Kidneys

The kidneys are organs of the urinary system - which remove

excess water, mineral ions and urea.

Blood is transported to the kidney through the renal artery. The

blood is filtered at a high pressure and the kidney selectively
reabsorbs any useful materials such as glucose, mineral ions and
water.
After it has been purified, the blood returns to the circulatory
system through the renal vein.
The kidneys produce urine and this helps maintain water balance.
The urine is taken from the kidneys to the bladder by the ureters.
The bladder stores the urine until it is convenient to expel it from
the body.. The ureters are tubes that carry urine from the kidneys to
the bladder, whereas the urethra is the tube that carries urine out of
the body.
Urine
Urine contains water, urea and mineral ions. Urea is produced in
the liver when excess amino acids are broken down. Urea is the
main waste product removed in the urine, as it is not reabsorbed in
the kidney.

The nephron

The role of the kidney

Each kidney contains over one million microscopic filtering units

called nephrons. Each nephron is made of a tubule and is
responsible for 'cleaning' the blood by removing urea, excess water
and mineral ions.
The kidney works in a number of different stages:

Stage 1 – Filtration

Blood passes into the many capillaries inside the kidney. The blood
is under high pressure at the start of the nephron, which helps the
ultrafiltration of the blood. Small molecules are squeezed out and
pass into the nephron tubule. These small molecules include urea,
water, ions, and glucose. However, large molecules, such as blood
proteins, are too big to fit through the capillary wall and remain in
the blood.
Stage 2 - Selective reabsorption

Having filtered out small essential molecules from the blood - the
kidneys must reabsorb the molecules which are needed, while
allowing those molecules which are not needed to pass out to form
urine. Therefore, the kidneys selectively reabsorb only those
molecules which the body needs back in the bloodstream.
The reabsorbed molecules include:
 all of the glucose which was originally filtered out
 as much water as the body needs to maintain a constant
water level in the blood plasma
 as many ions as the body needs to maintain a constant
balance of mineral ions in the blood plasma

Stage 3 - The formation of urine

The molecules which are not selectively reabsorbed (the urea,

excess water and ions) continue along the nephron tubule as urine.
This eventually passes down to the bladder.
In carrying out these processes, the kidney is able to fulfil its
functions of regulating the water and ion balance of the blood
plasma, as well as keeping the level of urea low.

Maintaining nitrogen balance in the body

The digestion of proteins from the diet results in excess amino
acids, which need to be excreted safely.

In the liver deamination takes place to form ammonia.

Ammonia is toxic and so it is immediately converted to urea for

safe excretion.

Once we have eaten our food, it is then digested by the body.

The digestion of proteins is broken down by protease enzymes
into amino acids in the stomach and small intestine.
When excessive amounts of protein are eaten, the excess amino
acids produced from digesting proteins are transported to the liver
from the small intestine.
The liver controls the amino acid concentration in the body, as
excess amino acids which need to be excreted safely. The body is
unable to store proteins or amino acids.
In the liver, ammonia is formed by the deamination of amino acids.

It is highly toxic and cannot be allowed to accumulate in

the body. Excess ammonia is converted to urea. Urea and water
are released from the liver cells in to the bloodstream and
transported to the kidneys where the blood is filtered and the urea
is passed out of the body in the urine.
The effect of ADH on tubule permeability and in
water balance

ADH
Two important areas inside the brain are the hypothalamus, which
detects changes in the blood plasma, and the pituitary gland, which
regulates the release of the anti-diuretic hormone, known as ADH.

Different amounts of ADH are released into the bloodstream

according to the concentration of water in the blood plasma.

ADH is released by the pituitary gland when the blood is too

concentrated and it causes the kidney tubules to become

more permeable.
This allows more water to be reabsorbed back into the blood during
selective reabsorption.
If a person has consumed a large volume of water and has not lost
much as sweat, too much water might be detected in the blood
plasma.
If this occurs, less ADH will be released, which results in less water
being reabsorbed and a dilute and larger volume of urine will be
produced.

If a person becomes too hot and sweats a lot, but doesn't drink
enough water to replace what was lost, too little water might be
detected in the blood plasma.
More ADH will be released, which results in water being reabsorbed
and a more concentrated but smaller volume of urine will be
produced.
This type of control is an example of the negative feedback
mechanism. It aims to keep the concentration of the blood plasma
constant.

ADH Effect on
Plasma Problem release Effect of ADH urine
High More water
concentratio Too little Increase reabsorbed by More
n water s nephrons concentrated
Low Less water
concentratio Too much Decrease reabsorbed by
n water s nephrons More dilute

A negative feedback control system responds when conditions

change from the ideal or set point and returns conditions to this set
point. There is a continuous cycle of events in negative feedback.
The consequences of kidney damage or disease
Causes, Consequences, Treatments
 The kidneys might not work properly for several reasons,
including accidents or disease
 Humans can survive with one functioning kidney, but if both
are damaged then there will quickly be a build-up of toxic
wastes in the body which will be fatal if not removed

The kidney is responsible for the removal of waste products from

the blood.

 Damage from accidents or disease can lead to a build-up of

poisonous wastes in the body.
 Humans can survive with one kidney, but for people who suffer
from total kidney failure this would be fatal if not treated.
 Treatment is available for kidney failure and can be by organ
transplant or by using kidney dialysis.
 In this procedure, patients are connected to a dialysis
machine which acts as an artificial kidney to remove most of
the urea and restore or maintain the water and ion balance of
the blood.
  Patients with kidney failure can be kept alive by using kidney
dialysis until a transplant becomes available.

How dialysis works

 Unfiltered blood that is high in urea is taken from a blood

vessel in the arm,

 mixed with blood thinners or an anti-coagulant to prevent

clotting,

 and pumped into the dialysis machine.

 Inside the machine the blood and dialysis fluid are separated
by a partially permeable membrane the blood flows in the
opposite direction to dialysis fluid, allowing a concentration
gradient to exist and exchange of substances to occur.
Dialysis fluid contains:
 a glucose concentration similar to a normal level in
the blood
  a concentration of mineral ions similar to that found
in normal blood plasma

 no urea
 As the dialysis fluid has no urea in it, there is a large
concentration gradient - meaning that urea moves across the
partially permeable membrane, from the blood to the dialysis
fluid, by diffusion.

 This is very important as it is essential that urea is removed

from the patients' blood.

 As the dialysis fluid contains a glucose concentration equal to

a normal blood sugar level, this prevents the net movement of
glucose across the membrane as no concentration gradient
exists.

 This is very important as the patients' need to retain glucose

for respiration.

 As the dialysis fluid contains an ion concentration similar to

the ideal blood plasma concentration, movement of ions
across the membrane only occurs where there is an
imbalance.
 if the patient's blood is too low in ions, they will diffuse from the
dialysis fluid into the blood, restoring the ideal level in the blood
 if the patient's blood is too high in ions, the excess ions will diffuse
from the blood to the dialysis fluid

Dialysis summary
Although dialysis is a life-saving treatment, it does have a
significant effect on a person's lifestyle.

Advantages

Kidney dialysis allows a person with kidney failure to maintain their

health. The overall effect of this is that the blood leaving the
machine and returning into the patient's arm will have:

 greatly reduced levels of urea – it is 'cleaned blood'

 no overall change in blood glucose levels

 the correct water and ion balance maintained or restored (with

only excess ions removed)

Disadvantages

 Kidney dialysis requires highly specialised and expensive

machinery.

 The patient must be connected to this machinery 2-3 times a

week for periods (on average) of between 4-6 hours at a time.
  This is time consuming and restrictive, as this mainly happens
in hospital.

 As the filtration only works when they are connected, kidney

patients must monitor their diet carefully in between dialysis
sessions.

 They need to avoid eating foods with a high salt content or a

high protein content as excess amino acids are broken down
into urea.
 This again can be difficult to control and monitor, but will help
maintain the health of the patient.

 Finally, dialysis will only work for a limited amount of time

before a transplant is needed, and sadly many patients will die
before a suitable one is found.

Treating kidney failure by transplant

A kidney transplant is a procedure where a new donor kidney is placed in your body.

This is typically done to treat kidney failure.

Once attached, your new kidney will start to do the job of the failing organ. The
transplanted kidney is usually placed on either the lower right or left side of your abdomen

Why are kidney transplants done?

Kidney transplants are done to help people with chronic kidney disease or end-stage renal
(kidney) failure.

When your kidneys can no longer filter waste properly, you’ll need either dialysis (which
uses a machine to remove waste from your bloodstream) or a kidney transplant.
Kidney Dialysis

 The usual treatment for someone with kidney failure is dialysis

 This is an artificial method of filtering the blood to remove toxins and

excess substances

Patients are connected to a dialysis machine which acts as an artificial

kidney to remove most of the urea and restore/maintain the water and
salt balance of the blood

 Unfiltered blood is taken from an artery in the arm, pumped into the
dialysis machine and then returned to a vein in the arm

 Inside the machine the blood and dialysis fluid are separated by
a partially permeable membrane - the blood flows in the opposite
direction to dialysis fluid, allowing exchange to occur between the two
where a concentration gradient exists

 Dialysis fluid contains:

o a glucose concentration similar to a normal level in blood

o a concentration of salts similar to a normal level in blood

o no urea
How dialysis works

 As the dialysis fluid has no urea in it, there is a large concentration gradient -

meaning that urea diffuses across the partially permeable

membrane, from the blood to the dialysis fluid

 As the dialysis fluid contains a glucose concentration equal to a normal blood sugar
level, this prevents the net movement of glucose across the membrane as no
concentration gradient exists

 As the dialysis fluid contains a salt concentration similar to the ideal blood
concentration, movement of salts across the membrane only occurs where there is
an imbalance (if the blood is too low in salts, they will diffuse into the blood; if the
blood is too high in salts, they will diffuse out of the blood)

 The fluid in the machine is continually refreshed so that concentration gradients are
maintained between the dialysis fluids and the blood

 Dialysis may take 3-4 hours to complete and needs to be done several times a
week to prevent damage to the body from the buildup of toxic substances in the
blood

 An anticoagulant is added to blood before it runs through the machine to prevent

the blood from clotting and slowing the flow
Kidney transplants

Kidney transplantation is an alternative method for treating kidney failure and can save a
patient's life. This procedure involves implanting a kidney from an organ donor into the
patient’s body to replace the damaged kidney. This is better than using a restrictive dialysis
machine, as the recipient can lead a normal life afterwards.

As with all cells, the donor kidney cells will have protein antigens on their surface. Antigens
are unique to each of us (with the exception of identical twins), and allow our body to
identify our own cells from those of potential pathogens.

Differences in the antigens of the donor kidney cells and those of the patient receiving the
transplant would mean that the patient's immune system would quickly form antibodies
against the kidney cell antigens, and would ultimately destroy the kidney. This is known
as organ rejection. This is potentially very harmful for the patient.

Precautions against rejection

Two precautions can be taken to reduce organ rejection:

1. Tissue typing - a kidney is given to patients who have antigens that are very similar
to the antigens of the donor kidney. This can lead to long waits for transplants while
compatible donors become available - during which time patients must undergo
dialysis, and in some cases they will die before a match is found.

2. Immuno-suppressant drugs – these drugs must be taken by transplant patients for

the rest of their lives. They suppress the immune system, greatly reducing the
immune response against the donor kidney. The negative effect of this is that it also
suppresses the immune response against pathogens which enter the body, increasing
the risk of infections.

Even with these two precautions, most donor kidneys will only survive for an average period
of 8-9 years before the patient will require a further transplant or a return to dialysis.
Transplants versus dialysis

The table below shows some of the pros and cons for both kidney dialysis and kidney
transplants

Advantages Disadvantages

Patients can lead a more normal life

without having to watch what they eat Must take immune-suppressant drugs
Transplants and drink which increase the risk of infection

TransplantsCheaper Shortage of organ donors

Transplants Kidney only lasts 8-9 years on average

Transplants Any operation carries risks

Patient must limit their salt and

Available to all kidney patients (no protein intake between dialysis
Dialysis shortage) sessions

Dialysis No need for immune-suppressant drugs Expensive

Regular dialysis sessions - impacts on

Dialysis the patient's lifestyle