interstitial fluid
increased rate of blood flow of filtrate o lateral surfaces: surfaces
past cells of macula densa between cells
o signal is sent to juxtaglomerular
cells and afferent arterioles  Active transport of Na across the
constricts basal membrane from cytoplasm to
interstitial fluid linked to reabsorption
Regulation of Glomerular Filtration Rate  Because of active transport,
(Extrinsic) concentration of Na is low inside the
cell
 Extrinsic mechanisms: sympathetic o Na moves into nephron cell from
nervous system and hormones filtrate through the apical
o occurs during severe conditions membrane
such haemorrhage or
dehydration  Number of carrier molecules limits
 Sympathetic simulation constricts rate of transport
small arteries and afferent  In diabetes mellitus
arterioles = decreasing renal blood o concentration of glucose in
flow and filtrate formation filtrate exceed state of transport
 Renin secreted from juxtaglomerular o high concentration of glucose in
cells results in the formation of plasma reflected in glucose in
angiotensin II which stimulates the urine
vasoconstriction and maintains GFR  Diffusion between cells: from lumen
of nephron into interstitial fluid

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 6

7 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

o depends on rate of transport of  Tubular secretion is the movement

same solute through the cells of of non filtered substances from the
the tubule blood into the filtrate
o K, Ca, and Mg o substances include metabolic by
products, drugs, and molecules
Reabsorption in the Loop of Henle not normally produced by the
body
 Wall of ascending limb of the loop o may be active or passive
of Henle is not permeable to water  Ammonia: produced by epithelial cells
 Na moves across the wall of the of nephron from deamination of amino
basal membrane by active acids diffuses into lumen (passive)
transport, establishing a  H, K, penicillin and
concentration gradient for Na paraaminohippuricacid (PAH) are
 K and Cl are symported with Na actively secreted into nephron (active)
across the apical membrane and ions
pass by facilitated diffusion across Secretion of Hydrogen and Potassium
the basal cell membrane of the tubule
cells  Hydrogen ions secreted into filtrate by
counter transport in proximal tubule
Reabsorption in the Distal Convoluted  H either diffuse from peritubular
Tubule and Collecting Duct capillaries into interstitial fluid and
then into epithelial cells of tubule
 Active transport of Na out of tubule or derived from re-action between
cells into interstitial fluid with co carbon dioxide and water in cells of
transport of Cl tubule
 Na moves from filtrate into tubule  Na and HCO3 contransported
cells due to concentration gradient across basal membrane into
 Water moves by osmosis from interstitial fluid, then diffuse into
distal tubule and collecting duct to peritubular capillaries
a more concentrated interstitial fluid
 Urine can vary in concentration from Urine Concentration Mechanism
low volume of high concentration to
high volume of low concentration  Kidneys can produce urine with
concentrations ranging from a
Changes in the Concentration of Urea and minimum of 65 mOsm/kg to a
Other Solutes in the Nephron maximum of 1200 mOsm/kg
 Ability to control volume and
 Urea: enters glomerular filtrate concentration of urine depends on:
o as volume of filtrate decreases, o Countercurrent mechanisms
concentration of urea increases o medullary concentration
o walls of nephron not very gradient
permeable to urea (only 40 to o hormonal mechanisms
60% passively reabsorbed)
 Urate ions, creatinine, sulfates, Countercurrent mechanisms
phosphates, nitrates are partially
reabsorbed  Countercurrent mechanism: fluid in
o concentration is high in urine separate structures flows in opposite
directions
Tubular Secretion o materials may be exchanged as
they pass

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 7

8 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

 Countercurrent multiplier the descending limb of the loops of

o in the loop of Henle is Henle to urea
responsible for much of the high
solute concentration in the Countercurrent Exchanger
interstitial fluid of medulla
 Countercurrent exchanger  Vasa recta supply blood to medulla
o in the vasa recta maintains the and carry away excess water and
high solute concentration in the solutes without changing
interstitial fluid concentration gradient
o due to countercurrent
Countercurrent mechanisms: Medullary mechanism
Concentration Gradient  Walls are permeable to both water
and solutes
 In order to concentrate urine, the  As blood flows towards medulla,
kidney must maintain a high water moves out and some solute
concentration of solutes in the move in
medulla  As blood flow towards cortex, water
 Medullary concentration gradient: moves in and solutes move out
interstitial fluid of medulla has a high o slightly more water and solute
solute concentration as compared to carried away from medulla than
that of the cortex to it
 Maintenance of this gradient
depends upon: Medullary Concentration Gradient and
o the two countercurrent Urea Cycling
mechanisms
o urea cycling  Responsible for large part of high
osmolality in medulla
Countercurrent Multiplier  Descending limbs of loops of Henle
permeable to urea
 Active transport of Na and o urea diffuses into interstitial
cotransport of ions such as K and fluid
Cl and other ions out of the thick  Ascending limbs and distal tubules
portion of ascending limb into impermeable to urea
interstitial fluid  Collecting ducts permeable to urea
 Impermeability of thin and thick parts o some diffuses into interstitial
of ascending limb of loop of Henle to fluid
water  Urea flows in a cycle maintaining
 Vasa recta removes excess water high urea concentration in medulla
and solutes that enter the medulla
without destroying the high
concentration of solutes in the
interstitial fluid of medulla
 Active transport of ions from collecting
ducts into interstitial fluid of medulla

Urea Cycling

 Passive diffusion of urea from

collecting ducts into interstitial
fluid of medulla, impermeability of
the ascending limb and permeability of

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 8

9 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

26.4 REGULATION OF URINE  ADH acts on DCT and CD to

CONCENTRATION AND VOLUME increase water absorption (by
insertions of aquaporins),countering
 Regulation of urine concentration any decrease in blood pressure and/or
and volume involves hormonal increase in solute concentration
mechanisms as well as
autoregulation and the  Insufficient ADH secretion =
sympathetic nervous system Diabetes insipidus

 Hormonal mechanisms include renin-

angio-tensin-aldosterone mechanism Atrial Natriuretic Hormone (ANH)
and anitdiuretic hormone (ADH)
mechanism  Produced by cells in right atrium of
heart when they are stretched
more than normal
Renin-angiotensin-aldosteroneHormone o increases stretch due to high
Mechanism blood volume
 ANH decreases blood volume by:
 Mechanism initiated under low o inhibiting NA reabsorption
blood pressure conditions o inhibiting ADH production
(counteracts dropping blood pressure) o increases volume of urine
o renin released by produced
juxtaglomerular cells o venous return is lowered,
o renin converts volume in right atrium
angiotensinogen to decreases
angiotensin I
26.5 PLASMA CLEARANCE AND TUBULAR
 Angiotensin-converting enzyme MAXIMUM
(ACE) in lungs converts angiotensin I
to angiotensin II, a potent  Plasma clearance: volume of plasma
vasoconstrictor which also stimulates that is cleared of a specific substance
aldosterone secretion, sensation of each minute
thirst, and ADH secretion o calculated using substances like
inulin
 Aldosterone acts on DCT and CD to o used to estimate GFR
increase sodium reabsorption and o used to calculate renal plasma
therefore water re-absorption flow using substances like
paraaminohippuric acid (PAH)
Antidiuretic Hormone Mechanism o used to determine which drugs
or other substances excreted by
 Antidiuretic hormone (ADH) kidney
produced by hupothalamic neurons,
stored in posterior pituitary  Tubular load: total amount of
substance that passes through filtration
 Osmoreceptors in hypothalamus membrane into nephrones each minute
detect in-creased osmolality of
interstitial fluid, stimulating ADH to be Tubular Maximum
released
 Maximum rate at which a
 Baroreceptors in atria of heart and substance can be actively absorbed
some vessels can also stimulate ADH o each substance has its own
release when blood pressure drops tubular maximum

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 9

10 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

 Normally, glucose-concentration in Bladder

the plasma is lower than the
tubular maximum and all of it is
reabsorbed; none of it is found in the
urine

 In diabetes mellitus, tubular load

exceed stubular maximum and glucose
appears in urine
o urine volume increases
because glucose in filtrate
increases osmolality of
filtrate reducing the
effectiveness of water
reabsorption

26.6 URINE MOVEMENT

 Ureters: bring urine from renal pelvis

to urinary bladder
o lined by transitional epithelium
 Urinary bladder: hollow muscular
container
o lined with transitional epithelium
o muscle part of wall is detrusor
muscle

 Trigone: interior of urinary bladder

o triangular area between the
entry of the two ureters and the Ureters
exit of the urethra

Anatomy and Histology of the Ureters and

Urinary Bladder

 Internal urinary sphincter: in males,

elastic connective tissue and smooth
muscles keep semen from entering
urinary bladder during ejaculation
 External urinary sphincter: skeletal
muscle surrounds urethra as it extends
through pelvic floor
 Male urethra extends from the
inferior part of the urinary bladder
through the penis
 Female urethra is shorter and opens
into vestibule anterior to vaginal
opening

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 10

11 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

Urine Flow Through the Nephron and Influence of Osmotic Pressure on Fluid
Ureters Movement

 Hydrostatic pressure forces urine

through nephron

 Peristalsis moves urine through

ureters from region of renal pelvis to
urinary bladder
o occur from once every few
seconds to once every 2 to 3
minutes

 Parasympathetic stimulation:
increases frequency
 Sympathetic stimulation: decreases
frequency

 Ureters enter bladder obliquely

through trigone
o pressure in bladder compresses
ureter and prevents backflow

Body Fluids

 50% or more of total weight of

body is water

 Total amount of water in body is

separated into two major
compartments:
o intracellular fluid compartment
o extracellular fluid compartment

 Intracellular fluid compartment

o all fluids inside cells of body
o about 40% of total body weight
 Extracellular fluid compartment
o all fluids outside cells Regulation of Extracellular Fluid
o about 20% of total body weight Composition

 Sub-compartments (extracellular):  Content regulated so total volume

o interstitial fluid between cells-- of water in body remains constant
plasma of the blood o total volume of water impacts
o lymph within lymphatic vessels body fluid solute concentrations,
o CSF of the brain and spinal cord blood pressure, and interstitial
o synovial fluid within synovial fluid pressure
joints
 90% of water entering body is from
Ions food and drinks, the rest is due to
cellular respiration
 Intracellular cation = K  Regulation of thirst
 Interstitial fluid cation = Na o hypothalamic osmoreceptors
 Plasma cation = Na o arterial and juxtaglomerular
 Intracellular anion = Phosphate
apparatus baroreceptors
 Interstitial fluid = Cl
 Plasma anion = Cl o dryness of mouth
o distension of stomach

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 11

12 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

Regulation of Thirst o adding or removing water from

a soluting changes osmolality
 Mechanisms that increase thirst
o osmoreceptors detect  Increased osmolality: triggers thirst
increased solute concentrations  Decreased osmolality: inhibits thirst
o baroreceptors detect less
stretch in vesels Effect of Blood Osmolality and Blood
o decrease in saliva production
Pressure on Water Reabsorption in the
 Mechanisms that decrease thirst Kidneys
o osmoreceptors detect normal
solute levels
o baroreceptors detect
increased stretch in vessels
o mouth no longer feels dry
o stomach is distended by
consumed fluid

 Effect of Blood Osmolality and

Blood Pressure on Thirst

Regulation of Extracellular Fluid Volume

 Extracellular fluid (ECF) volume can

change even if osmolality of extra
ceullular fluid is maintained

 Carotid sinus and oartic arch

baroreceptors monitor blood pressure
Regulation of Water Loss  Juxtaglomerular apparatuses
monitor pressure changes
 Water loss occurs through three  Receptors in walls of atria and
routes: large vessels respond to small
1. From the kidneys as urine (61%) changes in blood pressure
2. From the skin and respiratory passages
by evaporation (35%)  These receptors activate neural
 temperature and humidity of air, body hormonal mechanisms:
temperature, and volume of expired air
per breath determine how much water 1. Neural mechanisms
lost via respiratory passage 2. Renin-angiotensin-aldosterone
 water lost through skin is called hormone mechanism
insensible perspiration 3. Atrial natriuretic hormone mechanism
 sweat (sensible perspiration) results in 4. Antidiuretic hormone mechanism
water and solute loss
3. From digestive tract in feces (4%)
Regulation of Intracellular Fluid
Composition
Regulation of Extracellular Fluid
Osmolality
 Intracellular fluid (ICF)
composition is very different than
 Osmolality: measure of water versus
extracellular fluid
solute concentration
o in part, because many proteins
o the higher the solute
are synthesized inside cells and
concentration, the higher the
cannot pass through membrane
osmolality

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 12

13 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

o cells have transport proteins o hyperkalemia: abnormally

that help control ICF high levels of potassium in
composition extracellular fluid
o hypokalemia: abnormally low
 Many cells have sodium-potassium levels of potassium in
pumps that move sodium out of cell extracellular fluid
and potassium inside cell
Regulation of Calcium Ions
 Movement of water is guided by
osmosis  Regulated within narrow range
o elevated extracellular levels
prevent membrane
Regulation of Specific Electrolytes in the
depolarization
ECF
o decreased levels lead to
spontaneous action potential
 Electrolytes are formed when
generation
molecules dissociate into ions in water
o inorganic salts, inorganic acids
o hypocalcemia: low calcium
and bases, and some proteins
levels in ECF
o hypercalcemia: high calcium
 Nonelectrolytes do not dissociate into
levels in ECF
ions in water
o lipids urea and glucose
 PTH increases Ca extracellular levels
and decreases extracellular phosphate
 Regulation of sodium ions:
levels
o sodium ions are dominant
 Vitamin D stimulates Ca uptake in
extracellular cations; exert
intenstines
substantial osmotic pressure
 Calcitonin decreases extracellular Ca
o kidneys are major route sodium
levels
is excreted
o aldosterone increases sodium
Regulation of Magnesium Ions
reabsorption in kidney
o sodium levels affect blood
 Mast magnesium stored in bones or
pressure because water follows
ICF
sodium
o less than 1% in ECF is found
either bound to plasma proteins
o hyponatremia: low plasma
or as free ions
sodium levels(can lead to
o cofactors for intracellular
seizures and coma)
enzymes
o
o hypernatremia: high plasma o hypomagensemia: low blood
sodium levels (can lead to levels of magnesium
pulmonary edema, and muscle o hypermagnesemia: high blood
convulsions) levels of magensium
 Magnesium filtered and reabsorbed in
Regulation of Chloride and Potassium kidney
Ions
Regulation of Phosphate Ions
 Regulation of chloride ions
o predominant anions in ECF tied  Under normal conditions, reabsorption
to regulation or movement of of phosphate occurs at maximum rate
sodium in thenephron
o an increase in plasma
 Regulation of potassium ions phosphate increases amount of
o maintained in narrow range phosphate in nephron beyond
o affect resting membrane that which can be reabsorbed
potentials o excess is lost in urine
o aldosterone increases amount
secreted  Hypophosphatemia: low phosphate
levels

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 13

14 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

 Hyperphosphatemia: high phosphate o if pH rises, distal tubule

levels decreases H secretion into the
urine and decreases bicarbonate
Regulation of Acid-Base Balance absorption into the blood
o if pH falls, distal tubule
 Acids increases H secretion into the
o release H into solution urine and increases bicarbonate
o strong acids completely absorption into the blood
dissociate in solution
o weak acids release H into Regulation of Acid-Base Balance by the
solution but do not completely Respiratory System
dissociate into ions
 Achieved through carbonic acid/
 Bases bicarbonate buffer system
o remove H from solution (OH) o as CO2 levels increase, pH
o strong bases completely decreases
dissociate in solution o as CO2 levels decrease, pH
o weak bases reduce increases
concentration of H but do not
completely dissociate into ions  Carbon dioxide levels and pH affect
respiratory centers
Mechanisms of Acid-Base
BalanceRegulation  hypoventilation increases blood
carbon dioxide levels
 Three major ways to regulate H  hyperventilation decreases blood
concentration: carbon dioxide levels
o buffer systems
o respiratory systems Regulation of Acid-Base Balance by the
o kidneys Kidneys

 Buffers: resist changes in pH  Secretion of H into filtrate and

o when H added, buffer removes reabsorption of HCO3 into ECF
it cause extracellular pH to increase
o when H removed, buffer  HCO3 in filtrate is reabsorbed
replaces it  Rate of H secretion increases as body
fluid pH decreases or as aldosterone
 Types of buffer systems: levels increase
o carbonic acid/ bicarbonate  Secretion of H inhibited when urine
o protein pH falls below 4.5
 Buffers in the filtrate combine with
o phosphate
secreted H:
o bicarbonate buffer
Types of Buffer Systems o phosphate ions
o ammonia
 Buffer systems-
o protein buffer: intracellular Acidosis
and plasma proteins absorb H
provide 3/4 of buffering in body  Acidosis: pH body fluids below 7.35
o bicarbonate buffering  Respiratory acidosis
system: important in plasma o caused by inadequate
o phosphate buffer system: ventilation, reduced elimination
important as an intracellular of CO2, asthma, damage to
buffer respiratory center in brain, and
emphysema
 Respiratory system:
o if pH rises, respiratory rate  Metabolic acidosis
decreases o results from all conditions other
o if pH falls, respiratory rate than respiratory that decrease
increases pH, diarrhea, vomiting,
 Urinary System (Kidneys):- ingesting overdose of aspirin,

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 14

15 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY (LEC)

untreated diabetes mellitus, and

anaerobic respiration

Alkalosis

 Alkalosis: pH body fluids above 7.45

 Respiratory alkalosis
o caused by hyperventilation, high
altitude(reduced partial
pressure of O2)

 Metabolic alkalosis
o results from all conditions other
than respiratory that increase
pH, severe vomiting, too much
aldosterone, and ingestion of
substances like bicarbonate of
soda

 Compensatory mechanisms help

counter-act these pH disturbances

26.7 EFFECTS OF AGING ON THE KIDNEYS

1. The kidneys gradually decrease in size

due to a decrease in renal blood flow.
2. The number of functional nephrons
decreases.
3. Renin secretion and vitamin D
synthesis decrease.
4. The renal tubule’s ability to secrete and
absorb declines.

TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN |USA MLS 1-F Page 15