19 Urinary System

OBJECTIVES

This chapter should help the student to:

• List the organs of the urinary system and describe the role of each in the system's functions.
• Identify the structures and regions visible in a frontal section of a kidney and describe their functions.
• Describe the structure, function, and location of each component of a nephron and identify these
components in histologic sections.
• Describe the function of the juxtaglomerular apparatus and identify its components.
• Trace the flow of blood through the kidney and identify renal vascular elements in histologic sections.
• Trace the flow of urinary filtrate from Bowman's space to the exterior, naming in order the tubules and
components of the urinary tract and describing any changes in filtrate composition and epithelial lining
that occur in each component.
• Describe the kidney's endocrine functions and the hormonal regulation of renal function.

MAX-Yield™️ STUDY QUESTIONS

1. Name the organs of the urinary system (I.A.1 and 21) and describe their roles in the system's functions (I.B).
2. Sketch a frontal section of the kidney (Fig. 19-1) and label the following:
a. Capsule (II.A) j. Renal pelvis (I.A.1.a)
b. Cortex (II.A.3) k. Renal sinus (I.A.1.a) .
c. Medulla (II.A.4) l. Hilum (I.A.1.a)
d. Medullary pyramids (II.A.4) m. Renal artery and vein (I.A.2.a)
e. Medullary rays (II.A.5) n. Interlobar artery and vein (II.E)
f. Renal columns (Fig. 19-1) o. Arcuate artery and vein (II.E)
g. Major calyx (I.A.1.a) p. Interlobular artery and vein (II.E)
h. Minor calyx (I.A.1.a) q. Renal lobe (II.A.6)
i. Renal papilla (II.A.4) r. Renal lobule (II.A.7)
3. Sketch a nephron, label its major components, and show which components lie in the cortex and which in the
medulla (II.B.1-5; Fig. 19-5).
4. Sketch a renal corpuscle and label the following:
a. Glomerulus (II.B.1.a)
b. Visceral and parietal layers of Bowman's capsule (II.B.1.b)
c. Urinary space (II.B.1.b)
d. Afferent and efferent arterioles (II.B.1.f)
e. Vascular pole (II.B.1.d)
f. Urinary pole (II.B.1.e)
g. Proximal convoluted tubule (.B.2)
h. Mesangial cells (II.B.1.a)
5. Sketch the ultrastructure of a portion of the glomerular filtration barrier (Fig 19-2) and label the following:

1
See footnote on page 1.
243
244 / CHAPTER 19
a. Glomerular capillary lumen e. Pedicels
b. Glomerular capillary endothelial cell f. Filtration slits (slit pores)
c. Endothelial fenestrae g. Diaphragms covering filtration slits
d. Fused basal laminae h. Urinary space
6. Describe a role undertaken by mesangial cells in maintaining filtration barrier integrity (II.B.1.f)
7. Compare proximal and distal convoluted tubules in terms of:
a. Location in the kidney (II.B.2 and 4)
b. Epithelial lining (height, microvilli, mitochondria, staining, lateral and basal plasma membrane
infoldings; II.B.2 and 4)
c. Luminal diameter (II.B.2 and 4)
d. Substances absorbed from or secreted into filtrate (II.B.2 and 4)
8. What is the general function of the loop of Henle (II.B.3.b)?
9. Compare the ascending and descending loop of Henle in terms of the type of convoluted tubules its thick
portions resemble, the epithelial lining of its thin portions, and permeability to water (II.B.2.3.b.[1],[2], and 4.
10. Compare cortical and juxtamedullary nephrons in terms of their numbers, their roles (active versus passive) in
establishing medullary hypertonicity, and the length of their loops (II.B.5)
11. Compare collecting tubules and ducts (II.C.1 and 2) with convoluted tubules (II.B.2 and 4) in terms of location
and epithelia (epithelial height variation, cytoplasmic staining intensity, and intercellular border visibility).
12. Describe the juxtaglomerular apparatus (II.D) in terms of its components and their locations. Which cells
secrete renin?
13. Trace the flow of blood from the renal arteries to the glomerular capillaries (II.E).
14. Compare the paths taken to the renal vein by blood leaving the cortical and the juxtamedullary glomeruli. (Hint:
one path includes peritubular capillaries and stellate veins; the other includes the vasa recta; II.E.)
15. Compare the vasa recta (II.E) with the thin loops of Henle (II.B.3) from juxtamedullary nephrons in terms of
location, contents, epithelial type and thickness, and countercurrent function.
16. Compare aldosterone (II.B.4) and antidiuretic hormone (ADH; II.C.2) in terms of:
a. Site of synthesis and secretion
b. Stimulus for secretion
c. Site of action in the kidney
d. Role in kidney function
17. Beginning with the stimulus for the production of renin, diagram the cascade that produces angiotensin Il and
explain its role in renal function (II.D).
18. Trace the flow of fluid from the urinary (Bowman's) space to a minor calyx, naming, in order, the tubules
through which the fluid flows. Describe any changes in fluid composition (substances added or removed),
volume, and osmolarity (tonicity) that occur in each tubule segment (II.F; Fig. 19-3).
19. Describe the structural features of the walls of the renal calyces (III), renal pelvis (III), ureters (IV), and urinary
bladder (V).
20. Name-in order, from bladder to exterior-the parts of the male urethra and the epithelial lining of each part
(VI.A.1-3).
21. Compare male and female urethras in terms of length, function, and epithelial lining (VI.A and B)
22. Compare the internal (V) and external (VI.A.2) urinary sphincters in terms of location and muscle type.

SYNOPSIS

I. GENERAL FEATURES OF THE URINARY SYSTEM

A. Components of the System: The urinary system comprises the kidneys and the urinary tract.
1. Kidneys. These paired, bean-shaped, retroperitoneal organs are located in the posterior wall of the
abdominal cavity.
 URINARY SYSTEM / 245

Figure 19-1. General organization of the kidney.

a. Structural and functional subdivisions. In frontal section (Fig 19-1), each kidney shows a dark-
staining outer cortex and a light-staining inner medulla that partly surrounds the renal hilum.
Extensions of the medulla into the cortex are called medullary rays, and extensions of the cortex
into the medullar region are called renal columns (of Bertin). The hilum consists of the renal
sinus and its contents, which include the larger renal blood vessels, the renal pelvis, and adipose
tissue. Each human kidney consists of several pyramid-shaped subunits—renal lobes—whose
bases lie in the cortex and whose apices lie in the medulla. The apices are cupped by minor
calyces that collect and empty the urine from each lobe into the larger major calyces. These in
turn empty into the single, funnel-shaped renal pelvis, which is continuous with the ureter. Each
lobe consists of numerous renal lobules, each containing hundreds of nephrons. These largely
tubular structures filter the blood, modify the filtrate, and empty into a series of collecting tubules
and ducts that converge on the medulla to empty urine into the minor calyces.
b. Blood supply. Because they are blood-filtering organs, the kidneys' blood supply is crucial to
their function. A pair of renal arteries—one per kidney—arise from the aorta in the upper
abdomen. Each undergoes successive branching to feed specialized capillary beds in both the
cortex (glomeruli and peritubular capillaries) and medulla (vasa recta). Knowing the renal
artery's branching pattern within each kidney aids in understanding how the blood reaches the
capillaries that play integral roles in renal function. In addition, the structure, route, and location
of the branches provide clues to the arrangement of the structural and functional subdivisions of
the kidney

2. Urinary tract. The ureters, urinary bladder, and urethra are described mainly in terms of their
wall structure. Except for portions of the urethra, the lumen of the tract is characteristically lined with
transitional epithelium.

B. General Functions of the System: The kidneys filter the blood; reabsorb nutrients and excrete metabolic
wastes and foreign substances; regulate the ion, salt, and water concentrations of the fluids that bathe the
body's tissues, and produce renin and erythropoietin. The collection of raw filtrate from the blood in the
glomerular capillaries is only the first step in urine production. It is followed by the reabsorption of
important ions, small proteins, nutrients, and most of the water from the filtrate. These are returned to the
blood in the peritubular capillaries and vasa recta in precise proportions. The portion of the filtrate that is
not reabsorbed constitutes the urine; it is carried by the ureters from the kidneys, temporarily stored in the
urinary bladder, and released through the urethra.
246 / CHAPTER 19
II. KIDNEYS
A. General Organization: The kidneys, which measure approximately 11 X 6 cm, are bean-shaped,
retroperitoneal organs encapsulated by dense connective tissue and surrounded by adipose tissue. Several
components can be distinguished without the aid of a microscope.
1. Renal sinus. This medial concavity of each kidney contains the renal pelvis, the entering and exiting blood
vessels and nerves, and adipose tissue.
2. Hilum. This region comprises the renal sinus and its contents.
3. Cortex. This dark-staining outer region underlies the capsule. It contains the renal corpuscles, proximal
and distal convoluted tubules, peritubular capillaries, and medullary rays.
4. Medulla. This light-staining inner region partly surrounds the renal sinus. It comprises 8 to 18 conical
medullary pyramids whose bases abut the cortex and whose apices (renal papillae) point toward the renal
sinus. It also contains the collecting ducts, loops of Henle, and vasa recta. Each renal papilla, perforated
by openings of the collecting ducts, is cradled by a minor calyx into which the ducts empty. Several minor
calyces empty into a major calyx. The major calyces empty into the renal pelvis, which in turn drains into
the ureter.
5. Medullary rays. These extensions of medullary tissue, which penetrate the cortex, comprise clusters of
collecting tubules and ducts. One medullary ray occupies the center of each renal lobule.
6. Renal lobes. Each human kidney has 8 to 18 lobes. Each lobe (a medullary pyramid [II.A.4] and its
associated cortex) contains numerous renal lobules.
7. Renal lobules. Each lobule consists of a central medullary ray and all of the nephrons emptying into its
collecting tubules. The borders between adjacent renal lobules are marked by interlobular arteries and
veins.

B. Nephrons: Nephrons are the functional subunits of the kidney. Each includes a renal corpuscle, a proximal
convoluted tubule, a loop of Henle, and a distal convoluted tubule.
1. Renal corpuscle. This blood-filtering unit of the nephron consists of a glomerulus covered by a Bowman's
capsule; together, these structures form the filtration barrier. Each corpuscle has both a urinary and a
vascular pole.
a. Glomerulus. This small tuft of capillaries has fenestrae covered by thin diaphragms. Modified smooth
muscle cells called mesangial cells lie between the capillary loops.
b. Bowman’s capsule is a double-walled epithelial chamber. Its inner wall, or visceral layer, consists
of podocytes. These cells have long primary processes, from which arise interdigitating foot
processes (pedicels) that grasp the glomerular capillaries like fingers around a broom handle and
adhere tightly to the fused capillary-podocyte basal lamina. The outer wall-the parietal layer-is simple
squamous epithelium. The chamber between the visceral and parietal layers is the urinary (or
Bowman's) space.
c. Filtration barrier. The structures separating the capillary lumen from the urinary space (Figure 19-
2) include (1) the diaphragm-covered capillary fenestrations; (2) the fused basal laminae of the
capillary endothelial cells and podocytes; and (3) the diaphragm-covered filtration slits between the
interdigitating pedicels.
d. Vascular pole. This side of the corpuscle is where the afferent arterioles feeding the glomerular
capillaries enter and the efferent arterioles feeding draining them exit. It lies opposite the urinary pole.
e. Urinary pole. This side of the corpuscle is where the proximal convoluted tubule exits.
f. Filtration mechanism. Blood is delivered to the glomerulus by the afferent arteriole. Arterial
pressure forces fluid from the blood through the filtration barrier and into the urinary space. Each
component of the barrier (fenestrae, diaphragms, basal lamina, filtration slits) aids in limiting the
passage of blood components by size, thus preventing blood cells and large proteins from entering the
urinary space. Molecules trapped in the basal lamina are periodically removed by the mesangial cells.
A reduced volume of blood leaves the glomerulus by means of the narrower efferent arteriole, and
the raw filtrate in the urinary space enters the proximal convoluted tubule for further processing.
2. Proximal convoluted tubule. This epithelial tube begins at the renal corpuscle’s urinary pole. Its simple
low-columnar-to-cuboidal lining cells have abundant long microvilli, which form a brush border that
partly obscures the lumen and increases the surface area available for absorption. The lining cells absorb
approximately two-thirds of the sodium form the filtrate; water follows passively, reducing the filtrate
volume by approximately the same proportion.
 URINARY SYSTEM / 247

Figure 19-2. Schematic diagram of the glomerular filtration barrier. Fluid from the capillary lumen passes through
fenestrae in the capillary wall, subsequently moves through the fused basal laminae of the capillary endothelial cells and
podocytes, and finally proceeds through diagram-covered filtration slits between the pedicels of the podocytes to enter
the urinary space. The basal lamina exhibits a central lamina densa sandwiched between two less dense laminae rarae.

All of the glucose (unless present in great excess), amino acids, acetoacetate, and vitamins are
reabsorbed by facilitated transport (2.II.C.1.b), and small proteins are reabsorbed by pinocytosis. The
many mitochondria required for the energy-intensive absorptive function interdigitate with basal
membrane infoldings and make the lining cells acidophilic. The convoluted part of the proximal
tubule lies in the cortex and empties into its straight portion (also called the thick descending limb of
the loop of Henle), which has the same epithelium and function. Together, the convoluted and straight
portions of the proximal tubule measure approximately 14 mm, making this the longest portion of the
nephron in the cortex and the most often encountered tubule type in cortical sections.
3. Loop of Henle.
a. Structure. Henle's loop, a U-shaped epithelial tube, includes thick and thin descending limbs and
thin and thick ascending limbs (Fig. 19-3). It extends from the proximal convoluted tubule in the
cortex, dips into the medulla, and returns to the cortex, where it empties into the distal convoluted
tubule. The abrupt transition from thick to thin in both arms of the U reflects changes from low
columnar or cuboidal to squamous epithelium and from squamous back to cuboidal epithelium.
The luminal diameter changes less than the external diameter.
b. Function. A prerequisite for forming hypertonic urine, the loop acts as a countercurrent
multiplier to establish an osmotic gradient in the interstitial fluid of the medulla. Hypertonic
(concentrated) and hypotonic (dilute) are relative terms. The point of reference assumed is the
tonicity of normal tissue fluid or blood (isotonic). The medullary interstitium, for example, is
approximately isotonic near the corticomedullary junction gradually becomes most hypertonic
near the tips of the medullary papillae. The descending and ascending portions of the loop of
Henle play important roles in establishing and maintaining this osmotic gradient.
(1) Descending part. This first segment of Henle's loop plays a passive role in making the
medullary interstitium hypertonic and helps maintain the gradient. The filtrate delivered to
the descending part of the thin loop by the descending thick loop is isotonic, but the removal
of salt, nutrients, and water in the proximal tubule reduces the volume from its raw state in
the urinary space. The descending loop is permeable to both water and salt, although it is
more permeable to water. As the fluid in its lumen passes deeper into the hypertonic medulla,
it loses water to the interstitium and becomes more hypertonic. As water is lost, the filtrate
volume decreases. The filtrate's tonicity equilibrates with the hypertonic interstitium, peaking
at the bottom of the U as it enters the ascending portion.
248 / CHAPTER 19
A. Flow of Fluid B. Changes in Fluid Composition

Isotonic (by definition)

Reabsorbs glucose, amino acids, protein,

acetoacetate, vitamins, 2/3 of sodium, 2/3 of
water
↓ Volume; tonicity unchanged

Loses water.
May absorb some salt from the interstitium.
↓ Volume
↑ Tonicity toward bottom of loop

Is impermeable to water.
Actively pumps out salt (symporter).
No change in volume
↓ Tonicity to iso- or hypotonic

Is impermeable to water.
Removes sodium and adds potassium (if
aldosterone is present)
No change in volume, ↓ tonicity

Removes sodium and adds potassium (if

aldosterone is present).
Adjusts pH by adding hydrogen or ammonium
ions.

Loses water to medullary interstitium if ADH is

present.
↓ Volume, ↑ Tonicity

Figure 19-3. A. Flow of fluid from the urinary space to the minor calyx. B. Summary of the changes in fluid composition
(colored) and tonicity that occur in each tubule segment, owing to the actions carried out by that segment (uncolored).

(2) Ascending part. This segment of Henle's loop has more active role in setting up the gradient
and, in particular, making the medullary interstitium hypertonic. The cells lining the thick
ascending component resemble those in the distal convoluted tubule (II.B.4). They contain a
Na+/K+/Cl- pump (symporter) that constantly pumps these ions (in a 1:1:2 ratio) from the
filtrate into the interstitial fluid around the tubules. This symporter thus increases the salt
concentration (and tonicity, or osmolarity) in the interstitium and is responsible for
approximately 20% of the reabsorption of these ions from the filtrate.
 URINARY SYSTEM / 249

Because this part of the loop is impermeable to water, water in the filtrate cannot follow the salt
into the interstitium and dilute it As the reduced volume of filtrate ascends toward the distal
convoluted tubule in the cortex, the removal of salt (but not water) by the cells lining this part of
the loop causes the fluid in its lumen to gradually become isotonic or hypotonic. The importance
of the osmotic gradient to hypertonic urine production becomes clearer in light of the events
occurring in the collecting ducts as they pass through the medulla en route to the calyces (II.C.2).
4. Distal convoluted tubule. This last segment of the nephron lies in the cortex. Its epithelial lining is low
cuboidal and lacks a brush border making its lumen appear wider. The lining cells' nuclei are displaced
apically by abundant mitochondria interdigitating with folds of the basal plasma membrane-a common
feature of ion-transporting cells. These cells are more basophilic than those lining the proximal tubules.
The lateral cell boundaries are indistinct as a result of extensive lateral membrane interdigitations with
their neighbors. The distal tubule epithelium forms a disk of tightly packed columnar cells called a macula
densa at the point near the renal corpuscle's vascular pole where it contacts an afferent arteriole. This disk
may monitor NaCl concentration or the flow rate of the tubular fluid (II.D) The distal convoluted tubule
makes final adjustments of the salt, water, and acid balance. The presence of aldosterone (from the adrenal
cortex; 21.A.3.a) causes the lining cells to remove more sodium from and add potassium to the fluid.
Atrial natriuretic factor (11.III.B.2.a) increases sodium excretion. Elevated levels of parathyroid
hormone cause the lining cells to reabsorb more calcium and release more phosphate. The cells may further
adjust the pH by secreting hydrogen and ammonium ions into the lumen.
5. Cortical and juxtamedullary nephrons. Renal corpuscles are found throughout the cortex. Although
most belong to the cortical nephrons, the 15% closest to the medulla belong to the juxtamedullary nephrons.
The latter group has short, thick descending limbs and longer thin limbs that extend deeper into the medulla.
The juxtamedullary nephrons bear the primary responsibility for setting up the medulla's osmotic gradient.

C. Collecting Tubules and Ducts:

1. Structure. These differ from the nephrons in their embryonic origin and are easily distinguished from
proximal and distal tubules in sections. Their blocklike lining cells have distinct intercellular borders; they
are cuboidal in the smaller tubules and columnar in the larger (eg, papillary) ducts of the medulla. Because
their cytoplasm stains poorly, the lining cells appear clear or white.
2. Function. Cortical collecting tubules receive a reduced volume of hypotonic or isotonic urine from the
nephrons and empty it into larger collecting ducts. These leave the cortex in medullary rays and enter the
medulla, increasing in size until they open into a minor calyx through the tip of a papilla. The medullary
collecting ducts play the final role in forming hypertonic urine. Under the influence of pituitary
antidiuretic hormone [(ADH) or vasopressin; 20.IV.A.1], they become permeable to water. As they pass
through the osmotic gradient of the medulla, water diffuses passively from their lumens into the hypertonic
medullary interstitium, causing the osmolarity of the fluid in their lumens to equilibrate with the
interstitium; only a small volume of hypertonic urine is released. Without ADH, the collecting ducts
remain impermeable to water, and a larger amount of hypotonic or isotonic urine is produced. Without the
hypertonic medullary interstitium established by the ascending portion of the loop, the excess water would
not leave the ducts, even in the presence of ADH. This mechanism for concentrating the urine is inhibited
by drugs such as furosemide, which inactivates the ascending limb's symporter (II.B.3.b.[2]). reducing
the hypertonicity of the medullary interstitium.

D. Juxtaglomerular Apparatus: Located near each renal corpuscle's vascular pole, at the point of contact
between a distal convoluted tubule and an afferent arteriole, this apparatus includes juxtaglomerular (JG)
cells, a macula densa, and polkissen (extraglomerular mesangial cells). The JG cells, modified smooth
muscle cells in the afferent arteriole’s wall, exhibit secretory ultrastructure and numerous PAS-positive
cytoplasmic granules. Although the macula densa’s influence on the JG cells is poorly understood, subnormal
blood volume, pressure, or sodium causes the JG cells to secrete renin. This enzyme cleaves plasma
angiotensinogen to produce angiotensin I, which is converted to active angiotensin II by enzymes in the
lungs. Angiotensin II, a vasoconstrictor, increases blood pressure and stimulates aldosterone production
250 / CHAPTER 19
by the adrenal cortex, thereby increasing chloride and sodium reabsorption by the by the distal tubule.
The sodium and chloride enter the blood in the peritubular capillaries. Although the distal tubules are
impermeable to water, the increased tonicity of blood leaving the kidneys draws water into the blood as
it passes through other tissues, increasing blood volume and pressure. Increased blood pressure distends
the afferent arterioles, stretching the JG cells and halting renin secretion. The function of polkissen is
unknown.

E. Blood Supply and Circulation: The arteries are accompanied by similarly named veins. Each kidney
receives a renal artery - a branch from the abdominal aorta. Anterior and posterior branches arise
from the renal artery before reaching the hilum. Interlobar arteries arise from the anterior and posterior
branches in the hilum and penetrate the medulla between the pyramids. Arcuate arteries arise from the
interlobar arteries and course along the arched border between the cortex and medulla. Interlobular
arteries arise at right angles from the arcuate arteries; they penetrate the cortex between the medullary
rays and lie between neighboring renal lobules. Many afferent arterioles arise from each interlobular
artery, each of which supplies a glomerulus (II.B.1.a). An efferent arteriole carries blood away from the
glomerulus. Efferent arterioles of cortical nephrons branch to form abundant peritubular capillaries
that carry absorbed products away from the proximal and distal tubules and converge to form the stellate
veins of the peripheral cortex. These drain into the interlobular veins. Efferent arterioles of
juxtamedullary nephrons give rise to numerous straight capillary loops - vasa recta - that descends into
the medulla. Vasa recta arise mainly from the efferent arterioles of the juxtamedullary nephrons; some
arise from the arcuate artery. The descending vasa rectą carry isotonic blood into the medulla. This blood
loses water and picks up salt as it passes deeper into the medulla. Unlike the loop of Henle, the asçending
vasa secta are permeable to salt and water. As blood ascends through the gradient, its tonicity equilibrates
with the interstitium. The blood leaving the medulla is thus isotonic or slightly hypertonic. The passive
salt and water exchange between the vasa recta and the interstitium is known as the countercurrent
exchange mechanism. This mechanism is important in removing water lost to the filtrate during its
descent into the medulla and thus in maintaining the osmotic gradient set up by the countercurrent
multiplier of Henle's loop. Blood in the ascending vasa recta drains into interlobular veins and exits
through veins accompanying the larger arteries.

F. Summary of Renal Function: An organized arterial system carries blood to the glomeruli of the renal
corpuscles. Each corpuscle acts as both filter and funnel, collecting raw filtrate and directing it to the
proximal convoluted tubule, where glucose amino acids, acetoacetate,small proteins, vitamins, sodium
and water are reabsorbed (see Fig. 19-3). The remaining enter the loop of Henle, which sets up a
hypertonic osmotic gradient in the medulla. The fluid subsequently leaves thė loop and enters the distal
convoluted tubule. Here, aided by the juxtaglomerular apparatus and aldosterone, the salt, ion, and water
balance between the blood and urine is adjusted. Next, the fluid exits the nephron through the collecting
ducts, which pass back through the medulla as ADH renders the medullary collecting ducts permeable
water, allowing the water to flow out of the collecting duct lumens and into the medulary interstitium.
This results in the released of reduces volume of hypertonic urine into the minor calyx.

III. RENAL CLYCES & RENAL PELVIS

The walls of the renal calyx and pelvis consist of mucosa muscularis, and adventitia; no submucosa is present.
The mucosa, which consists of typical urinary (transitional) epithelium (4.III.B.8), attaches to an underlying
helical meshwork of smooth muscle (muscularis) by a connective tissue lamina propria of a variable density.
The epithelium forms an osmotic barrier that protects the surrounding tissues from the hypertonic urine and
the urine from dilution. The adventitia blends the adipose tissue in the renal sinus.

IV. URETERS
These carry urine from renal pelvis to the urinary bladder. Although the ureter's lumen is narrower than that
of the renal pelvis, the wall structure, including the transitional epithelial lining, is similar. The ureter wall
thickens and the muscle cells change from a helical to a longitudinal array near the bladder before fanning
out in the bladder wall to form the bladder's superficial and deep trigones.
 URINARY SYSTEM / 251

V. URINARY BLADDER
This distensible muscular sac, lined by transitional epithelium over a dense lamina propria, has walls like
those of the ureter, pelvis, and calyces but with a thicker muscularis. The smooth muscle fibers run in many
directions run in many directions and are not organized in layers except near the urethral orifice, where they
form an involuntary internal sphincter.

VI. URETHRA
The urethra differs in length, epithelium, and function in males and females.

A. Male Urethra: Longer than the female urethra, this conducts both urine and seminal fluid, it has three
main parts.
1. Prostatic segment. This most proximal part of the male urethra exits the neck of the urinary bladder.
It is surrounded by the prostate gland (22.IV.B) and is lined by transitional epithelium. This part
receives the prostatic and ejaculatory ducts and empties into the membranous segment.
2. Membranous segment. This is the shortest segment and is encircled by the skeletal muscle of the
urogenital diaphragm, whose fibers form a voluntary external sphincter. It is lined by
pseudostratified columnar epithelium and empties into the cavernous segment.
3. Cavernous segment. This section passes through the corpus spongiosum of the penis (22.V.A.2).
Within the glans, near the tip of the penis, the urethral lumen widens to form the fossa navicularis,
where the epithelium changes from pseudostratified columnar to stratified squamous. The urethra
opens at the end of the penis through the urethral meatus. Many glands of Littre empty mucous
secretions into the lumen all along the urethra; these glands are more numerous in the pendulous part.

B. Female Urethra: Shorter than the male urethra, this counterpart carries only urine. It is lined by stratified
squamous epithelium, with patches that are pseudostratified columnar. Midway along its path from
bladder to exterior, it is surrounded by a voluntary external sphincter formed by the urogenital diaphragm.

MULTIPLE-CHOICE QUESTIONS
Select the single best answer.

19.1. Which of the following structures is indicated by 19.3. Blood in the arcuate arteries subsequently flows
the letter A in Figure 19-4? into which of the following vascular channels?
(A) Afferent arterioles (A) Afferent arterioles
(B) Bowman’s space (B) Efferent arterioles
(C) Brush Border (C) Glomerular capillaries
(D) Efferent Arteriole (D) Interlobar arteries
(E) Macula densa (E) Interlobular arteries
(F) Parietal layer of Bowman’s capsule (F) Peritubular capillaries
(G) Podocyte (G) Stellate vein
19.2. Which of the following best describes the
composition of a renal lobule?
(A) Renal pyramid and associated cortex
(B) Medullary ray and all nephrons that empty
into it
(A) Renal pyramid and all nephrons that empty
into it
(B) Interlobular artery and all nephrons it
supplies
(C) Renal corpuscle and all associated renal
tubules
19.4. Collections of cortical tissue between the medullary pyramids
are called:
(A) Interlobular cortex
(B) Juxtamedullary nephrons
(C) Medullary rays
(D) Renal columns of Bertin
(E) Renal lobes
19.5. Which of the following vessels are typically seen at the border
between the renal cortex and medulla?
(A) Arcuate arteries and veins
(B) Interlobar arteries and veins
(C)Interlobular arteries and veins
(D) Stellate veins
(E) Vasa recta
19.6. Which of the labels in Figure 19-5 corresponds to the location
of podocytes?
19:7. Which of the labels in Figure 19-5 corresponds to the location
of the brush border?
19.8. Which of the labels in Figure 19-5 corresponds to the location
of the most hypertonic filtrate?
19.9. Which of the labels in Figure 19-5 corresponds to the nephron
component that contains the macula densa in its wall?
19.10. Which of the labels in Figure 19-5 corresponds to the location
of the filtration barrier?
19.11. Which of the labels in Figure 19-6 corresponds the cell body
of a podocyte?
19.12. Which of the labels in Figure 19-6 corresponds to an
endothelial cell of the glomerular capillary?
19.13. Which of the labels in Figure 19-6 corresponds to the fused
basal lamina of the glomerular filtration barrier?
19.14. Which of the labels in Figure 19-6 corresponds to a
pedicel?
19.15. Which of the labels in Figure 19-6 corresponds to a
filtration slit?
19.16. Which of the diagrams in Figure 19-7 best represents
the morphology of an epithelial cell from the proximal
convoluted tubule?
19.17. Which of the diagrams in Figure 19-7 best represents
the morphology of an epithelial cell from the thin loop
of Henle?
19.18. Which of the diagrams in Figure 19-7 best represents
the morphology of an epithelial cell from the distal
convoluted tubule?
19.19. Which of the diagrams in Figure 19-7 best represents
the morphology of an epithelial cell from a collecting
duct or tubule?
19.20. Which of the following is the modified smooth muscle
cell responsible for the secretion of renin?
(A) Endothelial cell
(B) Juxtaglomerular cell
(C) Mesangial cell
(D) Podocyte
(E) Polkissen (extraglomerular mesangial cell)