Urinary System

Introduction

Dr Sami Abdo Radman

 Urinary system
• Includes:
• Two kidneys,
• Two ureters,
• The urinary bladder,
• Two sphincter muscles, and
• The urethra
Urinary System – Anterior/Posterior Views
Costovertebral Angle (renal angle)

T11

R. Kidney L. Kidney
T12

12th Rib L
1
Costovertebral Angle
 Kidney anatomy
• Kidney is reddish-brown
• Lie in the superior lumber region of the posterior
abdominal wall
• weight about 300 g
• Looks like a bean
• Approximately 4 inches x 2 inches
• Extend from the level of the 11th or 12th thoracic
vertebra to the 3rd lumber vertebra
• Hilus – indentation where blood vessels and
structures enter or exit the kidney
 Kidney anatomy
–Two parts :
–Cortex: Glomerular apparatus
–Medulla:
Consists of about 1 million filtering
units called nephrons (basic
structural and functional unit)
 Renal Medulla
• Dark, triangular structure
• Form small cone shaped
regions called renal
pyramids
• Each pyramid is separated
by renal columns
• The lower ends of the
pyramids point to the renal
pelvis
• 5-11 pyramids in each
kidney
 Renal pelvis

• The major function of the renal pelvis is to

act as a funnel for urine flowing to the ureter.
• The renal pelvis represents the funnel-like
dilated proximal part of the ureter.
• It is the point of convergence of two or three
major calices.
• Each renal papilla is surrounded by a branch
of the renal pelvis called a calyx.
• Infection of renal pelvis is called pyelitis
 Ureters
• Urine is collected in the renal pelvis
• renal pelvis connects to the ureters,
which carry urine to the bladder.
• The ureters are about 200 to 250 mm
long.
• Smooth muscular tissue in the walls of
the ureters peristaltically force the urine
downward.
 Urinary bladder
• The urinary bladder is a hollow muscular organ
shaped like a balloon.
• It is located in the pelvic fossa and held in place by
ligaments attached to the pelvic bones.
• Located behind the symphasis pubis
• The bladder stores urine - up to 500 ml of urine
comfortably for 2 to 5 hours.
• Sphincters (circular muscles) regulate the flow of
urine from the bladder.
– Internal urethral sphincter = in the beginning of urethra
smooth muscle – not under our voluntary control
– External urethral sphincter = skeletal muscle – we can
control it
 Urethra
• The urethra has an excretory function in both sexes,
to pass urine to the outside
• A reproductive function in the male, as a passage for
sperm.
• The external urethral sphincter is a striated smooth
muscle that allows voluntary control over urination.
• Urethral sphincters:
– Internal
– External
• In males the internal and external urethral sphincters
are more powerful, able to retain urine for twice as
long as females
 Nephron

• Each kidney contains about 1 million

nephron units
• The number does not increase after birth
• They cannot be replaced if damaged
• 2 parts
– Renal curpuscles (Glomerulus, Bowmans
capsule)
– Renal Tubules
• Renal curpuscles
 Glomerular capsule (Bowman’s Capsule) – “C”
shaped capsule surrounding the glomerulus
 Glomerulus – cluster of capillaries
• Renal Tubules
– Proximal convoluted tubule
– Loop of Henle – ascending and descending limb
– Distal Convoluted tubule
– Collecting duct
 Renal Vasculature
• Receives blood from the renal artery
• Renal artery branches into the afferent arterioles
• Afferent arterioles feed into Bowman’s capsule
• The efferent arterioles exit Bowman’s capsule
• The efferent arterioles form the peritubular
capillaries
• The peritubular capillaries empty into the venules,
large veins, and then into the renal veins
• .
 Function of urinary system
• Excretion
• Keeping homeostasis
• Keeping acid-base balance PH
• Regulation of blood pressure (rennin)
• Formation of RBCs (erythropoiesis) by secretion of erythropoetin)
• Vitamin D synthesis
Excreted products:
• Product of the metabolism (It clears urea, a nitrogenous waste
product)
• Water
• Hormones
• Vitamins
• Toxic substances
• Regulation of blood volume:
The kidneys conserve or eliminate water from the blood,
which regulates the volume of blood in the body.
• Regulation of blood pressure:

• Adjusting the volume of blood in the body (by regulating

the quantity of water in the blood

• Action of the enzyme renin. The kidneys secret renin,

which activates the angiotensin-aldosterone pathway.

• Regulation of the pH of the blood:

The kidneys excrete H+ ions (hydrogen atoms that lack
their single electron), into urine. At the same time, the
kidneys also conserve bicarbonate ions (HCO3-), which
are an important buffer of H+.
• pH 7.4.
• The process of separating wastes from the
body fluids and eliminating them, is known
as excretion
 Formation of Urine
• Three processes are involved in urine
formation
– Glomerular filtration
– Tubular reabsorption
– Tubular secretion
 (1)Glomerular Filtration
• The diameter of the afferent (incoming) arteriole is
greater than the diameter of the efferent arteriole
• The pressure of the blood inside the glomerulus is
increased due to the difference in diameter of the
incoming and out-going arterioles.
• This increased blood pressure helps to force the
following components of the blood out of the glomerular
capillaries:
• Most of the water;
• Most/all of the salts;
• Most/all of the glucose;
• Most/all of the urea.
• Blood cells and plasma proteins are not filtered
through the glomerular capillaries.
. Presence of cells and protein indicate a kidney
dysfunction
• The water and salts that have been forced out of
the glomerular capillaries pass into the Bowman's
Capsule and are called the glomerular filtrate.
• Renal blood flow= 1200- 1300 ml/ min, (cardiac
output=5600 ml/min)
• This glomerular filtrate is formed at a rate of
above 125 cm3 (mL) per minute (glomerular
filtration rate) =7.5 L/h =180L/day
• This volume is approx. 20% of the plasma
delivered during that time
• Urine volume=1L/day (depends on ……………)
 (2)Tubular Reabsorption
• Only about 1% of the glomerular fitrate
actually leaves the body because the
rest (the other 99%) is reabsorbed into
the blood while it passes through the
renal tubules
• Most of the volume of the fitrate
solution is reabsobed in the proximal
convoluted tubule (PCT)
 (3)Tubular Secretion
• Substances being added to the tubular
fluid from the efferent arterioles
 CLEARANCE
• The GFR can be measured by measuring the
excretion and plasma level of a substance that
is freely filtered through the glomeruli and neither
secreted, nor reabsorbed by the tubules
• Amount per unit of time
• GFR = (UX) V/ PX
– (UX) = concentration of X in the urine
– V= urine flow per unit of time
Eg . Inulin
– PX = concentration of X in the plasma
 CLEARANCE
• Example:
• UIN=35 mg/Ml
• V= 0.9 mL/min
• PIN= 0.25 mg/Ml
• CIN=35х0.9/0.25 = 126ml/min
 )Micturition(
• The process of disposing urine from the
urinary bladder through the urethra to the
outside of the body.
• The process of urination is usually under
voluntary control.
• Urinary incontinence is the inability to control
urination, and is more common in women
than men.
• Urinary retention refers to the inability to
urinate.
• Enuresis nocturnia = incontinence during the
night
 Urine Characteristics
• Amount – 1500 ml in 24 hours
• pH – average 6.0
• Specific Gravity – heavier than water (1.001-
1.035)
• Color – yellow (amber, straw colored,
concentrated, orange, brown, red, sediment,
clear or cloudy)
• Dehydrated = deep yellow, dark
• Overhydrated = pale yellow, colorless
• Light yellow color of urine is due to a
pigment called urochrome
• Urochrome is formed from the breakdown
of hemoglobin in the liver
 Urine Testing
• Urinalysis
• Microscopic exam
• Culture and sensitivity
• Urine dipstick
• Urine Drug and alcohol screening
• 24 hour urine testing
Abnormal Constituents of Urine
• Albumin (protein)
• Glucose
• Red blood cells
• Hemoglobin
• White blood cells
• Ketone bodies
• Bilirubin