URINARY SYSTEM INTERNAL ANATOMY

THE EXCRETORY SYSTEM ORGANS o Cortex

▪ Superficial
- Kidney o Medulla
- Ureter ▪ deeper, consists mainly of pyramids
- Urinary bladder o Pelvis
- Urethra ▪ formed by the union of 2 or major
KIDNEY calyses
o Major calyx
- Retroperitoneal bean-shaped organ in superior lumbar ▪ is formed by the union of 2 or more
region minor calyses
- Extends from vertebral levels T12 superiorly and L3 o A minor calyx
inferiorly ▪ receives urine from several renal
- Coverings (from the innermost to the outermost): papilla
o Renal capsule
o Perirenal fat
▪ Most important because it holds
kidney in position
o Renal fascia
NEPHRON ▪ Branches of the octopus-like podocytes
terminate into pedicels or foot
- Structural and functional unit of the kidney processes; in between these are
- 1 million for each kidney openings called filtration slits or slit
- Parts: pores
o Glomerulus
▪ a high pressure tuft of capillaries, with
fenestrations or openings
o Renal tubule
▪ which is made up of:
1. Glomerular or Bowman’s
capsule
2. Proximal convoluted tubule
(PCT)
3. Loop of Henle
4. Distal convoluted tubule
(DCT)

RENAL CORPUSCLE

- Renal or Malphigian corpuscle

o Glomerulus plus Bowman’s capsule
- Juxtaglomerular apparatus
o Consists of juxtaglomerular cells of the afferent
arteriole and the macula densa of the DCT
o important in blood pressures regulation

URINE FLOW

From the nephron → to excretory ducts → arched collecting tube →

straight collecting tubes → papillary ducts → minor calyx → pelvis
→ ureter → urinary bladder → urethra

RENAL PHYSIOLOGY

MECHANISM OF URINE FORMATION

- Glomerular filtration
- Tubular reabsorption
- Tubular secretion

- Layers of the Bowman’s capsule:

o Outer parietal layer
▪ Composed of simple squamous
epithelium
o Inner visceral layer
▪ Composed of branching podocytes
which cling to the glomerulus.
 GLOMERULAR FILTRATION
FORCES ACTING ON GLOMERULAR FILTRATION
- Glomerular hydrostatic pressure
o Is the chief force pushing water and solutes
across the filtration membrane
- Glomerular osmotic pressutre
o Opposes filtration; resulting from attractive
forces exerted by the proteins in the glomeruli
- Capsular hydrostatic pressure
o Opposes filtration; force exerted by the fluid in
the Bowman’s capsule
- The glomerulus functions as filter
- 1/5th of the plasma flowing through the kidneys is filtered
from the glomeruli into the renal tubules
- Filtration barrier/membrane
o Glomerular endothelial cell
o Basement membrane
o Epithelial cells of Bowmann’s capsule
- The liquid that will result from filtration of blood is termed
glomerular filtrate

NET FILTRATION PRESSURE (NFP)
- The force responsible for filtrate formation; will tell
whether filtration will proceed or stop
- Formula:
o NTF = glomerular hydrostatic pressure –
(glomerular osmotic pressure + capsular
hydrostatic pressure)
- If the NFP is positive, it means that the glomerular
filtration will proceed; if its negative, it means glomerular
filtration will stop.
GLOMERULAR FILTRATION RATE
- Refers to the amount of filtrate formed per minute of time
- Is equal to 125 mL/min
- Directly proportional to the net filtration pressure
TUBULAR RE-ABSORPTION
RENAL CLEARANCE
- General Clearance Formula in mL/min =
o Urine substance in mg/dL x Volume in mL/min
Serum substance in mg/dL
- Clearance in mL/min/std. surface area =
o Urine substance x Urine Volume x 1.73m2
Serum Substance
- Creatinine Clearance = denotes GFR
- Urine Creat in mg/dL x Urine Volume in mL/min Serum
Creat in mg/dL
- Urine Creat x Urine Volume x 1.73m2 Serum Creat
1440 A
o Where 1440 = number of minutes/24 hrs
o 1.73m2 = BSA of an average normal person
o A = BSA from a normogram
- Estimated Creatinine Clearance
o Cockcroft & Gault (1976) with correction for age
and weight; results reported in mL/min
▪ Males = (140-age) x Weight in kg
(72 x Serum Creat in mg/dL)
▪ Females = (140-age) x Weight in kg
(0.85 x Serum Creat in mg/dL)
o NV males 90-139 females 80-125
▪ slight impairment 52--62.5
▪ mild impairment 42–52
▪ moderate impairment 28 – 42
▪ severe impairment < 28
- Renal Failure Index (RFI) =
o Urine Na in mEq/L x Serum Creatinine in mg/dL
Urine Creatinine in mg/dL
o Interpretation
▪ RFI <= 1: prerenal azotemia
▪ RFI =1-3: less definitive but usually
indicates tubular necrosis
▪ RFI >= 3: acute tubular necrosis
- Is the rate at which the kidneys clear the plasma of a
particular solute
- The process of returning needed substances from the
filtrate in the tubules to the capillary blood.
- Can be active or passive depending upon the substance to
be reabsorbed
- The PCT is the most active segment of the tubule in this
process; most of the nutrients, 80% of water and Na ions,
and the bulk of actively transported ions are reabsorbed
here
- Re-absorption of additional Na ions and water occur in the
distal convulated tubule (DCT) and collecting tubule (CT)
and is controlled by aldosterone and (antidiuretic
hormone) ADH respectively
- PCT
o Is the most active segment of the tubule in this
process
o Most of the nutrients, 80% of water and Na ions,
and the bulk of actively transported ions are
reabsorbed here
- Re-absorption of additional Na ions and water occur in the
distal convulated tubule (DCT) and collecting tubule (CT)
- Controlled by aldosterone and (antidiuretic hormone) ADH
respectively
TUBULAR SECRETION THE URINARY BLADDER

- Is a means of adding substances to the filtrate from the
blood or the tubule cells
- Can be passive or passive
- Important
o eliminating urea, excess ions and drugs
o maintaining the acid-base balance of the blood
REGULATION OF URINE CONCENTRATION AND VOLUME
- Hollow pyramid shaped organ located in the pelvis
- Lined with transitional epithelium
- With thick detrusor muscles
- Micturition reflex resulting from the distension of the
organ
- Impulses are transmitted to the sacral parasympathetic
segments to initiate urination

- Urine osmolarity ranges from 50-1200 mosm

- The hyperosmolarity of the medullary fluid ensures that
the urine reaching the DCT is dilute (hypo-osmolar)
- In the absence of ADH
o The dilute filtrate is allowed to pass the CT
a dilute urine is formed
- When blood levels of ADH rise
o The permeability of the DCT and CT to water
increases, more water is reabsorbed, less is left
with filtrate URETER
o Hence small volume of more concentrated urine
is formed - 25 to 30 cm slender muscular tube that conveys urine,
through peristalsis, from the kidney to the urinary bladder
- 3 Anatomical Constrictions of the Ureter where stones
can be arrested:
o Ureteropelvic junction
o Bifurcation of common iliac vessels near the
pelvic brim
o Vesico-ureteral junction

URINARY BLADDER

- A smooth, distensible muscular sac, lying posterior to the

pubic symphysis, which functions to store urine
- Has two inlet (ureters) and one outlet (urethra) which
form the vesical trigone
 - Left and right
o A long slender tube that propels urine from the
kidney to the urinary bladder
o With smooth muscles and transitional epithelium
o With innervations from the sympathetic and
parasympathetic

URETHRA

- A thin walled muscular tube draining urine from the

urinary bladder to body exterior
- With two sphincters that regulate the passage of urine: RENAL FAILURE
o Internal urethral sphincter - A very serious but uncommon problem
▪ located near the bladder, involuntary - Kidneys are unable to do its physiologic functions such as
o External urethral sphincter concentrating urine, removing nitrogenous wastes from
▪ located at the urogenital diaphragm the blood, and maintaining electrolyte and pH balance of
level, voluntary the body
- In females, the urethra is 3-4 cm long and conducts only - Causes: drugs, toxic chemicals, infections, hypertension,
urine; in male, 20 cm long and conducts both urine and DM, etc.
semen
- Tube extending from the urinary bladder to the external
urethral orifice
o 1 ½ inches in females
- 3 parts in Males
o Prostatic urethra – most dilatable
o Membranous urethra – least dilatable and
shortest
o Penile urethra – longest

BODY FLUIDS

- The human body is 45% to 75% water. The amount of

body water depends on the following:
o Age of the individual
o Sex
o Amount of adipose tissue

MICTURATION

- Also called urination, a process of emptying the bladder

- Micturation reflex:
o Stretching of the bladder wall by the
accumulating urine (200mL and above)
o Sensory impulses sent to the sacral segment of
the spinal cord
o Motor impulses conducted to the detrussor
muscles via the parasympathetic nerves
o Contraction of the detrussor muscles and
relaxation of the sphincters urine results to
voiding of urine

TOTAL BODY WATER (TBW)
- Total body water (TBW) is divided into compartments
o Intracellular fluid (ICF)
▪ Found within cells
▪ 25L, 40% of body weight
o Extracellular fluid (ECF)
▪ 15 L, 20% of body weight
▪ Subdivided into
1. interstitial fluid
2. intravascular fluid (or the
plasma)
- Note:
o Solutes dissolved in the body fluids are
electrolytes and nonelectrolytes (e.g., proteins).
o Intracellularly, there are abundant potassium,
magnesium, phosphates and proteins
o Extracellularly, there are abundant sodium,
chloride and bicarbonate.
FLUID EXCHANGES
- Fluid exchanges between these compartments are
regulated by several forces
o Hydrostatic pressure
▪ Refers to the pressure which tends to
push fluid out of the intravascular
compartment
o Osmotic pressure
▪ Refers to the pressure exerted by the
solutes which tend to attract water
o Water intake
▪ Must be equal to water output in order
to maintain proper hydration.
▪ Depends upon the habit of the
individual (2500ml/day in adults)
o Sources
▪ Ingested fluids (60%)
1. e.g., drinking water, juices
▪ Moist foods (30%)
▪ Cellular metabolism (10%)
1. a.k.a. water of oxidation or
metabolic water
SOURCES OF BODY WATER
- Water output, on the other hand occurs via several routes:
o Exhaled through the lungs in the form of water
vapor
o Diffuses through the skin (28%)
o Thru perspiration (8%)
o Goes with feces (4%)
o Goes with the urine (60%)
DISORDERS OF WATER BALANCE
- Dehydration
o Occurs when water loss exceeds water intake
o Manifested as
▪ Thirst
▪ Dry skin
▪ Decreased urine output.
- Edema
o Abnormal accumulation of fluid in the interstitial
space
▪ Increased hydrostatic pressure
(congestive heart failure)
▪ Decreased in osmotic pressure (dec
plasma proteins)
▪ Lymphatic obstruction
ELECTROLYTE IMBALANCE
- Electrolyte include salts, acids and bases; but in this topic
electrolyte balance pertains primarily to the salt balance in
the body
- Salts are important in cellular functions
o e.g., nerve excitability
o secretory activity of the gland
o controlling fluid movements
- Sources of salts:
o Ingested food, fluid, and Metabolism
- Routes of electrolyte losses:
o Perspiration or sweat
o Through the GIT in the form of feces of vomitus
o Urine
SODIUM SALTS
- (NaCl, NaHCO3) account for 90-95% of all solutes in the
ECF.
o Exert the bulk of ECF osmotic pressure
(280mosm of the 300mosm/L)
o Control water volume and distribution in the
body.
- Note:
o Remember, water follows salt; so, movement of
sodium salt is always linked to movement of
water. Sodium-water balance is inseparably
linked to blood pressure and blood volume. This
entails a variety of regulatory mechanisms.
RENAL CLEARANCE - Increased secretion is hyperaldosteronism
o e.g., Cushing disease
- Functional Excretion of Sodium (FENa) - Decreased secretion is hypoaldosteronism
- Na Clearance x 100 or Creatinine o e.g., Addison’s disease.
Clearance
- Urine Na x Serum Creat x 100
Urine Creat x Serum Na

FE-Na < 1% FE-Na > 1%

10% of cases of non-oliguric
ATN
Pre-renal azotemia
Acute glomerulonephritis
Early acute urinary tract
obstruction
Early sepsis
Most cases of ATN
After diuretic administration
Pre-existing chronic renal
failure
Diuresis due to mannitol,
glycosuria, bicarbonaturia

SERUM OSMOLALITY

- In mOsm/kg H20 NV 275-300

o 2Na + BUN(mg/dl) + Glucose(mg/dl)
2.8 18 CARDIOVASCULAR SYSTEM BARORECEPTORS
o If glucose and BUN are in mmol/L, do not use
the factors (18 & 2.8) anymore - Found in the heart and the large vessels (aortic sinus,
- In mOsm/L carotid sinus)
o (Na x 1.86) + (Glu x 0.056) + (BUN x 0.36) + 9 - Provides information on the “fullness” or volume of the
o (1.86xNa) + Glucose(mg/dL)+BUN(mg/dL) + 9 circulation
18 2.8 - Stimulated when stretched
o In SI units = (1.86 x NA) + glucose in mmol/L +
ANTIDIURETIC HORMONE
BUN in mmol/L + 9
- Responsible for reabsorbing water in the distal segments
ANION AND OSMOLAL GAP
of the kidney tubules
- Anion gap = - Factors that trigger release:
o Na – (HCO3 + Cl) NV: 10 + 2 or 8-16mEq/L o decreased fluid intake,
o (Na + K) – (Cl + HC03) NV: 10-20 o prolonged fever,
- Osmolal gap = o excessive sweating,
o Mathematical difference between measured and o vomiting or diarrhea,
calculated osmolality o severe blood loss,
o NV: <10 in healthy persons (0-6) o burns

ATRIAL NATRIURETIC FACTOR

- Released by cells in the atria of the heart in response to

increased BP
- Effects:
o systemic vasodilation
o inhibits release of rennin, aldosterone and ADH

OTHERS

- Estrogen
o due to its chemical similarity to aldosterone, it
increases Na reabsorption
ALDOSTERONE - Progesterone
o blocks the effect of aldosterone; thereby,
- Major controller
decreasing Na reabsorption
- Responsible for 75-80% of sodium reabsorbed in the
- Glucocorticoids
- proximal convoluted tubule
o such as cortisol and hydrocortisol exhibit
- Triggered by the rennin-angiotensin- aldosterone system aldosterone like effect
o Which is mediated by the juxtaglomerular
apparatus of the renal tubules
REGULATION OF POTASSIUM BALANCE Potassium K
- is the chief intracellular cation.
- It is important in neuromuscular activity and protein
synthesis.
- Relative ECF-ICF K+ concentration directly affects the
resting membrane potential, a slight change has profound
effects on the neurons and muscle cells.
- Hyperkalemia
o Increases excitability of the cells by increasing
depolarization
o e.g., cardiac arrhythmia
- Hypokalemia
o Decreased K+ in the ECF, causes non
responsiveness of the cells to stimuli due to
hyperpolarization
o e.g., cardiac arrest
- Factors that regulate blood levels of potassium:
o Intracellular level of K+ in the kidney tubules
o Aldosterone
o Blood pH
REGULATION OF OTHER IONS
- Calcium (Ca) concentration is regulated primarily by two
hormones:
o Parathyroid hormone
▪ which is secreted by the parathyroid
glands
▪ increases blood Ca by targeting the
bones, intestines and kidneys
o Calcitonin
▪ which is secreted by the parafollicular
cells of the thyroid gland
▪ decreases blood Ca by accelerating its
deposition in the bones and inhibiting
bone resorption
o Magnesium
▪ is stored in skeleton (majority), cardiac
muscles, skeletal muscles, and the
liver.
▪ Excretion is increased in increased
levels of aldosterone
o Chloride
▪ is the major anion accompanying
sodium under physiologic and slightly
alkaline pH.
▪ However, in acidosis, chloride is
replaced by bicarbonate ions.
- The concentrations of most anions in the plasma, not
mentioned in the text, are regulated primarily by their
transport maximums (“overflow” mechanism)
ACID-BASED BALANCE
- Acids
o are proton (H+) donors
o strong acids dissociate completely in a solution
(e.g., HCl);
o weak acids dissociate incompletely (e.g., H2CO3)
- Bases
o are protons acceptors
- The homeostatic pH of arterial blood ranges from 7.35-
7.45
o higher than this range is alkalosis
o lower is acidosis.
 ABNORMALITIES OF ACID-BASE BALANCE

- Respiratory acidosis
o decrease in blood pH resulting from CO2
retention
o e.g., drowning, coma
- Respiratory alkalosis
o increase in blood pH resulting from rapid
elimination of CO2 than its production
o e.g., hyperventilation syndrome
- Metabolic acidosis
o decrease in blood pH resulting from the
ACID-BASED BALANCE REGULATION accumulation of metabolic acids or rapid loss of
H2CO3 in the urine
- achieved by regulating the H+ concentration of the body o e.g., diabetic ketoacidosis, renal failure
fluids. - Metabolic alkalosis
- Chemical buffer system o increase in blood pH resulting from excessive
o Single or paired (weak acid + salt) sets of H2CO3 levels in the blood or loss of acids
molecules that resists shifts in pH by releasing or o e.g., excessive intake of antacids, vomiting of
binding H+ gastric contents
▪ bicarbonate buffer system (important
in both ECF and ICF)
▪ phosphate buffer system (important in
ICF and urine)
▪ protein buffer system (most plentiful
and powerful source both in the
plasma and in the cells)
▪ ammonia buffer system (act in the
urine)
- Respiratory center in the brain stem
o Eliminates volatile acids
o Acidosis activates the respiratory center to
increase respiratory rate and depth which
eliminates CO2 and causes blood pH to rise.
o Alkalosis depresses the respiratory center,
resulting in CO2 retention and a fall in blood pH

- Renal mechanism
o Eliminates metabolic or fixed acids e.g.
phosphoric uric, and ketone bodies
o Major long-term mechanism for controlling acid-
base balance, acts slowly but surely
o Acts mainly by excreting H+ and conserving or
generating new HCO3