The Urinary System

B. Pimentel, M.D.
University of Makati
College of Nursing
 The Urinary System

STRUCTURE FUNCTION

Kidney Filtration, regulation of blood volume, regulation of

solutes, pH of extra cellular fluid, RBC synthesis,
Vit. D synthesis

Ureters Urine flows from kidneys to urinary bladder

Urinary Storage of urine

bladder
Urethra Transports urine out from the urinary bladder
The Urinary System
 Kidneys (Anatomy)

• Bean shaped, retroperitoneal, and located in the superior

lumbar region, approx. size 11 x 5 x 3 cm.

• Renal capsule – layer of fibrous connective tissue

• Perirenal fat (Adipose capsule) – dense layer of adipose

tissue, engulfs the renal capsule. (Shock absorber)

• Renal fascia – anchors the kidneys and surrounding

adipose tissues to the abdominal wall.
 Kidneys (Anatomy)

• Hilum – medial side of kidney where the renal artery and

nerve enter; renal vein and urethra exit.

• Renal sinus – a cavity at the opening of the Hilum filled

with fat and connective tissue.

• Adrenal (or suprarenal) gland – sits on top of both

kidneys
Kidneys (Anatomy)
 Kidneys (Internal Anatomy)

A. Cortex

B. Medulla

C. Pelvis
 Kidneys (Internal Anatomy)

A. Cortex
– Superficial region

B. Inner medulla
– Renal pyramids – cone
shaped structures that
make up the medulla.

– Medullary rays – extend

from the renal pyramids
into the cortex.
 Kidneys (Internal Anatomy)

– Renal columns – consists

of the same tissue as the
cortex that projects
between the renal
pyramids.
• The bases of the pyramids
form the boundary
between the cortex and the
medulla.

– Renal papillae – tips of the

pyramids project toward
renal sinus.
 Kidneys (Internal Anatomy)

C. Pelvis

• Occupies a large portion of the

renal sinus

• An open space which forms the

ureter as it exits the kidney

• Forms the major and minor

calyces which enclose the
papillae of the renal pyramids
 Kidneys (Internal Anatomy)

– Minor calyces – funnel

shaped chambers into
which the renal papillae
extend.

– Major calyces – a larger

funnel formed by the minor
calyces of several
pyramids.
 Kidneys (Internal Anatomy)

– Each kidney contains 8 to 20 minor calyces and 2 to 3 major

calyces.

– Renal pelvis – convergence of the major calyces to form this

enlarged chamber.

– Ureter – narrowed renal pelvis into a small diameter tube exits at

the Hilum and connects to urinary bladder.
Kidneys (Blood Supply)
 Kidneys (Blood Supply)

• Renal artery - branches from abdominal aorta.

• Segmental arteries - diverge from renal arteries.

• Lobar arteries - branch from segmental arteries and

ascend within the renal columns toward the renal cortex.

• Interlobular arteries - branch to form arcuate arteries

which project into cortex.
 Kidneys (Blood Supply)

• Arcuate arteries - branch from interlobar arteries, diverge

near the base of each renal pyramid and arch over the
bases of the pyramids.

• Afferent arterioles - branch from interlobular arteries

supply blood to the glomerular capillaries.

• Efferent arteriole - arise from glomerular capillaries and

carry blood away from the glomeruli.

• Peritubular capillaries - as efferent arterioles exits the

glomerulus joins a plexus of capillaries around the
proximal and distal tubules. Low pressure capillaries
which are porous aswell.
Kidneys (Blood Supply)
 Kidneys (Blood Supply)

• Vasa recta - specialized parts of the peritubullar

capillaries that course into the medulla along the loops of
Henle and then back toward the cortex.

• Interlobular veins - drainage of peritubullar capillaries.

• Arcuate veins - drainage of the interlobular veins.

• Interlobar veins - drainage of arcuate veins.

• Renal vein - drainage of interlobar veins. Exits the kidney

at the hilum empties into inferior vena cava.
Kidneys (Blood Supply)
Kidneys (Histology)
 Kidneys (Histology)

Nephron
• Histological and functional unit
of the kidney.

• Tube like structure which

serves a the site for filtration,
reabsorption, and secretion
 Kidneys (Histology)

• Juxtamedullary nephron –
nephrons whose renal
corpuscles lie near the
medulla. With long loops of
Henle extending deep into the
medulla, account for 15% of
nephrons.

• Cortical nephrons – loops of

Henle do not extend deep into
medulla.
 Kidneys (Histology)

• Renal corpuscle – consists of

the enlarged end of the
nephron (Bowman’s capsule),
and a network of capillaries
(glomerulus).

• Bowman’s capsule – enlarged

terminal end of the nephron.
Indented to form a double
walled chamber.

• Glomerulus – capillary within

Bowman’s capsule.
 Kidneys (Histology)

Filtration membrane

• Filtration slits – consists of

capillary endothelial fenestrae
and podocyte cells of the
visceral layer of the Bowman’s
capsule which wrap around the
glomerular capillaries.
 Kidneys (Histology)

Afferent arteriole – supplies

blood to the glomerulus.

Efferent arteriole – drains

blood from the capillary.
 Kidneys (Histology)

Proximal tubule – simple

cuboidal epithelium with
microvilli projecting from the
luminal surface.

Loops of Henle –
continuations of the
proximal tubules, consists
of two loops:
– descending and ascending
loops.
 Kidneys (Histology)

Descending loop of Henle –

first part is similar in
structure to the proximal
tubule the loop that
extends into the medulla
become very thin near the
end of the loop.
– There is an abrupt change
to simple squamous
epithelium.
 Kidneys (Histology)

Ascending loop – continuous

in diameter of the
descending loop then
thickens with simple
cuboidal cells near the
renal corpuscle.
 Kidneys (Histology)

Distal tubule – shorter than

proximal tubules, simple
cuboidal epithelium,
– do not posses a large
number of microvilli.
 Kidneys (Histology)

Collecting ducts –
connection of many distal
tubules of many
nephrons. Forms much
of the medullary rays and
extend through the
medulla towards the tips
of the renal pyramids.
 Urine Production

• Filtration – movement of fluid across the filtration

membrane as a result of a pressure difference.
– Filtrate – fluid entering the nephron.

• Reabsorption – movement of substances from the filtrate

back into the blood.

• Secretion – active transport of solutes into the nephron

Urine Production
 Urine Production (Filtration)

• Renal fraction – the part of the cardiac output that passes

through the kidneys. Average 21% of cardiac output.

• Filtration fraction – part of the plasma flowing through the

kidney that is filtered through the filtration membrane into
the lumen of Bowmen’s capsule to become filtrate.

• Glomerular filtration rate – the amount of filtrate produced

each minute. 120-125ml/min.
– 1 to 2 liters of urine are produced per day.
 Urine Production (Filtration)

• Filtration pressure – pressure gradient which forces fluid

from the glomerular capillary across the filtration
membrane into the lumen of Bowmen’s capsule.

– Smooth muscle in the walls of the afferent and efferent arterioles

can alter the vessel diameter and the glomerular filtration
pressure.
– The diameter of the afferent arteriole is greater than the diameter
of the efferent arteriole.
– High hydrostatic pressure
– Glumerular endothelium is highly permeable
Urine Production (Filtration)
 Urine Production
(Reabsorption)
• 99% of the filtrate leaves the nephron (proximal and distal
tubules, and loop of Henle) to enter the interstitial fluid.

• These substances then enter the low pressure

peritubullar capillaries and flow through the renal veins
back to general circulation.

• Solutes reabsorbed from the lumen of the nephron to the

interstitial fluid include; Potassium, Sodium, Calcium,
Magnesium, Chloride, Phosphate

• Organic nutrients: Glucose and Amino acids

Urine Production
(Reabsorption)
 Urine Production
(Reabsorption)
• Sodium reabsorption
– Active transport via Na+/K
pump

• Water reabsorption
– Obligatory due to osmotic
gradient created by Na+
reabsorption
 Urine Production
(Reabsorption)
• Glucose reabsorption
– secondary active transport
or cotransport
Urine Production
(Reabsorption)
 Urine Production
(Reabsorption)
• Proximal convoluted tubule
– Highest concentration of reabsortion
– NaCl and H2O
• Loop of Henle
– NaCl and H2Oreabsorption will be crucial for the creation of an
osmotic gradient between the renal cortex and renal medulla.
• DCT
– NaCl and H2O reabsorption influenced by the presence of
aldosterone.
• Collecting duct
– reabsorption of H2O due to ADH
 Urine Production (Secretion)

• The movement of some substances, such as by products

of metabolism that become toxic in high concentrations
and drugs or molecules not normally produced by the
body, into the nephron.

• Some of the secreted products include:

– Ammonia, Potassium, Hydroxybenzoates, Neurotransmitters, Bile
pigments, Uric acid, Drugs, Toxins
 Thinking back…

1. Glumerular Filtration Rate (GFR)

3. Filtration Pressure

5. Filtration Membrane
Thinking back…
Thinking new!
 Urine Concentration

• Osmolarity
– A solution's osmolarity is
the number of solute
particles dissolved in the
volume of solvent.
– It's indicative of the
solution's ability to cause
osmosis.
– Normal plasma osmolality:
300 milliosmoles per liter
 Urine Concentration

• The loops of Henle in the juxtamedullary nephrons

creates this osmotic gradient
– As filtrate passes through the ascending limb of the loop of
Henle, sodium is pumped out into the interstitial fluid.
– As the filtrate reaches the distal tubule, the filtrate is dilute or
hyposmotic.
• Ascending limb of the loop is impermeable to water, so water can't
follow the pumped sodium.
• The urine osmolarity falls to about 100 mOsm/L.
• The salt pumped out raises the ISF osmolarity to as high as 1200
mOsm/L in the medulla of the kidney.
– This creates a gradient with the cortex isotonic to plasma (300 mOsm/L)
and the medulla very hypertonic (1200 mOsm/L).
Urine Concentration
Urine Concentration
 Urine Concentration

• When large amounts of water are ingested it is necessary

to excrete large amounts of water but not large amounts
of solutes. Thus, the urine excreted is of low
concentration.

• When small amounts of fluid are ingested, the urine must

be concentrated with the small amount of water excreted
to avoid dehydration.
 Urine Concentration

• These are accomplished by;

– Medullary concentration gradient – maintains a high
concentration of solutes in the medulla, this is dependent on the
function of the loops of Henle, the vasa recta, and on the
distribution of urea.

– Countercurrent system – the vasa recta perform this function. It

is a system of parallel tubes in which fluid flows in opposite
directions. The walls of the vasa recta are permeable to water
and solutes.

– Urea – responsible for a substantial part of the high osmolality in

the medulla.
 Regulation (ADH)

• Acts on distal tubules and collecting ducts.

• Absence of ADH results in impermeability of water at the

distal tubule and collecting ducts.

• Diabetes insipidus – insufficient secretion of ADH,

production of up to 20 liters of dilute urine per day.
 Regulation (ADH)

• Stimulation of ADH secreting neurons is regulated by

osmolality of the blood and the interstitial fluid, and blood
pressure.
– Reduced osmolality and increasing blood pressure inhibits
secretion of ADH.
– Increased osmolality and decreased blood pressure increase
secretion of ADH.
 Regulation (Aldosterone)

• Increases the transport of sodium out of the filtrate and

back into the blood

• Resulting in increased urine volume and increased

sodium concentration.
Renin-Angiotensin-Aldoeterone
Axis
 Renin-Angiotensin-Aldoeterone
Axis
During low [Na] or low BP
• Juxtaglumerular cells secrete renin which converts angiotensinogen
into angiotensin I

• Angiotensin I will be converted into angiotensin II by Angiotensin

Converting Enzyme (ACE)

• Angiotensin II is a potent vasoconstrictor and thus increases BP

– The increase in BP will increase Filtration pressure and GFR.
– Stimulate the release of aldosterone from the adrenal glands and ADH
from the posterior pituitary
 Regulation (Autoregulation)

• Involves changes in the degree of vasoconstriction of the

afferent arterioles.

• Maintenance, within the kidneys, of a relatively stable

glomerular filtration rate.

• Glomerular filtration rate is relatively constant as systemic

blood pressure changes between 90 and 180 mmhg.
 Regulation (Autoregulation)

• Increases in blood pressure causes the vasoconstriction

of the afferent arterioles to prevent an increase in renal
blood flow and the filtration pressure across the filtration
membrane.

• Decreased blood pressure results in less vasodilation of

the afferent arterioles thus preventing a decrease in renal
blood flow and filtration pressure across the filtration
membrane.
Regulation (Autoregulation)
Regulation (Autoregulation)
 Micturation Reflex

• Activated by stretching of the urinary bladder wall,

resulting elimination of urine.

• Micturition center is located in the pons and cerebrum.

• Parasympathetic stimulation causes the walls to contract

and the external urinary sphincter to relax.
 Urethers

• Slender tubes which

serves to conduct urine
from the kidneys to the
bladder

• Histology: Transitional
epithelium with smooth
muscles and a fibrous
adventitia
 Urinary Bladder

• A muscular sac which is located anterior to the rectum in

males and in females, is anterior to the vagina and
uterus.

• Trigone: Triangular region within the bladder which forms

the opening for 2 urethers and urethra

• Histology: Transitional epithelium with a muscular layer

(detrusor muscle)
 Urinary Bladder and Urethra

• A thin walled muscular tube which drains the urine out

from the bladder

• Histology:
– Proximal, transitional epithelium
– Middle, pseudostratified columnar epthelium
– Distlally, stratified squamous

• Sphincters
– Internal – junction between the bladder and urethra (involuntary)
– Extrenal - voluntary
Urethra
END