Control of Filtration

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Juxtaglomeruluar Apparatus

The kidney can make adjustments with or without consideration for the rest of your body.  Renal autoregulation is when the kidney tightly controls its filtration rate despite changes in blood pressure.  So, if you eat a salty meal, the kidney makes a small adjustment. This adjustment is very minute compared to how much the osmolarity of your whole blood changes. 

We have to make the anatomy of the renal corpuscle even more complicated before talking about how your nephrons regulate the rate of filtration. First, we must understand that additional complex details exist. There is a group of cells within the glomerulus. Another group is closely located to it. Together, they are called the juxtaglomerulus apparatus. This is a feedback mechanism of sensory inputs. It consists mostly of smooth muscle outputs. These help the kidney control its filtration rate despite changes in your blood pressure.

Within the glomerulus are mesangial cells between the podocytes, kinda like filling in space.  There are also mesangial cells our here between the afferent and efferent arterioles.  Sometimes we call these two populations different names such as the intraglomerular mesangial cells or the extraglomerular mesangial cells.  These cells are smooth muscle cells.

Remember how we said that a nephron is not really all stretched out?  The loop bent back around so that the DCT could come close to the renal corpuscle.  This is the DCT.  In the calls of the DCT are some cells called the macula dense.  These cells are essential chemoreceptors that monitor the amount of sodium in your filtrate

Granular or juxtaglomerular cells are smooth muscle cells that surround the afferent arteriole and a little bit surrounds the efferent.


Renal Autoregulation

When the kidney makes adjustment without regard for the rest of your body, this is called renal autoregulation.  There are two ways the kidney can employ to stabilize GFR despite changes in the systemic circuit.  So, if you are blooding out, the kidney uses these mechanisms to maintain GFR. 

The myogenic mechanism concerns the afferent arteriole and the volume of blood it is allowing into the glomerulus.  When blood pressure goes high, the afferent arteriole stretches.  But, it stretches so much that it snaps back like a rubber band.  As a response to high blood pressure, the afferent arterioles all constrict and reduce the glomerular hydrostatic pressure.  Remember that this was the only pressure encouraging filtration.  Reducing this will reduce the rate of filtration.

Here’s one way in which the tubuloglomerular mechanism works.  The macula densa chemoreceptor cells in the wall of the DCT sense a high amount of sodium in the filtrate.  They interpret this to mean that filtration is happening to fast and we are losing too much sodium.  The macular densa can communicate with the mesangial cells making them constrict.  This constriction makes the filtration membrane smaller and reduces filtration. 


GFR Nervous & Hormonal  Regulation

Your kidney can take input from the rest of your body.  It doesn’t HAVE to, but it will.  Your kindey is innervated with sympathetic and parasympathetic fibers.  Most of the time the parasympathetic fibers are in control, helping you maintain a good GFR.  But, these parasympathetic fibers can be overrun by the activation of the sympathetic fibers.  These sympathetic fibers decrease GFR.  You are responding to a threat, you don’t need to make filtration.  But, it’s not just nervous input that the kidney is subjected to.  There are also hormonal inputs that control the kidney.

Renin-Angiotensin-Aldosterone Mechanism

When the granular cells on the afferent arteriole sense low systemic blood pressure, they release renin.  Renin is converted to angiotensin I by an enzyme from the liver.  Then, in the lungs, angiotensin I is converted to angiotensin II. This change is facilitated by another enzyme called the angiotensin-converting enzyme, or ACE.  Now, Angiotensin II circulates through your body, targeting different organs.  First and foremost, angiotensin II is a powerful vasoconstrictor of all your blood vessels.  So, right from the start angiotensin raises blood pressure.  But, it doesn’t stop there.  It encourages the release of ADH from the posterior pituitary gland. It also prompts the release of aldosterone from the zona glomerulus in the adrenal cortex.  These circulate in blood and go back to the kidney and affect the DCT and CD mainly.  ADH inserts aquaporins in the DCT and CD, allowing them to do facultative water reabsorption.  This increases your blood volume (or keeps it the same) and increases your blood pressure.   Aldosterone targets the same cells, making them reabsorb sodium, which further increases the amount of water reabsorption can cause.  So, the combined effect of these two hormones is also very powerful.  All of this increases blood pressure.  For most people with essential hypertension, the first drug you might try is an ACE inhibitor.  Actually, no, you might get on a diuretic first.  You might consider a drug like captopril. Or, any of those other ones ending in –pril.  These drugs are ACE inhibitors.  They stop the angiotensin converting enzyme in the lungs.  This prevents all these blood pressure raising effects of angiotensin II. 

Side note – I take BP drugs occasionally. This happens when I have a high pressure issue with one of my eyes.  The first time this happened, I got catopril.  It caused this horrible, unavoidable, hacking cough.  I found out that this is common for people who just don’t tolerate the –pril drugs.  I have found some literature, although not a lot, that hypothesizes the cough comes from abnormal activity of the angiotensin converting enzyme in the lungs. 


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