URINARY SYSTEM

OVERVIEW OF URINARY SYSTEM

Learning Objectives
Describe the gross structure and functions of the kidney

Label a diagram of a nephron with the names of the main components

Define the terms filtration, absorption and secretion within the nephron
Understand how the micro structure of the kidney relates to their

functions in the process of urine formation

Understand how hormones affect water volume and maintain BP

http://quizlet.com/19545630/pharmacology-4-pharmacokinetics-objectives-flash-cards/

OVERALL ANATOMY
The Urinary System

Urinary Organs
1.

Kidneys (x2)

2.

Ureters (x2)

3.

Bladder (x1)

4.

Urethra (x1)

The Kidneys
the major organ
(Trelease 2011, p. 30)

the major excretory organ

RENAL ANATOMY

KIDNEY ANATOMY
Bilateral to vertebral column, Between T12-L3, in sup. Lumbar region

L
R

R) kidney lies lower

Renal hilum concave medial surface
lies in a retroperitoneal position
Highly vascular 20% of CO/min
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KIDNEY PHYSIOLOGY
Perform the major work of the urinary system

1.

Filtration/excretion

2.

Regulation of blood

3.

ionic composition
pH acid/basic balance
blood volume & pressure
glucose level

Production of hormones
(EPO and enzymes, renin)

(Hansen 2009, p. 163)

KIDNEY ANATOMY EXTERNAL

Three supportive layers surrounding the external part of the kidney

Peritoneum
Renal Capsule

Adipose Capsule

Renal fascia

External layers (from inside to outside):

(Modified from Hansen 2009, p. 163)

1)

Renal capsule preventing infection

2)

Adipose capsule cushioning

3)

Renal fascia anchoring

KIDNEY ANATOMY INTERNAL

Consists of three distinct regions
Renal cortex

Renal medulla
(pyramid)
Minor calyx

Renal pelvis

Internal regions:
1)

Renal cortex contains nephrons

2)

Renal medulla contains pyramids

3)

Renal pelvis tube cont. w/ ureter

(Modified from Hansen 2009, p. 164)

RENAL INNERVATION
A rich blood supply for its functions: cleansing & adjusting blood

Blood and nerve supply:

Approx. 25% of Cardiac Output per minute
Largely innervated by sympathetic vasomotor fibres
(http://www.britannica.com/EBchecked/topic/79572/Bright-disease)

NEPHRON

NEPHRON
Blood processing unit: structural & functional unit of the kidney
Renal corpuscle
Renal tubule
A

Function of nephrons:

= carry out processes of urine formation

Filtration mechanical; filter except ?
Reabsorption of molecules, into blood
Secretion of ions, into urine
http://1.bp.blogspot.com/-btzy2TU19XM/UNcPDYOUwfI/AAAAAAAAAfM/Yw9VFwLgXi0/s1600/renal6.jpg

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NEPHRON
Consists of renal corpuscle & renal tubule
Bowmans
capsule

PCT

DCT

Glomerulus

Descending
limb

Collecting
duct

Ascending
limb
Loop of
Henle

Renal corpuscle
D
D
Renal tubule
d
d
d
Name the structure, that is not a
part of the nephron:

http://1.bp.blogspot.com/-btzy2TU19XM/UNcPDYOUwfI/AAAAAAAAAfM/Yw9VFwLgXi0/s1600/renal6.jpg

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RENAL CORPUSCLE
Consists of glomerular (Bowmans) capsule & glomerulus
Bowmans
capsule

Capsular space

Proximal tubule
E

Podocyte

Endothelium

Pedicel

1)

Bowmans capsule a double-walled membrane

2)

Glomerulus a ball of capillaries

http://higheredbcs.wiley.com/legacy/college/tortora/0470565101/hearthis_ill/pap13e_ch26_illustr_audio_mp3_am/simulations/figures/histology_renal.jpg

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HISTOLOGY OF GLOMERULUS
The site of filtration
Basement
membrane
Endothelium

Pedicels

Podocyte

Filtration
slit

Fenestrations

Capsular
space

Endothelium
(Barrett et al. 2010, p. 641)

Fenestrated endothelium permits all, except blood cells or platelets

Filtration slit permits all in filtrate, except large plasma proteins
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HISTOLOGY OF GLOMERULUS
Endothelial capsular membrane the filtration membrane

Endothelial Capsular Membrane

1.

Simple squamous cells

2.

Podocytes

3.

Basement membrane

Function
= filters water & solutes from blood,
except protein RBCs & WBCs

http://www.columbia.edu/itc/hs/medical/sbpm_histology_old/micrographs/47.jpg
https://courses.stu.qmul.ac.uk/smd/kb/microanatomy/senior/metabolism/renal/images/emgfc.jpg

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RENAL PHYSIOLOGY:
URINE FORMATION

GLOMERULAR FILTRATION
Simple filtration at glomerulus Non-selective, passive
Filtration
= the use of pressure to force fluids and solutes through a membrane
Driving force: hydrostatic pressure gradients
Resulting fluid: filtrate (Filtered plasma)

Glomerular Filtration Rate (GFR)

= the volume of filtrate formed each minute by all glomeruli in kidneys
measured by the Net Filtration Pressure (NFP)
directly proportional to BP (i.e., BP = GFR)
provides a measure to assess renal function (using creatinine)
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GLOMERULAR FILTRATION RATE

GFR measure by the Net Filtration Pressure (NFP)

GBHP (CHP + BCOP) = NFP

http://higheredbcs.wiley.com/legacy/college/tortora/0470565101/hearthis_ill/pap13e_ch26_illustr_audio_mp3_am/simulations/figures/glomerular.jpg

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TUBULAR REABSORPTION
Selective transepithelial process begins at PCT
Selective transepithelial process
= meaning that reabsorption is carried out by tubular epithelial cells
Only 1% of the filtrate (1.5L) leaves as urine per day
99% of the filtrate reabsorbed into blood (via peritubular capillaries)

Tubular Reabsorption:
Selective process only specific amounts of certain substances
Mechanisms: both active & passive transport mechanisms
Reabsorbed substances: Glucose, a.acids, water, urea & ions

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TUBULAR REABSORPTION
Reabsorbed back into the blood stream, via peritubular capillaries

Peritubular capillaries:
arise from efferent capillaries
wrapping around tubules (peritubular)
reclaims most of filtrate (99%)

drain into renal vein, then IVC

http://dualibra.com/wp-content/uploads/2012/04/037800~1/Part%2012.%20Disorders%20of%20the%20Kidney%20and%20Urinary%20Tract/271_files/loadBinary_007.gif

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TUBULAR REABSORPTION
Selective transepithelial process begins at PCT

http://www.highlands.edu/academics/divisions/scipe/biology/faculty/harnden/2122/images/dct.jpg

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TUBULAR REABSORPTION
Tubular transport maximum (Tm) renal threshold
Tubular Transport Maximum (Tm):
= the max. amount of a substance

that cab be reabsorbed (Threshold)

Glucose:
Reabsorption by carrier (active transp.)
Carrier exists in epithelial cells
Fix & limited amounts of carrier
Normally all reabsorbed

http://dualibra.com/wp-content/uploads/2012/04/037800~1/Part%2012.%20Disorders%20of%20the%20Kidney%20and%20Urinary%20Tract/271.htm

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TUBULAR REABSORPTION
Tubular transport maximum (Tm) renal threshold
Sodium & Potassium:
most are actively reabsorbed by Renin-

angiotensin-aldosterone (RAA) pathway

amount varies with BP

Water:
80% reabsorption by osmosis
20% w/ help of ADH

http://dualibra.com/wp-content/uploads/2012/04/037800~1/Part%2012.%20Disorders%20of%20the%20Kidney%20and%20Urinary%20Tract/271.htm

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TUBULAR REABSORPTION
Summary in a healthy individual

Tubular fluid concentration

Reabsorption:
Glucose: 100%
Amino acids: 100%
Water: 99%
Urea: ~50%
Creatinine: 0%
Electrolytes/ions: Depends

(Barrett et al. 2010, p. 643)

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TUBULAR SECRETION
Essentially reabsorption in reverse mainly occurs in DCT
Tubular secretion
= a fine tuning mechanism of chemical balance
Eliminate excess materials to the filtrate (from the blood)
Eliminate undesirable substances or end products

Principal effects
1)

Removal
= of certain materials (e.g. excess K+ , creatinine )

2)

Blood pH regulation
by eliminating H+ into filtrate
by conserving HCO3- in blood

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URINE FORMATION
One of the main functions of the urinary system

Filtrate

(1%)
Urine

(Trelease 2011, p. 12)

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URINE
Chemical composition of the urine

Urine
= 95% water + 5% solutes

Concentration decreases

Urea (most abundant)

Sodium
Potassium
Phosphate
Sulfate
Creatinine
Uric acid

Others: chloride, calcium, magnesium, bicarbonate, ammonia,

urobilogen, drugs & metabolites

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RENAL PHYSIOLOGY:
BLOOD PRESSURE & ACID/BASE

KIDNEY PHYSIOLOGY
Perform the major work of the urinary system

1.

Filtration/excretion

2.

Regulation of blood

3.

ionic composition
pH acid/basic balance
blood volume & pressure
glucose level

Production of hormones
(EPO and enzymes, renin)

(Hansen 2009, p. 163)

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OVERVIEW
Hormones & the Urinary System
Hormones
= play a major role, especially on tubular reabsorption & secretion

Main Hormones:
ADH (anti-diuretic hormone)
Angiotensin I & II
Aldosterone
EPO (erythropoietin)

http://www.nature.com/nm/journal/v20/n4/full/nm.3524.html

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RENAL CONTROL OF BP
BP controlled by controlling BV
Fundamental principle
= More water in blood more BV higher BP
involves reabsorption of water & electrolyte
Primarily controlled by: Aldosterone & ADH
Both work in synergism (i.e., both increase BV & BP)

Two BV & BP regulatory pathways:

1)

RAA pathway (Aldosterone)

2)

ADH

http://www.nature.com/nm/journal/v20/n4/full/nm.3524.html

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JUXTAGLOMERULAR APPARATUS
A part of nephron where DCT comes in contact w/ afferent arteriole

Glomerular capsule

JG cells
Capsular space
Macula densa cells

DCT

PCT

Juxtaglomerular (JG) apparatus:

a)

JG cells modified cells on the arteriole

b)

Macula densa cells modified cells in the DCT

http://higheredbcs.wiley.com/legacy/college/tortora/0470565101/hearthis_ill/pap13e_ch26_illustr_audio_mp3_am/simulations/figures/histology_renal.jpg

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JUXTAGLOMERULAR APPARATUS
Important roles in regulating systemic BP & GFR
JG cells:
smooth muscle cells containing

DCT

renin
NaCl

NaCl

NaCl NaCl

act as mechanoreceptors

(sensitive to BP)

Macula densa cells:

have osmoreceptors that are

sensitive to NaCl in filtrate

Modified from http://ajprenal.physiology.org/content/ajprenal/298/1/F1/F1.large.jpg

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RAA PATHWAY
a fine tuning hormonal control of BP via controlling water balance

Modified from http://s3.amazonaws.com/rapgenius/filepicker%2Fz89nnTqCT1OKjWUwr98k_renin-angiotensin-aldosterone-reflex-system-1024x739.jpg

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JUXTAGLOMERULAR APPARATUS
When NaCl concentration in the filtrate is low
When Na+ in ECF/filtrate:
1. Macula densa cells sense low

DCT

sodium levels in filtrate (DCT)

NaCl

NaCl

NaCl NaCl

2. Signals JG cells to release

renin
3. RAA pathway activated
4. Aldosterone increases sodium

RENIN

reabsorption in tubules

Modified from http://ajprenal.physiology.org/content/ajprenal/298/1/F1/F1.large.jpg

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REGULATION BY ADH
ADH, a hormone that controls water reabsorption in the collecting ducts

(Modified from FIGURE 29-8, Craft et al. 2010)

Modified from: http://dualibra.com/wp-content/uploads/2012/04/037800~1/Part%2012.%20Disorders%20of%20the%20Kidney%20and%20Urinary%20Tract/271.htm

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REGULATION BY ADH
ADH regulates BV and BP

http://classes.midlandstech.edu/carterp/Courses/bio211/chap25/figure_25_17_labeled.jpg

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RENAL CONTROL OF ACID/BASE

two renal mechanisms maintain blood pH tubular secretion & buffering
Tubular secretion
= the main renal mechanism for blood pH balance

Carbonic
anhydrase
Acid

Base

If blood is too acidic

secrete more H+ into urine
retain more HCO3- in blood

http://dualibra.com/wp-content/uploads/2012/04/037800~1/Part%2012.%20Disorders%20of%20the%20Kidney%20and%20Urinary%20Tract/271.htm

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RENAL CONTROL OF ACID/BASE

two renal mechanisms maintain blood pH tubular secretion & buffering
Tubular buffering systems
= two buffering systems (a) ammonia buffer, and (b) phosphate buffer

Carbonic
anhydrase

(a)

OR
(b)

Tubular buffering systems:

= two systems involve binding hydrogen ion with filtered compound,

and then the end-product get eliminated into tubular fluid ( urinated)
http://dualibra.com/wp-content/uploads/2012/04/037800~1/Part%2012.%20Disorders%20of%20the%20Kidney%20and%20Urinary%20Tract/271.htm

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OTHER URINARY SYSTEM

OVERALL ANATOMY
The Urinary System

Urinary Organs
1.

Kidneys (x2)

2.

Ureters (x2)

3.

Bladder (x1)

4.

Urethra (x1)

(Trelease 2011, p. 30)

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URETERS
paired tubes that transport urine from the kidneys to the bladder

Its wall has three layers

Smooth muscle in walls contract to

propel urine by peristalsis

Urine reflux prevented by sphincters

in the bladder (located at bladderureter junction)

Ureter

Bladder mucosa

Modified from Kelly et al. 2012, p. 7;

http://www.highlands.edu/academics/divisions/scipe/biology/faculty/harnden/2122/images/ureterbladderurethra.jpg

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URINARY BLADDER
Collapsible muscular sac in pelvis temporarily stores urine
Ureteric orifices

Three openings: 2 ureter openings &

single urethral opening

Trigone: smooth triangular region
Bladder wall: 3 layers
Bladder neck
Trigone

a) Smooth muscle
b) Detrusor muscle
c) Special transitional epithelium
Normal bladder capacity: 500-600 mls

(Modified from Kelly et al. 2012, p. 10)

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URETHRA & SPHINCTERS

Involve in micturition

Urethra:

= muscular tube that drains urine from

bladder, then conveys it out of the body
Internal urethral
sphincter

Urethral sphincters:

External urethral
sphincter

a)

Internal detrusor smooth muscle

b)

External skeletal muscle

Urethra

(Modified from Kelly et al. 2012, p. 10)

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REFERENCE LIST
All copyrights are reserved. No copyright infringement intended
Trelease, RB 2011, Netters Surgical Anatomy Review P.R.N, Elsevier, Philadelphia.
Hansen, JT 2009, Netter's Clinical Anatomy, 2nd edn, Saunders, Philadelphia.

Barrett, KE, Brooks, HL, Boitano, S & Barman, SM 2010, Ganongs Review of Medical
Physiology, 23th edn, McGraw-Hill.
Craft, J, Gordon, C, Tiziani, A, Huether, S, McCance, KL, Brashers, VL & Rote, NS 2011,
Understanding Pathophysiology, Mosby Elsevier, Australia.
Kelly, CR, Landman, J, Machado, AG, Craig, JA, Netter, FH & Ebscohost, EBSCOHOST 2012,
The Netter collection of medical illustrations. Volume 5, Urinary system a compilation of
paintings, 2nd edn, Elsevier Saunders, Philadelphia.

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