Chapter 18

Renal System

26-1
©2020 McGraw-Hill Education
 26-2
©2020 McGraw-Hill Education
 Urinary System
Urinary system is major
excretory system of the
body.
Two kidneys produce
excretory products, carried
by ureters to urinary bladder
which is emptied via urethra.

26-3
©2020 McGraw-Hill Education
 URINE

26-4
©2020 McGraw-Hill Education
 26.1 Functions of the Urinary System
Functions of kidneys:
Excretion of waste products from the blood.

26-5
©2020 McGraw-Hill Education
 26.1 Functions of the Urinary System
Functions of kidneys:
Regulation of blood volume and pressure.

26-6
©2020 McGraw-Hill Education
 26.1 Functions of the Urinary System
Functions of kidneys:
Regulation of blood solute concentrations.

26-7
©2020 McGraw-Hill Education
 26.1 Functions of the Urinary System
Functions of kidneys:
Regulation of extracellular fluid pH.

26-8
©2020 McGraw-Hill Education
 26.1 Functions of the Urinary System
Functions of kidneys:
Regulation of red blood cell synthesis.

26-9
©2020 McGraw-Hill Education
 26.1 Functions of the Urinary System
Functions of kidneys:
Regulation of vitamin D synthesis.

26-10
©2020 McGraw-Hill Education
 26.2 Kidney Anatomy and Histology
Location:
• The kidneys are bean-shaped
organs that are
retroperitoneal.
• Lie on posterior abdominal
wall on either side of vertebral
column.
• Lumbar vertebrae and rib cage
partially protect.
• Right kidney slightly lower than
left.
26-11
©2020 McGraw-Hill Education
 Location and External Anatomy of the
Kidneys
External Anatomy.
• Renal capsule: fibrous connective tissue. Surrounds each
kidney.
• Adipose tissue: engulfs renal capsule and acts as
cushioning.

26-12
©2020 McGraw-Hill Education
 RENAL PTOSIS

26-13
©2020 McGraw-Hill Education
 Location and External Anatomy of the
Kidneys
External Anatomy.
• Renal fascia: thin layer
loose connective tissue.
• Anchors kidneys and
surrounding adipose to
abdominal wall.
• Hilum.
• Renal artery and nerves
enter and renal vein and
ureter exit kidneys.
• Opens into renal sinus
(cavity filled with fat and
loose connective tissue).
26-14
©2020 McGraw-Hill Education
 Internal Anatomy and Histology
of the Kidneys
Cortex: outer area.
• Renal columns: part of
cortical tissue that extends
into medulla.
Medulla: inner area;
surrounds renal sinus.
• Renal pyramids: cone-
shaped. Base is boundary
between cortex and
medulla. Apex of pyramid
is renal papilla, points
toward sinus.

26-15
©2020 McGraw-Hill Education
 Internal Anatomy and Histology
Calyces. of the Kidneys
• Minor calyx: papillae extend into funnel of minor calyx.
• Major calyx: converge to form renal pelvis.
Renal pelvis: enlarged chamber formed by major calyces.
Ureter: exits at the hilum; connects to urinary bladder.

26-16
©2020 McGraw-Hill Education
 Frontal Section of the Kidney and
Ureter1

26-17
©2020 McGraw-Hill Education
 Frontal Section of the Kidney and
Ureter2

26-18
©2020 McGraw-Hill Education (b) ©McGraw-Hill Education/Rebecca Gray, photographer
 Structure of a Nephron
Nephron: functional and
histological unit of the
kidney.
Regions of the nephron:
1. Renal corpuscle.
2. Proximal convoluted
tubule.
3. Loop of Henle.
4. Distal convoluted
tubule.

26-19
©2020 McGraw-Hill Education
 Structure of a Nephron
Path of urine
produced by nephron:
collecting duct 
toward renal papilla
 papillary duct 
minor calyx and
beyond.

26-20
©2020 McGraw-Hill Education
 Types of Nephrons
Juxtamedullary
nephrons. Renal
corpuscle near
the cortical
medullary
border. Loops of
Henle extend
deep into the
medulla.

26-21
©2020 McGraw-Hill Education
 Types of Nephrons
Cortical nephrons.
Renal corpuscle nearer
to the periphery of the
cortex. Loops of Henle
do not extend deep
into the medulla.
The filtration part of a
nephron is called a
renal corpuscle.
26-22
©2020 McGraw-Hill Education
 The Renal
Corpuscle
Bowman capsule: outer
parietal (simple
squamous epithelium)
and visceral (cells called
podocytes) layers.
Glomerulus: network of
capillaries. Blood enters
through afferent
arteriole, exits through
efferent arteriole.
26-23
©2020 McGraw-Hill Education
 Bowman Capsule
Parietal layer: outer.
Simple squamous
epithelium that
becomes cube-shaped
where Bowman’s
capsule ends and
proximal tubule
begins.
Visceral layer: inner.
Specialized podocytes
that wrap around the
glomerular capillaries.
26-24
©2020 McGraw-Hill Education
 Fenestrae and Filtration Slits
Fenestrae: window-like
openings in the endothelial
cells of the glomerular
capillaries.
Filtrations slits: gaps
between the cell processes
of the podocytes.
Basement membrane
sandwiched between the
endothelial cells of the
glomerular capillaries and
the podocytes.
26-25
©2020 McGraw-Hill Education
 Arterioles
Afferent arteriole:
supplies blood to
glomerulus.
Efferent arteriole: drains
glomerulus.
Glomerular capillaries
have high pressure
because efferent
arterioles have small
diameter compared to
afferent.

26-26
©2020 McGraw-Hill Education
 Filtration Membrane
Filtration membrane:
capillary endothelium,
basement membrane
and podocytes. First
stage of urine formation
occurs here when fluid
from blood in capillaries
moves across filtration
membrane into the
lumen inside Bowman
capsule.

26-27
©2020 McGraw-Hill Education
 JUXTAMEDULLARY APPARATUS
Juxtaglomerular apparatus: specialized structure near
glomerulus; site of renin production.
• Juxtaglomerular cells- ring of smooth muscle in the afferent
arteriole where the latter enters Bowman’s capsule.
• Macula densa- Specialized tubule cells of the distal tubule. The
distal tubule lies between the afferent and efferent arterioles.

26-28
©2020 McGraw-Hill Education
 The Renal Tubule
Proximal tubule: simple
cuboidal epithelium with
many microvilli.
Loops of Henle.
• Descending limb: first part
similar to proximal tubule.
Latter part simple
squamous epithelium and
thinner.
• Ascending limb: first part
simple squamous
epithelium and thin, distal
part thicker and simple
cuboidal.
26-29
©2020 McGraw-Hill Education
 The Renal Tubule
Distal tubule: shorter
than proximal tubule.
Simple cuboidal, but
smaller cells and very
few microvilli.
Collecting ducts: form
where many distal
tubules come together.
Larger in diameter,
simple cuboidal
epithelium. Form
medullary rays and lead
to papillary ducts.
26-30
©2020 McGraw-Hill Education
 Arteries and Veins of the Kidneys 1

1. Renal arteries branch from

abdominal aorta.
2. Segmental arteries branch
from renal.
3. Interlobar arteries ascend
within renal columns
toward cortex.
4. Arcuate arteries branch
and arch over
the base of the pyramids.
5. Interlobular arteries
project into cortex and give
rise to afferent arterioles.
26-31
©2020 McGraw-Hill Education
 Arteries and Veins of the Kidneys 2

6. Afferent arterioles supply

blood to glomerulus.
7. Glomerulus.
8. Efferent arterioles exit the
renal corpuscle.
9. Peritubular capillaries form
a plexus around the
proximal and distal tubules.
10. Vasa recta: specialized parts of
peritubular capillaries that course
into medulla along with loops of
Henle, then back toward cortex.

26-32
©2020 McGraw-Hill Education
 Arteries and Veins of the Kidneys 3

11. Peritubular
capillaries drain
into interlobular
veins and lead to.
12. Arcuate veins.
13. Interlobar veins.
14. Renal veins.

26-33
©2020 McGraw-Hill Education
 26-34
©2020 McGraw-Hill Education
 Blood supply

26-35
©2020 McGraw-Hill Education
 26.3 Urine Production
Nephrons serve as the major functional units as they regulate
body fluid composition.
Three major steps in urine formation: filtration, tubular
reabsorption, and tubular secretion.

26-36
©2020 McGraw-Hill Education
 Filtration
Movement of fluid, derived from blood flowing through the glomerulus, across
filtration membrane.
Filtrate: water, small molecules, ions that can pass through membrane.
Pressure difference forces filtrate across filtration membrane.

26-37
©2020 McGraw-Hill Education
 Filtration
Renal fraction: part of total cardiac output that passes through the kidneys.
Varies from 12 to 30%; averages 21%.
Renal blood flow rate: rate of whole blood flow through kidneys.
Renal plasma flow rate: renal blood flow rate X fraction of blood that is
plasma: 650 mL/min.

26-38
©2020 McGraw-Hill Education
 Filtration
Glomerular filtration rate (GFR): amount
of filtrate produced each minute. 180
L/day.
Filtration fraction: part of plasma that is
filtered into lumen of Bowman’s capsules;
average 19%.
Average urine production/day: 1 to 2 L.
Most of filtrate must be reabsorbed.

26-39
©2020 McGraw-Hill Education
 Filtration Membrane 2

Filtration membrane:
filtration barrier. It prevents
blood cells and proteins from
entering lumen of Bowman’s
capsule, but is many times
more permeable than a
typical capillary.
Components:
1. Fenestrated glomerular
capillaries.
2. Basement membrane.
3. Podocytes of visceral
layer of Bowman capsule.
26-40
©2020 McGraw-Hill Education
 Filtration Membrane 2

Some albumin and small protein hormones enter the

filtrate, but these are reabsorbed and metabolized by the
cells of the proximal tubule. Very little protein normally
found in urine.

26-41
©2020 McGraw-Hill Education
 Filtration Pressure 1

Filtration pressure: pressure

gradient responsible for
filtration; forces fluid from
glomerular capillary across
membrane into lumen of
Bowman’s capsules.
Pressures that contribute to
filtration pressure:
• Glomerular capillary pressure
(GCP): blood pressure inside
capillary tends to move fluid
out of capillary into Bowman’s
capsule.
• Capsule hydrostatic pressure
(CHP): pressure of filtrate
already in the lumen.
26-42
©2020 McGraw-Hill Education
 Filtration Pressure 1

• Blood colloid osmotic

pressure (BCOP): osmotic
pressure caused by proteins
in blood. Favors fluid
movement into the capillary
from the lumen. BCOP greater
at end of glomerular capillary
than at beginning because of
fluid leaving capillary and
entering lumen.
Filtration pressure (10 mm
Hg) = GCP (50 mm Hg) −
CHP (10 mm Hg) − BCOP (30
mm Hg).

26-43
©2020 McGraw-Hill Education
 Filtration Pressure 2

Colloid osmotic pressure in

Bowman’s capsule normally
close to zero. During diseases
like glomerular nephritis,
proteins enter the filtrate and
filtrate exerts an osmotic
pressure, increasing volume of
filtrate.
High glomerular capillary
pressure results from.
• Low resistance to blood flow in
afferent arterioles.
• Low resistance to blood flow in
glomerular capillaries.
• High resistance to blood flow in
efferent arterioles: small
diameter vessels.
26-44
©2020 McGraw-Hill Education
 Filtration Pressure 2

Filtrate is forced across

filtration membrane; fluid
moves into peritubular
capillaries from interstitial
fluid.
Hypertension can damage
glomerular capillaries.

26-45
©2020 McGraw-Hill Education
 Filtration Pressure 3

26-46
©2020 McGraw-Hill Education
 26-47
©2020 McGraw-Hill Education
 Regulation of Glomerular Filtration
Rate 1

Intrinsic mechanisms:
autoregulation.
• Involves changes in
degree of constriction in
afferent arterioles.
• Myogenic mechanism: as
systemic BP increases,
afferent arterioles
constrict and prevent
increase in renal blood
flow.
26-48
©2020 McGraw-Hill Education
 Regulation of Glomerular Filtration
Rate1

• Tubuloglomerular
feedback: increased
rate of blood flow
of filtrate past cells
of macula densa =
signal sent to
juxtaglomerular
cells, afferent
arteriole constricts.

26-49
©2020 McGraw-Hill Education
 Regulation of Glomerular Filtration
Rate 2

Extrinsic mechanisms:
sympathetic nervous
system and hormones.
• Occurs during severe
conditions such as
hemorrhage or
dehydration.

26-50
©2020 McGraw-Hill Education
 Regulation of Glomerular Filtration
Rate 2

• Sympathetic simulation
constricts small arteries
and afferent arterioles,
decreasing renal blood flow
and filtrate formation.
• Renin secreted from
juxtaglomerular cells;
results in formation of
angiotensin II which
stimulates vasoconstriction
and maintains GFR.
26-51
©2020 McGraw-Hill Education
 Abnormal U.O.

26-52
©2020 McGraw-Hill Education
 Tubular Reabsorption: Overview
Tubular reabsorption: transport of water and
solutes from filtrate into the blood; occurs as filtrate
flows through the lumens of the renal tubule.
Substances transported to interstitial fluid and
reabsorbed into peritubular capillaries: sodium,
potassium, calcium, bicarbonate, chloride (overall
99% of filtrate is reabsorbed).
Portion not reabsorbed ends up in urine; contains
urea, uric acid, creatinine, potassium, and other
subtances.
26-53
©2020 McGraw-Hill Education
 26-54
©2020 McGraw-Hill Education
 Reabsorption In the Proximal
Convoluted Tubule 1

Site of majority of reabsorption.

Substances pass through cells of
tubule wall. Each cell has.
• Apical membrane: surface that
faces filtrate.
• Basal membrane: faces interstitial
fluid.
• Lateral surfaces: surfaces between
cells.

26-55
©2020 McGraw-Hill Education
 Reabsorption In the Proximal
Convoluted Tubule 1

Active transport of Na+ across the

basal membrane from cytoplasm
to interstitial fluid linked to
reabsorption of most solutes.
Because of active transport, the
concentration of Na+ is low inside
the cell and Na+ moves into
nephron cell from filtrate through
the apical membrane. Other
substances moved by symport
from the filtrate into the nephron
cell are substances that should be
retained by the body.

26-56
©2020 McGraw-Hill Education
Reabsorption In the Proximal
Convoluted Tubule 2

Number of carrier
molecules limits rate of
transport.
In diabetes mellitus.
• Concentration of glucose in
filtrate exceeds rate of
transport.
• High concentration of
glucose in plasma (and thus
in filtrate) reflected in
glucose in the urine.

26-57
©2020 McGraw-Hill Education
 Reabsorption In the Proximal
Convoluted Tubule 2

Diffusion between cells:

from lumen of nephron
into interstitial fluid.
• Depends on rate of
transport of same
solutes through the cells
of the tubule.
• K+, Ca2+, and Mg2+
Filtrate volume reduced
by 65% due to osmosis
of water.

26-58
©2020 McGraw-Hill Education
 26-59
©2020 McGraw-Hill Education
 Reabsorption In the Loop of
Henle 1

Loop of Henle descends into

medulla; interstitial fluid is
high in solutes.

Descending thin segment is

highly permeable to water
and moderately permeable
to urea, sodium, most other
ions (passive).

26-60
©2020 McGraw-Hill Education
 Reabsorption In the Loop of
Henle 1

Water moves out of

nephron, solutes in. Volume
of filtrate reduced by
another 15%.
Ascending thin segment is
not permeable to water, but
is permeable to solutes.
Solutes diffuse out of the
tubule and into the more
dilute interstitial fluid as the
ascending limb projects
toward the cortex. Solutes
diffuse into the descending
vasa recta.
26-61
©2020 McGraw-Hill Education
 Reabsorption In the Loop
of Henle 2
The wall of the ascending
limb of the loop of Henle is
not permeable to water. Na+
moves across the wall of the
basal membrane by active
transport, establishing a
concentration gradient for
Na+. K+ and Cl− are
symported with Na across
the apical membrane and
ions pass by facilitated
diffusion across the basal cell
membrane of the tubule
cells.
26-62
©2020 McGraw-Hill Education
Reabsorption In the Loop of
Henle 2

At the end of the loop

of Henle, inside of
nephron is 100
mOsm/kg. Interstitial
fluid in the cortex is
300 mOsm/kg. Filtrate
within DCT is much
more dilute than the
interstitial fluid which
surrounds it.

26-63
©2020 McGraw-Hill Education
 26-64
©2020 McGraw-Hill Education
 Reabsorption In the Distal
Convoluted Tubule and Collecting
Duct
Active transport of Na+ out of
tubule cells into interstitial fluid
with cotransport of Cl−
Na+ moves from filtrate into tubule
cells due to concentration gradient.
Collecting ducts extend from cortex
(interstitial fluid 300 mOsm/kg)
through medulla (interstitial fluid
very high).

26-65
©2020 McGraw-Hill Education
 Reabsorption In the
Distal Convoluted Tubule
and Collecting Duct
Water moves by osmosis from
distal tubule and collecting duct
into more concentrated
interstitial fluid.
Permeability of wall of distal
tubule and collecting ducts have
variable permeability to water.
Urine can vary in concentration
from low volume of high
concentration to high volume of
low concentration.
26-66
©2020 McGraw-Hill Education
 26-67
©2020 McGraw-Hill Education
 Changes In the Concentration of Urea
and Other Solutes In the Nephron
Urea: enters glomerular filtrate.
• As volume of filtrate decreases, concentration of
urea increases.
• Walls of nephron not very permeable to urea: only
40 to 60% passively reabsorbed.
Urate ions, creatinine, sulfates, phosphates,
nitrates partially reabsorbed.
• Concentration is high in urine.
• Toxic substances and are eliminated.
26-68
©2020 McGraw-Hill Education
 Tubular Secretion
Tubular secretion is the movement of nonfiltered
substances from the blood into the filtrate.
Substances include metabolic by-products, drugs and
molecules not normally produced by the body.
Active or passive.
Ammonia: produced by epithelial cells of nephron
from deamination of amino acids. Diffuses into lumen.
H+, K+, penicillin, and substances such as para-
aminohippuric acid (PAH): actively secreted into
nephron.
26-69
©2020 McGraw-Hill Education
 26-70
©2020 McGraw-Hill Education
 26.4 Regulation of Urine Concentration
and Volume
Regulation of urine
concentration and volume
involves hormonal
mechanisms as well as
autoregulation and the
sympathetic nervous
system.
Hormonal mechanisms
include renin-angiotensin-
aldosterone mechanism
and antidiuretic hormone
(ADH) mechanism.
26-71
©2020 McGraw-Hill Education
 Renin-Angiotensin-Aldosterone Hormone Mechanism

26-72
©2020 McGraw-Hill Education
 26-73
©2020 McGraw-Hill Education
 Renin-Angiotensin-Aldosterone Hormone
Mechanism
Angiotensin-converting
enzyme (ACE) in lungs
converts angiotensin I to
angiotensin II, a potent
vasoconstrictor which
also stimulates
aldosterone secretion,
sensation of thirst, and
ADH secretion.
Aldosterone acts on DCT
and CD to increase
sodium reabsorption
and therefore water
reabsorption.
26-74
©2020 McGraw-Hill Education
 Effect of Aldosterone on the DCT
1. Aldosterone secreted from the
adrenal cortex enters cells of
the distal convoluted tubule.
2. Aldosterone binds to nuclear
receptors and increases the
synthesis of transport proteins
of the apical and basal
membranes.
3. Newly synthesized transport
proteins increase the rate at
which Na+ are absorbed and K+
and H+ are secreted. Chloride
ions move with the Na+
because they are attracted to
the positive charge of Na+.

26-75
©2020 McGraw-Hill Education
 Antidiuretic Hormone Mechanism
Antidiuretic hormone (ADH)
produced by hypothalamic
neurons, stored in posterior
pituitary.
Osmoreceptors in
hypothalamus detect increased
osmolality of interstitial fluid,
stimulating ADH to be
released.
Baroreceptors in atria of heart
and some vessels can also
stimulate ADH release when
blood pressure drops.
26-76
©2020 McGraw-Hill Education
 Effect of ADH
on Renal
Tubule Water
Movement

1. ADH moves from the peritubular capillaries and binds to ADH receptors in the plasma membranes of the distal
convoluted tubule cells and the collecting duct cells.
2. When ADH binds to its receptor, a G protein mechanism is activated, which in turn activates adenylate cyclase.
3. Adenylate cyclase increases the rate of cAMP synthesis. Cyclic AMP promotes the insertion of aquaporin-2
containing cytoplasmic vesicles into the apical membranes of the distal convoluted tubules and collecting ducts,
thereby increasing their permeability to water. Water then moves by osmosis out of the distal convoluted tubules
and collecting ducts into the tubule cells through the aquaporin-2 water channels.
4. Water exits the tubule cells and enters the interstitial fluid through aquaporin-3 and aquaporin-4 water channels in
the basal membranes.
26-77
©2020 McGraw-Hill Education
 Antidiuretic Hormone Mechanism
ADH acts on DCT and CD to increase water reabsorption (by
insertions of aquaporins), countering any decrease in blood
pressure and/or increase in solute concentration.
Insufficient ADH secretion = diabetes insipidus.

26-78
©2020 McGraw-Hill Education
 Effect of ADH on Urine Concentration
and Volume

26-79
©2020 McGraw-Hill Education
 26-80
©2020 McGraw-Hill Education
 MAINTAINING WATER BALANCE OF
BLOOD

26-81
©2020 McGraw-Hill Education
 MAINTAINING WATER BALANCE OF
BLOOD

26-82
©2020 McGraw-Hill Education
 REGULATION OF WATER INTAKE
AND OUTPUT

26-83
©2020 McGraw-Hill Education
 THIRST MECHANISM

26-84
©2020 McGraw-Hill Education
 26-85
©2020 McGraw-Hill Education
 Atrial Natriuretic Hormone
Atrial natriuretic hormone (ANH) is produced by
cells in right atrium of heart when they are
stretched more than normal.
• Increases stretch due to high blood volume.
• ANH decreases blood volume by.
• Inhibiting Na+ reabsorption (therefore less water
reabsorbed).
• Inhibiting ADH production.
• Increases volume of urine produced.
• Venous return is lowered, volume in right atrium decreases.
26-86
©2020 McGraw-Hill Education
 26.6 Urine Movement
Ureters: bring urine from
renal pelvis to urinary
bladder. Lined by
transitional epithelium.

26-87
©2020 McGraw-Hill Education
 RENAL CALCULI

26-88
©2020 McGraw-Hill Education
 RENAL CALCULI

26-89
©2020 McGraw-Hill Education
 Urine Movement
Urinary bladder: hollow
muscular container. In pelvic
cavity posterior to
symphysis pubis. Lined with
transitional epithelium;
muscle part of wall is
detrusor muscle.
Trigone: interior of urinary
bladder. Triangular area
between the entry of the
two ureters and the exit of
the urethra. Area expands
less than rest of bladder
during filling.
26-90
©2020 McGraw-Hill Education
 CYSTITIS

26-91
©2020 McGraw-Hill Education
 Internal urinary sphincter: in males, elastic connective tissue
and smooth muscle keep semen from entering urinary bladder
during ejaculation.
External urinary sphincter: skeletal muscle surrounds urethra as
it extends through pelvic floor. Acts as a valve.

26-92
©2020 McGraw-Hill Education
 URETHRA
Male urethra extends
from the inferior part
of the urinary bladder
through the penis.

26-93
©2020 McGraw-Hill Education
 URETHRA
Female urethra is
shorter; opens into
vestibule anterior to
vaginal opening.

26-94
©2020 McGraw-Hill Education
 URINARY CATETHERIZATION

26-95
©2020 McGraw-Hill Education
 URINARY TRACT INFECTIONS

26-96
©2020 McGraw-Hill Education
 Urine Flow Through the Nephron
and Ureters
Hydrostatic pressure forces urine through nephron.
Peristalsis moves urine through ureters from region
of renal pelvis to urinary bladder. Occur from once
every few seconds to once every 2 to 3 minutes.
• Parasympathetic stimulation: increase frequency.
• Sympathetic stimulation: decrease frequency.
Ureters enter bladder obliquely through trigone.
Pressure in bladder compresses ureter and prevents
backflow.

26-97
©2020 McGraw-Hill Education
 26-98
©2020 McGraw-Hill Education
 Micturition Reflex 1

Urinary bladder is reservoir for urine; can stretch

to hold about 1 L.
Micturition reflex is activated when urinary
bladder is stretched.
• Detected by stretch receptors.
• Parasympathetic action potentials cause detrusor
muscle to contract.
• Decreased somatic motor signals cause external
urethral sphincter to relax.

26-99
©2020 McGraw-Hill Education
 26-
©2020 McGraw-Hill Education 100
 26.7 Effects of Aging on the Kidneys
Gradual decrease in size of kidneys, but only one-third
of one kidney necessary for homeostasis.
Amount of blood flowing through gradually decreases.
Number of glomeruli decrease and ability to secrete
and reabsorb decreases.
Ability to concentrate urine declines and kidney
becomes less responsive to ADH and aldosterone.
Reduced ability to participate in vitamin D synthesis,
contributing to Ca2+ deficiency, osteoporosis, and bone
fractures.
26-
©2020 McGraw-Hill Education 101
 INCONTINENCE, URINARY RETENTION,
HYPERPLASIA

26-
©2020 McGraw-Hill Education 102
 MAINTAINING ACID-BASE BALANCE
OF BLOOD

26-
©2020 McGraw-Hill Education 103
 BLOOD BUFFERS

26-
©2020 McGraw-Hill Education 104
 Bicarbonate buffer system

26-
©2020 McGraw-Hill Education 105
 Renal mechanisms

26-
©2020 McGraw-Hill Education 106