Chapter 18

FlexArt
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 Figure 18.1

Kidney

Ureter

Urinary
bladder

Urethra

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 Figure 18.2

Liver

Spleen

Adrenal glands
Renal artery

Tenth rib Renal vein

Left kidney

Right kidney
Inferior vena cava

Abdominal aorta
Ureters
Common iliac vein

Common iliac artery

Urinary bladder

Urethra

Anterior view

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 Figure 18.2 Contd.

Anterior
Body wall

Parietal peritoneum
Renal vein
Peritoneal cavity
Renal artery
Liver
Inferior vena cava Renal fascia

Abdominal aorta
Adipose tissue
Psoas major muscle

Vertebra Renal capsule

Back muscle Kidney

Posterior
Inferior view

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 Figure 18.3

Renal capsule

Arteries and veins Cortex

in the renal sinus
Medulla

Renal column
Hilum (indentation)
Renal sinus
(space)
Renal papilla Renal artery

Renal vein

Renal pyramid
Renal pelvis

Calyx

Ureter

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 Figure 18.3 Contd.

Renal capsule

Cortex

Medulla

Hilum
Renal pyramid
(indentation)
Renal papilla Renal sinus (space)
Renal column Renal artery

Renal vein

Renal pelvis

Calyx

Ureter

(b) ©McGraw-Hill Education/Rebecca Gray

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 Figure 18.4

Bowman
Renal corpuscle capsule
(cut) Glomerulus
Proximal convoluted
tubule

Proximal convoluted Distal convoluted

tubule tubule
Renal
Distal convoluted
corpuscle
tubule

Blood
supply Cortical nephrons
Juxtamedullary have loops of Cortex
nephrons have Henle that do
loops of Henle that not extend
extend deep into the deep into the
medulla. medulla.

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 Figure 18.4 Contd.

Thin segment
descending
limb

Loop of
Thin segment Henle
ascending limb

Thin segment
ascending limb

Collecting
Renal
ducts
pyramid of
the medulla

Papillary
duct

To a calyx

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 Figure 18.5

Proximal
Bowman convoluted
Renal capsule tubule
corpuscle
Glomerulus
Afferent
arteriole

Distal
convoluted
tubule

Efferent
arteriole

The renal corpuscle consists of the Bowman

capsule and the glomerulus. The Bowman capsule
is the enlarged end of a nephron, which is indented
to form a double-walled chamber. The Bowman
capsule surrounds the glomerulus, which is a
network of capillaries. Blood flows from the afferent
arteriole into the glomerulus and leaves the
glomerulus through the efferent arteriole.

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 Figure 18.5 Contd.

Parietal layer
Bowman capsule Visceral layer Proximal
Renal (podocyte) convoluted
corpuscle tubule
Glomerular capillary
(covered by visceral layer) Afferent Capillary
arteriole (enclosed by
podocytes)

Juxtaglomerular
Juxtaglomerular cells
apparatus
Macula densa

Distal
convoluted
tubule

Efferent
arteriole

The visceral layer of the Bowman capsule covers the

glomerular capillaries. Fluid from the blood enters the
Bowman capsule by passing through the capillary walls
and the visceral layer of the Bowman capsule. From
there, fluid passes into the proximal convoluted tubule
of the nephron. The juxtaglomerular apparatus consists
of cells from the wall of the afferent arteriole and the
distal convoluted tubule.

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 Figure 18.5 Contd.
Podocyte (visceral layer Cell processes
of the Bowman capsule)
Cell body

Filtration
slits

Glomerular
capillary (cut)

Fenestrae
(c) The glomerulus is composed of fenestrated capillaries.
The visceral layer of the Bowman capsule consists of
specialized cells called podocytes. Spaces between the
podocyte cell processes are called filtration slits.

Podocyte Bowman
capsule

Podocyte cell
processes

Filtration Basement
membrane membrane
Capillary
endothelium

Capillary
Fenestrae in Filtration
capillary endothelium slits

(d) The filtration membrane consists of the fenestrated

glomerular capillary endothelium, a basement membrane,
and the podocyte cell processes. Fluid passes from the
capillary through the filtration membrane into the Bowman
capsule.

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 Figure 18.6
Proximal convoluted
tubule
Efferent Distal convoluted
Glomerulus arteriole tubule
Peritubular
Bowman capillaries (blood
capsule flows to the vasa
Afferent
arteriole recta or directly
to the interlobular
veins)

Interlobular
artery
Interlobular Interlobular
Arcuate
artery vein
artery

Arcuate
artery Arcuate
vein Interlobular
vein
Interlobar
artery Arcuate
vein
Interlobar
vein
Ascending limb,
Renal loop of Henle
artery
Descending limb,
Renal loop of Henle
vein

Medulla Collecting
Vasa recta
duct
Cortex

Renal
Ureter pyramid

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 Table 18.1

The Average Concentration

of Major Urine Substances
Substance Plasma Urine
Water (L/day) 1.4

Organic molecules (mg/dL)

Protein 3900–5000 0*
Glucose 100 0
Urea 26 1820
Uric acid 3 42
Creatinine 1 196
Ions (mEq/L)
Na+ 142 128
K+ 5 60
Cl– 103 134
HCO3– 28 14
Specific gravity (g/ml)† 1.019-1.022 1.005-1.030
pH 7.35-7.45 4.5-8.0
*Trace amounts of protein can be found in the urine.
†The specific gravity increases as the concentration of solutes in urine increases.

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 Figure 18.7

Urine formation results from the following three processes:

Filtration Filtration (blue arrow) is the movement Peritubular capillaries
of materials across the filtration
Interstitial fluid
membrane into the Bowman capsule
to form filtrate. To interlobular
veins
Tubular Solutes are reabsorbed (purple arrow) Filtrate Urine
reabsorption across the wall of the nephron into the
interstitial fluid by transport processes, Rest of the nephron
such as active transport and cotransport. Bowman capsule
Water is reabsorbed (orange Renal corpuscle
Glomerular capillaries
arrow) across the wall of the nephron
by osmosis. Water and solutes pass Efferent arteriole
from the interstitial fluid into the Afferent arteriole
peritubular capillaries.

Tubular Solutes are secreted (green arrow) across

secretion the wall of the nephron into the filtrate.

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 Figure 18.8

Glomerular capillary pressure,

the blood pressure within the
glomerulus, moves fluid from the
blood into the Bowman capsule. Glomerular capillary
pressure
Capsular pressure, the pressure
inside the Bowman capsule, moves
fluid from the capsule into the Capsular pressure
blood.

Glomerular capillary pressure

Colloid osmotic pressure, produced
– Capsular pressure
by the concentration of blood
– Colloid osmotic pressure
proteins, moves fluid from the
Bowman capsule into the blood by Filtration pressure
osmosis.

Colloid osmotic pressure

Filtration pressure is equal to the
glomerular capillary pressure minus
the capsular and colloid osmotic
pressures.

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 Figure 18.9

Proximal convoluted Distal convoluted

tubule tubule
Bowman
capsule 65% H2O

19% H2O

Cortex
H2O

300 300 100 300

Interstitial fluid Interstitial fluid

400 320 200 320

400
Outer NaCl
medulla
600 400 400
H2O
NaCl H2O
600

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800
Inner
medulla 1000
1200
Concentration of
interstitial fluid
(mOsm)
Approximately 180 L of filtrate enters the
nephrons each day; of that volume, 65% is
reabsorbed in the proximal convoluted
tubule. In the proximal convoluted tubule,
solute molecules move by active transport
and cotransport from the lumen of the tubule
into the interstitial fluid. Water moves by
osmosis because the cells of the tubule wall
are permeable to water (see figure 18.10).
Approximately 15% of the filtrate volume is
reabsorbed in this segment of the
descending limb of the loop of Henle. The
descending limb passes through the
concentrated interstitial fluid of the medulla.
Because the wall of the descending limb is
permeable to water, water moves by
osmosis from the tubule into the more
concentrated interstitial fluid
(see figure 18.11, step 1). By the time the
filtrate reaches the tip of the renal pyramid,
the concentration of the filtrate is equal to
the concentration of the interstitial fluid.
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Figure 18.9 Contd.
800
H 2O H 2O
15% H2O
800
1000
H 2O
NaCl
1200 1200
Loop of Henle Collecting duct
One percent remains
as urine.
The ascending limb of the loop of Henle is not The distal convoluted tubule and collecting
permeable to water. Solutes diffuse out of the duct are permeable to water if ADH is
thin segment (see figure 18.11, step 2). present. If ADH is present, water moves by
osmosis from the less concentrated filtrate
Na+ are actively transported, and K+ and Cl–
into the more concentrated interstitial fluid
are cotransported, from the filtrate of the thick
(see figure 18.13). By the time the filtrate
segment into the interstitial fluid (see figure
reaches the tip of the renal pyramid, an
18.12).
additional 19% of the filtrate is reabsorbed.
The volume of the filtrate doesn’t change as it
passes through the ascending limb, but the One percent or less remains as urine, when
ADH is present.
concentration is greatly reduced (see figure
18.12). By the time the filtrate reaches the
cortex of the kidney, the concentration is
approximately 100 mOsm/L, which is less
concentrated than the interstitial fluid of the
cortex (300 mOsm/L).
 Figure 18.10

Solute molecules, such as amino acids,

glucose, and fructose, as well as Na+, K+,
Ca2+, HCO3–, and Cl–, are reabsorbed by
active transport and cotransport out of
the proximal convoluted tubule by the
epithelial cells.

Solutes plus 65% of the filtrate volume

are reabsorbed from the proximal
convoluted tubule and enter the
peritubular capillary.

Water moves by osmosis out of the

proximal convoluted tubule.

Peritubular
Blood Solutes H2O capillary
flow

Interstitial fluid

Filtrate Proximal convoluted

flow tubule

Active transport
Cotransport
Osmosis

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 Figure 18.11

Osmosis
Solute diffusion

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 Figure 18.11 Contd.

Blood flow
Water moves by Water does not
osmosis into the Filtrate move into the
interstitial fluid flow interstitial fluid.
and then into the
vasa recta. Blood
flow
Filtrate
flow

H2O
Solute H2O Solute
diffusion diffusion
The descending
limb is permeable
to water.
Osmosis
H2O of water

The ascending limb

is not permeable
H2O to water.

Ascending Interstitial Descending Thin segment Interstitial Descending

vasa recta fluid limb, loop of ascending fluid vasa recta
of Henle limb, loop of
Henle

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The wall of the thin segment of the descending
limb of the loop of Henle is permeable to water
and, to a lesser extent, to solutes. The interstitial
fluid in the medulla of the kidney and the blood in
the vasa recta have a high solute concentration.
Water therefore moves by osmosis from the
tubule into the interstitial fluid and into the vasa
recta. An additional 15% of the filtrate volume is
reabsorbed. To a lesser extent, solutes diffuse
from the vasa recta and interstitial fluid into the
tubule.
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Figure 18.11 Contd.
The thin segment of the ascending limb of the
loop of Henle is not permeable to water but is
permeable to solutes. The solutes diffuse out of
the tubule and into the more dilute interstitial
fluid as the ascending limb projects toward the
cortex. The solutes diffuse into the descending
vasa recta.
 Figure 18.12

Blood flow
Filtrate flow

Active transport
Cotransport

H2O The thick segment of

the ascending limb of
the loop of Henle is not
Na+ permeable to water.
Na+ moves by active
transport, and K+ and Cl–
H2O K+, Cl– move by cotransport, out
of the ascending limb of
the loop of Henle.

Na+

Thick segment Interstitial Descending

of the ascending fluid vasa recta
limb, loop of Henle
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 Figure 18.13

Active transport
Filtrate flow Cotransport
Osmosis

Water moves by
osmosis from the distal
convoluted tubule and
collecting duct.
H 2O
Na+ moves by active
transport and Cl– moves
Na+ by cotransport out of the
distal convoluted tubule
Cl – and collecting duct.
The reabsorbed water
and solutes enter the
peritubular capillaries
and vasa recta.

Peritubular Interstitial Distal

capillary or fluid convoluted
vasa recta tubule or
collecting duct

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 Figure 18.14

Increased
renin secretion
(from kidney) Decreased
BP

Angiotensinogen

Kidney
Angiotensin I

Angiotensin II

Increased Na+ and

water reabsorption
results in increased BP.
Increased
aldosterone secretion

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 Figure 18.15

Increased blood solute concentration or

large decrease in BP

Increased
ADH release

Kidney

Increased water
reabsorption
results in
decreased solute
concentration and
increased BP.

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 Figure 18.16

Increased blood
pressure in right atrium

ANH
Kidney

Increased Na+
excretion and
increased water
ANH secretion loss result in
decreased BP.

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Stimulus
Receptors and control centers:
Pituitary:
Baroreceptors inhibit posterior pituitary ADH
secretion when blood volume increases.
Kidney:
Juxtaglomerular apparati inhibit renin release
when blood volume increases, which decreases
aldosterone secretion.
Heart:
Atrial cardiac muscle cells secrete ANH when
blood volume increases.
Blood vessels:
Sympathetic division baroreceptors detect
increased blood volume, which causes
vasodilation of renal arteries.
HOMEOSTASIS DISTURBED:
High blood volume induces elevated blood pressure.
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Figure 18.17
Response
Effectors:
Decreased ADH decreases water
reabsorption by the distal convoluted tubules
and collecting ducts. Less water returns to the
blood and more water is lost in the urine,
which decreases blood volume.
Decreased aldosterone and increased ANH
decrease Na+ reabsorption from the distal
convoluted tubule and collecting duct. More
Na+ and water are lost in the urine, which
decreases blood volume.
Increased renal blood flow increases the rate
of filtrate formation, and more water is lost in
the urine.
HOMEOSTASIS RESTORED:
Reduced blood volume due to loss of water
and Na+ in the urine lowers blood pressure.

(normal range)
Blood volume
Start here
HOMEOSTASIS DISTURBED:
Low blood volume induces lowered blood pressure.
Stimulus
Receptors and control centers:
Blood vessels:
Sympathetic division baroreceptors detect
decreased blood volume, which causes
vasoconstriction of renal arteries.
Heart:
Atrial cardiac muscle cells do not secrete ANH
when blood volume decreases.
Kidney:
Juxtaglomerular apparati stimulate renin release
when blood volume decreases, which increases
aldosterone secretion.
Pituitary:
Baroreceptors stimulate posterior pituitary ADH
secretion when blood volume decreases.
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Figure 18.17 Contd.
(normal range)
Blood volume
HOMEOSTASIS RESTORED:
Increased blood volume due to decreased Na+
and water loss in the urine raises blood pressure.
Response
Effectors:
Decreased renal blood flow decreases filtrate
formation, and less water is lost in urine, which
increases blood volume.
Increased aldosterone and decreased ANH
increase Na+ reabsorption in the distal
convoluted tubule and the collecting duct.
Less Na+ and water are lost in the urine, which
increases blood volume.
Increased ADH increases the permeability
of the distal convoluted tubule and the collecting
duct to water. Increased ADH also increases
the sensation of thirst. Less water is lost in the
urine.
 Figure 18.18

Kidney
Transitional
epithelium

Ureter

Connective tissue
(lamina propria)
Smooth muscle layer
Connective tissue Parietal peritoneum
(adventitia)
Urinary bladder
Opening of ureter
Trigone
Opening of urethra Transitional epithelium
Location of external
Connective tissue
urethral sphincter

Smooth muscle layer

Connective tissue

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 Figure 18.19

Control of the micturition reflex by higher brain

centers Cerebrum
Ascending pathways carry an increased
frequency of action potentials up the spinal
cord to the pons and cerebrum when the
urinary bladder becomes stretched. This
increases the conscious urge to urinate.

Descending pathways carry action potentials

to the sacral region of the spinal cord to
tonically inhibit the micturition reflex,
preventing automatic urination when the
urinary bladder is full. Descending pathways
carry action potentials from the cerebrum to
the sacral region of the spinal cord to facilitate
the reflex when stretch of the urinary bladder
produces the conscious urge to urinate and Pons
when a person voluntarily chooses to urinate.
This reinforces the micturition reflex.

Ascending Descending
pathways pathways

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 Figure 18.19 Contd.

Micturition reflex
Urine in the urinary bladder stretches the
urinary bladder wall.
Action potentials produced by stretch
receptors are carried along pelvic nerves
(green line) to the sacral region of the spinal
cord.
Action potentials are carried by
Sacral region
parasympathetic nerves (red line) to contract
of spinal cord
the smooth muscles of the urinary bladder.
Decreased action potentials carried by
somatic motor nerves (purple line) cause the Pelvic
external urethral sphincter to relax. nerves Parasympathetic
nerves

Ureter
Somatic
motor
nerves

Urinary
bladder

External urethral
sphincter

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 Table 18.2

Approximate Volumes of Body Fluid Compartments*

Intracellular Extracellular
Age of Person Total Body Water Fluid Plasma Fluid Interstitial Total
Infant 75 45 4 26 30
Adult male 60 40 5 15 20
Adult female 50 35 5 10 15
*Expressed as percentages of body weight.

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 Figure 18.20

Increased blood concentration or large

decrease in blood pressure Increased
thirst

Hypothalamus

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 Figure 18.21

Stimulus Response

Receptors and control centers: Effectors:

Increased aldosterone increases
Increased blood levels of K+ act on
the rate of K+ secretion from the
the control center, the adrenal
effectors, the distal convoluted
cortex, to increase aldosterone
tubules and collecting ducts of
secretion.
the kidney, into the urine.

HOMEOSTASIS DISTURBED: HOMEOSTASIS RESTORED:

Blood K+ levels increase. Blood K+ levels decrease.

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(normal range)
Blood k+
Start here
HOMEOSTASIS DISTURBED:
Blood k+ levels decrease.
Stimulus
Receptors and control centers:
Decreased blood levels of K+ act on
the control center, the adrenal
cortex, to decrease aldosterone
secretion.
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Figure 18.21 Contd.
(normal range)
Blood k+
HOMEOSTASIS RESTORED:
Blood k+ levels increase.
Response
Effectors:
Decreased aldosterone reduces
the rate of K+ secretion from the
effectors, the distal convoluted
tubules and collecting ducts of
the kidneys, into the urine.
 Figure 18.22

Stimulus
Receptors and control centers:
Kidney:
The distal convoluted tubules decrease
H+ secretion into the urine and decrease
HCO3– reabsorption into the blood.
Lungs:
The respiratory control center in the
brain decreases the rate and depth of
respiration, which increases blood CO2.
Response
Effectors:
Fewer H+ are removed from the
blood, and fewer HCO3– are
available to bind H+.
Increased blood CO2 reacts with
water to produce carbonic acid,
which dissociates to increase H+.

Buffers: H2O + CO2 H2CO3 H+ + HCO3–

Buffers release H+. The number of H+ in the blood increases.
H2O + CO2 H2CO3 H+ + HCO3–

HOMEOSTASIS DISTURBED: HOMEOSTASIS RESTORED:

Blood pH increases (H+ decreases). Blood pH decreases (H+ increases).

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 Figure 18.22 Contd.

(normal range)
(normal range)

Blood pH
Blood pH
Start here

HOMEOSTASIS DISTURBED: HOMEOSTASIS RESTORED:

Blood pH decreases (H+ increases). Blood pH increases (H+ decreases).

Stimulus Response
Receptors and control centers:
Buffers: Effectors:
Buffers bind H+. The number of H+ in the blood
H2O + CO2 H2CO3 H+ + HCO3– decreases.
Lungs: Decreased blood CO2 causes H+ to
The respiratory control center in the react with HCO3– to form carbonic acid,
brain increases the rate and depth of which decreases H+ in the blood.
respiration, which decreases blood H2O + CO2 H2CO3 H+ + HCO3–
CO2.
Kidney: More H+ are removed from the blood,
The distal convoluted tubules increase and more HCO3– are available to bind
H+ secretion into the urine, and increase H+.
HCO3– reabsorption into the blood.

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 Table 18.3

REPRESENTATIVE DISEASES AND DISORDERS: Urinary System

Condition
Inflammation of the Kidneys
Glomerulonephritis
(glō-mār′ū-lō-nef-rῑ′tis)
Acute glomerulonephritis
Description
Inflammation of the filtration membrane within the renal corpuscle, causing increased membrane permeability;
plasma proteins and blood cells enter the filtrate, causing increased urine volume due to increased osmotic
concentration of the filtrate
Often occurs 1–3 weeks after a severe bacterial infection, such as strep throat; normally subsides after several days

Chronic glomerulonephritis Long-term and progressive process whereby the filtration membrane thickens and is eventually replaced by
connective tissue and the kidneys become nonfunctional

Renal Failure
Acute renal failure
Chronic renal failure
Can result from any condition that interferes with kidney function
Occurs when damage to the kidney is rapid and extensive; leads to accumulation of wastes in the blood; can lead to
death in 1–2 weeks if renal failure is complete
Results from permanent damage to so many nephrons that the remaining nephrons are inadequate for normal kidney
function; can be caused by chronic glomerulonephritis, trauma to the kidneys, tumors, or kidney stones

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INTEGUMENTARY
Anemia causes pallor, and bruising results from
clotting proteins lacking in the blood because
they are lost in the urine. Accumulation of
urinary pigments changes skin tone. High
urea gives a yellow cast to light-skinned
people, and white crystals of urea, called
uremic frost, may appear on areas of the
skin where there is heavy perspiration.
DIGESTIVE
Decreased appetite, mouth infections,
nausea, and vomiting result from altered
digestive tract functions due to the effects
of ionic imbalances on the nervous system.
RESPIRATORY
Early during acute renal failure, the depth of
breathing increases and becomes labored
as acidosis develops because the kidneys
are not able to secrete H+. Pulmonary
edema often develops because of water
and Na+ retention as a result of reduced
urine production. The likelihood of infection
increases as a result of pulmonary edema.
LYMPHATIC
There are no major direct effects on the
lymphatic system, except that increased
lymph flow occurs as a result of edema.
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Figure 18.23
SKELETAL
Bone resorption can result
because of excessive and chronic
loss of Ca2+ in the urine. Vitamin D
levels may be reduced.
MUSCULAR
Neuromuscular irritability results from the
toxic effect of metabolic wastes on the central
nervous system and ionic imbalances, such
as elevated blood K+ levels. Involuntary jerking
and twitching can occur as neuromuscular
irritability develops.
Acute Renal
Failure
NERVOUS
Elevated blood K+ levels and the toxic
Symptoms effects of metabolic wastes result in
• Decreased urine depolarization of neurons. Slowing of
volume action potential conduction, burning
sensations, pain, numbness, or tingling
• Increased Na+ results. Also, decreased mental acuity,
in urine reduced ability to concentrate, apathy,
• Decreased urine and lethargy occur. Or in severe cases,
osmolality confusion and coma occur.
Treatment
• Hemodialysis
• Kidney transplant
ENDOCRINE
Major hormone deficiencies
include vitamin D deficiency.
In addition, the secretion of
reproductive hormones decreases
due to the effects of metabolic
CARDIOVASCULAR wastes and ionic imbalances on
the hypothalamus.
Water and Na+ retention cause edema in peripheral
tissues and in the lungs, leading to increased blood
pressure and congestive heart failure. Elevated blood
K+ levels result in dysrhythmias and can cause cardiac
arrest. Anemia due to decreased erythropoietin
production by the damaged kidney exists.
 Figure 18.24

Blood
From an artery
Diffusion
Blood pump of waste
products,
such as
Bubble urea
trap
To a vein
Diffusion of
Dialysis waste products
membrane
across the dialysis
membrane

Compressed Fresh Constant Used

CO2 and air dialysis temperature dialysis
fluid bath fluid Dialysis fluid

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