- Human kidney receives 25% of the blood pump from the heart

Afferent arteriole – entrance of the blood to the kidney

- Unique because it contains pores that allows filtration of plasma

Efferent arteriole – exit of the blood from the kidney

Glomerulus – housed by the Bowman’s capsule

- Where filtration of blood (plasma) takes place

Yellow tube – tubule or nephron

- Where the filtrate flows

Glomerular Filtration Barrier – composed of layers such as the capillary wall membrane, basement
membrane, visceral epithelium of the Bowman’s capsule

Juxtaglomerular cells – located in the afferent arteriole

Macula densa – located in the distal convoluted tubule

Renin – is an enzyme produced by the kidney when there is low blood pressure/low plasma sodium
concentration

- As it is being secreted in the blood, it mixes with a substrate called Angiotensinogen and forms
Angiotensin 1. As it continues to flow with the blood and returns to the heart via venous blood
and to the lungs to be reoxygenated, Angiotensin 1 meets with Angiotensin Converting Enzyme
in the lungs and converts Angiotensin 1 to Angiotensin 2, the active form of Angiotensin.

Angiotensinogen – is a blood-borne substrate

*If there is High Blood Pressure or High Plasma Sodium Concentration, Renin production will not occur

Tubular Reabsorption – is for reabsorption of the essential substances that are still needed by the body

Tubular Secretion – secretes waste materials that are not filtered maybe due to some reasons such as
medications that causes the substances to bind with protein and cause them to have bigger sizes which
cannot be filtered.

- It passes the unfiltered substances from the capillaries to the tubules entering the filtrate(urine)
- It maintains the acid-base balance by secretion the hydrogen ions

7.4 – normal pH of the blood, maintained by the kidney through tubular secretion
2 ways to release Hydrogen Ion:

1. Binding of the PHOSPHATE

Bicarbonate (HCO3-) – are normally filtered by the nephron, but if there is an occurrence of an
abnormality in the pH, it is being reabsorbed again

*If the concentration of Hydrogen Ion is HIGH, it leads to LOW pH – Blood is ACIDIC (Hydrogen ions
need to be secreted)

*If the concentration of Hydrogen ion is LOW, it leads to HIGH pH – Blood is ALKALINE (Hydrogen ions
don’t need to be secreted)

Glomerular Filtration Rate (GFR test) – evaluates the glomerulus

Substances that are specifically measured that would represent the ability of the glomerulus to filter
(GFR TEST):

1. Exogenous – the substances that comes from the outside of the body
(e.g administered or drinking meds)
2. Endogenous – substances that are measured which are produced within
the body

Creatinine Clearance Test – its goal is to measure milliliters of plasma/fluid cleared per minute

- Substances in clearance test are neither reabsorbed nor secreted by the tubules
- SAMPLE: 24-hour urine sample/Timed sample
- FINAL UNIT: mL/min

Creatinine – waste product of the muscle metabolism and is produced enzymatically by Creatinine
Phosphokinase during energy production

- Normally found at a relatively constant level in the blood, it provides a good source of
endogenous procedure for glomerular filtration test

FORMULA:

CP = UV and C = UV/P

Estimated Glomerular Filtration Rate (EGFR) – doesn’t need a 24-hour urine sample

1.73 m2 – reference body size

175 – used in the IDMS

Cystatin C – final product after the process of filtration, reabsorption and the broken down by the renal
tubular cells

SAMPLE: Blood Serum

Iothalamate – provides a method for determining glomerular filtration though the plasma
disappearance of the radioactive materials and enables visualization of the filtration in one or both

Clearance Test – used to determine the extent of nephron damage of known cases of renal disease, to
monitor the effectiveness of treatment designed to prevent further nephron damage.

Tubular Reabsorption ability of the nephron – is often the first function to be affected in renal disease

Concentration Test – measures the tubular reabsorption activity of the nephron

Specific Gravity – relationship of the solute and the solvent in the urine

Solute – the amount of the substances that are found in the urine and the volume of the urine (e.g
concentrated or diluted)

1.010 – the specific gravity of the urine as soon as it is being filtered

*The ability of the nephron to concentrate the urine is affected is influenced by the HYDRATION of the
body

*If the specific gravity is increased, it means that the urine is CONCENTRATED with the substances

*If the specific gravity is decreased, it means that the urine is DILUTED with the substances

Fishberg and Mosenthal Concentration – Tests used before to measure specific gravity.

- There is deprivation of fluid intake for 24 hours to measure specific gravity especially the
Mosenthal concentration test which compares the volume and specific gravity of day and night
urine sample to evaluate the concentrating ability
- Not used anymore since there is already a new test used which is the OSMOMETRY TEST

Osmolality Test – measuring urine and serum osmolality

- A test that measures the concentration abilities of the tubules; the ability of the nephron to
concentrate a urine
- Just like in Mosenthal and Fishberg, patients are deprived from water intake but in this test,
deprivation of water is done for 12 hours or overnight to measure osmolality
- Normal Value: 800 mOsm or higher
- If after 12 hours of water deprivation, the patient’s urine is not concentrated enough, water
deprivation will be extended for 2 more hours, then osmolality will be measured using the urine
and the serum. Urine and Serum ratio ratio should be (U:S ratio) of 3:1.
- If the result is still abnormal (urine is not concentrated enough) after the extended 2-hour water
deprivation, patient will undergo ADH challenge test since the doctor is now suspecting a
Diabetes Insipidus

*Diabetes mellitus – insulin-related problem

*Diabetes insipidus – more on related to ADH produced in the hypothalamus

ADH Challenge Test – ADH is administered to the patient and then is osmolality is tested
 - If the result of the Urine Osmolality is >800 mOsm, it means the patient’s urine is not
concentrated even when deprived from water intake because patient’s HYPOTHALAMUS is not
producing ADH. No one is initiating the reabsorption of water. The patient needs an exogenous
source of ADH to correct the ability to concentrate the urine by the nephron. This leads to the
patient being diagnosed with NEUROGENIC DIABETES INSIPIDUS.
- If the result of the urine osmolality after administering ADH to the patient is <400 mOsm (still
diluted), this means the patient is suffering from NEPHROGENIC DIABETES INSIPIDUS which
means that the patient’s tubules in his kidney is not functioning well or is not responding to the
ADH.

Dew Point – it’s the temperature at which water vapor condenses at a liquid state

Free Water Clearance – indicates how much water must be cleared each minute to produce a urine with
the same osmolality as the plasma

- It means that the urine osmolality will be compared to plasma osmolality and should produce
the same result
- An indicator of how the body is regulating the water

Isosmotic – the specific gravity or the osmolality is normal in respect to the plasma

TUBULAR SECRETION AND RENAL BLOOD FLOW TEST:

1. p-aminohippuric acid (PAH) test – measures the exact amount of blood flowing through the
kidney

Tubular secretion – happens between the peritubular capillaries and the tubules of the nephron

- refers to the waste substances that are not filtered by the glomerulus to the tubules

Titratable Acidity – ability of the kidney to produce acid urine

Renal Tubular Acidosis – inability to produce an acid urine in the presence of metabolic acidosis