BMedSci Year 1

The Renal and Urinary System

Histology of the Kidneys and Urinary Tract

Introduction

The urinary system is made up of the kidneys, ureters, urinary bladder and the urethra. Their combined functions are
primarily concerned with the homeostasis of blood and tissue fluids. The kidneys filter blood passing through them,
removing excess water, urea, electrolytes and drugs whilst ensuring that the blood leaving the kidneys has the
appropriate levels of water, electrolytes and glucose. Urine passes from the kidneys, via the ureters, to the bladder
for short-­­term storage prior to micturition, when urine passes from the bladder to the exterior via the urethra.

The ureters are long muscular tubes with close and important anatomical relations to the posterior abdominal and
pelvic walls. Any solid structure within the ureter’s lumen, such as a ureteric stone (calculi), can obstruct the flow of
urine and cause retention proximal to the obstruction, which in turn can result in renal failure. It can also cause
intense colicky loin to groin pain, and depending on the level of obstruction pain can be referred to lumbar or
inguinal regions, external genitalia, or the anterior aspect of the thigh. In the female, the ureter passes beneath the
uterine artery, in the male below the ductus deferens to reach the lateral angle of the bladder. The bladder itself is a
highly distensible muscular sac with clinically significant peritoneal relations, differing slightly in males and females. It
is supported in its position by the pelvic walls and pelvic diaphragm.

Given the crucial role of an adequate blood supply at the appropriate pressure to the optimal function of the kidney,
anything affecting cardiovascular function will require a change in renal function in order to maintain homeostasis.
For instance, if perfusion of the kidney is at too low a pressure to permit adequate filtration at the glomerulus, then
renal failure can occur. Renal failure is a major cause of morbidity and mortality in terminally ill patients.

As has been said many times, most anatomical structures have more than one major function: the kidneys also have
an endocrine function through the production of renin and erythropoietin. In addition, when circulating glucose
levels are low, the kidney is a site of gluconeogenesis. The urethra also has reproductive functions in the male.

The functional unit of the kidney is the nephron, of which there are over one million in each human kidney. Filtration
at the renal or Bowman’s capsule is achieved at the glomerular filtration barrier, formed of the leaky endothelium of
the glomerular capillaries, foot-­­like processes of squamous cells (also known as podocytes) and their fused but thick
basement membrane. After entering the capsular space, the glomerular filtrate then passes into the proximal
convoluted tubule, then the loop of Henle, the distal convoluted tubule and finally the collecting duct system. Urine
leaving this leaves the kidney to enter the urinary tract at the minor calyx.

The primary functions of the nephron, excretion of waste products and excess water and osmoregulation, are achieved
through filtration of small molecules from the plasma, followed by selective reabsorption of most of the
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water, and some small molecules from the primary filtrate. The microvasculature of the kidney incorporates a portal
system whereby the first capillary bed supplies blood to the glomeruli, whilst the second is associated with the
tubules in the cortex, or when close to the corticomedullary junction those in the medulla too.

The juxtaglomerular apparatus of the kidney is involved in the regulation of systemic blood pressure via the renin-­­
angiotensin-­­aldosterone mechanism.

Objectives

It is important that you read these objectives and ensure that you are able to discuss these points in some detail.
They will help you in your preparative reading for this session.

When you have prepared for this small group session, and following it, completed any follow-­­up work required, you
should be able to:

 Describe the functional anatomy of the kidney, and extra-­­renal urinary tract.
 Recognise and discuss the micro-­­anatomical appearance of the kidneys and urinary tract in histological sections
visualised under light microscopy and electron microscopy.
 Identify and describe the cells present within a histological specimen of the kidney and relate kidney architecture
to the functions of the tissue.
 Discuss the functional microanatomy of the ureter, bladder and urethra.
 Explain the functional role of transitional epithelium in the bladder.
 Describe the histological response resulting from common diseases of the kidney, and the response of the kidney
to trauma of the individual.

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Suggested Reading

You will need to revise appropriate sessions from the Fundamentals of Life Science module, particularly:

 Histological staining of intracellular organelles

 Connective tissues
 Epithelia

You will need to make concise notes and may of course use other resources you discover on your own.

You are expected to have a copy of this histology text, and therefore guidance as to page numbers is given. You may
have chosen another text, but you will need to find appropriate sections to read yourself.

Wheater’s Functional Histology (Sixth E dition) Pages: 292 -­­ 317

Young, O’Dowd, Woodford
Churchill Livingstone / Elsevier

Some key images will be given to you during this session – it is important however that you obtain a few images from
textbooks, and the internet that you source yourself.

There will be a short video presentation during this session – you may choose to take notes

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Extra notes:

 It is worthwhile spending a few minutes with the model in your room to examine the position of the kidneys,
ureters, bladder and urethra (male and female). You will notice that distally, the bladder and urethra have close
associations with the reproductive system – this reflects the combined genitourinary development in the embryo.
You may choose to look at this in texts but it is not part of this session.

 Label the diagrams below which show the close anatomical relations of the urinary tract in the male and female
pelvis. You might find it helpful to highlight the ureter, bladder and urethra in yellow.

Histology

 You ought to be able to draw simple diagrams summarising the structural relationship between the different
components of the juxtaglomerular apparatus.

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 Label the nephron and consider where the medulla and cortex of the kidney might be.

Questions referring to the coloured sheet

 Image 1 shows a low power view of the kidney cortex. Identify the structure arrowed at (a).

Name the structures indicated at (b).

 In Image 2, an intermediate view of the kidney cortex is shown. Name the structure arrowed at (a).

Name the structure indicated at (b) -­­ what type of cells line this structure?

Identify the space arrowed at (c).

Identify the structure arrowed at (d) and name the blood vessels connected to it.

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 This section has been stained with Masson’s trichrome, identify the blue / green tissue.

What is meant by the term filtration barrier? List the components of that barrier, and the molecules that pass
through it.

 Image 3 shows a high power view of a section through the cortex of the kidney. Identify the structures arrowed
at (a) and (b).

Describe the micro-­­anatomical differences between these two structures and briefly describe their
functions.

Identify the cells arrowed at (c). Name the structure of which they are a part -­­ what is the function of this
structure?

 An intermediate power view of a section taken through the medulla of the kidney is shown in Image 4. Identify
the structures arrowed at (a).

Name the structures that i) drain into (a), and ii) that (a) empties into.

 Image 5 shows a low power view of the medulla of the kidney. Identify the structures marked (a) and (b).

What type of cells line these structures, and what are their functions?

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  Image 6 is a low power view of a section taken through the ureter. Note the shape of the lumen and name
the layer arrowed at (a).

Identify the tissue arrowed at (b).

What types of cells are found in these layers?

 A high power view of a section through the ureter is shown in Image 7. Name the layer arrowed at (a).

What type of cells line this layer -­­ and how is their structure related to their function?

 Image 8 shows a low power view of a section taken through an undistended bladder. Name the layers arrowed at
(a) and (b).

What type of cells are present in these layers?

What types of nerve fibres are present in this tissue?

 Image 9 shows a high power view of an undistended bladder. Identify the layer shown at (a).

How is this layer specialised regarding function?

 Image 10 shows a scanning electron-­­micrograph of podocytes (a) surrounding glomerular capillaries. Are these
epithelial or connective tissue cells?

Identify the structures arrowed at (b). What is their function?

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 Image 11 shows a transmission electron-­­micrograph of the glomerular filtration barrier. Identify the regions (a),
(b) and (c) and comment on the cells involved in each region.

Identify the fluid present in the lumen labelled (d).

Describe the fluid present in the lumen labelled (e).

 Image 12 shows a transmission electron-­­micrograph of a section taken from the proximal convoluted tubule.
Describe the epithelial specialisations present in the apical aspect of these cells. Why are they present?

You may be able to see vesicles in the apical aspect of the cell. Given that these cells are not secreting a
protein, what do you think these vesicles are?

 Use your textbook to find images of the glomerular filtration barrier, GFB, under electron microscopy. Consider
the fenestrated endothelium (how is this different from a continuous endothelium; how does this reflect
function?), the podocytes and their process (how wide are they, what are they wrapped around?) and the thicker
than normal fused basement membrane between them (is that special? Does it have layers?). How selective is
this membrane? Draw diagrams to represent this.

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 What are the components of the juxtaglomerular apparatus and what together is their function?

 The mesangium is comprised of mesangial cells and extracellular matrix. It supports the glomerular capillary
system. How would you be able to distinguish mesangial cells from endothelial cells in a histological specimen?

Suggestions for functional correlations for discussion:

 Can the endothelium of capillaries in the glomerulus be too leaky?

 What size / charge of molecules passes easily through the GFB and which don’t? What pathologies can be caused
if the GFB is too leaky or does the rest of the nephron compensate?
 What type of urine is formed in a subject with diabetes insipidus (and why)?
 What disorders are associated with the development of nephrotic syndrome -­­ and what is the role of the
abnormal basement membrane?
 Why do patients with hypovolaemia sometimes die of renal failure?
 Why is an assessment of protein content of urea important in patients with suspected kidney disease?

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