HISTOLOGY OF THE URINARY SYSTEM

Anatomy of the Urinary System

-Composed of paired kidneys, paired ureters: leads the kidneys to the urinary bladder where the urine are
stored prior to excretion. Urethra: which leads from the bladder to the exterior of the body

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Kidneys
-large, reddish, bean-shaped organs
-Located on either side of the spinal column in the retroperitoneal space
-Right is lower than the left because of the liver lobe superior to the right kidney
-Each kidney measures approx. 10cm x 6.5cm x 3 cm
-On the upper pole of each kidney lies the adrenal glands
-Closely to the kidney structure the median border is a concave structure known as the HILUM
-Through the HILUM renal blood vessels and nerves enters the kidneys
-Renal Pelvis: expanded part of the ureter, exits from the organ

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Renal Parenchyma
-once dissected chronally
-The parenchyma is divided in to:
1. Outer dark cortex
-there are parts of the cortex that goes deep down into the spaces between the pyramids forming the renal
columns.
2. Lighter striated medulla
-consists of 12-15 cone-shaped renal pyramids, the base of which borders the cortex and medulla
-Apex forming a nipple-like projection called the Papilla
-A funnel-shaped renal pelvis, the pelvis forms 2-3 cup-like major calyces each is further divided in to minor
calyces eventually each draining a papilla of the pyramid

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-Blood filtered form one glomerulus is drained to the renal pyramids
-The urine created from the flowing blood in the renal pyramids is eventually drained by the Renal papilla
-From the renal papilla the urine flows to the minor calyces then collected by the major calyces
-Flows directly to the renal pelvis then to the ureter
-Eventually ending up in the urinary bladder

-Urine is initially collected at the level of the papilla and because of this histologist use this structure to
determine the renal lobes
-The areas observed by the renal papilla: renal pyramids, overlying cortex: constitutes one renal lobe

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Organization of the Renal Vasculature
-renal vasculature of the renal parenchyma
-Kidney is the recipient of nearly 25% blood pump by the heart
-When a patient is losing so much blood due to trauma, the body will always maintain blood supply too the
kidney to the point that the gastrointestinal system is deprived of blood flow
-The function of the kidney depends greatly on blood flow hence histologic characteristics of the kidney is
arranged totally dependent on how the blood will circulate in the organ
-The renal blood flow is arranged in such a way that there should be a direct blood supply to the glomeruli of
the renal corpuscles and around all parts of the renal tubules.
-Arterial blood supplied to kidney is provided by the renal artery: a direct branch of the abdominal aorta
-As the renal artery enter the kidney through the hilum the renal artery branches out in to Segmental Arteries.
-Segmental Arteries: eventually gives rise to Interlobar Arteries
-Interlobar Arteries: branches out to form the arcuate artery
-Arcuate artery: eventually enters the corpuscles of the nephron initially as afferent arteriole which supplies
the renal corpuscles in general. The arteriole then branches out in to a taft of fenestrated capillary called the
Glomerulus
-Filtered blood from the glomerulus leaves the area then enters an Efferent arteriole.

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-Capillary networks starts as an arteriole, then the capillary network will eventually end and drained via a
venule
-Uniqueness of the glomerulus: after the capillary network instead of a venule another arteriole arises in the
form of an efferent arteriole.
-Efferent arteriole: then gives rise to a second capillary network and the nature of the secondary capillary
network depends on the location of the nephron tubule.
-If the nephron tubule is mostly located in the cortex, as in the Cortical Nephron. The efferent arteriole will
give rise to the peritubular capillaries
-If the nephron tubules are deep down in the medulla as in juxtamedullary nephron. The efferent arteriole will
give rise to the vasa recta.
*These differences in the secondary capillary plexus is the primary determinant of the relatively higher
parenchymal osmolarity or salt-concentration in the medulla compared in the cortex.
-Regardless of the type of the secondary plexus whether it is a peritubular capillary or a vasa recta it will
always be drained by an arcuate vein
-The arcuate vein will eventually be drained by the interlobar vein
-The interlobar vein eventually drains in to the segmental vein then eventually goes back to the general
circulation through the renal vein

TRIVIAL QUESTION
What makes the renal blood supply unique: A capillary that is drained by an arteriole
*Almost all organs have one artery and one renal vein
*There are many organs that are with blood vessels that are eventually branches out into many segments

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2nd reason why the renal capillaries are unique
-After the glomerular tuft of the capillary, initially being drained by the efferent arteriole, then another
network of capillary arises, this is unique: among other tissues blood vessels only have one capillary bridging
the arteriole and the venule
-But for the kidneys particularly the blood supply to the nephrons, we have 2 capillaries bridging that of the
arteriole and venule.

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What makes renal blood supply unique?
1. The glomerular capillary is drained by another arteriole and not a venule
2. The glomerular capillary is followed by another capillary before totally draining to the arcuate vein

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Histology of the Kidney
-The kidney is an organ invested externally by a capsule like any other organs of the body
-On a histologic slide: Capsule of a kidney: have 2 layers
a. Outer layer of the capsule-known to contain fibrous collagen with admixed fibroblastic cells
b. Inner Layer-appears more cellular. On immunohistochemical staining these cells would exhibit
immunohistochemical properties consistent with Myofibroblast

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Histologic view of Renal Cortex and Medulla LPO
-We see structures with a clear lumen and lined by epithelial tissue consistent with a tubular structure. These
tubular structures are generally a segment of the kidney named as Uriniferous Tubules.
-Uriniferous tubules consists of 2 tubular complexes.
1. Nephron
2. Collecting Ducts

2 types of Nephron
1. Cortical nephron-nephron segments are localized within the renal cortex. With the minor segment of the
loop of henle going deep to the upper regions of the renal medulla.
2. Juxtamedullary Nephron-has the glomerulus, DCT, PCT on the deeper parts of the renal cortex. While the
LOH is deeper down in the renal medulla
-The classification is based on the location of the nephron tubules in the renal parenchyma

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Histology of the Renal Corpuscles
-the renal corpuscle of the nephron
-The renal corpuscles structurally has two poles:
1. Vascular pole- where the afferent arteriole enters the capillary tuft and where the efferent arteriole exits
the structure
2. Urinary pole- where the proximal tubule begins

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Vascular Pole-Structure lined by simple squamous epithelium with the lumen filled with RBC
Urinary Pole-appears to be expanded and the lumen is relatively clear: contained in this region is the
ultrafiltrate of the plasma/ urine

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2 components of the Renal Corpuscle
1. Vascular component
- consist of the afferent, efferent, glomerular tuft of capillary and Bowman’s capsule
-Exhibits histologic features consistent with a capillary that is the lining epithelium is squamous, with a
vascular lumen filled with RBCs
-What makes the endothelium of the glomerular capillary unique: it appears fenestrated, though not seen is
histologic prep.
-The fenestrations in EM are quite distinct

The Bowman’s capsule has two layers

1. Parietal layer- the outermost layer. Lined by a simple squamous type of epithelium lying on top of a
basement membrane
2. Visceral layer-inner layer, closely apposed to the capillary endothelium of the glomerulus. It is lined by
special cells Podocytes.

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Podocytes
-exhibits a multiple, primary processes called Trabeculae
-Each trabeculae gives rise to to secondary processes known as Pedicles
-The pedicles of the neighboring podocytes tend to intertwine with each other effectively creating a Filtration
slit.

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-The relationship of the structures consisting the renal corpuscle, the fenestrated endothelium, the podocytes
with vesicle, basement membrane
-Basement membrane consist of connective tissue fibers: collagen, laminin, fibronectin. It also contains
heparan-sulfate, which anionic sites effectively creating a net negative surface
Mesangial cells
- One last cellular component of the renal corpuscle
-provides support for the renal corpuscle and exhibiting its phagocytic function indicating its protective role in
the kidney nephron

Correlation of the histologic property of the Renal corpuscles to its function in the Urine Formation
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-endothelium, basement membrane, podocyte
-The fenestrations in the endothelium, the connective tissue nature of the BM, and the filtration slit of the
podocytes all works together to increase the filtrating capacity of the renal corpuscle.
-As blood flows from afferent arteriole and enters the glomerular tuft the larger cellular elements are filtered
by the endothelial fenestrations, this includes the formed elements of the blood, RBCs, WBCs, thrombocytes.
-But smaller components: the ones dissolved in the plasma can pass through the fenestrations: soluble
proteins, nutrients such as glucose, amino acids and even waste products such as urea
-at the BM, the key player is the heparan-sulfate rich anionic sites which makes the BM net negatively
charged, the filtration of the BM is not by size but by net charges: all dissolved particles of the plasma that are
negatively charged will be retained by the BM, predominantly the example is the plasma protein ALBUMIN, all
other proteins and dissolved substances are able to pass through this layer.
-Podocytes: the last filtrating barrier of the renal corpuscle. The podocytes filters the ultrafiltrate by size, to
contrast the podocyte filtration slit and the fenestrations of the endothelium, the filtrating size is significantly
smaller among podocyte filtration slits. All plasma particles that are small able to pass through the fenestrated
endothelium will then be filtered by the podocytes such as: Immunoglobulin complexes

*With all of the filtrating capacity of each of the layer of the renal corpuscles the plasma ultrafiltrate that
eventually will become the urine later on is characterized as acellular

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Plasma ultra filtrate
-devoid of cell
-devoid of albumin
-All substances carried by albumin such as drug metabolites only contains dissolved substances such as:
glucose, amino acids, electrolytes, waste products such as urea

Why is urine devoid of cell, devoid of albumin and substances carried by albumin, and only contains smaller
plasma dissolved substances

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Proximal Convoluted Tubule
-initial segment of the nephron tubule that receives the plasma ultrafiltrate created by the renal corpuscle
-The segment of the nephron is considered the longest, occupies most of the renal cortex parenchyma.
-Lined: Simple cuboidal epithelium to low columnar epithelium
-Basally located nuclei

EM [PICTURE]
-Abundant interdigitations effectively increasing the surface area of the basal aspect of the cell
-Mitochondria appears elongated, they overcrowd in the basal aspect of the cell, their axis is parallel to the
axis of the basal interdigitations. This is eventually depicted in histologic slides as basal striations in the PCT
epithelial cell
-Brush border in the luminal aspect of the lining epithelium
-Not seen in the EM is the extensive interdigitations in the lateral aspect of the neighboring cells, but in
routine histologic slides the extensive interdigitations in the lateral aspect of the epithelial cells is seen as
apparent fusion of the cytoplasm of the lining epithelium. We cannot clearly see the boundary between the
lining epithelium of the PCT cytoplasmic fusion

-Consistent of a highly absorptive cell, functionally the apical membrane of the cell is rich in protein transport
channel making the PCT the initial and the major absorptive site of the nephron.
-65% of filtered plasma is reabsorbed by the segment almost all filtered glucose and 100% amino acids are
likewise reabsorbed in this segment

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Histology of the Loop of Henle
-basically with multiple segments
a. Thick descending limb- also known as the proximal straight tubule
b. Thin segment of the loop of Henle
c. Thick ascending limb of the loop-or also known as the distal straight tubule: actually the proximal part of the
DCT later on

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-The loop of henle is lined 4 types of simple epithelium, the epithelium type depends on the location in
reference to the loop of henle segment
 Type 1 loop of henle epithelium- found in thin descending and ascending limbs of the LOH particularly of
those short loop nephrons of the cortical nephrons. Epithelium is of simple type with almost no
interdigitations with neighboring cells.
 Type 2 epithelium- found in the thin descending limb of the long LOH in the cortical labyrinth the
epithelium is taller, the lateral interdigitations with neighboring cells are basically many and this varies in
between species
 Type 3 epithelium- found in the thin descending limb of loop of henle in the inner medulla of the renal
parenchyma. Epithelium is thinner compared to type II, more simple, fewer microvilli compared to the
type 2 epithelial cells. Lateral interdigitations are absent compared to type 2 epithelium
 Type 4 epithelium- found in the bends of long looped nephrons and throughout the entire thin ascending
limb the epithelium is characterized as low, flattened epithelium w/o noticeable microvilli

The thin descending limb -highly permeable to water due to the presence of aquaporins
The thin ascending limb- highly permeable to sodium and chloride due to the presence of Na-K-Cl co-
transporters and is relatively impermeable to water

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DCT is distinguished from PCT
1. The epithelium is shorter
2. Less complex convolutions
3. Cells are smaller and less eosinophilic cuboidal cells
4. Lumen is wider than PCT

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Collecting Ducts
-are the conduits of the urine from the DCT to the medullary rays
-the collecting tubules shows a large lumen, the diameter of the tubule gradually increases as does the height
of the epithelial lining
-the lining epithelium is simple ranging from cuboidal to low columnar epithelial cells
-The cells base rest on top of a thin basement membrane with apical surfaces with a direct contact to the large
central lumen.
-A lack of cellular projections or invaginations makes lateral cell borders more distinct than in other segments
of the nephron
-each cell has round centrally located nucleus, pale cytoplasm due to relatively posity** of cytoplasmic
organelles
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Juxtaglomerular Apparatus
-Located near the vascular pole of the renal corpuscle
- several components
1. DCT particularly the specialized cuboidal epithelium known as the Macula Densa cells
2. Juxtaglomerular cells of the afferent arteriole which are modified smooth muscle cells. This complexes
produces the substance Renin, a vital component of the Renin Angiotensin Aldosterone System or RAAS