Summary

Renal Anatomy and Physiology Summary Notes (with diagrams)

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Course
Licentiate of the Medical Council of Canada

Institution
Licentiate Of The Medical Council Of Canada

Summary notes made in clerkship in preparation for the LMCC. Simplified renal anatomy and physiology, complete with incredible graphics to walk you through the function of the renal tubules.

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Uploaded on February 1, 2024
File latest updated on February 1, 2024
Number of pages 12
Written in 2021/2022
Type Summary

kidney
kidneys
renal
kidney anatomy
kidney physiology
anatomy
physiology
medicine
medical school
summary notes
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Proximal Convoluted Tubule (PCT) Brush border cells Interstitial space Peritubular capillary
Renal Tubule 300 mOms/L
Glomerulus
Proximal convoluted tubule Distal convoluted tubule Glutamine
Late Ammonium
Renal Corpuscle Early Ammonium + HCO3
Renal Cortex

PTH Thiazide diuretics
Urea Medications
Bowman’s Capsule Na
Glucose Na Passive diffusion
Na Urea Urea
HCO3 Cl H+ Cl H2O H2O H2O
Urea Ca K ADH
Osmotic diuretics
H2O
325 mOsm/L Aldosterone Ca2+
Na+ Na+
NH4
Medications Na
Cl K+ K+
300 mOsm/L K Na/K
Na+
ATPase
Cl-
Ascending limb
GLUT1
Loop diuretics Na+ Na-glucose
Na, H2O Glucose
transporter
Na+ Glucose GLUT2
Renal Medulla

H+, K
H2O
600 mOsm/L K-sparing diuretics
Na+
Na-H exchanger
Na
Cl H+ Na-HCO3 Na+
Descending limb
cotransporter
Collecting duct H + HCO3 H + HCO3- HCO3-

H2CO3 Carbonic anhydrase II
1200 mOsm/L Carbonic anhydrase IV H2O + CO2 H2CO3
H2O + CO2

Renal Anatomy and Physiology
Loop of Henle Urine to ureter Filtrate

Diuretics Summary Note: ATPase
Collecting = both ions are going against [ ] gradient
Duct Brush border cells Interstitial space Peritubular capillary
400 mOms/L
Types MOA Indications Dosing SE Contraindications

ADH
Thiazides Hydrochlorothiazide, ↓ Na reabsorption in DCT Htn (1st line essential htn), HCTZ: Hypotension, Sulfa allergy,
chlorthiazide edema, idiopathic Htn: 12.5-25 mg PO od hypokalemia, polyuria pregnancy H2O
hypercalciuria and stones (max 50 mg/d)
Edema: 25-100 mg PO od Urea Aquaporin
Stones: 25-100 mg PO od

H2O H2O
Aquaporin
Principal cell
Ca2+

Loop diuretics Furosemide (Lasix) Blocks luminal Na/K/Cl CHF, Edema: 20-80 mg IV/IM/PO Hypovolemia, Hypovolemia,
transporter in thick pulmonary/peripheral q6-8h (max 600 mg/d) hypokalemia, metabolic hypokalemia K+ a-intercalated cell
ascending limb edema, Htn Htn: 20-80 mg/d PO od/BID alkalosis
↓ Na, K, Cl reabsorption

Cl- H+
K-sparing/ Spironolactone, Antagonizes aldosterone R Htn, CHF, hypokalemia Spironolactone: Edema, hyperkalemia, Renal insufficiency, H-K ATPase
Aldosterone eplenerone to ↓ Na at collecting duct Htn: 25-200 mg/d od/BID gynecomastia hyperkalemia, K+ K+
antagonists pregnancy Na+

Aldosterone H2O
Osmotic Mannitol (Osmitol) Non-reabsorbable solute Decrease intracranial and Mannitol: Transient volume Anuria, active cranial
Na+
Glycerol increases osmotic pressure intraocular pressure ↓ICP: 0.25-2 g/kg IV over expansion bleeding ENaC
Urea of filtrate; inhibits H2O RF/edematous states 30-60 mins Electrolyte Aquaporin
reabsorption at PCT and abnormalities
ATP-dependent
collecting duct K+ K pump Aldosterone
K+
Na/K Na+
ATPase
Principal cell Aldosterone
H2O Aquaporin
1200 mOms/L
Filtrate

, Renal Anatomy

Kidneys:
• Retroperitoneal, surrounded by renal capsule, adipose capsule, and renal fascia
• Renal hilum = ureter, renal arteries, renal veins, lymphatics, nerves
• L higher than R
• Functions: filtering blood, regulating blood pH/volume/pressure/osmolality, hormone production
• Filters 150 L of blood/day

Nephron:
• 1 million nephrons/kidney
• Basic structural functional unit of kidney
• Renal corpuscle = glomerulus + Bowman’s capsule
• Blood flow from afferent arteriole à glomerular capillaries à efferent arteriole à vasa recta
à renal venules
Renal tubules:
• Reabsorption and secretion between tubules and vasa recta
Glomerulus:
• Glomerular filtration barrier = endothelium, GBM, podocytes
• Particles positively charged, < 60 kDa
Cell types:
1. Mesangial cells: in between loops of glomerular capillaries; structural and produce vasoactive substances
2. Capillary endothelial cells (sinusoidal)
3. Podocytes (visceral epithelium): interdigitated foot processes form slit diaphragms
4. Parietal epithelium: lines interior of Bowman’s capsul;, contains podocyte progenitor population
5. Juxtaglomerular cells: smooth muscle cells lining afferent arteriole; produce and secrete renin

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