Introduction
Q. What are the functions of kidneys?
Ans: The kidneys secrete a variety of hormones, including erythropoietin, and the enzyme renin. Erythropoietin is released in response to hypoxia (low levels of oxygen at tissue level) in the renal circulation. It stimulates erythropoiesis (production of red blood cells) in the bone marrow.
Functions
- The functioning of the kidneys is efficiently monitored and regulated by hormonal feedback mechanisms involving the hypothalamus, JGA and to a certain extent, the heart.
- Osmoreceptors in the body are activated by changes in blood volume, body fluid volume and ionic concentration. An excessive loss of fluid from the body can activate these receptors which stimulate the hypothalamus to release antidiuretic hormone(ADH) or vasopressin from the neurohypophysis.
- ADH facilitates water reabsorption from latter parts of the tubule, thereby preventing diuresis (increased or excessive production of urine).
- An increase in body fluid volume can switch off the osmoreceptors and suppress the ADH release to complete the feedback.
- ADH can also affect the kidney function by its constrictory effects on blood vessels. This causes an increase in blood pressure. An increase in blood pressure can increase the glomerular blood flow and thereby the GFR.
- The JGA plays a complex regulatory role. A fall in glomerular blood flow/glomerular blood pressure/GFR can activate the JG cells to release renin which converts angiotensinogen in blood to angiotensin I and further to angiotensin II.
- Angiotensin II, being a powerful vasoconstrictor, increases the glomerular blood pressure and thereby GFR.
- Angiotensin II also activates the adrenal cortex to release Aldosterone. Aldosterone causes reabsorption of [latex]Na^+[/latex] and water from the distal parts of the tubule. This also leads to an increase in blood pressure and GFR. This complex mechanism is generally known as the Renin-Angiotensin mechanism.
- An increase in blood flow to the atria of the heart can cause the release of Atrial Natriuretic Factor(ANF). ANF can cause vasodilation (dilation of blood vessels) and thereby decrease the blood pressure. ANF mechanism, therefore, acts as a check on the renin-angiotensin mechanism.
- Urine formed by the nephrons is ultimately carried to the urinary bladder where it is stored till a voluntary signal is given by the central nervous system (CNS). This signal is initiated by the stretching of the urinary bladder as it gets filled with urine. In response, the stretch receptors on the walls of the bladder send signals to the CNS.
- The CNS passes on motor messages to initiate the contraction of smooth muscles of the bladder and simultaneous relaxation of the urethral sphincter causing the release of urine. The process of release of urine is called micturition and the neural mechanisms causing it is called the micturition reflex.
- An adult human excretes, on an average, 1 to 1.5 liters of urine per day. The urine formed is a light yellow colored watery fluid which is slightly acidic (pH-6.0) and has a characteristic odor.
- On an average, 25-30 gm of urea is excreted out per day. Various conditions can affect the characteristics of urine.
- Analysis of urine helps in the clinical diagnosis of many metabolic disorders as well as malfunctioning of the kidney. For example, the presence of glucose (Glycosuria) and ketone bodies (Ketonuria) in urine are indicative of diabetes mellitus.
- Other than the kidneys, lungs, liver and skin also help in the elimination of excretory wastes.
- Our lungs remove large amounts of CO2 (approximately 200mL/minute) and also significant quantities of water every day.
- Liver, the largest gland in our body, secretes bile-containing substances like bilirubin, biliverdin, cholesterol, degraded steroid hormones, vitamins and drugs. Most of these substances ultimately pass out alongwith digestive wastes.
- The sweat and sebaceous glands in the skin can eliminate certain substances through their secretions. Sweat produced by the sweat glands is a watery fluid containing NaCl, small amounts of urea, lactic acid, etc.
- Though the primary function of sweat is to facilitate a cooling effect on the body surface, it also helps in the removal of some of the wastes mentioned above.
- Sebaceous glands eliminate certain substances like sterols, hydrocarbons and waxes through sebum. This secretion provides a protective oily covering for the skin. Small amounts of nitrogenous wastes could be eliminated through saliva too.
- Malfunctioning of kidneys can lead to accumulation of urea in blood, a condition called uremia, which is highly harmful and may lead to kidney failure. In such patients, urea can be removed by a process called hemodialysis.
- Blood drained from a convenient artery is pumped into a dialyzing unit after adding an anticoagulant like heparin. The unit contains a coiled cellophane tube surrounded by a fluid (dialyzing fluid) having the same composition as that of plasma except the nitrogenous wastes.
- The porous cellophane membrane of the tube allows the passage of molecules based on concentration gradient. As nitrogenous wastes are absent in the dialyzing fluid, these substances freely move out, thereby clearing the blood.
- The cleared blood is pumped back to the body through a vein after adding anti-heparin to it. This method is a boon for thousands of uremic patients all over the world.
- Kidney transplantation is the ultimate method in the correction of acute renal failures (kidney failure). A functioning kidney is used in transplantation from a donor, preferably a close relative, to minimise its chances of rejection by the immune system of the host. Modern clinical procedures have increased the success rate of such a complicated technique.
- Renal calculi: Stone or insoluble mass of crystallised salts (oxalates, etc.) formed within the kidney.
- Glomerulonephritis: Inflammation of glomeruli of kidney.
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