Renal A and P

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Renal A and P

• A Review
• Instructor
• Mary V. Kennedy RN, MSN, CCRN

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Structure and Function of the Kidney

• Introduction to Renal Function
• Primary Function Regulation of ECF (plasma and
  tissue fluid)
• This process results in regulation of
• The volume of blood plasma (BP)
• Concentration of waste products in the blood
• Concentration of Electrolytes and other ions in
  the plasma
• The pH of the plasma

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Gross Structure

• Paired Rt. and Lt. in abdomen
• Size
• Urine drains into renal pelvis (basin)
• Channeled via long connecting ducts (ureters)
• Single urinary bladder

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Cross section of the Kidney (coronal view)

• Cortex (outer part)
• Covered by a capsule
• Reddish brown and granular in appearance (many
  capillaries)
• Medulla (inner part)
• Lighter in color and stripped in appearance
• Microscopic tubules and blood vessels
• Made up of 8-15 conical renal pyramids
• Pyramids separated by renal columns

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Cross Section (cont)

• Cavity of kidney
• Collects and transports urine
• Each pyramid projects into a small depression
  (minor calyx)
• Several calyces join to form major calyx
• Major calyces join to form renal pelvis (an
  expanded portion of the ureters)

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Microscopic Structure of the Kidney

• Nephron
• Functional unit of kidney
• Formation of urine
• Consists of tubules and associated small blood
  vessels
• Fluid formed by capillary filtration enters
  tubules
• Modified by transport processes and leaves
  tubules as urine.

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Glomerular Filtration

• Before fluid can enter the interior of the
  glomerular capsule it passes through the
  capillary pores, basement membrane, and the inner
  viseral layer of the glomerular capsule.
• Inner layer of glomerular capsule is composed of
  unique cells (podocytes) with numerous
  cytoplasmic extensions (pedicels)

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Filtration (continues)

• Pores permit passage of proteins, fluid that
  enters the capsular space is almost completely
  free of plasma proteins.

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Renal Blood Flow

• Arterial supply
• Renal artery (aorta)
• Interlobar arteries
• Arcuate arteries
• Afferent arterioles
• Capillary network (glomeruli)
• Venous
• Efferent arterioles
• Capillary network (peritubular capillaries)
• Arcuate veins, Interlobar veins,
• Renal Vein (inferior vena cava)

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Nephron Tubules

• Refers to the tubular portion of the nephron
• Glomerular capsule
• Proximal convoluted tubule
• A descending Loop of Henle
• An ascending Loop of Henle
• And a distal tubule

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Glomerular (Bowmans) Capsule

• Surrounds glomerulus
• Located in cortex
• Glomerular capsule glomerulus renal corpuscle
• Consists of 2 layers
• Visceral inner
• Parietal outer
• Glomerular filtrate

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Glomerular Ultrafiltrate

• Fluid in glomerular capsule is called
  ultrafiltrate

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Tubule

• Proximal convoluted
• Single cell walls with millions of microvilli
• Reabsorb Salt water into surrounding peritubular
  capillaries
• Glomerulus, glomerular capsule, and proximal
  tubule are located in the renal cortex
• Loop of Henle
• Descending limb, Ascending limb
• Distal convoluted
• Short and few microvilli

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Nephrons

• Juxtamedullary Nephrons
• Long loops of Henle
• Inner 1/3 of cortex
• Cortical Nephrons
• Numerous
• Shorter loops of Henle
• Outer 2/3 of cortex
• All drain into collecting ducts

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Other Kidney Functions

• Erythropoietin
• Vitamin D
• Renin
• Juxtaglomerular apparatus
• Prostaglandins (PGs)

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Fluid drains

• Collecting Ducts
• Cortex to Medulla
• Renal pyramid
• Fluid then called urine
• Passes into minor calyx
• Passes into renal pelvis
• Exits kidney via ureters

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Ureters

• UPJ and UVJ
• What controls contraction?

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Bladder

• Location
• Urine volume
• Prevention of Back Flow
• Transitional Cells

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Urethra

• Conduit
• Function

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• Questions?