Anatomy and Physiology

The Urinary System

The urinary tract is composed of four structures:

 Kidney
 Ureters
 Bladder
 Urethra

The kidneys balance the urinary excretion of substances against the

accumulation within the body through ingestion or production. Consequently, they are
a major controller of fluid and electrolytes homeostasis. The kidneys also have several
no excretory metabolic and endocrine functions, including blood pressure regulations,
erythropoietin regulation and vitamin D metabolism.

Filtration at the renal glumerulus is the first steps in urine formation. Normally, a
volume equal to plasma volume is filtered every 24 minutes and a volume equal to total
body water is filtered every 6 hours. This glomerular filtrate is similar to plasma, but it lack
cells and large-molecular-weight proteins. The glomerular filtrate is modified by active
transport, diffusion and osmosis as it passes through the renal tubules. Reabsorption of
filtrate components enhances elimination of organic acids and bases (and some
drugs). The remnants of the glomerular filtrate exit the kidney through the uterus.

The ureters conduct urine from the kidney to the bladder by peristaltic
contraction. The bladder is distensible chamber that stores urine until it is excreted. The
urethra is the exit passageway from the bladder that carries urine for elimination from
the body.
 Structures of the Urinary System

The kidneys are located retro peritoneal, in the posterior aspects of the
abdomen, on either side of the vertebral column. They lie between the 12th thoracic
and the third lumbar vertebrae. The left kidney is usually positioned slightly higher than
the right. Adult kidney average approximately 11 cm in length, 5 to 7.5 cm in width and
2.5 cm in thickness. Affixing the kidneys in position behind the parietal peritoneum is a
mass of perirenal fat (adipose capsule) and connective tissue called Gerota's
(subserosa) fascia. A fibrous capsule (renal capsule) forms the external covering of the
kidney except for the hilum. The kidney is further protected by layers of muscles of the
back. Flank abdomen as well as by layer of fat, subcutaneous tissues and the skin.

The kidney has a characteristics curve shape, with a convex distal edge and a
concave medial boundary. In the innermost part of the concave section is hilus,
through which pass the renal artery, renal vein, lymphatic, nerves and renal pelvis (the
natural upper extension of the ureter). A fibrous capsule surrounds each kidney and
adheres the renal parenchyma. Each kidney is divided in to three major areas: (1)
cortex, (2) medulla and (3) pelvis.
The cortex of the kidney lies just under the fibrous capsule, and portions of the
extend down into the medulla layer to form the renal columns (columns of Bertin) or
cortical tissue that separates the pyramids. The medulla is divided into eight to 18 cone
shaped masses of collecting ducts called the renal pyramids. The bases of the pyramids
are positioned on the corticomedullary boundary. Their apices extend toward the renal
pelvis, forming papillae. The papillae have 10-25 openings each on the surface, through
which the urine empties into the renal pelvis. Eight or more groups of papillae are
present in each pyramid; each empties into a minor calix and several minor calices join
to form a major calix. The two or three major calices are outpouching of the renal pelvis
(inner area of the kidney). They channel urine from the pyramids to the renal pelvis. The
renal pelvis is a cavity lined with transitional epithelium. The combined volume of the
pelvis and calices is approximately 8 ml. Volumes in excess of this amount damage the
renal parenchyma tissue. The renal pelvis narrows and reaches the hilus and becomes
the proximal end of the ureter.
 Within the cortex lies the nephron, the functional unit of the kidney, consisting
both vascular and tubular elements. Filtration begins at the glumerulus. The glomerular
tuft (glumerulus) contains capillaries and the beginning of the tubule system, Bowman's
capsule. Filtrate from the glumerulus enters the Bowman's capsule and the passes
through a series of tubule segments that modify the filtrate as it passes through the renal
cortex and medulla and finally, flows into the renal calices. A second capillary bed, the
peritubular capillaries, carries the reabsorbed water and solutes back towards the vena
cava..

Renal Blood Flow, Glomerular Filtration

The kidneys receive 20% to 25% of the cardiac output under resting conditions,
averaging more that 1 L of the arterial blood per minute. The renal arteries branch from
the abdominal aorta at the level of the second lumbar of vertebra, enter the kidney,
and progressively branch into lobar arteries, inner lobar arteries, accurate arteries and
interlobular arteries. Blood flows from the inerlobular arteries through the afferent
arteriole and the peritubular capillaries carry a small amount of blood (5% of renal
blood flow) to the renal medulla in the vasa recta (long, straight blood vessels) before
entering the venous drainage. The blood leaves the kidney in a venous system closely
corresponding to the arterial system: interlobular veins, accurate veins, interlobular
veins, and the renal vein. The renal circulation then empties the inferior vena cava.

Ureters

The ureters from the medial tapering of the renal pelvis at the hilus of the kidney.
Usually 25-35 cm long in the adult, the ureters lie in the extraperitoneal connective tissue
and descend vertically along the psoas muscle towards the pelvic cavity. After dipping
into the pelvic cavity, the ureters course anteriorly to join the bladder in its
posterolateral aspect. At each ureterovesical junction, the ureter runs obliquely through
the bladder wall for about 1.5 to 2 cm before opening into the lumen of the bladder.

Each ureter has elastic characteristics and is made of three tissues layers; (1) an
inner mucosa (transitional epithelial membrane) lining the lumen, (2) a muscular layer
and (3) a fibrous outer layer. The musculature is generally designed as inner longitudinal
and outer circular. Along most of the ureter, however, the muscle fiber actually run
obliquely and blends with one another to form a mesh-like tissue. The muscle
arrangement allows urine to propel down by the ureter by peristaltic action. Peristalsis is
regulated by a myogenic pacemaker located near the renal calices.

Blood is supplied to ureters by one or more vessels that run longitudinal along the
tube. The number and assortment of articles anastomosing with the ureteric vessels vary
with each individual. Because the ureters travel through several anatomic areas, the
urethral vessels are fed several of the following arteries: (1) renal (frequently), (2)
testicular or ovarian, (3) aorta and common iliac, (4) internal iliac (frequently), (5)
vesical, (6) umbilical and (7) uterine.

Bladder

The urinary bladder is a hallow organ located in the anterior half of the pelvis
behind the symphisis pubis. The space between the bladder and symphisis pubis is filled
with a loose connective tissue that allows the bladder to stretch cranially as it fills. The
peritoneum covers the top border of the bladder, and the base is held loosely in place
by the true ligaments. The bladder is also enveloped by a loose fascia.
 Urethra

The urethra differs greatly in females and males. The urethra is a muscular tube
that connects the bladder with the outside of the body. The function of the urethra is to
remove urine from the body. It measures about 1.5 inches (3.8 cm) in a woman but up
to 8 inches (20 cm) in a man. Because the urethra is so much shorter in a woman it
makes it much easier for a woman to get harmful bacteria in her bladder this is
commonly called a bladder infection or a UTI. The most common bacteria of a UTI is E-
coli from the large intestines that have been excreted in fecal matter. Female urethra.
In the human female, the urethra is about 1-2 inches long and opens in the vulva
between the clitoris and the vaginal opening.

Men have a longer urethra than women. This means that women tend to be more
susceptible to infections of the bladder (cystitis) and the urinary tract.
SUMMARY OF FINDINGS
CONCLUSIONS

Acute Glomerulonephritis is relatively common bilateral inflammation of the

glomeruli. It follows a streptococcal infection of the respiratory tract or less commonly, a
skin infection. It is a must that we should give enough attention to those suffering of
such disease so as to prevent aggravation and further complications that could
possibly occur. To help patient to cope up with his/her condition we are to perform
proper monitoring and treatment.

As a student nurse, the student should be competitive enough, equipped with

enough and accurate knowledge of the disease. Not just with learning through lectures
and theories is the way to understand these diseases. Through interaction, knowledge
acquired from theories was much appreciated by the students since he/she can
actually assess the patient’s condition. Equip with enough and accurate information
and enhance skills, she/he may be able to be competitive enough to handle future
situations and patients suffering from the mentioned condition.

Bibliography:
 www.yahoo.com
 www.emedicine.com
 Medical Surgical Nursing
 PDR Nurses Drug Handbook 2005
 Nurse’s Pocket Guide
 http://en.wikibooks.org/wiki/Human_Physiology/The_Urinary_
System#Urethra