Chapter 19

URINARY SYSTEM

OBJECTIVES:
At the end of the chapter, the students will be able to:
A. discuss the organs, structures and functions of urinary system;
B. identify the microscopic anatomy of the kidney;
C. explain the physical characteristics of urine
D. enumerate abnormal urine constituents.

Urinary system produces, stores, and excretes urine via a filtration mechanism in

which potentially harmful molecules are removed from the body. It also plays a
crucial role in water homeostasis, electrolyte and acid-base balance, and red blood
cell production.The human urinary tract is composed of two kidneys, two ureters, one
bladder, two sphincters, and one urethra.

How Does the Urinary System Work?

Urinary system works relatively simple, although the supplementary roles of the
kidneys can be complex.
1. Blood is transported to the kidneys via the renal artery.
2. A system of filtration units within the kidney regulates levels of dilution (water),
salts and other small  molecules in the filtrate.
3. Any excess or undesired products travel through each ureter and are deposited
into the reservoir of the bladder, while purified blood re-enters the circulatory
system by way of the renal vein.
4. Urine is stored in the bladder until the urinary nervous system releases the
contents through the urethra and out of the body. 
5. micturition or urination - the passing of urine

Urinary system is split into:

1. upper urinary tract - kidneys and ureters
2. lower urinary tract - bladder and urethra
Factors affecting the volume of urine excretion: factors:
1. ratio of waste products to water,
2. dietary habits,
3. physical activity levels,
4. medications,
5. comorbidities,
6. state of health of various organs and systems within the body

Urinary System Function

1. main function - to filter the blood of excess water, salts, and waste products,
temporarily store these within a reservoir, and intermittently expel these products
from the body.

Filtration, Reabsorption, and Secretion

Each kidney contains approximately one million nephrons. Nephrons play a
crucial role in removing waste products and adjusting concentrations of water,
ions and smaller molecules in the blood. A single kidney contains enough
nephrons to filter the blood and produce urine – for this reason, kidney
transplants can use organs from living donors. When both kidneys are damaged,
ions, salts, water, and small molecules accumulate in the body, causing
complete organ failure and death if left untreated. A kidney cannot generate new
nephrons – once they are damaged, they can not be replaced.
A nephron is an entire system within itself with different parts of its structure situated
in different areas of the kidney. The long Loop of Henlé (some nephrons only have a
short loop) can be found in the central region of the kidney – the medulla. Other
structures are found in the renal cortex or outer layer. Nephrons receive a blood
supply via an afferent arteriole and return filtered blood back into the circulation
via an efferent arteriole. These are two ends of a long, convoluted group of
capillaries which surrounds the nephron, allowing the diffusion of water, ions, salts,
and other molecules. The image below shows the blood flow into the kidney and
nephron (in red), the production and excretion of urine (yellow), and the return of
reabsorbed products and filtered blood into the circulatory system (blue).
Microscopic Anatomy of the Kidney:
1. Nephron – Responsible for forming urine; has:
a. renal tubule b. renal corpuscle
Each renal corpuscle consists of :
a. glomerulus (a knot of capillaries)
b. glumerular (Bowman’s) capsule - a cup-shaped hollow structure that
completely surrounds the glomerulus
podocytes – specialized cells; the inner wall with long branching processes
called foot processes
Renal tubule – make up the rest of the nephron, 3 cm 91.25 in) long; extends from
glomerular capsule, it coils and drop down into a long hairpin loop and the coils again
and twists before entering a connecting duct. The other parts of the renal tubule are
the proximal convoluted tubule, nephron loop (loop of Henle), and distal convoluted
tubule
Three functions of nephron:
1. glomerular filtration (of water and solutes within the blood), . Filtration occurs
within the glomerulus
2. tubular reabsorption (the return of water and required molecules to the
circulation); tubular reabsorption in the proximal convoluted tubule
3. tubular secretion (of waste or excess molecules – including water) into a distal
tube; secreted fluid (urine). tubular secretion in the distal convoluted tubule
Every minute, approximately 125 ml of blood is filtered by the nephrons of both
kidneys. The majority of filtrate is reabsorbed – meaning in a period of 24 hours,
around 180 liters of filtrate are produced but only 1.5 liters of this is excreted as
urine;The loop of Henlé maintains a concentration gradient so that water and ions
are more easily reabsorbed. In the image below, the achievement of equal
concentrations of a solute on either side of a membrane by the process of diffusion is
depicted. Both osmosis and diffusion occur within nephrons. Osmosis is the
movement of water, not solute, through a semi-permeable membrane.

The concentration gradient

Reabsorbed molecules include glucose, amino acids, sodium chloride, and water,

as well as calcium, potassium, hydrogen and bicarbonate ions.
Secreted molecules are urea, uric acid, creatinine and hydrogen, and potassium
ions.
a. Uric acid is a product of nitrogenous metabolism, a mechanism that breaks
down ingested purine proteins.
b. Urea is a byproduct of ammonia which is formed in the liver, also from the
breakdown of amino acids.
c. Creatinine phosphate or phosphocreatine is a by-product of cellular energy
production when adenosine triphosphate (ATP) is converted to
adenosine diphosphate (ADP). In order to form another ATP molecule, an
extra phosphate molecule is necessary – creatinine phosphate.
The liver and kidney produce creatinine phosphate, and it can also be
ingested from meat sources.
Larger molecules such as proteins and glucose are usually unable to pass into
the nephron, yet in kidney diseases and their symptoms such as diabetic
nephropathy or nephrotic syndrome, the glomeruli of the nephrons leak and large
molecules and even blood cells can be found in the ultrafiltrate (urine). For this
reason, the protein content of urine is often measured in at-risk patients such as
diabetics and pregnant women. A simple urine test strip will indicate levels of
various large cells or molecules within the urine, including white blood cells,
proteins, ketones, and glucose.

Urine test strip

Characteristics of Urine: https://www.slideshare.net/sana1718/characteristics-of-

urine-46606286 (Please see this)

Urine Transportation and Storage

Nephrons empty the final product – urine or ultra filtrate – into a system of collecting
ducts which bring the urine into the ureter. Ureters are two narrow but relatively long
tubes (approximately 25 – 30 cm) which leave the kidneys and enter the urinary
bladder. Ureter muscle layers help by way of peristalsis – the involuntary contraction
and relaxation of smooth muscle – to propel urine towards the urinary bladder.
Gravity also plays a part.

Urinary bladder - store and expel urine. Once the urine is transported into the
bladder it does not flow back due to directional forces of the ureter muscle layers
and the flattened ends of the ureters where ureter and bladder meet (the
vesicoureteral junction). This flattening increases as the bladder fills, making it
difficult for urine to flow back towards the kidneys. However, this can occur in
cases of vesicoureteral reflux due to anatomical abnormalities in ureteral
positioning at the vesicoureteral junction or in nerve disorders where peristalsis and
muscle tone are affected.
Micturition
Human bladder usually stores around 300 to 600 ml of urine before micturition and
is controlled by the pontine micturition center of the brain.
The triangular shaped bladder is a large muscle into the top of which the two ureters
empty the urine. Under the bladder, close to where it connects to a single urethra, lie
two circular sphincters – internal and external. These only relax during
micturition and otherwise prevent urine from constantly leaking out. The
internal sphincter is an involuntary muscle; the external sphincter is voluntary.
The urinary bladder is lined by a thick mucosa which forms folds when the bladder is
empty but opens out as the bladder fills and expands.
Located within the bladder wall are stretch receptor cells. When the bladder fills
to around 250 ml, the mucosal folds open and stimulate these stretch receptors.
They send signals to the pontine micturition center of the brain. The brain
responds by relaxing the internal urethral sphincter. The external urethral sphincter
remains closed until the person in question chooses to urinate, although in babies,
the elderly, and those with motor or sensory nerve disorders such as sufferers
of multiple sclerosis, this is not always a voluntary action.
Upon relaxation of the voluntary external sphincter, urine from the bladder
flows through the urethra and is expelled from the body. The image below shows the
stages of micturition and the muscles involved, namely the detrusor muscle of the
urinary bladder, the internal urethral sphincter, and the pelvic floor muscle which
surrounds the external sphincter.

Stages of Micturition

Urinary System Organs and Urinary System Structures

Main urinary system organs and other urinary system structures:
1. kidneys,
2. bladder,
3. ureters, and
4. urethra.
These form a sterile environment which is protected against the non-sterile outside
world, provide the forces necessary to expel urine through a series of organs, and
respond to sensitive involuntary and voluntary nervous stimulation.

Kidneys - located just below the ribs and are close to the middle of the back; have
multiple functions:
1. kidney creates balance in the amount of water and electrolytes in the body’s
circulatory system,
2. removes waste products (including drugs) from the body,
3. controls blood pressure through the release of hormones (RAAS, Renin-
Angiotensin-Aldosterone-System) and fluid balance

4. regulates red blood cell production and subsequent tissue oxygenation levels

(erythropoietin), and
5. increases bone mass through calcium and phosphorus regulation.

Kidneys contribute vastly to homeostasis . Homeostasis is an automated

mechanism whereby concentrations of chemicals and fluids within the biological
systems of an organism are stabilized. 
a. maintaining extracellular fluid volumes,
b. acidity and alkalinity (pH),
c. osmotic concentrations (concentration of solute molecules in a solution), and
d. excreting potentially harmful products or excess molecules which can upset
natural homeostasis.

Ureters - two ureters which extend from kidney to bladder. Peristalsis and gravity
bring urine along these narrow, hollow, thickly-layered tubes. Because the hollow
areas are narrow, ureters can become blocked by debris such as salt crystals
which have stuck together to create urinary stones. Complete blockage in one tube
causes high pressures and urine buildup in its attached kidney and requires
emergency surgery before permanent damage is done. Alternatively, reflux or the
return of urine back into the ureters can cause infection and dangerously high
pressures within the kidneys.

Bladder - is kept in place by a series of external ligaments. It’s main function is as a

reservoir for urine. The bladder expands as it fills due to its thick layer of transitional
epithelium. The cells of this layer can stretch and change shape, allowing the bladder
to hold increasing amounts of urine. Two sphincter muscles stop urine from
continually leaking out of the bladder. When this mechanism does not function
properly incontinence is the result. The urinary nervous system provides the cues
for bladder emptying and depends on signals sent from the stretch receptor cells
inside the bladder wall. The image below shows the neural circuitry involved in
urination.
 Neural control of micturition

Urethra - lengths differ in male and female urinary systems. The comparatively long
male urethra that runs from the bottom of the bladder to the external urethral meatus
of the penis is approximately 20 cm in length.
Urethra of the human female is only around 4 cm in length; short length is the
reason why women are more susceptible to urinary tract infections than men.
The image below shows urinary catheterization in male and female subjects. Note
the significantly longer length of the male catheter compared to that of the female.

Male and female urinary catheterization

The single urethra allows urine to pass outside the body once the brain has released
the involuntary internal sphincter and the person in question has voluntarily released
the external sphincter. No peristalsis occurs in the urethra – the passage of urine
into the outside world is controlled by a combination of :
1. the pressure of the urine in the bladder,
2. muscle tone, and
3. gravity.
Urinary System Diseases
1. Urolithiasis -
Most kidney stones are small and simply pass through the urinary system without
being noticed. Larger stones are most likely to become lodged in the narrow
openings of either ureter. Low urine volumes and high salt concentrations in the
urine contribute to stone formation. Stones are formed through
the crystallization of salts. The presence of urinary system stones is referred to as
urolithiasis (renal calculi, or nephrolithiasis)

2. Urinary Schistosomiasis
Parasitic flatworms called Schistosoma are the cause of urinary schistosomiasis or
snail fever; common tropical disease. Symptoms develop after the adults have laid
eggs and include fever, shivering, cough, and muscle pain. Chronic forms present
with symptoms much later on with the potential for ascites, blood in the urine,
breathing problems, and overall weakness; possible to experience seizures,
paralysis, and changes in behavior and mental state in untreated chronic
schistosomiasis.

3.Nephrotic Syndrome
Nephrotic syndrome - not a disease in itself but the result of a wide range of
kidney diseases. The main symptoms of nephrotic syndrome are fluid retention
(edema) in the lower limbs and face, foam-like urine caused by high levels of
proteins, fatigue, and loss of appetite. Fluid retention also causes significant
weight gain. Any of the kidney diseases listed here have the potential to cause
nephrotic syndrome if the filtering system of the nephrons becomes damaged and
allows large molecules, primarily a protein found in the blood called albumin, to
pass into the ultrafiltrate. Treatments of this syndrome need to manage the
underlying cause(s) and not only the symptoms.

4. Urinary Tract Infections

Upper urinary tract infections (UTIs) involve symptoms such as high fever, shivering,
vomiting, and pain in the loins. Lower urinary tract infections cause frequent, urgent
or irregular urination, pain above the pubis (suprapubic pain), and sometimes traces
of blood in the urine. The main cause of both types of infection is the E. coli
bacteria, transferred into the urinary tract via the anus.

5. Chronic Kidney Disease and Chronic Renal Failure

Chronic kidney disease (CKD) can be inherited, as in autosomal dominant polycystic
kidney disease (ADPKD), be the long-term result of acute kidney infection or trauma,
or occur through a process in which damage to the urinary system takes place over
many years. Approximately 70% of patients with CKD are diabetics,
hypertension patients or patients presenting with atherosclerosis.  These three
diseases are often comorbid. Over time, nephron function is reduced through high
levels of larger molecules passing through the nephrons, hormonal imbalances, or
nervous system degeneration. caused by a low oxygen supply or hypoxia.
When both kidneys are no longer able to function, chronic renal failure is the result.
In these cases, dialysis via the peritoneum of the abdominal cavity or via the
circulatory system (hemodialysis) must take over all of the kidneys’ roles.

5. Acute Kidney Injury

Trauma or short-term illness can cause acute kidney injury (AKI), otherwise known
as acute renal failure. Nephrons are damaged by a sudden lowering of the
blood supply due to hypovolemia. This can even be the result of excessive
vomiting or long-term diarrhea. Symptoms include low amounts of urine, swelling
in the lower limbs, fatigue, trouble breathing, confusion, nausea and chest pain. If left
untreated, AKI can lead to convulsions and death. Immediate treatment is
mandatory, where either injury or illness (or both) recovery allows the blood volume
to be restored. Short-term hemodialysis is sometimes necessary to take over the
role of the kidneys until the patient has stabilized.

6.Diabetic Nephropathy
When untreated or badly managed, diabetes causes high levels of glucose in the
blood, giving it a syrupy consistency. Over time, high glucose levels damage the
nephrons and they begin to leak proteins into the urine. Diabetic African
Americans and Hispanic populations are particularly susceptible to renal disease
caused by type 2 or type 1 diabetes.
Type 1 diabetes don’t produce insulin, destroyed immune system ( lymphoid organ –
pancreas, don’t produce insulin); juvenile diabetes (developed during childhood or
adolescence)

7. Benign Prostatic Hyperplasia

The non-malignant form of prostate enlargement affects elderly males. Urologists
agree that all men from the age of sixty have some degree of prostate
enlargement. While this is not a life-threatening disease, the enlarged prostate can
push against the urethra and narrow it, causing frequent urination, a weak urine
stream, and incontinence. Treatment includes muscle relaxant or prostate-shrinking
drugs or prostate removal in a surgical procedure.
Urine – liquid product secreted by the kidney, excreted through uretha, composed of
nitrogenous waste.
Composition of Urine:
1. 95% volume of normal urine is water
2. Organic components – urea, urobilinogen (UBG), nitrogenous waste (urea,
uric acid, creatinine) amino acids, metabolites of hormones
3. Inorganic components –
a. cations: Na+, K+. Ca+2, NH4+
b. anions: Cl-, SO4-2, HCO3-, HPO4-

Characteristics of Urine:
A. Physical Characteristics
1. Color – pale to deep yellow (due to urochrome)
a. Red or red-brown (abnormal) could be from a food dye, eating fresh
beets, dragon fruit, drug or the presence of Hemoglobin or myoglobin,
many RBC
b. Dark yellow – indicative of hydration
c. Yellow, Orange – removal of Vit B
d. Orange – from mrdication as rifamine
e. Brown – symptoms of jaundice, rhabdomyolosis, or gibert’s syndrome
(mild liver disorder – not processing bilirubin properly)
f. Pinkish – consumption of beet
2. Odor – slightly aromatic (fresh)
a. Ammoniacal – prolonged standing of urine
b. Fruity – or acetone-like due to elevated ketones
c. Teltale scents – (smelly) -consumption of alcohol, saffron, coffee,
tunafish and onion
3. Turbidity or cloudiness – clear; turbidity caused by excessive cellular
material or protein in the urine; many RBC, pus cells
4. pH – 5.5 – 6.8 (slightly acidic)
a. acidic – meat food, diabetes mellitus, starvation, fever; contribute to
the formation of stones of uric acid; cranberries
 b. alkaline – plant food vegetables, cystitis, pyelitis
5. Volume – 1 to 2 L/day; depending on state of hydration, activity level,
environmental factor (cold- greater volume), health of the individual
6. Density (Specific gravity) – 1.003 to 1.035 g/cc
7. Urine sterility-
a. Normal – No microorganisms
b. Abnormal – presence of microorganisms

Anuria – complete stoppage of urine

Oliguria – reduced amount of urine
Polyuria – increased amount of urine
Nocturia – increased amount of urine at night
Proteinuria – inc. proteins (glomerulonephritis, bacterial infection, pregnancy) ; 150
mg excreted daily
Albuminuria – inc. albumin same as above
Glycosuria – inc. glucose (diabetes mellitus, stress, 10 mmol/L
Ketonuris – inc. ketone bodies ; starvation, diabetes, pregnancy
Cast – small fibrous formed of proteins; settle in the kidney tubules and collecting
ducts; large number is a sign ok kidney disease.
Triple PO4 crystals – coffin lid
Calcium oxalate crystal can be seen in normal urine if the individual drank calamansi
juice, ate tomatoes or kamias the night before the urine collection

REFERENCES:

https://www.livescience.com/27012-urinary-system.html

https://biologydictionary.net/urinary-system/

https://www.slideshare.net/sana1718/characteristics-of-urine-46606286