Renal Function and Micturition

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Renal Function and Micturition

Presented by Kelly L. Sparks, RN, BSN, CWOCN, CFCN Capital Nursing Education

Made possible by

a grant from

Shield HealthCare

(2)

OBJECTIVES

Review the anatomy of the kidney and bladder

Define glomerular filtration rate and list the major factors affecting it

Outline tubular handling of Na

^+,

water, glucose, and K

⁺

Define autoregulation in the kidneys Understand Micturition

PROVIDER APPROVED BY THE CALIFORNIA BOARD OF REGISTERED NURSING/Provider Number 16028, approved for 1 1

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Renal Function

(4)

Urinary System

 Filter blood

 Eliminate liquid waste (urea)

 Keep chemicals in balance

 Create urine

 Expel urine

Kidney

Bladder Ureters

K.Sparks

(5)

Kidneys

 Remove waste products and drugs from the body

 Balance the body's fluids

 Release hormones to regulate blood pressure

 Control production of red blood cells

Fibrous capsule Renal pyramid in renal medulla

Minor calyx

Major calyx

Renal Cortex Renal

Medulla

Renal sinus

Renal artery Renal Vein Renal pelvis

Ureter Fat in

renal sinus

K.Sparks

(6)

 Superficial and Midcortical

 Loop of Henle-short or long

 One Million Per Kidney

 Products include urine, renin,

erythropoietin and calcitriol

(7)

salturea water

urea

water salt

urea

salt water

urea water

water water water water urea

salt urea

salt salt

salt

Vasa Recta Afferent

Efferent

K.Sparks

Nephron

The Working Part

Of The Kidney

(8)

 90-100% Stage 1 Kidney damage with normal kidney function

 89-60% Stage 2 Kidney damage with mild loss of kidney function

 59-45% Stage 3aMild to moderate loss of kidney function

 44-30% Stage 3bModerate to severe loss of kidney function

 29-15% Stage 4 Severe loss of kidney function

 < 15% Stage 5 Kidney failure

GFR-Glomerular Filtration Rate

(9)

Adrenal Glands

 Top of kidneys

 Right is shape of pyramid

 Left is semilunar shape and a bit larger

 Produce hormones vital to health

 Cortisol-for stress

 Aldosterone- helps control BP

Adrenal Glands

K.Sparks

(10)

 Adrenal Cortex

 Zona Fasciculata-Cortisol

• Negative feedback loop in hypothalamus and pituitary gland

 Zona Glomerulosa-Aldosterone

• Regulates BP, electrolytes and blood pH

 Zona Reticularis-DHEA and Androgenic Steroids

• Weak Male Hormones

 Adrenal Medulla-Adrenaline (epinephrine) and Noradrenaline (norepinephrine)

 Increasing heart rate

 Increasing heart contractions

 Increasing blood flow to muscles and brain

 Relaxing airway smooth muscles

 Assisting with glucose metabolism

 Vasoconstriction

Adrenal Glands Functions

Capsule

Blood Vessels

Medulla Cortex

(11)

Regulation of

Hypertension or

Hypovolemia

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Regulation of Hypotension or Hypovolemia

 Renin release

 Angiotensin from Liver

 Converted by renin becomes Angiotensin I

 Angiotensin converting enzyme (ACE) to Angiotensin II

 Binds to cause vasoconstriction

 Aldosterone increases NA

absorption which increases volume

(-)

Angiotensin Produced in the liver Angiotensin I

Converted by angiotensin converting enzyme (ACE) on vascular endothelium

Site of action of ACE inhibitors Angiotensin II

Site of action of Binds angiotensin receptors ARBs

Increased Blood volume Increased Blood

pressure

Low afferent arteriole pressure

Decreased NaCl delivery to macula densa

Hypertension or Hypovolemia

Renal hypoperfusion Activation of aortic/carotid

baroreceptors

Increased sympathetic tone

Converted by Renin Renin release From juxtaglomerular cells of

nephrons

Vasoconstriction

Increased sympathetic NS activity Aldosterone release (from adrenal cortex) Increased Na absorption (in proximal tubule) Endothelial dysfunction

Prothrombotic effects (increases PAI-1)

(13)

Autoregulation

To minimize changes in Renal blood flow and

Glomerular filtration rate at different blood

pressure values.

(14)

Renal Blood Flow

K.Sparks

Renal Artery Interlobular

Arterioles

Arcuate arteries

Afferent Arteriole

Glomerular capillaries

Efferent Arteriole Peritubular

Capillaries Vesa Recta Arcuate vein

Renal vein

(15)

Autoregulation of the Renal Blood Flow (RBF) and

Glomerular Filtration Rate (GFR)

The major function of autoregulation in the kidneys, is to maintain a relatively constant GFR and to allow very precise control of the renal excretion of water and solutes .

K.Sparks

CO = 5 L/Min RBF = 20% of CO

1000 ml/min

1000 ml

120 ml/

min

(16)

Autoregulation

Due to changes in the resistance of the afferent arterioles

15

MAP

GFR

RBF MAP RBF

GFR

(17)

Mechanisms of RBF (GFR) Autoregulation

Myogenic and Tubuloglomerular Feedback

(18)

RBF (GFR) Autoregulation

Myogenic

MAP

RBF

GFR

Ca**

K.Sparks

(19)

RBF (GFR) Autoregulation

Tubuloglomerular Feedback

18

Afferent Arteriole

Distal Convoluted

Tubule Efferent Arteriole

Juxtaglomerular Apparatus

Afferent

Arteriole Efferent

Arteriole

Macula Densa Cells Juxtaglomerular

Cells

DCT

Distal

Convoluted

Tubule

(20)

Afferent Arteriolar Feedback Mechanism

MAP RBF

GFR

Na Cl Na Cl Na Cl Na Cl

NaCl

Afferent Arteriole

K.Sparks

(21)

MAP RBF

GFR

NaCl NaCl NaCl NaCl

Ascending loop of Henle

NaCl

Afferent Arteriole

Vasodilation

Afferent Arteriolar Feedback Mechanism

K.Sparks

(22)

Efferent Arteriolar Feedback Mechanism

MAP RBF

GFR

NaCl NaCl NaCl NaCl

Juxtaglomerular Cells

ANGII

Afferent Arteriole Efferent Arteriole

PGC ^Renin

K.Sparks

(23)

MAP RBF

GFR

ClNa ClNa Cl

Macula Densa Cells

NaCl

Vasoconstriction

Afferent arteriole

Efferent Arteriolar Feedback Mechanism

K.Sparks

(24)

0 0

80

Autoregulatory Range

RBF

GFR

120 1000

RBF mm/min GFR mm/min

MAP mmHg

180

Renal Function

Curve

(25)

Micturition

(26)

K.Sparks

Kidney

Kidney Ureters

Ureters bladder bladder

Detrusor muscle Internal sphincter

Urogenital diaphragm

urethra urethra

penis

External sphincter

Female Male

prostate

Anatomical Review

of Urinary Tract

(27)

Kidney

Kidney Ureters

Ureters bladder bladder

Detrusor muscle Internal sphincter

Urogenital diaphragm

urethra urethra

penis

External sphincter

Female Male

prostate

Anatomical Review

of Urinary Tract

(28)

Nicotinic Receptor M3 Receptor

B3 Receptor

Alpha 1 Receptor prostate

 Muscarinic (M3) - top of bladder

 Beta Adrenergic (B3) - in bladder

 Alpha 1 internal - sphincter

 Nicotinic external - sphincter area

K.Sparks

Receptors

(29)

Nicotinic Receptor M3 Receptor

B3 Receptor Alpha 1 Receptor Brain

Mid brain, Pons, Medulla

Brain stem

Pons

Thoracic

sacral Cervical

Lumbar

prostate

K.Sparks

Central Nervous

System is in control

(30)

Nicotinic Receptor

M3 Receptor

B3 Receptor

Alpha 1 Receptor Brain stem

Cervical

Mid brain, Pons, Pons

Medulla

Brain

Thoracic

sacral Lumbar

Pudendal Nerve (Somatic)

Hypogastric Nerve

(Sympathetic) Pelvic Nerve

(Parasympathetic) ACH

ACH ganglion NA

prostate

K.Sparks

Central Nervous

System is in control

(31)

M3 B3

1

Nicotinic prostate

Pons Micturition Center

Thoracic

Sacral

urine Slow Impulses

Through Sensory Pelvic Nerve

Brain

K.Sparks

Empty Bladder

(32)

M3 B3

1 Nicotinic Pons

Micturition Center

Thoracic

Sacral

urine Slow Impulses

Hypogastric

Brain

K.Sparks

Empty Bladder

(33)

M3 B3

1 Nicotinic Pons

Micturition Center

Thoracic

Sacral

urine Slow Impulses

Hypogastric

Brain

K.Sparks

Empty Bladder

1

(34)

M3 B3

1

Nicotinic Pons

Micturition Center

Thoracic

Sacral

urine Slow Impulses

Hypogastric

Brain

K.Sparks

Empty Bladder

(35)

M3 B3

1

Nicotinic Pons

Micturition Center

Thoracic

Sacral

urine Slow Impulses

Hypogastric

Brain

K.Sparks

Empty Bladder

(36)

M3

B3 1

Nicotinic Pons

Micturition Center

Thoracic

Sacral

urine Slow Impulses

Hypogastric

Brain

Pelvic efferent

K.Sparks

Empty Bladder

(37)

M3 B3

1

Nicotinic Pons

Micturition Center

Thoracic

Sacral

urine Slow Impulses

Hypogastric

Brain

Pelvic efferent

Pudendal

K.Sparks

Empty Bladder

(38)

M3

B3 1

Nicotinic M3

1B3

Nicotinic

Thoracic

Sacral

Brain

Increased firing of afferent pelvic nerve

K.Sparks

Full Bladder

(39)

M3

B3 1

Nicotinic M3

1B3

Nicotinic

Thoracic

Sacral

Brain

K.Sparks

Full Bladder

(40)

M3

B3 1

Nicotinic M3

1B3

Nicotinic

Thoracic

Sacral

Brain

Hypogastric

K.Sparks

Full Bladder

(41)

M3

B3 1

Nicotinic M3

1B3

Nicotinic

Thoracic

Sacral

Brain

Hypogastric

K.Sparks

Full Bladder

(42)

M3

B3 1

Nicotinic M3

1B3

Nicotinic

Thoracic

Sacral

Brain

Hypogastric

pudendal

K.Sparks

Full Bladder

(43)

Sacral Pelvic

Pelvic

K.Sparks

Voiding Reflex

(44)

 John Hopkins Medicine article https://www.hopkinsmedicine.org/health/conditions-and-diseases/adrenal-glands

 https://www.sciencedirect.com/topics/medicine-and-dentistry/blood-pressure-regulation

 https://www.youtube.com/watch?v=JwaeWXhklio

 https://medlineplus.gov/lab-tests/glomerular-filtration-rate-gfr-test/

 https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=glomerular_filtration_rate

 https://www.kidney.org/atoz/content/gfr

 Department of Cell and Molecular Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Submitted 17 May 2006; accepted in final form 14 September 2006

 Physiology, Renal Authors Ifeanyichukwu Ogobuiro; Faiz Tuma. Last Update: July 26, 2021. Treasure Island (FL): StatPearls Publishing;

2021 Jan-.

References

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for your

attention!

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