The Urinary System

Chapter 23

Introduction
Kidneys - maintain purity and chemical constancy of blood and other extracellular body fluids
- filters liters of fluid sending toxins, metabolic wastes, excess water, and excess ions out in urine - while returning needed substances from the filtrate to the blood

Main waste products are 3 nitrogenous compounds

1) urea derived from breakdown of amino acids 2) uric acid results from the turnover of nucleic acids 3) creatinine formed by the breakdown of creatine phosphate, molecule in muscle that stores energy for manufacture of ATP

 Kidneys also regulate the volume and chemical makeup of the blood
- maintains the proper balance of water and salts and of acids and bases

Other organs of the urinary system include:

- the paired ureters (pertaining to urine), tubes that carry urine from the kidney to the bladder - urinary bladder, temporary storage sac for urine - urethra, a tube that carries urine from the bladder to the body exterior

Organs of the Urinary System

Kidneys Ureters Urinary bladder Urethra

Fig 23.1a

Location and External Anatomy of Kidneys

Bean-shaped kidneys lie retroperitoneal - lateral to T11,12 - L3 vertebrae
- right kidney crowded by the liver lies slightly inferior to the left kidney - on superior part of each kidney is the suprarenal gland

Average kidney 12cm tall, 6cm wide, 3cm thick

- lateral surface, is convex; medial surface is concave - with a vertical cleft, the renal hilum where vessels, ureters, and nerves enter and leave the kidneys

 Several layers of supportive tissue surround each kidney

Fibrous (renal) capsule surrounds the kidney surface
- maintains its shape and forms a barrier that can inhibit the spread of infection from surrounding regions

Perirenal and pararenal fat layers - cushion and help hold the kidneys in place
- perirenal fat capsule lies external to the renal capsule - external to that is an envelope of renal fascia - pararenal fat lies external and mostly posterior to the renal fascia

Relationship of the Kidneys to Vertebra and Ribs

Figure 23.1b

Kidneys within the Posterior Abdominal Wall

Figure 23.2a

Internal Gross Anatomy

Frontal section through the kidney reveals 2 distinct regions:
- superficial renal cortex, lighter in color with a granular appearance - deeper renal medulla, darker color consists of coneshaped masses called renal pyramids - renal pyramids contain parallel bundles of tiny urinecollecting tubules - pyramids apex or papilla points internally - renal columns, inward extensions of the renal cortex, separate adjacent pyramids

Internal Anatomy of the Kidneys

Figure 23.3b

Kidney lobes a single renal pyramid + the cortical tissue that surrounds that pyramid
- 5 to 11 lobes and pyramids in each kidney

Renal sinus large space within the medial part opening to the exterior through the renal hilum
- filled space, contains the renal vessels and nerves, some fat, and the urine-carrying tubes

Renal pelvis flat, funnel-shaped tube

- expanded superior part of the ureter - branching extensions form 2 or 3 major calices (sing. calyx = cup), each divide to form several minor calices - calices collect urine draining from the papillae, empty it into the renal pelvis urine flows into the ureter bladder

Gross Vasculature & Nerve Supply

About 1/4 of the hearts systemic output reaches the kidneys via the large renal arteries
- divide into 5 segmental arteries that enter the hilum - within the renal sinus, each segmental artery divides into interlobar arteries - at the medulla-cortex junction, interlobar arteries branch into arcuate (shaped like a bow) arteries - radiating outward from arcuate arteries are the small cortical radiate arteries (supply the cortical tissue) - give rise to the glomerular arterioles, which feed into the peritubular capillaries

 Veins trace the pathway of the arteries in reverse

except there are no segmental veins

Nerve supply renal plexus (offshoot of the celiac plexus)

- a network of autonomic fibers and autonomic ganglia on the renal arteries - supplied by sympathetic fibers from the inferior thoracic splanchic and 1st lumbar splanchnic nerves, and other sources - fibers control the diameters of the renal arteries and influence the urine-forming functions of the uriniferous (urine-carrying) tubules

Summary of Blood Vessels Supplying the Kidney

Figure 23.3c

Mechanisms of Urine Production

Uriniferous tubule - main structural and functional unit of the kidney
- more than a million within each kidney

3 interacting mechanisms: filtration, resorption, secretion

- in filtration, a filtrate (similar to blood plasma) leaves the kidney capillaries, it is processed into urine by resorption and secretion - during resorptionm nutrients, water, and essential ions are recovered and returned to the blood via tissue capillaries, remaining waste contribute to urine - secretion, removes additional undesirable molecules into the tubule

Uriniferous Tubules
2 major parts: 1) urine-forming nephron, where filtration, resorption, and secretion occur, and 2) a collecting duct, concentrates urine by removing water Uriniferous tubule is lined by simple epithelium, one cell thick, adapted for urine production

Figure 23.4

Nephrons
Composed of the renal corpuscle and a tubular section
- proximal convoluted tubule, loop of Henle, distal convoluted tubule

Renal corpuscle (1st part of the nephron) located in the cortex, where filtration occurs
- consist of a tuft of capillaries called the glomerulus (ball of yarn) surrounded by the glomerular capsule (Bowmans capsule) - glumerulus is supplied by an afferent arteriole and drained by an efferent arteriole

- endothelim is fenestrated, allowing large quantities of fluid and small molecules to pass from the capillary blood into the capsular space - about 20% of the fluid leaves the glomerulus and enters the capsular space; 80% remains in the blood within the capillary - parietal layer of the capsule contributes only to the structure - visceral layer consists of branching epithelial cells called podocytes (foot cells), end in pedicels, foot processes that interdigitate - filtrate passes into the capsular space through thin clefts between the podocytes called filtration slits or slit pores

Uriniferous Tubule

Figure 23.5a

Filtration Membrane
Filtration barrier - lies between the blood in the glomerulus and the capsular space Consists of 3 layers 1) fenestrated endothelium of the capillary 2) filtration slits between the pedicels
- each covered by a thin slit diaphragm

3) intervening basement membrane

- consists of the fused basal laminae of the endothelium and the podocyte epithelium - capillary fenestration restrict passage of the largest molecules (blood cells) - basement membrane & slit diaphragm allow small proteins and molecules (water, ions, glucose, amino acids, urea)

Fig 23.6a

Renal Corpuscle and the Filtration Membrane

Renal Corpuscle and the Filtration Membrane

Fig 23.6c

Tubular Section of the Nephron

After formation in the renal capsule the filtrate proceeds into the long tubular section: Proximal convoluted tubule (renal cortex), is most active in resorption and secretion
- walls are cuboidal epithelial cells with long microvilli on the exposed luminal surface - contain many mitochondria and a highly infolded basolateral membrane with - many ion-pumping enzymes responsible for resorbing molecules from the filtrate

 U-shaped loop of Henle (the nephron) consists of a descending limb and ascending limb

Descending limb, continuous with the proximal tubule (has a similar structure)
- rest of the descending limb, the thin segment, is the narrowest part of the nephron with walls of permeable simple squamous epithelium, continues into the - ascending limb, joining the thick segment or thick ascending limb, cell structure resembles the distal convoluted tubule

 Distal convoluted tubule (in the renal cortex) selective secretion and resorption of ions
- walls of simple cuboidal epithelium - less active in resportion, cells do not have abundant microvilli - but do have many mitochondria and infoldings of the basolateral membrane (typical of all ion-pumping cells in the body)

 2 classed of nephrons 1) Cortical nephrons (85%) almost entirely within the cortex
- loops of Henle dip only a short distance into the medulla

2)Juxtamedullary (near the medulla) nephrons (15%) renal corpuscles lie near the cortexmedulla junction
- loops of Henle deeply invade the medulla - thin segments are much longer - long loops of Henle, with nearby collecting ducts, contribute to production of concentrated urine

Fig 23.8

Collecting tubules - receive urine from distal convoluted tubules

Collecting Ducts
Receive urine from several nephrons runs straight through the cortex into the deep medulla
- adjacent collecting ducts join to form larger papillary ducts that empty into the minor calices - most important role to conserve body fluids is shared with the distal tubules - pituitary gland secretes ADH, increases permeability of the collecting ducts and distal tubules to water; - water is resorbed from the filtrate into the surrounding BVs, decreasing the total volume of urine produced Note: Alcohol inhibits the release of ADH, reduced water resorption from the renal tubules results in copious amounts of dilute urine

Microscopic Blood Vessels

Nephrons are associated with 2 types of capillary beds (a portal system): glomerulus and the peritubular capillaries Juxtamedullary nephrons also associate with the capillary-like vasa recta

Micrograph through the Renal Medulla

Figure 23.7

Glomeruli
Capillaries produce the filtrate that moves through the uriniferous tubule to become urine Both fed and drained by an afferent arteriole and an efferent arteriole (respectively)
- high-resistance vessels, the efferent arteriole is narrower than the afferent arteriole BP is high for a capillary bed and easily forces the filtrate out of the blood and into the glomerular capsule

Kidneys generate 1 L of filtrate every 8 minutes only 1% ends up as urine

- 99% resorbed by the uriniferous tubule, and returned to the blood in the peritubular capillary beds

Peritubular Capillaries
Or intertubular capillaries - arise from the efferent arterioles draining the cortical glomeruli
- lie in the interstitial CT of the renal cortex, areolar CT surrounds the uriniferous tubules - capillaries cling closely to the convoluted tubules and empty into nearby venules of the renal venous system - are adapted for absorption: low-pressure porous capillaries readily absorb solutes and water - all molecules secreted by the nephrons into the urine are from the blood of peritubular capillaries

Vasa Recta (straight vessels)

Located in the deepest part of the renal cortex
efferent arterioles from the juxtamedullary glomeruli continue into these thin-walled looping vessels - part of the kidneys urine-concentrating mechanism

Fig 23.9a

Classes of Nephron

Juxtaglomerular Apparatus
Near the glomerulus functions in the regulation of blood pressure
- area of specialized contact between the terminal end of the ascending limb and the afferent arteriole - within the apparatus, structures of both the tubule and the arteriole are modified - granular cells (juxtaglomerular cells), modified smooth muscle cells (mechanoreceptors) secrete renin in response to falling blood pressure in the afferent arteriole

 Macula densa (dense spot) the terminal portion of the loop of Henle
- tall, closely packed epithelial cells, act as chemoreceptors, monitor solute concentrations in the filtrate - level of solute concentration drops, cells signal the granular cells to secrete renin - renin initiates the renin-angiotensin mechanism that results in secretion of aldosterone from the adrenal cortex - aldosterone increases Na+ resorption, water follows along the osmotic gradient, causing blood volume and BP to rise - extraglomerular mesangial cells interact with cells of the macula densa and granular cells to regulate blood pressure

Figure 23.10

Ureters
Slender tubes ~25cm (10in) long carry urine from the kidneys to the urinary bladder
- begins superiorly at L2 as a continuation of the renal pelvis - descends retroperitoneal through the abdomen, enters the true pelvis into the posterolateral corner of the bladder - runs medially within the posterior bladder wall before opening into the bladders interior - oblique entry into the bladder prevents backflow of urine

Innervated by both sympathetic and parasympathetic nerve fibers

- although neural control of peristalsis is insignificant compared to local stretch response of smooth muscle

Histology of ureter 3 basic layers: Mucosa lining of transitional epithelium that stretches when the ureters fill with urine
- and a lamina propria composed of fibroelastic CT with patches of lymphoid tissue

Muscularis consists of 2 layers

- inner longitudinal layer - outer circular layer

Adventitia in the inferior 1/3 of the ureter is an external longitudinal layer of muscularis
- typical CT

Microscopic Structure of the Ureter

Figure 23.12

Urinary Bladder
Collapsible muscular sac - stores and expels urine Full bladder spherical - expands into the abdominal cavity Empty bladder lies entirely within the pelvis
Figure 23.13

Urinary Bladder
Urachus closed remnant of the allantois Prostate gland - in males - lies directly inferior to the bladder - surrounds the urethra

Figure 23.14

Bladder wall has 3 layers: Mucosa distensible transitional epithelium and a lamina propria Thick muscular layer, the detrusor (to thrust out) muscle intermingled smooth muscle fibers
- arranged in inner and outer longitudinal layers and a middle circular layer - contraction squeezes urine from the bladder

Fibrous adventitia (except on the superior surface which is covered by parietal peritoneum) Basic pyramidal shape contains little urine
- walls are thick and mucosa thrown into folds, or rugae

Histology of the Urinary Bladder

Fig 23.15a, b

Urinary Bladder and Urethra

Trigone (triangle) openings for both the ureters and urethra
- defines a triangular region on the posterior wall

Urethra thin-walled tube

- drains urine from the bladder, conveys it out of the body

Internal urethral sphincter involuntary smooth muscle at the bladder-urethra junction

External urethral sphincter surrounds the urethra

- lies within the urogenital diaphragm muscle - voluntary skeletal muscle inhibits urination until the proper time, relaxes when one urinates

Male Urinary Bladder and Urethra

Long urethra of the male has 3 regions: Prostatic passes through the prostate gland Membranous through the urogenital diaphram Spongy (penile) passes through the length of the penis
Fig 23.16a

Male Urinary Bladder and Urethra

In females length of 3-4 cm

Fig 23.16b

Urethra
Transitional epithelium at the proximal end (near the bladder) Stratified and pseudostratified columnar mid urethra (in males) Stratified squamous epithelium at the distal end (near the urethral opening)

Micturition

Figure 23.17

Disorders of the Urinary System

UTI urinary tract infections, more common in females
- burning sensation during micturition

Renal calculi kidney stones Bladder cancer 3% of cancers, more common in men Kidney cancer
- arises fro epithelial cells of uriniferous tubules

Urinary System Throughout Life

Embryo develops 3 pairs of kidneys: pronephros, mesonephros, metanephros
- only metanephros persists to become the adult kidneys - metanephric kidney produces urine by fetal month 3 - contributes to the volume of amniotic fluid

Development of the Urinary Organs

Figure 23.18a,b

Figure 23.18c, d

Urinary System Throughout Life

Kidney and bladder function declines with advancing age Nephrons decrease in size and number Tubules less efficient at secretion and reabsorption Filtration declines Recognition of desire to urinate is delayed Loss of muscle tone in the bladder