The Urinary System

• Functions of urinary system

• Anatomy of kidney
• Urine formation
– glomerular filtration
– tubular reabsorption
– tubular secretion
• Urine and renal function tests
• Urine storage and elimination
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 Urinary System

Two kidneys

Two ureters

Urethra

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Kidney Location

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Three layers of supportive tissue surround each kidney:
1. Renal capsule
--- fibrous, transparent capsule
--- adheres directly to the kidney surface
--- provides a strong barrier that prevents infections in surrounding
regions from spreading to the kidneys
2. Adipose capsule
--- middle layer
--- fatty mass
--- helps to hold the kidney in place against the posterior trunk muscles
and cushions it against blows
3. Renal fascia
--- the outermost layer
--- dense connective tissue
--- surrounds not only the kidney and its attendant membranes, but also
the adrenal gland and anchors these organs to surrounding structures
 INTERNAL ANATOMY: 3 Distinct
Regions
1. Renal cortex
--- the most superficial region
--- light in color and has a granular appearance
2. Renal medulla
--- deep to the cortex
--- darker, reddish brown which exhibits cone-shaped tissue
masses called medullary or renal pyramids
3. Renal pelvis
--- medial to the hilus within the renal sinus
--- funnel-shaped tube which is continuous with the ureter
leaving the hilus
BLOOD AND NERVE SUPPLY
The kidneys receive 25% of the total cardiac
output/minute.
The vascular pathway through a kidney is as follows:

Aorta  renal artery  segmental arteries  lobar

arteries  interlobar arteries  arcuate arteries 
interlobular arteries  afferent arterioles  glomeruli
 efferent arterioles  peritubular capillary beds 
interlobular veins  arcuate veins  interlobar veins
 renal vein  inferior vena cava
 Kidney Functions
• Filters blood plasma
– returns useful substances to blood
– eliminates waste
• Regulates
– osmolarity of body fluids, blood volume, BP
– acid base balance
• Secretes
– renin and erythropoietin
• Detoxifies free radicals and drugs
• Gluconeogenesis 23-7
 Nitrogenous Wastes
• Urea
– proteinsamino acids NH2
removed forms ammonia, liver
converts to urea
• Uric acid
– nucleic acid catabolism
• Creatinine
– creatine phosphate catabolism
• Renal failure
– azotemia: BUN, nitrogenous
wastes in blood
– uremia: toxic effects as wastes
accumulate 23-8
 Excretion
• Separation of wastes from body fluids and
eliminating them; by four systems
– respiratory: CO2
– integumentary: water, salts, lactic acid, urea
– digestive: water, salts, CO2, lipids, bile
pigments, cholesterol
– urinary: many metabolic wastes, toxins,
drugs, hormones, salts, H+ and water

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 Anatomy of Kidney
• Position, weight and size
– retroperitoneal, level of T12 to L3
– about 160 g each
– about size of a bar of soap (12x6x3 cm)
• Shape
– lateral surface - convex; medial - concave
• CT coverings
– renal fascia: binds to abdominal wall
– adipose capsule: cushions kidney
– renal capsule: encloses kidney like cellophane
wrap 23-10
 Anatomy of Kidney

• Renal cortex: outer 1 cm

• Renal medulla: renal columns, pyramids - papilla
• Lobe of kidney: pyramid and it’s overlying cortex
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Lobe of Kidney

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 Renal Corpuscle

• Glomerular filtrate collects in capsular space, flows into renal tubule

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 Renal (Uriniferous) Tubule
• Proximal convoluted
tubule (PCT)
– longest, most coiled,
simple cuboidal with
brush border
• Nephron loop - U
shaped; descending
and ascending limbs
– thick segment
(simple cuboidal)
initial part of
descending limb and
part or all of
ascending limb,
active transport of
salts
– thin segment (simple
squamous) very
water permeable
• Distal convoluted
tubule (DCT)
– cuboidal, minimal 23-14
microvilli
 Renal (Uriniferous) Tubule 2
• Collecting duct
– several DCT’s join

• Flow of glomerular
filtrate:
– glomerular capsule
 PCT  nephron
loop  DCT 
collecting duct 
papillary duct 
minor calyx 
major calyx  renal
pelvis  ureter 
urinary bladder  23-15
urethra
Nephrons
• True proportions of nephron
loops to convoluted tubules
shown
• Cortical nephrons (85%)
– short nephron loops
– efferent arterioles branch off
peritubular capillaries
• Juxtamedullary nephrons
(15%)
– very long nephron loops,
maintain salt gradient, helps
conserve water
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 Nephron Diagram

• Peritubular capillaries shown only on right

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 Path of Blood Through Kidney
• Renal artery
 interlobar arteries (up renal columns, between lobes)
 arcuate arteries (over pyramids)
 interlobular arteries (up into cortex)
 afferent arterioles
 glomerulus (cluster of capillaries)
 efferent arterioles (near medulla  vasa recta)
 peritubular capillaries
 interlobular veins  arcuate veins  interlobar veins
• Renal vein
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Blood Supply Diagram

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Urine Formation Preview

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Mechanisms of Reabsorption in the Proximal Convoluted Tubule

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 Tubular Secretion of PCT
and Nephron Loop
• Waste removal
– urea, uric acid, bile salts, ammonia,
catecholamines, many drugs
• Acid-base balance
– secretion of hydrogen and bicarbonate ions
regulates pH of body fluids
• Primary function of nephron loop
– water conservation
– generates salinity gradient, allows CD to conc.
urine
– also involved in electrolyte reabsorption 23-22
 DCT and Collecting Duct
• Principal cells – receptors for hormones;
involved in salt/water balance
• Intercalated cells – involved in acid/base
balance
• Function
– fluid reabsorption here is variable, regulated
by hormonal action

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 DCT and Collecting Duct
• Aldosterone effects
  BP  renin release  angiotensin II
formation
– angiotensin II stimulates adrenal cortex
– adrenal cortex secretes aldosterone
• promotes Na+ reabsorption  promotes water
reabsorption   urine volume  maintains BP

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 DCT and Collecting Duct
• Effect of ADH
– dehydration stimulates hypothalamus
– hypothalamus stimulates posterior pituitary
– posterior pituitary releases ADH
– ADH  water reabsorption
  urine volume

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 DCT and Collecting Duct
• Atrial natriuretic peptide (ANP)
– atria secrete ANP in response to  BP
– has four actions:
1. dilates afferent arteriole, constricts efferent
arteriole -  GFR
2. inhibits renin/angiotensin/aldosterone
pathway
3. inhibits secretion and action of ADH
4. inhibits NaCl reabsorption
• Promotes Na+ and water excretion, 
urine volume,  blood volume and BP 23-26
 DCT and Collecting Duct
• Effect of PTH
  calcium reabsorption in DCT -  blood Ca2+
  phosphate excretion in PCT,  new bone
formation
– stimulates kidney production of calcitriol

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Collecting Duct Concentrates
Urine

• Osmolarity 4x as concentrated
deep in medulla
• Medullary portion of CD is more
permeable to water than to NaCl
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 Control of Water Loss
• Producing hypotonic urine
– NaCl reabsorbed by cortical CD
– water remains in urine
• Producing hypertonic urine
– dehydration   ADH   aquaporin
channels,  CD’s water permeability
– more water is reabsorbed
– urine is more concentrated

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 Countercurrent Multiplier
• Recaptures NaCl and returns it to renal medulla
• Descending limb
– reabsorbs water but not salt
– concentrates tubular fluid
• Ascending limb
– reabsorbs Na+, K+, and Cl-
– maintains high osmolarity of renal medulla
– impermeable to water
– tubular fluid becomes hypotonic
• Recycling of urea: collecting duct-medulla
– urea accounts for 40% of high osmolarity of medulla
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Countercurrent Multiplier
of Nephron Loop Diagram

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 Countercurrent Exchange System

• Formed by vasa recta

– provide blood supply to medulla
– do not remove NaCl from medulla
• Descending capillaries
– water diffuses out of blood
– NaCl diffuses into blood
• Ascending capillaries
– water diffuses into blood
– NaCl diffuses out of blood
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Maintenance of Osmolarity
in Renal Medulla

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 Summary of Tubular
Reabsorption and Secretion

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Composition and Properties of Urine
• Appearance
– almost colorless to deep amber; yellow color due to
urochrome, from breakdown of hemoglobin (RBC’s)
• Odor - as it stands bacteria degrade urea to ammonia
• Specific gravity
– density of urine ranges from 1.001 -1.028
• Osmolarity - (blood - 300 mOsm/L) ranges from
50 mOsm/L to 1,200 mOsm/L in dehydrated person
• pH - range: 4.5 - 8.2, usually 6.0
• Chemical composition: 95% water, 5% solutes
– urea, NaCl, KCl, creatinine, uric acid
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 Urine Volume
• Normal volume - 1 to 2 L/day
• Polyuria > 2L/day
• Oliguria < 500 mL/day
• Anuria - 0 to 100 mL/day

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 Diabetes
• Chronic polyuria of metabolic origin
• With hyperglycemia and glycosuria
– diabetes mellitus I and II, insulin
hyposecretion/insensitivity
– gestational diabetes, 1 to 3% of pregnancies
• ADH hyposecretion
– diabetes insipidus; CD  water reabsorption

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 Diuretics
• Effects
  urine output
  blood volume
• Uses
– hypertension and congestive heart failure
• Mechanisms of action
  GFR
  tubular reabsorption

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 Renal Function Tests
• Renal clearance: volume of plasma cleared of a
waste in 1 minute
• Determine renal clearance (C) by assessing
blood and urine samples: C = UV/P
– U (waste concentration in urine)
– V (rate of urine output)
– P (waste concentration in plasma)
• Determine GFR: inulin is neither reabsorbed or
secreted so its GFR = renal clearance GFR =
UV/P
• Clinical GFR estimated from creatinine excretion
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 Urine Storage and Elimination
• Ureters (about 25 cm long)
– from renal pelvis passes dorsal to bladder and
enters it from below, with a small flap of
mucosa that acts as a valve into bladder
– 3 layers
• adventitia - CT
• muscularis - 2 layers of smooth muscle with
3rd layer in lower ureter
– urine enters, it stretches and contracts in
peristaltic wave
• mucosa - transitional epithelium
– lumen very narrow, easily obstructed 23-42
Urinary Bladder and Urethra -
Female

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 Urinary Bladder
• Located in pelvic cavity, posterior to pubic
symphysis
• 3 layers
– parietal peritoneum, superiorly; fibrous adventitia rest
– muscularis: detrusor muscle, 3 layers of smooth
muscle
– mucosa: transitional epithelium
• trigone: openings of ureters and urethra,
triangular
• rugae: relaxed bladder wrinkled, highly
distensible
• capacity: moderately full - 500 ml, max. - 800 ml
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Female Urethra
• 3 to 4 cm long
• External urethral orifice
– between vaginal orifice and
clitoris
• Internal urethral sphincter
– detrusor muscle thickened,
smooth muscle, involuntary
control
External urethral sphincter
skeletal muscle, voluntary
control
23-45
Male Bladder and Urethra

• 18 cm long
• Internal urethral sphincter
• External urethral sphincter
3 regions
prostatic urethra
during orgasm receives semen
membranous urethra
passes through pelvic cavity
spongy urethra

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 Voiding Urine - Micturition
• 200 ml urine in bladder, stretch receptors send
signal to sacral spinal cord
• Signals ascend to
– inhibitory synapses on sympathetic neurons
– micturition center (integrates info from amygdala, cortex)
• Signals descend to
– further inhibit sympathetic neurons
– stimulate parasympathetic neurons
• Result
– urinary bladder contraction
– relaxation of internal urethral sphincter
• External urethral sphincter - corticospinal tracts to
sacral spinal cord inhibit somatic neurons - relaxes 23-47
Neural Control of Micturition

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Hemodialysis

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