Chapter 15 Kidneys

The Urinary System  Kidney structure

Filtration  Reabsorption secretion Excretion o An adult kidney is about 12 cm (5 in) long and 6
cm (2.5 in) wide
o Renal hilum
Functions of the Urinary System  A medial indentation where several
 Kidneys dispose of waste products in urine structures enter or exit the kidney
o Nitrogenous wastes (ureters, renal blood vessels, and
o Toxins nerves)
o Drugs o An adrenal gland sits atop each kidney
o Excess ions
 Kidneys’ regulatory functions include:
o Production of renin to maintain blood pressure
o Production of erythropoietin to stimulate red
blood cell production
o Conversion of vitamin D to its active form

Calcitriol – active form of vitamin D, circulates as a hormone,

regulates calcium & phosphate conc.

Organs of the Urinary System

 Kidneys
 Ureters
 Urinary bladder
 Urethra

Kidneys
 Location and structure
o The kidneys are Kidneys
situated against  Kidney structure (continued)
the dorsal body o Three protective layers enclose the kidney
wall in a  Fibrous capsule encloses each kidney
retroperitoneal  Perirenal fat capsule surrounds the
position (behind kidney and cushions against blows
the parietal  Renal fascia is the most superficial
peritoneum) layer that anchors the kidney and
o The kidneys are situated at the level of the T12 to adrenal gland to surrounding
L3 vertebrae structures
o The right kidney is slightly lower than the left
(because of position of the liver)
Kidneys
 Kidney structure (continued)
o Three regions revealed in a longitudinal section
1. Renal cortex—outer region
2. Renal medulla—deeper region
o Renal (medullary)
pyramids—triangular regions
of tissue in the medulla
o Renal columns—extensions
of cortexlike material that
separate the pyramids

Kidneys
 Kidney structure (continued)
o Three regions (continued)

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 3. Renal pelvis—medial region that is a
flat, funnel-shaped tube
o Calyces form cup-shaped
“drains” that enclose the renal
pyramids
o Calyces collect urine and
send it to the renal pelvis, on
to the ureter, and to the
urinary bladder for storage

Aorta – major (largest artery) red blood vessel leading to

Kd & other parts of the body
The inferior vena cava is a vein. It carries
deoxygenated blood
The heart pumps blood from the left ventricle into
the aorta

Nephrons
 Structural and functional units of the kidneys
Figure 15.2b Internal anatomy of the kidney  Each kidney contains over a million nephrons
 Each nephron consists of two main structures
1. Renal corpuscle
Kidneys 2. Renal tubule
 Blood supply
o One-quarter of the total blood supply of the body
passes through the kidneys each minute
o Renal artery provides each kidney with arterial
blood supply
o Renal artery divides into segmental arteries →
interlobar arteries → arcuate arteries →
cortical radiate arteries

Kidneys
 Venous blood flow
o Cortical radiate veins → arcuate veins →
interlobar veins → renal vein
o There are no segmental veins
o Renal vein returns blood to the inferior vena
cava
Nephrons
 Renal corpuscle consists of:
Arterial blood – oxygenated except for pulmonary where 1. Glomerulus, a knot of capillaries made of
deoxygenated podocytes
 Podocytes make up the inner (visceral)
layer of the glomerular capsule
o Foot processes cling to the
glomerulus
o Filtration slits create a porous
membrane—ideal for filtration
2. Glomerular (Bowman’s) capsule is a
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 cup-shaped structure that surrounds the calyces, and then to the renal pelvis
glomerulus
 First part of the renal tubule

Figure 15.3b Structure of the Nephron

Nephrons
 Renal tubule
o Extends from glomerular capsule and ends
when it empties into the collecting duct
o From the glomerular (Bowman’s) capsule, the
subdivisions of the renal tubule are:
1. Proximal convoluted tubule (PCT)
2. Nephron loop (loop of Henle)
3. Distal convoluted tubule (DCT)

Figure 15.3a Structure of the nephron

Nephrons
 Two capillary beds associated with each nephron
1. Glomerulus
2. Peritubular capillary bed

Convolute – rolled longitudinally

Nephrons
 Cortical nephrons
o Located entirely in the cortex
o Include most nephrons
 Juxtamedullary nephrons
o Found at the cortex-medulla junction
o Nephron loop dips deep into the medulla
o Collecting ducts collect urine from both types of
nephrons, through the renal pyramids, to the
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Glomerulus- knot of capillaries

Nephrons
 Glomerulus
o Fed and drained by arterioles
 Afferent arteriole—arises from a
cortical radiate artery and feeds the
glomerulus
 Efferent arteriole—receives blood that
has passed through the glomerulus
o Specialized for filtration
o High pressure forces fluid and solutes out of
blood and into the glomerular capsule

Nephrons
 Peritubular capillary beds
o Arise from the efferent arteriole of the
glomerulus
o Low-pressure, porous capillaries
o Adapted for absorption instead of filtration
o Cling close to the renal tubule to receive solutes
and water from tubule cells
o Drain into the interlobar veins  PCT
Urine Formation and Characteristics
 Urine formation is the result of three processes
1. Glomerular filtration
2. Tubular reabsorption
3. Tubular secretion

PCT Proximal convulated tubule

DCT-Distal convulated tubule

Concept Link: Recall that filtration, as a passive process,

requires a pressure gradient. The capillaries of the glomerulus
are under higher pressure compared to the glomerular
capsule; as a result, fluids move down the pressure gradient,
from the blood into the glomerular capsule.

Urine Formation and Characteristics

 Glomerular filtration
o The glomerulus is a filter
o Filtration is a nonselective passive process
 Water and solutes smaller than
Figure 15.4 The kidney depicted schematically as a proteins are forced through glomerular
single large, uncoiled nephron capillary walls
 Proteins and blood cells are normally
Creatinine is the byproduct of metabolism. too large to pass through the filtration
membrane
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  Once in the capsule, fluid is called  Creatinine
filtrate
 Filtrate leaves via the renal tubule

Urine Formation and Characteristics

 Glomerular filtration (continued)
o Filtrate will be formed as long as systemic blood
pressure is normal
 If arterial blood pressure is too low,
filtrate formation stops because
glomerular pressure will be too low to
form filtrate

Urine Formation and Characteristics

 Tubular reabsorption
o The peritubular capillaries reabsorb useful
substances from the renal tubule cells, such as:
 Water
 Glucose
 Amino acids
 Ions
o Some reabsorption is passive; most is active
(ATP)
o Most reabsorption occurs in the proximal
convoluted tubule
Urine Formation and Characteristics
 Tubular secretion (continued)
o Secretion is important for:
 Getting rid of substances not already in
the filtrate
 Removing drugs and excess ions
 Maintaining acid-base balance of
blood
o Materials left in the renal tubule move toward
the ureter

Concept Link: Recall that pH is a measure of hydrogen ion

(H+) concentration. When the body experiences a high level
of hydrogen ions, which can lower pH, the kidneys help by
eliminating excess hydrogen ions from the body via the
urine.

Urine Formation and Characteristics

 Nitrogenous wastes
o Nitrogenous waste products are poorly
Figure 15.5 Sites of filtration, reabsorption, and secretion
reabsorbed, if at all
in a nephron o Tend to remain in the filtrate and are excreted
from the body in the urine
 Urea—end product of protein
Urine Formation and Characteristics breakdown
 Tubular secretion  Uric acid—results from nucleic acid
o Reabsorption in reverse metabolism
o Some materials move from the blood of the  Creatinine—associated with creatine
peritubular capillaries into the renal tubules to metabolism in muscles
be eliminated in filtrate
 Hydrogen and potassium ions

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Creatinine clearance is a good estimation of the glomerular sugary foods
filtration rate.
Pathological:
Creatinine is a chemical waste product that's produced by Diabetes mellitus
your muscle metabolism and to a smaller extent by eating Proteins Proteinuria (aka Nonpathological:
meat. Albuminuria) Physical exertion,
pregnancy
Abnormally high levels of creatinine thus warn of possible
malfunction or failure of the kidneys. Pathological:
Glomerulonephritis,
hypertension
Urine Formation and Characteristics Pus (WBCs and Pyuria Urinary tract
 In 24 hours, about 1.0 to 1.8 liters of urine are produced bacteria) infection
 Urine and filtrate are different RBCs Hematuria Bleeding in the
o Filtrate contains everything that blood plasma
urinary tract (due to
does (except proteins)
trauma, kidney
o Urine is what remains after the filtrate has lost
stones, infection)
most of its water, nutrients, and necessary ions
Hemoglobin Hemoglobinuria Various:
through reabsorption
Transfusion
o Urine contains nitrogenous wastes and
reaction, hemolytic
substances that are not needed
anemia
Bile pigment Bilirubinuria Liver disease
Urine Formation and Characteristics (hepatitis)
 Urine characteristics
o Clear and pale to deep yellow in color
Ureters
o Yellow color is normal and due to the pigment
 Slender tubes 25–30 cm (10–12 inches) attaching the
urochrome (from the destruction of hemoglobin)
kidney to the urinary bladder
and solutes
o Continuous with the renal pelvis
 Dilute urine is a pale, straw color
o Enter the posterior aspect of the urinary bladder
o Sterile at the time of formation
o Run behind the peritoneum
o Slightly aromatic, but smells like ammonia with
 Peristalsis aids gravity in urine transport
time
o Slightly acidic (pH of 6)
o Specific gravity of 1.001 to 1.035

Urine Formation and Characteristics

 Solutes normally found in urine
o Sodium and potassium ions
o Urea, uric acid, creatinine
o Ammonia
o Bicarbonate ions

Urine Formation and Characteristics

 Solutes NOT normally found in urine
o Glucose
o Blood proteins
o Red blood cells
o Hemoglobin
o WBCs (pus)
o Bile

Table 15.1 Abnormal Urinary Constituents

Substances Name of Possible Causes
Condition
Glucose Glycosuria Nonpathological:
Excessive intake of
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 Urinary Bladder
 Wall of the urinary bladder
o Three layers of smooth muscle collectively
called the detrusor muscle
o Mucosa made of transitional epithelium
o Walls are thick and folded in an empty urinary
bladder
o Urinary bladder can expand significantly without
increasing internal pressure

Urinary Bladder
 Capacity of the urinary bladder
o A moderately full bladder is about 5 inches long
Figure 15.1a Organs of the urinary system and holds about 500 ml of urine
o Capable of holding twice that amount of urine

Urinary Bladder
 Smooth, collapsible, muscular sac situated posterior to Urethra
the pubic symphysis  Thin-walled tube that carries urine from the urinary
 Stores urine temporarily bladder to the outside of the body by peristalsis
 Trigone—triangular region of the urinary bladder base  Function
based on three openings o Females—carries only urine
o Two openings from the ureters (ureteral orifices) o Males—carries urine and sperm
o One opening to the urethra (internal urethral
orifice)
 In males, the prostate surrounds the neck of the urinary
bladder

Urethra
 Release of urine is controlled by two sphincters
1. Internal urethral sphincter
 Involuntary and made of smooth
muscle
2. External urethral sphincter
 Voluntary and made of skeletal muscle

Urethra
 Length
o In females: 3 to 4 cm (1.5 inches long)
o In males: 20 cm (8 inches long)
 Location
o Females—anterior to the vaginal opening
o Males—travels through the prostate and penis
 Prostatic urethra
 Membranous urethra
 Spongy urethra
Figure 15.7 Position and shape of a distended and an empty urinary
bladder in an adult male

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 Maintaining Water Balance of the Blood
 Water occupies three main fluid compartments
1. Intracellular fluid (ICF)
 Fluid inside cells
 Accounts for two-thirds of body fluid
2. Extracellular fluid (ECF)
 Fluids outside cells; includes blood
plasma, interstitial fluid (IF), lymph,
and transcellular fluid
3. Plasma (blood) is ECF, but accounts for 3L of
total body water.
 Links external and internal
environments (Figure 15.9)
Micturition
 Micturition
o Voiding, or emptying of the urinary bladder
o Two sphincters control the release of urine, the
internal urethral sphincter and external urethral
sphincter
 Bladder collects urine to 200 ml
 Stretch receptors transmit impulses to the sacral region
of the spinal cord
 Impulses travel back to the bladder via the pelvic
splanchnic nerves to cause bladder contractions

Micturition
 When contractions become stronger, urine is forced past
the involuntary internal sphincter into the upper urethra
 Urge to void is felt
 The external sphincter is voluntarily controlled, so Figure 15.8 The major fluid compartments of the body
micturition can usually be delayed

Fluid, Electrolyte, and Acid-Base Balance

 Blood composition depends on three factors
1. Diet
2. Cellular metabolism
3. Urine output

Fluid, Electrolyte, and Acid-Base Balance

 Kidneys have four roles in maintaining blood composition
1. Excreting nitrogen-containing wastes
(previously discussed)
2. Maintaining water balance of the blood
3. Maintaining electrolyte balance of the blood
4. Ensuring proper blood pH

Maintaining Water Balance of the Blood

 Normal amount of water in the human body Figure 15.9 The continuous mixing of body fluids
o Young adult females = 50%
o Young adult males = 60%
o Babies = 75% Maintaining Water Balance of the Blood
o The elderly = 45%  The link between water and electrolytes
 Water is necessary for many body functions, and levels o Electrolytes are charged particles (ions) that
must be maintained conduct electrical current in an aqueous
solution
o Sodium, potassium, and calcium ions are
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 electrolytes
Maintaining Water Balance of the Blood
 Regulation of water intake and output
o Water intake must equal water output if the body
is to remain properly hydrated
o Sources for water intake
 Ingested foods and fluids
 Water produced from metabolic
processes (10%)
o Thirst mechanism is the driving force for water
intake
Figure 15.10 Water intake and output
Maintaining Water Balance of the Blood
 Thirst mechanism
o Osmoreceptors are sensitive cells in the
hypothalamus that become more active in
reaction to small changes in plasma solute
concentration
o When activated, the thirst center in the
hypothalamus is notified
o A dry mouth due to decreased saliva also
promotes the thirst mechanism
o Both reinforce the drive to drink
Maintaining Water Balance of the Blood
 Sources of water output
o Lungs (insensible since we cannot sense the
water leaving)
o Perspiration
o Feces
o Urine
Maintaining Water Balance of the Blood
 Hormones are primarily responsible for reabsorption of
water and electrolytes by the kidneys
o Antidiuretic hormone (ADH) prevents excessive
water loss in the urine and increases water
reabsorption
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o ADH targets the kidney’s collecting ducts
Maintaining Electrolyte Balance
 Small changes in electrolyte concentrations cause water
to move from one fluid compartment to another
 A second hormone, aldosterone, helps regulate blood
composition and blood volume by acting on the kidney
o For each sodium ion reabsorbed, a chloride ion
follows, and a potassium ion is secreted into the
filtrate
o Water follows salt: when sodium is reabsorbed,
water follows it passively back into the blood
Electrolyte Balance
 Renin-angiotensin mechanism
o Most important trigger for aldosterone release
o Mediated by the juxtaglomerular (JG) apparatus
of the renal tubules
o When cells of the JG apparatus are stimulated
by low blood pressure, the enzyme renin is
released into blood
Electrolyte Balance
 Renin-angiotensin mechanism (continued)
o Renin catalyzes reactions that produce
angiotensin II
o Angiotensin II causes vasoconstriction and
aldosterone release
o Result is increase in blood volume and blood
pressure
Maintaining Acid-Base Balance of Blood
 Blood pH must remain between 7.35 and 7.45 to maintain
homeostasis
o Alkalosis—pH above 7.45
o Acidosis—pH below 7.35
o Physiological acidosis—pH between 7.0 and
7.35
Maintaining Acid-Base Balance of Blood
 Kidneys play greatest role in maintaining acid-base
balance
 Other acid-base controlling systems
o Blood buffers
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 o Respiration
Maintaining Acid-Base Balance of Blood
 Blood buffers
o Acids are proton (H+) donors
 Strong acids dissociate completely
and liberate all of their H+ in water
 Weak acids, such as carbonic acid,
dissociate only partially
o Bases are proton (H+) acceptors
 Strong bases dissociate easily in water
and tie up H+
 Weak bases, such as bicarbonate ion
and ammonia, are slower to accept H+
Maintaining Acid-Base Balance of Blood
 Molecules react to prevent dramatic changes in hydrogen
ion (H+) concentrations
o Bind to H+ when pH drops
o Release H+ when pH rises
 Three major chemical buffer systems
1. Bicarbonate buffer system
2. Phosphate buffer system
3. Protein buffer system
Maintaining Acid-Base Balance of Blood
 The bicarbonate buffer system
o Mixture of carbonic acid (H2CO3) and sodium
bicarbonate (NaHCO3)
 Carbonic acid is a weak acid that does
not dissociate much in neutral or acid
solutions
 Bicarbonate ions (HCO3−) react with
strong acids to change them to weak
acids
HCl + NaHCO3 → H2CO3 + NaCl
strong acid weak base weak acid salt
Maintaining Acid-Base Balance of Blood
 The bicarbonate buffer system (continued)
o Carbonic acid dissociates in the presence of a
strong base to form a weak base and water
NaOH + H2CO3 → NaHCO3 + H2O
strong base weak acid weak base water
Maintaining Acid-Base Balance of Blood
 Respiratory mechanisms
o Respiratory rate can rise and fall depending on
changing blood pH to retain CO2 (decreasing
the blood pH) or remove CO2 (increasing the
blood pH)
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Maintaining Acid-Base Balance of Blood
 Renal mechanisms
o When blood pH rises:
 Bicarbonate ions are excreted
 Hydrogen ions are retained by kidney
tubules
o When blood pH falls:
 Bicarbonate ions are reabsorbed
 Hydrogen ions are secreted
o Urine pH varies from 4.5 to 8.0
Developmental Aspects of the Urinary System
 The kidneys begin to develop in the first few weeks of
embryonic life and are excreting urine by the third month
of fetal life
 Common congenital abnormalities include polycystic
kidney and hypospadias
 Common urinary system problems in children and young
to middle-aged adults include infections caused by fecal
microorganisms, microorganisms causing sexually
transmitted infections, and Streptococcus
Developmental Aspects of the Urinary System
 Control of the voluntary urethral sphincter does not start
until age 18 months
 Complete nighttime control may not occur until the child
is 4 years old
 Urinary tract infections (UTIs) are the only common
problems before old age
o Escherichia coli (E. coli), a bacterium, accounts
for 80 percent of UTIs
Developmental Aspects of the Urinary System
 Renal failure is an uncommon but serious problem in
which the kidneys are unable to concentrate urine, and
dialysis must be done to maintain chemical homeostasis
of blood
 With age, filtration rate decreases and tubule cells
become less efficient at concentrating urine, leading to
urgency, frequency, and incontinence
 In men, urinary retention is another common problem
Developmental Aspects of the Urinary System
 Problems associated with aging
o Urgency—feeling that it is necessary to void
o Frequency—frequent voiding of small amounts
of urine
o Nocturia—need to get up during the night to
urinate
o Incontinence—loss of control
o Urinary retention—common in males, often the
result of hypertrophy of the prostate gland
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