Glomerular Filtration is the first step in urine formation. It is a non-selective, passive process driven by blood pressure (hydrostatic pressure) in the glomerular capillaries. The filtration barrier consists of: Capillary endothelium (fenestrated - porous), Basement membrane (main filter - blocks proteins and cells), and Podocyte filtration slits (slit diaphragm - further filtration). Everything in blood except large proteins and blood cells passes into the filtrate. The filtrate is identical to plasma minus proteins. The GFR (Glomerular Filtration Rate) = ~125 mL/min. Normal GFR indicates healthy kidneys; reduced GFR indicates Chronic Kidney Disease (CKD).

Dialysis is a life-saving treatment for patients with End Stage Renal Disease (ESRD) or acute kidney failure. Two main types: Haemodialysis (HD) - blood is drawn out, filtered through an artificial kidney machine (dialyser - semipermeable membrane), and returned to the body. Typically 3-4 hours, 3 times/week. Requires arteriovenous (AV) fistula access. Peritoneal Dialysis (PD) - dialysis fluid (dialysate) is infused into the peritoneal cavity; the peritoneal membrane acts as the filter. Can be done at home. Dialysis removes waste products (urea, creatinine), excess fluid, and corrects electrolyte imbalances. It does NOT restore other kidney functions (hormone production, etc.).

Haematuria is the presence of blood (red blood cells) in urine. Two types: Macroscopic (Gross) Haematuria (visible red/pink/brown urine - alarming to patient) and Microscopic Haematuria (red blood cells visible only under microscope - >3 RBCs/high power field). Important causes: Kidney stones (renal colic + haematuria - most common benign cause), UTI (infection - most common cause overall), Glomerulonephritis (cola-coloured urine), Kidney/bladder/prostate cancer (painless haematuria in elderly = cancer until proven otherwise), and Trauma. Haematuria always requires investigation: urine culture, ultrasound, CT scan, cystoscopy (bladder examination).

Tubular Reabsorption is the second step in urine formation - the process by which useful substances from the glomerular filtrate are selectively transported back into the peritubular capillaries (blood). Substances reabsorbed: All glucose (in PCT - by active transport with Na+), All amino acids (in PCT), Most water (~99% - in PCT, loop of Henle, DCT, collecting duct), Most Na+, K+, Cl- (various tubule segments), and Bicarbonate (HCO3-) in PCT. Of 180 L/day filtered, only 1-1.5 L/day becomes urine - meaning ~99% is reabsorbed.

The skin acts as an accessory excretory organ through sweat glands (sudoriferous glands): Eccrine sweat glands (most numerous, found all over body) = produce watery sweat for thermoregulation. Apocrine sweat glands (axilla, groin) = produce thicker sweat (body odour when broken down by bacteria). Sweat composition: Water (~99%), NaCl, urea, lactic acid, ammonia, small amount of glucose. Primary role of sweating = thermoregulation (cooling the body). Secondary role = excretion (minor). In kidney failure, urea accumulation causes uraemic frost - white crystalline deposits of urea on skin.

Tubular Secretion is the third step in urine formation - substances are actively transported from peritubular capillaries INTO the tubular fluid. This allows the kidney to eliminate substances not filtered by the glomerulus or to increase elimination of certain wastes. Substances secreted: H+ ions (acid secretion - regulates blood pH), K+ ions (regulated by aldosterone), Creatinine, Drugs and toxins (penicillin, aspirin, morphine), and Ammonia (NH3). Tubular secretion is important for acid-base balance and drug elimination. Together, filtration + reabsorption + secretion = final urine composition.

The Liver plays an important excretory role: Bile production (liver cells/hepatocytes produce bile containing bile pigments - bilirubin and biliverdin - breakdown products of haemoglobin from old red blood cells), Bile excretion (bile is stored in the gallbladder and released into the duodenum - bile pigments are eventually excreted in faeces - giving faeces its brown colour), Urea synthesis (converts toxic ammonia to urea for kidney excretion), and Detoxification (metabolises drugs, alcohol, and other toxins for excretion). Jaundice = yellowing of skin/eyes due to accumulation of bilirubin when liver function is impaired or bile duct is blocked.

A healthy adult produces approximately 1-1.5 litres (1000-1500 mL) of urine per day under normal conditions. Urine output terminology: Normal = 1-1.5 L/day (or 0.5-1 mL/kg/hour), Polyuria = excess urine production (>2.5 L/day) - diabetes mellitus, diabetes insipidus, excessive fluid intake, Oliguria = reduced urine output (<400 mL/day or <0.5 mL/kg/hour) - dehydration, kidney failure, Anuria = no urine output (<100 mL/day) - severe kidney failure, urinary obstruction, and Nocturia = excessive urination at night - heart failure, diabetes, prostate enlargement.

Jaundice (Icterus) is a yellowish discolouration of the skin, mucous membranes, and whites of the eyes (scleral icterus) caused by hyperbilirubinaemia (elevated bilirubin in blood). Three types: Pre-hepatic (Haemolytic) = excess RBC breakdown - too much bilirubin produced (e.g., malaria, sickle cell anaemia, haemolytic anaemia). Hepatic (Hepatocellular) = Liver damage - cannot process bilirubin (e.g., hepatitis, cirrhosis). Post-hepatic (Obstructive) = Bile duct blockage - bilirubin cannot be excreted (e.g., gallstones, pancreatic cancer). Neonatal jaundice is common in newborns (immature liver) - treated with phototherapy (blue light).

The Loop of Henle is a U-shaped tubule that dips into the renal medulla. It is responsible for creating a hyperosmotic concentration gradient in the medullary interstitium through the countercurrent multiplier mechanism: Descending limb (permeable to water not solutes - water leaves by osmosis - filtrate becomes concentrated) and Ascending limb (permeable to solutes not water - NaCl actively pumped out - filtrate becomes dilute). This gradient allows the collecting duct to concentrate urine under the influence of ADH (Antidiuretic Hormone). Juxtamedullary nephrons with long loops are most efficient at concentrating urine.