458 + Chapter 21. The Urinary System FIGURE 21-8. Factors that control water reabsorption. Noa detected By ‘umorecentor veut ‘Caisse Mer amare ‘remure npesulue ose a as Proximal RETURN TO HOMEOSTASIS : snipers flict? “Tene i ae b= Distal convoluted La al 7 oer Soman” roe Se abe ees iz the blood. These secreted substances include potassium and hytro- gen ions, ammonia, creatinine, and certain drugs, such as penicillin ‘Tubular secretion has two principal functions, to rid the body of certain materials and to help control blood pH. ‘Normally, most potassium ions (K*) are actively secreted into the distal convoluted tubules; a small amount is secreted into collect- ing tubules. As Na* is reabsorbed, K* is secreted, although this is not a one-to-one exchange. A negative potential is created when Na* is reabsorbed, which attracts K* ions. Secretion of K* is regulated in three ways. Inthe presence of more aldosterone, more K" js secreted. Also, when plasma K* concentration is high, K* secretion increases. Finally, high levels of Na* in the distal ‘convoluted tubules increase the rate of Na” absorption and therefore K° secretion. Secretion of K* is very important. Ifthe K* concen tration in plasma nearly doubles, cardiac arthythmias may develop. ‘At higher concentrations, cardiac arrest may occur. ‘The body must maintain normal blood pH (7.35 to 7.45) even though a normal diet provides more acid-producing foods than alkali-producing foods. To raise blood pH, that is, to make it more alkaline, the renal tubules secrete hydrogen ions into the filtrate, which is also what normally makes urine acidic. This ‘occurs in the proximal convoluted tubule, distal convoluted tubule, and collecting tubule, As aresult of H* ion secretion, urine normally has a pH of 6. Exhibit 21-2 and Figure 21-9 summarize filtration, reabsorption, and secretion in the nephrons. If the kidneys are so impaired by disease or injury that they are unable toexcrete nitrogenous wastes and regulate pH and electo- lyte and water concentration of the plasma, then the blood must be filtered by artificial means. The process is called hemodialysis and an artificial kidney machine is used (Figue 21-10). Blood is pumped from the radial artery through tubes to on side of a selectively permeable dialyzing membrane made of cell lose acetate. The other side of the membrane is continually washed with an artificial solution called the dialysate. Only about 500 ml ‘of the patient's blood is in the machine at a time, a volume tht is easily compensated for by vasoconstriction and increased cardiae output. Al substances (including wastes) in the blood, except protit ‘molecules and blood cells, can diffuse back and forth across th selectively permeable membrane. Since the dialysate contains 0 ‘wastes, substances such as ured move down the concentration dient and into the dialysate and wastes are removed. Hemodial)s ‘typically is performed three times a week, each session lasing for 4 to 6 hours , ‘The principal drawback to the artificial ki slow ste at which th blood ean be processed. Teena mecomuté and blood cells can be damaged inthe process, To date, no are! ‘Kidney has been implanted permanently.Of endthol-copsar membrane ste olemeriar Bowmen’) ets oro selectively reabsorbed into bien Po Eto the filtrate for elimination in urine, Proximal convoluted ‘bale Glomerular (Bowman's) capsule Etferent arteriole Afferent arteriole Blood trom renal artery tration © Glomersia @ Tubular reabsorption @ tubuiar secretion Ureters = 459 ‘Collecting tubule Loop of the nephron (Henle) Ui define glomeniar fain, tubular reabsorption, and tubular secretion. ti sae a eee ERS, HOMEOSTASIS Excretion is one of the primary ways in which the volume, pH, and chemistry of body fluids are kept in homeostasis. The kidneys axe principally responsible, but other organ systems are involved. ‘The integument, lungs, and gastrointestinal tract all perform special excretory functions (Exhibit 21-3). Body temperature is regulated largely through the excretion of water by sudoriferous (sweat) glands of the skin. The lungs maintain blood-gas homeosta~ sis through the elimination of carbon dioxide. ‘One way in which the kidneys maintain homeostasis is by coordi- nating their activities with other excretory organs. When the integu- tment increases its excretion of water, the renal tubules increase their reabsorption of water, and blood volume is maintained. If the lungs fail to eliminate enough carbon dioxide, the kidneys attempt to compensate by changing some of the carbon dioxide into sodium bicarbonate, which becomes part of the blood buffer systems, and they seerete more H* a ee URETERS ‘Once urine is formed by the nephrons and passed into collecting tubules, itdrains into the calyces. The minor calyces jin to become the major calyces that unite to become the renal pelvis. From the pelvis, the urine drains into the ureters and is carried to the urinary erSE AS a ee a FIGURE 21-10 Operation of an artificial kidney. The blood rovte is indicated in red ond blue. The route ofthe dialysate i indicated in gold. = ri ‘constant Ccamprossed Freeh aaaste sod aayeate ial kidney simulate @ natural kidney? bladder, where it is discharged from the body through the single urethra. Beyond the minor calyces, urine is in no way modified in either volume or composition. STRUCTURE ‘The body has two ureters (YOO-te-ters)—one for each kidney Each ureter is an extension of the pelvis of the kidney and extends to the urinary bladder (see Figure 21-1). Like the kidneys, the ureters are retroperitoneal. ‘The ureters pass under the urinary bladder for several centime- ters, causing the bladder to compress the ureters and thus prevent backflow of urine when pressure builds up in the bladder during urination. If this physiological valve is not operating, cystitis (uri- nary bladder inflammation) may develop into a kidney infection. ‘The inner layer of the wall of the ureter is a mucous membrane. “Mucus prevents the cells from coming in contact with urine, which has a drastically different pH and solute concentration from the cell's intemal environment. The middle layer of the ureter wall consists of smooth muscle. FUNCTIONS ‘The principal function of the ureters is to transport urine from the renal pelvis into the urinary bladder. Urine is conveyed primarily by peristaltic contractions of the muscular walls of the ureters, but hydrostatic pressure and gravity also contribute, —. EXHIB 21-2 ittration, Reabsorption, ang | ‘Summary of Fil ‘Sheréiion Region Filtration of glomerular biog under hydrostatic pressure re sults in the formation of fltrae that contains water, glucose some amino acids, Na*, Ct-, HCO,” K* urea, uric acing creatinine, Plasma proteins arg ‘cellular elements of blood nor rally do not passthrough the cendothelial-capsular mem. branes and are not found inf. trate Reabsorption of physiologically important solutes such a pa cose, amino acids, Na*, CI-, HCO,” K*. Reabsorion of urea. Obligatory water absorp. tion by osmosis, secretion of ne Passive reabsorption of water Proximal Convoluted Tubule Descending Limb of the Loop of the Nephron : a “Ascending Limb of the Loop of Reabsorption of Na*, CI”, and the Nephron urea, Distal Convototos Pat Reabsorption of Na* under in fluence of aldosterone, CI HCO,”, and urea. Facultative water reabsorption under infu- ‘ence of ADH. Secretion of H* and K*, NH,, creatinine, and ‘certain drugs. sete Reabsorption of Na* under in- fluence of aldosterone, reabsorp- tion of CI” and urea. Facultative ‘water reabsorption under inf ence of ADH. Secretion of H* and K* A has el ed URINARY BLADDER ‘The urinary bladder is a hollow muscular organ situated in th Pelvic cavity behind the symphysis pubis. In the male, its in front of the rectum. In the female, it is in front of the vas and below the uterus. It is a freely movable organ held in posit by folds of the peritoneum. The shape of the urinary bladder (on how much urine it contains. When empty, it looks like «defi balloon. It becomes spherical when slightly distended and, 28 vole arenes, becomes pear-shaped and rises into the abdomitWater, nitrogenous Urinary Bladder « 461 STRUCTURE, At the base ofthe urinary bladder is a small triangular area, the trigone (TRI-g6n) (Figure 21-11). The opening into the urethra (internal urethral orifice) is in the apex of this triangle. At the ‘two points of the base, the ureters drain into the urinary bladder. ‘The mucous membrane of the urinary bladder contains transi- tional epithelium that is able to streich—a marked advantage for an organ that must continually infate and defate. Rugae (Folds Kidneys Heat and carbon dione |i the mucosa) are also present. The muscular layer of the wall wastes from proteinca- ide. Consists of three layers of smooth muscle. Around the opening to tabolism, and inor- the urethra is an internal urethral sphincter muscle. Below the ganic sals. internal sphincter is the external urethral sphincter, which is com- mgs Posed of skeletal muscle and is a modification of the urogenital skin diaphragm muscle. The outermost coat, the serous coat, is formed (Sadoriterous by the peritoneum, which covers the superior surface of the organ; Gand) the rest has a fibrous covering. Gastrointestinal Soli Carbon dioxide, water, (Gy Tract cxetions. salts, and heat. FUNCTIONS FIGURE 21-11. Urinary bladder and female urethra. Urine is expelled from the urinary bladder by an act called mictur- tom (mik’-too-RISH-un), commonly known as urination or voiding. Ureters Rugee of mucosa oH A Sy ey y)r——— 7 wasesso I Urinary Tract Infections rinary tract infections (UTIs) are the most common bacterial infections for women, and the second most common illness (after colds) for them. Men get UTIs too, but very infre- quently. Why is the female urinary tract more vulnerable to bacterial invasion? For one thing, the female urethra is about 3.8 cm (114 inches) long, compared to the male urethra, which is about 20 cm (almost 8 inches) long. The shorter urethra allows bacteria to enter the urinary bladder more easily, where they set up housekeeping and multiply, feeding on the urine stored there. Symptoms of bacterial infection appear within 24 to 48 hours after bacteria enter the bladder. Second, the urethral and anal openings are closer together in women. Eighty-five percent of first-time UTIs are caused by Escherichia coli (E. coli) bacteria, which migrate to the urethra from the anal area. Escherichia coli bacteria are necessary for proper digestion and are welcome in the intestinal tract, but they cause much pain and suffering if they infect the urinary system. ‘When infection occurs in the urinary bladder, the most common site of a UTI, the infection is called cystitis. If it moves up the ureters to the kidney, it becomes pyelone- phritis, a much more serious illness. ‘Symptoms of cystitis include a frequent and urgent need to urinate, but with very little urine produced each time. Sometimes very intense pain and burning accom- pany urination. Fever, nausea, and vomiting may accom- pany pyelonephritis. UTIs are diagnosed by urinalysis ‘and treated with antibiotics. Patients are urged to drink 25 to 3 liters of fluid per day to dilute the urine, so it will be less nutritious for the invading bacteria, and to void frequently to flush the bacteria out of the bladder. Vaginal intercourse is discouraged, since it may irritate the urethra and/or reintroduce bact About 10 to 15 percent of women develop UTIs several times a month. They must offen examine their life-styles very closely to track down possible causes for the re- peated infections. UTI symptoms may indicate the presence of a sexually transmitted disease, such as gonorrhea, chlamydia, or herpes, and these must be ruled out in cases of recurrent UTIs. Sometimes a woman's partner may be the source of bacterial transmission, and when UTIs continue fo re- ye tested for nonsymptomatic urethritis, Which is the term for any bacterial infection of the urethra Siher than gonorrhea. Sometimes treating the partner with antibiotics cures both parties. cur, he should b The Importance of Prevention — "Antibiotics are very effective in treating most UTIs, The problem comes when the infection recurs very soon after antibiotic treatment has been completed. The patien sometimes feels she is living on antibiotics and can’t seem fo stay healthy without them. For these patients, life-style analysis can uncover possible causes of bacte- rial transmission and suggest ways to prevent future UT recurrences, and the frustration of feeling victimized by this illness. Personal hygiene is the first line of prevention. Care must be taken to avoid transporting bacteria from the ‘anal area to the Girls should be taught to wipe from front to be: to wash hands thoroughly after Using the toilet. ¥ihher bathing, women and girls should wash from front to ack as well. Mild soaps are often less irritating than sores with fragrances or deodorants, which may cause allergic reactions. Other perfumed products, such as perfumed toilet paper, feminine deodo- rant sprays, and even bubble baths can contribute to UTIs. Laundry products such as detergents, bleaches, and fabric softeners leave residues on clothing, and moy thus cause irritation. Menstrual blood provides an excellent growth medivm for bacteria. Sanitary napkins and tampons should be changed frequently, Some women find that switching from tampons to napkins or from napkins to tampons reduces the frequency of UTIs. During menstruation, @ woman's hands come into more frequent contact with the vaginal area as she changes tampons and napkins Women are used to washing their hands after changin? tampons and napkins, but it is just as important to wor them before, especially if tampons are inserted manual Deodorant tampons and napkins can increase irritation Superabsorbent tampons can also increase irritation, They absorb the normal secretions of the vaginal ¥2 along with menstrual flow, and women tend to chand® them less frequently than less-absorbent tampons expand to a larger size in the vagina, and may thus b®more irritating. Intercourse duri Should be avoided, since blood sears mens flow the urethra. get pushed up into People who are prone to UTI 210 25 liters of fluid daily. It ies eee eet that caffeinated beverages be avoided, since these be irritating. Cranberry vice inereases the acidity of the urine, which may help to decrease bacterial growth, and many women believe drinking cranberry juice helps them get over a UTI more quickly. On the other hand some people may find that the increased acidity of the urine Causes an increase in the burning during urination. (This part of the frustration of dealing with recurrent UTls: there is a great deal of individual variation in the effec- tiveness of most lifestyle change recommendations.) Voiding frequently, every 210 3 hours, helps to prevent recurrent UTIs, since it expels bacteria and eliminates the urine needed for their growth. (Most people find that itis natural to urinate this often when you drink 2 liters of fluid doily!) One study found that the urinary bladders of women with recurrent UTIs were stretched from urinating infre- quently. A full bladder stretches the bladder wall and compresses the blood vess: ider wall. A de- creased blood supply means fe ting im- mune cells. More frequent urinction prevents this prob- lem, so women are advised nor to “ho'd it” Honeymoon Cystitis The observation that intercourse is frequently associ- ‘ated with the onset of UTIs led to the term honeymoon cystitis. Sexual intercourse can be problematic for women who get recurring UTIs. Women who find that intercourse brings on UTIs learn to develop and teach their partners stringent personal hygiene. Both partners should wosh hands and genitals before sex. Some women find that certain positions are more irritating than others, and part- ners must communicate with each other to find workable solutions. Women should drink plenty of water before and after sex, and urinate os soon afterward os possible. This flushes out bacteria that may have entered the urethra. Diaphragm users may find that the rim of the die- phragm presses on the urethra and prevents comp a emptying of the bladder. Since the diaphragm mus) worn for several hours after intercourse, this can preven bacteria from being flushed out of the urethra and en- a Se ae $ é courage their migration to the bladder. Sometimes switching to a smaller diaphragm and/or one with a different type of rim solves the problem. Otherwise, o different method of contraception must be adopted. Estrogens increase the risk of cysitis, since they make the urinary tract more hospitable to bacteria. Hence, risk increases during pregnancy. UTI symptoms should be treated aggressively during pregnancy to prevent py- elonephritis, which has been associated with premature birth and low-birth-weight babies. UTI risk is also higher for women using the birth-control pill, which increases levels of estrogens. A Wellness Partnership These recommendations seemto place the responsibil ity for UTI care and prevention primarily on the woman who is at risk for recurrent infection, But there is a great deal a woman's partner can do to help os well. Under- standing and emotional support are the first lines oftreat- ment in the wellness approach to self-care. Many people find it difficult to discuss matters of sexual behavior and personal hygeine, and a partner's openness to communi- cation on these matters is essential. An understanding of the self-care measures necessary to prevent recurrent UTIs, such as urinating frequently and avoiding sex at times, is important, too. Keep Trying ‘Sometimes women with recurrent UTIs find keeping «@ diary is helpful in identifying out factors associated with their UTIs. Sex is not the only activity copable of bruising the urethra; horseback riding, motorcycling, and bicycling can all put too much pressure on this sensitive orea. Heat and moisture favor bacterial growth. Underweor made of breathable fabrics like cotton keep the perineum cooler and drier than synthetics. Panty hose and fight jeans can increase heat and humidity. ‘Sometimes tracking down the offending organism is the problem. Women who feel that they are coming down with cystitis usually rush to the sink and start drinking ‘Gs much water as they can. By the time the urine specimen is submitted it may be quite dilute, and the bacteria count low. Escherichia coli grows well in urine culture, but some ther bacteria, such as chlamydia, do not and may be missed. Treating UTIs requires persistent cooperative teamwork on the part of the patient, her doctor, and her pariner if she is sexually active. eR ET LT I ee my »464 = Chapter 21. The Urinary System Itis brought about by a combination of involuntary and voluntary nerve impulses similar to defecation. ‘The average capacity ofthe urinary bladder is 700 to 800 ml. ‘When the amount of urine inthe urinary bladder exceeds 200 t0 400 ml, stretch receptors in the urinary bladder wall transmit im- pulses to the lower portion of the spinal cord. These impulses, by way of sensory tracts to the cerebral cortex, initiate both ‘conscious desire fo void urine and a subconscious reflex that causes the parasympathetic impulses to relax the internal urethral sphincter. ‘Then the conscious portion of the brain sends impulses to the extemal urethral sphincter to relax and urination takes place. Al- though emptying of the urinary bladder is controlled by reflex, it ‘may be initiated voluntarily and stopped at will because of cerebral control of the extemal urethral sphincter. ‘A lack of voluntary control over micturition is refered to as incontinence. Under about 2 years of age, incontinence is normal because neurons to the external urethral sphincter muscle are not completely developed. Infants void whenever the urinary bladder js sufficiently distended to arouse a reflex stimulus. Proper training ‘overcomes incontinence if the later is not caused by emotional stress or initation of the urinary bladder. URETHRA ‘The urethra is a small tube leading from the floor ofthe urinary bladder to the exterior of the body (see Figure 21-11). In females, it lies directly behind the symphysis pubis and is embedded in the front wall of the vagina. The opening of the urethra to the exterior, the external urethral orifice, lies between the clitoris and vaginal opening, Tamales, the urethra passes vertically through the prostate gland, the urogenital diaphragm, and finally the penis (see Figures 23-1 and 23-6) FUNCTIONS ‘The urethra is the terminal portion of the urinary system. It is the passageway for discharging urine from the body. The mi urethra also serves as a duct through which reproductive fu (semen) is discharged from the body. URINE ‘The by-product of the kidneys” activities is urine, named for one Of its constituents—uric acid. The volume, pH, and solute concen- tration of urine vary with the state of the internal environment. ‘An analysis of the volume and physical and chemical properties of urine, called urinalysis (UA), tells us much about the state of the body. VOLUME, “The volume of urine eliminated per day in the normal adult varies between 1000 and 2000 mi (1 to 2 qt). Urine volume is influenced by blood pressure (low pressure triggers the renin-angiotensin path- way), blood concentration (low water concentration induces se- hormone), temperature (high dasotes (increase urine production), meng, inerease urine flow), and general health cretion of antidiuretic reduce urine volume), state (nervousness Ca PHYSICAL CHARACTERISTICS ‘The principal physical characteristics of urine are summarized jg Exhibit 21-4. EXHIBIT 21-4 Physical Characteristics of Normal Urine Description 12 liters in 24 hours but varies conser ably. 5 Yellow or amber, but vies with conenta- tion and diet. Color is due to wrochrome (pigment produced in breakdown of bl) ‘Concentrated urine is darker in coor. Det (Geddish colored rine from beets and green colored from asparagus) and certain dis- ‘eases (kidney stone may produce bled in urine) affect color “Transparent shen freshly voided but be comes turbid (cloudy) upon standing ° ‘Aromatic but Becomes ammonalike pon standing. Some people inherit the ability to form methylmercaptan from ingesting ssparagus that gives urine a characteristic ‘xr. Urine of diabetics has a sweet odoe Jue to presence of Ketone bodies. +4.5-8.0; average 6.0; varies considerably with diet. High-protein diets increase acid ‘iy; vegetables increase alkalinity ‘Specific gravity (density) is the ratio of the weight ofa volume of a substance anequal volume of distilled water. ranges from 1,001 to 1.035. The higher the cow centration of solutes, the higher the speci avi Characteristic ‘Volume Tarbiaty Specific Gravity CHEMICAL COMPOSITION ‘Water accounts for about 95 percent of the total volume of urine ‘The remaining 5 percent consists of solutes derived from celluet ‘metabolism and outside sources such as drugs. The solutes described in Exhibit 21-5, ABNORMAL CONSTITUENTS In a pathological state, traces of substances not normally presé The, tPPear in the urine, or normal constituents may appes i a amounts. A urinalysis. provides information that # ‘A summary of x So! in Bano 9 some abnormal constituents of wine is esecreatinine Ue Add Mppurie Acid Indican “Values are fora urine sample clleted ove — Abnormal EXHIBIT 21-5 Albumin Principal Solutes in Urine of Adult Male on Mixed Diet Amount . ‘eee (ey Comments Constituent oe ‘Comments Ketone Bodies 0.04 Normally found in small LAN ‘Comprises 60-90 percent of all amounts. In cases of diabetes x nitrogenous material. Derived tells and acute starvation, ke- Primarily from proteins (ammo- tone bodies appear in high con- nia combines with CO, to form ceatratons. Ae Nae ig Other 29 May be present in minute quanti- nen constituent of ‘Substances ties depending on diet and gen- |. Derived primarily trom eral health. Inclde carbo eine opens sb dates, pigments, fatty aids, in muscle tissue) ‘mucin, enzymes, and hormones 0.41.0 Product of breakdown of nucleic INORGANIC acids (DNA and RNA) derived ‘NaCl 15.0 salt. Amount from fod or celular destucin. ees Because of insolubilty tends to Ke 3.3 Occurs as chovide, sulfate, and ‘rstallize and is common com- phosphate sats ponent of kidney stones, sog- 25 Derived from aminoacids. 0.7 Form in which benzoic acid Po 25 Occurs as sodium compounds (oxic substance in fruits and (vonosodium and disodium vegetables) is believed to be eli- (Phosphate) that serve as buffers rinated from body. High-vege- in Blood. table diets increase quantity of Nae 0.7 Occurs as ammonium salts. De- hippuric acie excreted Fived from protin breakdown, 0.01 s indole Amount produced by kidney may byeakd=wn of pro- vary with need of body for con- & 6 care serving Na* ions tw ofset acidity » of blood and tissue fluids. i Met 0.1 Occurs as chloride, sulfate, and came Phosphate salts. cat 0.3 Occurs as chloride, sulfate, and eh Phosphate sats EXHIBIT 21-6 Summary of Abnormal Constituents in Urine Abnormal Comment Constituent Comment 7 a ee this case, thee isa fequent or continuous elimi- Nema isin fae tl Cet ey eh eee PER produce sufficient insulin i the prices ar 0 args 1 ass ough trate Red blo cll inthe ui called hematria pores in capillary walls, The presence of 186 and generally indicates a pathological contin. albumin nthe urine— ala al capa ‘One cause is acute inflammation of the urinary increase inthe pemesbly endothe 4 organ as result of disease or iitation from lar membranes due to injury or disease. er kidney stones. Other causes include tumors, Blood pressure, or itation of Kid ell trauma, and Kidney disease, One should make ‘substances such as bacterial toxins, ether, sure the urine sample was not contaminated with heavy metals A ‘menstrual blood from the vagina ‘The presence of sugar inthe urine is termed sD Leuueyes The presence of leucocytes and other components scour, Sesscan case eee cra of einen be secre, which aoa tne bekdown of glycogen et Simcoe mt ive. A se Pe an resale rom bees mel of pus inthe urine, refered to as pyuria (p= YOU-ré-a), indicates infection in the kidney or other urinary organs.—— BXAIBIT 21-6 (Continued Summary-of Abnormal Constituents 1” TT SE er as Abnormal ‘Comment Fc “onstituer Constituent ‘Comment g Spe tbale by a buildup of filtrate edad them, after the substances that com, “tone Hadi High quanities of Ketone bodies, called ketosis Cassar pane arte substan th compe (acetomuria), may indicate diabetes mellitus, them or afer appearance, Thee ae white starvation, oF simply (00 litle carbobyérate in Seen, ed lon el casts, and eit the diet. ‘ 4 " ‘casts that nom from the walls of the tu- iru ‘When red blood cells are destroyed by reticuloen- bules, for example. bea othetial cells, the globin portion of hemoglobin icasonally, te erjstals of salts found in urine $s plitoff andthe heme is converted tobiliverdin. ssney Sones Ocasonl oes called id oer ‘Most ofthe biliverdin is converted to biliubin, sortie leading (0 stone formation include ‘which gives bie its major pigmentation. Above- the ingestion of excessive mineral salts, too low normal levels of biiubin in urine are refered water intake, abnormally alkaline or acidic urine, as ar land overactive parathyroid glands. Kidney stones Urohitngen Te presence of urobilinogen (reakdown produc aaa inthe pes of he Kidney, vie of emolobi) in win is called roiinagen- ne be tari Traces are norma, but increased urobilino- ses Che ee eae igen may be de to hemolytic and pernicious ane- ie ea eee ae hi infstous hepa, blr obarcton, a LN ade cee se . a cause of vaginitis, The most frequent protozoan moe ,onas vaginalis, a -veginie Casts ‘Casts are tiny masses of material that hardened seen is Trichomonas vaginalis, a cause of vagini tnd assumed the shape of the lumen of a tubule in which itis formed and is then flushed out of tl COMMON DISORDERS ©) Glomerulonephritis (Bright’s Disease) Glomerulonephritis (Bright’s disease) is an inflammation of the kidney that involves the glomeruli Pyelitis and Pyelonephritis Pyelitis is an inflammation of the renal pelvis and its calyces. Pyelonephritis, an inflammation of one or both kidneys, involves the nephrons and the renal pelvis. The disease is generally a complication of infection elsewhere in the body. Cystitis, Cystitis is an inflammation of the urinary bladder. Symptoms include burning on urination or painful urination, urgency and frequent urination, and low back pain. Nephrotic Syndrome Nephrotic syndrome refers to protein in the urine, primarily albumin, that results in Iow blood level of albumin, edema, and high blood levels of cholesterol, phospholipids, and tri- slycerides. tis in females and urethritis in males. Renal Failure Renal failure is « decrease ot cessation of glomerular filtration. In acute renal failure (ARF), the kidneys abruptly stop working entirely or almost entirely. The main feature of ARF is suppres- sion of urine flow. Chronic renal failure (CRF) refers to the progessive and generally irreversible decline in glomerular filt- tion rate (GFR). Renal failure causes edema from salt and water retention acidosis due to inability of the kidneys to excrete acidic sub- stances; increased levels of urea due to impaired renal excretiot of metabolic waste products; elevated potassium levels that cal lead to cardiac arrest; anemia, since the kidneys no longer Pro duce renal erythropoietic factor required for red blood cell pro duction; and osteomalacia, since the kidneys are no longer abl¢ to convert vitamin D to its active form for calcium absorptiot from the small intestine. Urinary Tract Infections (UTIs) ‘he form urinary tract infection (UTD is used to desribe cite an infection of a part of the urinary system or the presence © large numbers of microbes in uris ited wit UTI include burning o1 30 wes Sorpeiyny carta mn urination or painful urination, urinat tay am Ssuene, pubic and back pain, passage of cloud ood-t ine, chills, feve ing ret tal discharge, ‘Usually in, _" somesAzotemia (a2-0-TE-mé-a; az0 = nitrogen-containing; emia = condition of blood) Presence of urea or other nitrogenous clements in the blood. Cystocele (SIS-t0-S8l; cyst = bladder; cele = cyst) Hernia of the urinary bladder. Dysuria (dis-YOO: urination. Enaresis (en'-yoo-RE-sis; enourein = to void urine) Bed-wet- ting; may be due to faulty toile taining, to some psychologi- cal or emotional disturbance, or rarely to some physical disor- det. Also referred to as nocturia. Intravenous pyelogram (in'tra-VE-nus Pl-e-I6-gram') or IVP (intra = within; veno = vein; pyelo = pelvis of kidney; {gram = written or recorded) X-ray film of the kidneys after injection of a dye. dys = painful; wria = urine) Painful Nephroblastoma (nef'-16-blas-TO-ma; neph = kidney; = germ or forming; oma = tumor) Embryonal carcinosar- coma; a malignant tumor ofthe kidneys arising from epithelial and connective tissue. Polyuria (pol'-8-YOO-ré-a; poly = much) Excessive urine. Stricture (STRIK-chur) Narrowing of the lumen of a canal or hollow organ, as the ureter or urethra. Uremia (yoo-RE-mé-; emia = condition of blood) Toxic levels, of urea in the blood resulting from severe malfunction of the kidneys. Urethritis (yoo'-ré-THRi-tis) Inflammation of the urethra, caused by highly acid urine, the presence of bacteria, or constriction of the urethral passage. 1. The primary function of the urinary system is to regulate the concentration and volume of blood by removing and restoring selected amounts of water and solut 2, The organs ofthe urinary system are the ki bladder, and urethra, ys. ureters, urinary Kidneys (p. 449) External Anatomy; Internal Anatomy (p. 449) 1. The kidneys are retroperitoneal organs attached to the posterior abdominal wall 2. Each kidney is enclosed in a renal capsule, which is surrounded by adipose tissue. 3. Internally, the kidneys consist of a cortex, medulla, pyramids, Papillae, columns, calyces, and a pelvis. 4. The nephron is the functional unit of the kidneys. 5. A nephron consists of a glomerular (Bowman's) capsule, glo- Merulus, proximal convoluted tubule, descending limb of the loop of the nephron, loop of the nephron (loop of Henle), ascending limb of the loop of the nephron, distal convoluted tubule, and collecting tubule. 6. The filtering unit of a nephron tubule is the endothelial-capsular membrane, 7. Blood enters the kidney through the renal artery and leaves through the renal vein. 8. The juxtaglomerular apparatus (JGA) consists of the juxtaglo- ‘merilar cells and the macula densa of the distal convoluted tubule, Functions (p. 453) 1. Nephrons help form urine and regulate blood composition. 2. Nephrons form urine by glomerular filtration, tubular reabsorp- tion, and tubular secretion, 3. The primary force behind glomerular filtration is hydrostatic pressure. 4, Filtration of blood depends on the force of glomerular blood hydrostatic pressure in relation to two opposing forces: capsular hydrostatic pressure and blood colloidal osmotic pressure. This relationship among the pressures is called net filtration pressure (NFP). ‘5. Most substances in plasma are filtered by the glomerular (Bow- man’s) capsule. Normally, blood cells and most proteins are not filtered. 6. The amount of filtrate that forms in both kidneys every minute is glomerular filtration rate (GFR). GFR is regulated by renal autoregulation, which includes the juxtaglomerular apparatus and neural regulation. 7. The renin-angiotensin pathway refers to the release of renin (by the juxtaglomerular cells) and conversion of angiotensin I to angiotensin II that is initiated by too low levels of chloride ions. Angiotensin II restores blood pressure and GFR to normal. 8. Tubular reabsorption retains substances needed by the body, including water, glucose, amino acids, and ions. The maximum amount of a substance that can be absorbed is called tubular ‘maximum (Tm). 9. About 80 percent of the reabsorbed water is returned by obliga- tory water reabsorption, the rest by facultative water reabsorp- tion.