Kidney Functions: The Guardians of Homeostasis

(This article is part of the original post and is written in Spanish. Funciones renales)

The kidneys, together with the urinary system, are crucial to maintaining the internal balance of the human body. While many people know they produce urine, their true range of functions goes far beyond that.

In this article, we’ll explore the main physiological roles of the kidneys, from waste elimination to hormone production — a must-know for any medical student or healthcare professional.


1. Excretion of Waste Products

One of the kidneys’ primary tasks is to remove metabolic waste from the body:

  • Nitrogenous waste: urea and creatinine

  • Nucleic acid metabolism: uric acid

  • Drug excretion: e.g., gentamicin

  • Toxin elimination: various environmental and dietary toxins


2. Regulation of Water and Electrolyte Balance

The kidneys precisely control the volume of water and the concentration of electrolytes (sodium, potassium, chloride, etc.) — maintaining proper hydration and cellular function.


3. Maintenance of Acid-Base Balance

They help keep blood pH stable through:

  • Buffer systems, especially bicarbonate and phosphate

  • Urine acidification, performed by intercalated cells in the distal convoluted tubule and collecting duct


4. Gluconeogenesis During Fasting

The kidneys can produce glucose from non-carbohydrate sources, a vital backup during prolonged fasting or starvation.


5. Hormonal Catabolism

They degrade several circulating hormones, such as:

  • Insulin

  • Parathyroid hormone (PTH)


6. Regulation of Blood Pressure

The kidneys play a key role in long-term blood pressure control:

  • Via the renin-angiotensin-aldosterone system (RAAS)

  • By adjusting the glomerular filtration rate (GFR)


7. Endocrine Functions

Though not classic endocrine glands, the kidneys produce several hormones:

  • Vitamin D activation (calcitriol synthesis)

  • Erythropoietin: stimulates red blood cell production

  • Renin: part of RAAS for blood pressure control


 8. Excretion of Vasoactive Substances

  • Renal prostaglandins: protect the kidneys from ischemia and stress

  • Kallikrein-kinin system: produces bradykinin, a potent vasodilator similar to histamine


 9. Target of Multiple Regulatory Hormones

The kidneys are regulated by several systemic hormones:

  • Angiotensin II

  • Aldosterone

  • Vasopressin (ADH)

  • Parathyroid hormone (PTH)

  • Fibroblast Growth Factor 23 (FGF23)


Conclusion

The kidneys are more than just urine factories — they are dynamic, multitasking organs that protect our internal environment with precision and complexity. Their proper function is essential for electrolyte balance, detoxification, acid-base regulation, and more.


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