One of the processes that occurs in the body is called “inflammation.” Inflammation occurs when a cut into the skin also punctures a blood vessel. This situation directly exposes the blood to the air. Inflammation occurs in a few steps. First, the blood vessels near the wound are expanded (which causes the swelling that we see near the cut) and special proteins called “fibrins” are brought in. These fibrins bind to each other to form a net-like structure. We are all quite familiar with this net, which we call a blood clot. This net stops the bleeding and cuts the interaction between the air and the blood within a few minutes.

Next, it is time to quickly eliminate any foreign objects that got into the tissue. Special immune cells called “macrophages” are sent to the crime scene to clean up. Macrophages are large white blood cells that “eat” microbes and other foreign objects using a process called “phagocytosis.” After the scene is all cleaned up, these macrophages excrete special molecules that induce tissue repair and return the blood flow to normal. An important note here is the specific order of these events. Like every single process in the body, they occur in the most purposeful way possible. What do I mean? I mean that, first the wound is closed urgently; second, macrophages are sent in; third comes the tissue repair. Any other order would have greatly lowered the effectiveness of inflammation. Imagine that the wound is closed after the macrophages are sent in. Then, by the time the macrophages killed all the microbes, twice as many would have entered the scene. The body seems to know every single event beforehand and plans its defense accordingly.

Our body is perfectly calibrated to keep our blood, the milk of our organ systems, absolutely pristine.

Let’s say a microbe managed to sneak into the blood before inflammation occurred, and is long gone to another region of the body. Does the microbe win? Unfortunately for the microbe, it has to pass another test. This time the tester is the lymphatic system. The lymphatic system is the sewage system of the body. When the blood transfers its nutrients to the tissue, the fluid goes through the “interstitial area” (the empty space between organs). During this process, some of the fluid stays in this area and starts to accumulate. This is where the lymphatic system kicks in. The lymphatic system consists of many tubes running parallel to the blood vessels and recollects any excess fluid and transports them to the subclavian vein near the neck. This way, excess fluids of the body and all of the molecules in them, are reintroduced into the circulation. If there is a problem with this process, an abnormality called “edema” occurs. Of course, the blood is a very sensitive fluid because it travels through the whole body and seeps into almost every single cell. If a microbe were to get into it, it would easily spread and cause disease. So, the lympatics first does a checkup on the body fluid. This checkup occurs at special nodes in the system called lymph nodes found all over the body. Two of the most famous lymph nodes are the spleen and the tonsils. Within these nodes are lymphocytes, special immune cells that “tag” bacteria and other microbes to be later destroyed by macrophages. Thus, the blood is continuously cleaned and kept safe from harmful microbes.

Last but certainly not the least, the final inspection the blood goes through takes place in the kidneys. The aforementioned two checkpoints prevent the entrance of any foreign materials into the blood, and the elimination of any microbes lucky enough to somehow make it through. So, the only task to be completed is the elimination of excess molecules formed in the metabolism. For example, the blood in the veins (the vessels that carry carbon dioxide formed by the respiration of cells) is carried to the lungs where the carbon dioxide is exhaled. But, a much more precise mechanism comes into play in the kidneys. Blood vessels that come from all around the body form a knot-like structure in the kidney called the “glomerulus.” This knot-like shape increases the surface area of filtration. The blood running from the glomerulus is then filtered into the “Bowman capsule,” which surrounds the glomerulus.

But wait! The sanitation system is not satisfied with this first filtration and “thinks” that the filtrate is not ready to be excreted by the urine. So, a more delicate filtration occurs right after the filtrate enters the “proximal tubule.” While passing through this tubule, essential molecules are immediately reabsorbed into the body. The most valuable of all these molecules is glucose, since it is the main source of energy in the body. The proximal tubule reabsorbs around 98 % of all the glucose, while the distal tubule scouts out the rest. After the tubules are done with the filtration, not a single glucose molecule is left in the urine. As a matter of fact, the presence of even a few glucose molecules in the urine leads to a diagnosis of “renal glycosuria.”

After the proximal tubule, the filtrate goes into the “loop of Henle,” where it is dipped into a high-concentration environment. Water travels passively (without the need for energy) from low-concentration to high-concentration areas. In the loop of Henle, the urine is low-concentration, so water runs back into the body. Thus, any excess water in the urine is effectively and economically reabsorbed. The big machine that consists of the glomerulus, the Bowman capsule, the tubules, and the loop of Henle is called a “nephron.” Everything described above occurs in a single nephron. The average number of nephrons in one kidney is around 1,000,000. The human bladder holds around 150 ml of urine on average. So, each nephron is actually responsible for 0.00015 ml of urine production. The kidneys filter over 1,000 liters of blood each day, so our blood is kept just as we want it. Millions of tiny nephrons work in unison to take in huge amounts of blood and they know exactly what to leave and what to keep, 24 hours a day, 7 days a week.

Our blood is our life source. It is the milk of the organs, and our organs would dry up without it. Believe it or not, our organs are quite picky. If they are to receive anything they don’t like, they will start acting up. In order to keep the organs happy, the three mechanisms mentioned above have to work hard and not make a single mistake. These mechanisms are, of course, also made up of cells. These miniscule cells “know” exactly what their clients on the ends of the body like and don’t like, and prepare the blood composition accordingly. Only one word can describe these wondrous mechanisms: Impeccable.

Brian Turk is a medical student from New Jersey. He writes on medicine, health, and biology on a freelance basis.

Some medications are effective directly over the area they are applied to. Some however are transported to distant regions via blood flow and that is where they are most effective. Medication is either taken orally or through injection. When medicine passes into the blood stream from the place of administration, it is considered to be absorbed. A good example is the transportation of medicine into the blood stream of capillary vessels between the muscle cells when injected into muscle tissue. A drug taken orally however is absorbed through the blood vessels in the gastro-intestinal system.

For orally-taken medication to be absorbed, it should be able to dissolve in gastro-intestinal fluids. First, it is broken into smaller units due to the corroding effects of stomach acid and various enzymes are secreted, then chemicals in the drug composition pass into the gastro-intestinal fluid in a molecular form. This event resembles the dissolving of a sugar cube inside a glass of hot tea. First, the sugar cube gets broken into pieces and then dissolves. A mix with a tea spoon makes this event happen a little faster. In a similar fashion gastro-intestinal movements help with the absorption of medicine. Liquid drugs like syrups dissolve in the gastro-intestinal fluid faster since they are already in smaller units; therefore they get absorbed faster.

Drugs mostly get absorbed through the small intestine. The most important task of this organ is to enable the absorption of nutrients. It is approximately 10 meters long and 4 centimeters wide. The inner lining of the small intestine has finger-like projections called villus and even smaller projections that are located on these villi are called microvillus. One of the reasons, maybe the most important reason, why the our intestines are created in this way is that as a result, the inner surface area of intestines increases multifold. Such that the inner surface area of a human beings small intestine can increase up to 200 m2 and this greatly facilitates the absorption. These projections are made of intestinal cells.

The molecules carrying the medication reach the capillary vessels by passing through these cells and then join the blood stream by crossing through capillary vessel cells. Furthermore, intestinal cell membranes host a special protein that filters unwanted substances for the cell and returns them back to intestinal lumen. Thus these unwanted substances are excreted out of the body along with other unabsorbed matter. In the same way, some drugs are held by this protein and released back into the lumen thus decreasing absorption rate for drugs experiencing this reaction.

Liver: The organ responsible for eliminating the harmful effects of medication

As soon as medication joins the bloodstream after absorption, it is first transported to the liver. This is because pulmonary veins that collect blood from the intestines are connected primarily to the liver. One of the many functions of the liver is the elimination of harmful substances entering the body. For this reason, absorbed substances are directly sent to the liver. The liver is employed with the task of chemical conversion with these substances that are transported to it. One of the wisdoms behind liver metabolism is to reduce the effects of these harmful substances via these events and to convert them into an excretal material. In the same way, drugs are metabolized in the liver, lose their efficacy and prepare for excretion.

Many drugs interfere with each other’s metabolism. If one drug’s metabolism is inhibited, blood concentration of such chemicals increase and adverse effects of drugs become more frequent. Irresponsible drug use must be avoided for this reason. Drug interactions may lead to major damage in addition to the drug’s individual adverse effects. Moreover different nutrients also affect drug metabolism. For instance, grapefruit inhibits metabolism of certain medicines, as a result blood concentration of these medicines increase and adverse effects can be observed. On the other hand, some nutrients like broccoli, cabbage, and charcoal roasted meat speed up the metabolism of certain medicines. In this case, the blood concentration of the affected drug drops and may lead to reduced benefits from intended use. Because of this reason, patients on long-term medicine treatment should not consume these types of food.

The rest of the drug molecules that escape these metabolisms is directed towards blood vessels feeding other organs. Some drug metabolisms in the liver present individual differences as metabolic levels change from person to person. Thus, a drug with the same dosage develops desired blood concentrations for some people, fails to meet this level for others or can even cause high blood concentrations enough to generate adverse effects in other individuals. That is why a medicine that has benefited a patient should never be used by somebody else without consulting a doctor.

The function of bile

Bile secretion originating from the liver and gall bladder has critical importance in the digestion and absorption of fats. Bile breaks apart fats into small pieces so that digestive enzymes can affect them. As a result of this, absorption is provided for fats and vitamins like A, D, E, K that are soluble in fats. In a similar fashion bile improves solubility and absorption of some drugs that does not dissolve in gastro-intestinal fluid. Another task of bile secretion is the removal of certain substances from the body. Waste materials in the bile that is dumped into duodenum are excreted through the digestive track. Some drugs are excreted in this way.

Drug intake before or after meals

It is a well known practice that medications are advised either to be taken after or before meals. When medications are taken after a meal, they cause less of the possible unwanted disturbances such as stomach sickness, aches or indigestion.

On the other hand, nutrients may reduce intake of certain drugs, therefore they need to be taken before meals. However medications taken right before a meal does not apply in this case since the food will still mix with the medication in the stomach. When taking these medicines, it should at least be an hour before meals. Generally consumption of a medicine before or after a meal does not really change its absorption level. But medications taken before meals pass the stomach into the intestines without delay and therefore get absorbed faster. This practice is important in cases where an immediate effect is desired such as pain relief. Plentiful water intake also helps with faster and improved absorption of drugs.

Some medications are packed into capsules made of gelatin-like substances. Medicines with undesirable taste and smell can be offered in this form for consumption. Moreover, if a drug is harmful to the stomach or gets degraded in stomach acid, then this drug can be prepared in capsules that are durable to stomach acid but soluble in the intestines. That is why consumption of medication without its intended capsule should be avoided. In a similar fashion, some medicinal tablets are designed to deliver its molecular contents particularly to the intestines. These types of medication must be taken as a whole unit. Otherwise it can be ineffective or may lead to harmful reactions.

Delivery of drugs to targeted regions

The molecules carrying medication that join the blood via absorption get dispersed by blood circulation throughout the body. These molecules reach various parts of the system via blood vessels, and then diffuse into organs via capillary vessels. However, their entry to the brain is difficult because this vital organ of the body has a special protection to guard itself from possible harmful effects of various substances that enter the body from the outside. Capillary vessels in the brain are different from other capillary structures in the rest of the body as they are created without an intercellular space in between vessel cells. Furthermore, these cells are bound to each other with their tight connective regions.

These capillaries are surrounded by a thicker membrane compared to other capillary vessels. This membrane is also host to various cells that wrap around the vessel. Therefore, because of these factors and other similar ones, some medications can enter the brain in very limited amounts. Drug molecules can display their targeted effects when they bind to target proteins, called receptors, in the organs. These proteins, which are very unique to each drug, exist on the cell membrane or in the cell. In addition, drug molecules also bind to other receptors that are not specific for them, and this causes adverse effects as a result.

Excretion of drugs from the body

Drugs are excreted from the body via the liver and kidneys. One function of these organs is to filter the blood from foreign substances. It was previously mentioned that absorbed substances from intestines are transported to the liver first where some amount gets metabolized and the remaining amount rejoins blood circulation that feeds other organs. Drug molecules that pass through the liver return back to it repeatedly many times because of continual blood circulation. In each of these arrivals, some amount is again metabolized. Molecules of metabolized drugs are excreted out of the body via the kidneys and through the bile at a limited level.

Only some portion of drug molecules get excreted via the kidneys without being metabolized. This ratio is higher with some medications. These types of medications are considered to be removed only by the kidneys, whereas some other drug types cannot be excreted without getting metabolized through the liver. As previously mentioned, the purpose of drug metabolism is to convert drugs into easily removable forms. If these types of drugs are not metabolized, they are rejoined to the blood circulation after filtration by the kidneys without joining the urine. It is impossible for the liver to sense these happening within the kidneys if it was not that the liver and every cell in it were employed by one authority who created them in the first place. Drug molecules concentrate in the liver and kidneys since these organs are employed with drug removal. As a result harmful effects of drugs are often experienced in these organs. Therefore unnecessary drug use should be avoided, otherwise the health of these organs deteriorate and eventually fail to carry out their basic functions.

As noted above, events that are taking place within many of our organs, stomach and elsewhere like kidneys impact on the journey of drugs in our body, therefore changing its effect. The harmonious creation of our organs that are home to many miraculous events is the major component of the entire process in which causations have their due role only as much as they are allowed by their Creator. As a test for humankind, both illness and the cure is provided by God, the All-Healer. Therefore it is the duty of a patient to see a doctor, take the medication properly and never forget that cure is only provided by the Almighty, without obsessing over causational chains.

References

• Guyton, Arthur C., John E. Hall. 1991. Textbook of Medical Physiology, Saunders.
• Patton, Kevin T., Gary A. Thibodeau. 1993. Anatomy & Physiology, Mosby.
• Rang, Humphrey P., Maureen B. Dale, James M. Ritter. 1999. Pharmacology, Churchill Livingstone.
• Brunton, Laurence, John Lazo, Keith Parker. 2006. The Pharmacological Basis of Therapeutics. McGraw-Hill Professional

Nephrology is the study of the kidneys, the essential organ of excretion, and elements related to it. If due observation and research are thoroughly carried out on every part of the human metropolis, when the integrated hierarchical mechanisms are analyzed, it can be seen that numerous events are constantly taking place; these can open new doors to various sciences and offer us new horizons of reflection on the Divine Wisdom. In this way, these events are an interpretation of the saying “If all the seas were to be made up of ink, and all the trees were pens, they would still not be able to write down the knowledge of God,” which points to the existence of an Omnipotent Being with infinite knowledge.

One of these constant activities in our body is the excretion system which works like a well-regulated clock. In the body of a healthy adult, the bladder, after an accumulation of urine that has been filtered through the kidneys, resembles a balloon that has been inflated. The bladder enlarges according with the amount of urine that has been filtered by the kidneys. The autonomous nervous system has a significant role in the wonderful functioning of this urine storage mechanism. If we assume that an average adult urinates 5-6 times a day, we can say that the average time adults spend for urination is about 5 minutes daily. The autonomous system of a baby however, is not properly developed and has a very limited capacity of urine storage. Therefore, the bladder of a baby is frequently emptied. As for newborn babies, the number of times that they empty their bladder can be as much as 20-25 times a day. In this way, both the urine that comes from the kidneys flows to the bladder freely, and the urination channels are automatically cleaned.

In order to allow the urine flowing from the kidneys to the bladder to pass freely through the small tubes that measure between 3-7 mm (the urethra) the inner pressure in the bladder needs to be kept at low levels. This is realized in the body of a baby by the frequent emptying of the bladder, until the autonomous nervous system has properly developed. After the sixth month, the autonomous nervous system develops, the urine storing capacity of the bladder increases, and the number of urination times decreases. As the child grows, the ability to store urine and to excrete it at the proper time and place is completed in a gradual process. Being only one of the hundreds of wonders in the human metropolis, this balance is maintained as a clear reflection of Divine Mercy.

Cooperation in the urinary tract

There is a fascinating cooperation between the departments of this metropolis. The urine that is excreted by the kidneys does an excellent job of cleaning all along the urinary tract, like a river cleaning the stones over which it passes. This cleaning includes not only any microorganisms, but also any gravel which might form in the urination channels. Research has proved that when bacteria are injected into the bladders of healthy people no infection is developed in the urinary tract, since the pressure of their urine excretion drives the bacteria away. The protection of the kidneys by both the expansion of the flexible bladder wall and the decrease in the pressure inside the bladder is a good example of the cooperation between the kidneys and the bladder. If the pressure was not able to be decreased by such flexibility, the kidneys could not function under the resulting high pressure. The smooth functioning of the kidneys is maintained through urine excretion in suitable amounts and at a suitable pressure. Taking all this for granted, one usually comes to realize what a blessing the excretion system is only when there is a problem.

The urination of a baby in the womb

The placenta has the duty of being the main regulator of the feeding and excretion systems of a fetus. The kidneys of a fetus also play significant roles. For instance, they balance acidity through liquid electrolytes, carry out the functions of hormone production, and growth. From the fourth month on, the fetus begins to produce urine and the bladder is filled and emptied every 30-60 minutes. The urine inside the bladder is emptied into the amniotic fluid which surrounds the fetus like a protective pad. The duty of the amniotic fluid includes protecting the fetus against the changes in the mother’s body temperature, providing space for normal development, providing suitable conditions for food and oxygen supply, and protecting the baby against any possible blows that the mother’s belly might be exposed to. The amniotic fluid in which a baby is placed is a liquid similar to urine, and it is produced for the comfort of this new guest to our world.

The formation of urine

The blood, which is charged with transmitting nutrients and oxygen even to the remotest parts of the body, brings the toxic disposal our body has produced due to various causes on its way back to the kidneys. The blood, which bears the responsibility of maintaining the health of metropolis of the body, is continuously filtered when it reaches the kidneys. In the kidneys, the waste material is so delicately separated that it as if the kidneys know “which substance is needed in what amounts,” without meticulous calculation and infinite knowledge. Artificial kidneys supported by latest technology (like modern devices of dialysis) are never a substitute for a real kidney. A healthy kidney, which is made to serve under the veil of causes created by the Owner of infinite knowledge and power, does its duty with divine guidance. It sends what is to be disposed of to the bladder in the form of urine.

The substances urine contains are used when diagnosing illnesses, for they possess different qualities. The color, smell, and density of the urine and the substances it contains give us various clues about the health of that person. Deviations in the sensitive balance established in the excretion system are considered to be a sign of something gone wrong in the human metropolis. In other words, a urine analysis is an important indication of health, for many factors, such as our lifestyle, our eating habits, disease, and the medicines we use can effect changes on the consistency and composition of the urine (figure 1-3). The urine of a healthy person is yellow and clear. This color is derived from the urochrome pigment along with urobilin and uroerythrin. Colorless urine can be seen if there has been recent fluid consumption, or the use of diuretics, or disorders such as different types of diabetes (diabetes mellitus, diabetes insipitus, etc). The color of urine can fluctuate between yellow and clear within the day (for example, 1-2 hours after a meal it can be clear, whereas it can turn to dark orange due when one has been making heavy effort). Beetroot, artificial colorings and some drugs can turn the urine red. When the complaints of a patient are taken together with a medical examination and lab analyses, urine samples which are colored red-brown, blue-grey, milky-white or which are cloudy may all be symptoms of disease.

As we learn new things about urine we will hopefully attain a deeper comprehension of the infinite divine blessings that have been bestowed upon us, offering thanks to our Creator from new perspectives.