MLS 407: HUMAN HISTOLOGY | LABORATORY

THE URINARY SYSTEM

FINALS | S.Y 2022 – 2023
ANGELO JAYSON UY, M.D.

OUTLINE ■ Secretion of
I. The Urinary System ERYTHROPOIETIN,
II. Kidneys ● a glycoprotein growth
A. Nephrons factor that stimulates
III. Blood Circulation erythrocyte production
IV. Renal Function: Filtration, Secretion, &
in red marrow when the
Reabsorption
A. Renal Corpuscles & Blood Filtration blood O2 level is low;
B. Proximal Convoluted Tubule ■ Conversion of the steroid
C. Loop Of Henle prohormone vitamin D, initially
D. Distal Convoluted Tubule & produced in the skin, to the
Juxtaglomerular Apparatus active form
E. Collecting Ducts (1,25-dihydroxyvitamin D3 or
V. Ureters, Bladder, & Urethra
calcitriol); and
VI. Assess Your Knowledge
■ Gluconeogenesis during
JUNQUEIRA’S BASIC HISTOLOGY: 15TH EDITION starvation or periods of
prolonged fasting, making
I. THE URINARY SYSTEM glucose from amino acids to
● URINARY SYSTEM supplement this process in the
○ Consists of: liver.
■ Paired kidneys
■ Ureters II. KIDNEYS
■ Bladder ● KIDNEYS
■ Urethra ○ Bean-shaped, 12-cm long, 6-cm wide,
○ Primary role: to ensure optimal and 2.5-cm thick in adults.
properties of the blood, which the ○ Each kidney has a concave medial
kidneys continuously monitor. This border, the hilum, and a convex lateral
general role of the kidneys involves a surface, both covered by a thin fibrous
complex combination of renal functions: capsule.
■ Regulation of the balance
between water and electrolytes
(inorganic ions) and the
acid-base balance;
■ Excretion of metabolic
wastes along with excess water
and electrolytes in urine, the
kidneys’ excretory product
which passes through the
ureters for temporary storage in
the bladder before its release to
the exterior by the urethra; ● HILUM
■ Excretion of many bioactive ○ Where nerves enter, the ureter exits,
substances, including many and blood and lymph vessels enter and
drugs; exit.
■ Secretion of RENIN, ● RENAL PELVIS
● a protease important ○ Expanded upper end of the ureter within
for regulation of blood the hilum.
pressure by cleaving ○ Divides into two or three major calyces.
circulating ● MINOR CALYCES
angiotensinogen to ○ Smaller branches that arise from each
angiotensin I; major calyx.

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 ○ The area surrounding the renal pelvis
and calyces contains adipose tissue.
● The parenchyma of each kidney has:
○ An outer RENAL CORTEX,
■ A darker stained region with
many round corpuscles and
tubule cross sections.
○ An inner RENAL MEDULLA
■ Consisting mostly of aligned
linear tubules and ducts.
● RENAL PYRAMIDS
○ Attached to each minor calyx.
○ 8-15 conical structures that constitute
the renal medulla of humans, all with
their bases meeting the cortex (at the
corticomedullary junction).
● RENAL COLUMNS
○ Extensions of the cortex that separate
the renal pyramids from each other.
● RENAL LOBE
○ Consists of each pyramid plus the
cortical tissue at its base and extending
along its sides.
● MEDULLARY RAYS
○ Consists of parallel ducts and tubules
extending from the medulla into the
cortex.
● RENAL LOBULES
○ Medullary rays plus their associated
cortical tissue.
● RENAL PAPILLA
○ The tip of each pyramid
○ Projects into a minor calyx that collects
urine formed by tubules in one renal
lobe.
A. NEPHRONS
● NEPHRONS
○ 1-4 million functional units of the kidney.
○ Each consisting of a corpuscle and a
long, simple epithelial renal tubule with
three main parts along its length.
○ Each nephron originates in the cortex, at
the renal corpuscle surrounding a small
tuft of glomerular capillaries.
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● The following are the major divisions of each
nephron:
○ RENAL CORPUSCLE
■ An initial dilated part enclosing
a tuft of capillary loops and the
site of blood filtration, always
located in the cortex.
○ PROXIMAL TUBULE
■ A long convoluted part, located
entirely in the cortex, with a
shorter straight part that enters
the medulla.
○ LOOP OF HENLE (or nephron loop),
■ In the medulla, with a thin
descending and a thin
ascending limb.
■ Ends with a thick ascending
limb, a straight tubule that
reenters the cortex and ends at
its thickened macula densa
area where it contacts the
arterioles entering the
glomerulus.
○ DISTAL TUBULE
■ Consisting of a thick straight
part ascending from the loop of
Henle back into the cortex and
a convoluted part completely in
the cortex.
■ Beyond the macula densa.
○ CONNECTING TUBULE
■ A short minor part linking the
nephron to collecting ducts.
■ Connecting tubules from
several nephrons merge to form
collecting tubules that then
merge as larger collecting
ducts that transport urine to the
calyx.
● CORTICAL NEPHRONS
○ Located almost completely in the cortex
● JUXTAMEDULLARY NEPHRONS
○ About one-seventh of the total.
○ Lie close to the medulla and have long
loops of Henle.
III. BLOOD CIRCULATION
● KIDNEY VASCULATURE
○ A large, well-organized vasculature that
is closely associated with all
components of the nephron.
○ Blood vessels of the kidneys are named
according to their locations or shapes.
● Each kidney’s RENAL ARTERY
○ Divides into two or more segmental
arteries at the hilum.
● INTERLOBAR ARTERIES
○ Further branches of the renal arteries
around the renal pelvis.
○ Extend between the renal pyramids
toward the corticomedullary junction.
● ARCUATE ARTERIES
○ Further divisions of the interlobar
arteries.
○ Run in an arc along this junction at the
base of each renal pyramid.
● INTERLOBULAR ARTERIES or CORTICAL
RADIAL ARTERIES
○ Radiate from the arcuate arteries,
extending deeply into the cortex.
● AFFERENT ARTERIOLES IV. RENAL FUNCTION: FILTRATION, SECRETION, &
○ The microvascular that arise from the REABSORPTION
● All the major functions of the kidneys—the
interlobular arteries.
removal of metabolic wastes and excess water
○ GLOMERULUS
and electrolytes from blood— are performed by
■ Further division of afferent
various specialized epithelial cells of nephrons
arterioles.
and collecting systems. The renal function
■ A plexus of capillary loops, each
involves the following specific activities:
of which is located within a
○ FILTRATION
renal corpuscle where the
■ Water and solutes in the blood
blood is filtered.
leave the vascular space and
■ Small mass of capillaries
enter the lumen of the nephron.
housed within a bulbous
○ TUBULAR SECRETION
glomerular capsule.
■ Substances move from the
● EFFERENT ARTERIOLES
epithelial cells of the tubules
○ Where the blood leaves the glomerular
into the lumens, usually after
capillaries
uptake from the surrounding
○ The blood does not leave via venules
interstitium and capillaries.
but via efferent arterioles.
○ TUBULAR REABSORPTION
○ PERITUBULAR CAPILLARIES
■ Substances move from the
■ Another capillary network.
tubular lumen across the
■ These are branches of efferent
epithelium into the interstitium
arterioles.
and surrounding capillaries.
■ Profusely distributed throughout
● Along the length of the nephron tubule and
the cortex.
collecting system, the filtrate receives various
● From the juxtaglomerular corpuscles near the
secreted molecules, while others are reabsorbed
medulla, efferent arterioles do not form
and then enter the minor calyces as urine and
peritubular capillaries but instead branch
undergo excretion.
repeatedly to form vasa recta.
● VASA RECTA
A. RENAL CORPUSCLES & BLOOD FILTRATION
○ Parallel tassel-like bundles of capillary
loops.
○ Penetrate deep into the medulla in
association with the loops of Henle and
collecting ducts.
● Collectively, the cortex receives over 10 times
more blood than the medulla.
● Blood leaves the kidney in veins that follow the
same courses as arteries and have the same
names.
● RENAL CORPUSCLE
● The outermost peritubular capillaries and
○ Beginning of each nephron.
capillaries in the kidney capsule converge into
○ About 200 μm in diameter and
small stellate veins that empty into the
containing a tuft of glomerular
interlobular veins.
capillaries.

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● GLOMERULAR (BOWMAN) CAPSULE
○ A double-walled epithelial capsule that
surrounds the renal corpuscle.
○ The internal or visceral layer of this
capsule closely envelops the glomerular
capillaries, which are finely fenestrated.
○ The outer parietal layer forms the
surface of the capsule.
● CAPSULAR (OR URINARY) SPACE
○ Between the two capsular layers which
receive the fluid filtered through the
capillary wall and the visceral layer.
● Each renal corpuscle has:
○ VASCULAR POLE
■ Where the afferent arteriole
enters and the efferent arteriole
leaves.
○ TUBULAR POLE
■ Where the proximal convoluted
tubule (PCT) begins.
● Outer Parietal Layer of a Glomerular Capsule
○ Consists of a simple squamous
epithelium supported externally by a
basal lamina.
○ At the tubular pole, this epithelium
changes to the simple cuboidal
epithelium that continues and forms the
proximal tubule.
● PODOCYTES
○ Unusual stellate epithelial cells at the
visceral layer of a renal corpuscle.
○ Together with the capillary endothelial
cells compose the apparatus for renal
filtration.
○ From the cell body of each podocyte
several primary processes extend and
curve around a length of glomerular
capillary.
○ Cover each capillary, forming slit-like
spaces between interdigitating
processes called pedicels.
● PEDICELS
○ These are many parallel, interdigitating
secondary processes that arise from
each primary process.
○ Cover much of the capillary surface, in
direct contact with the basal lamina.
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● FILTRATION SLIT PORES
○ Elongated spaces between the
interdigitating pedicels.
○ 25- to 30-nm wide
● SLIT DIAPHRAGMS
○ Zipper-like structures that span adjacent
pedicels and bridge the slit pores.
○ These are modified and specialized
occluding or tight junctions composed of
nephrins, other proteins, glycoproteins,
and proteoglycans important for renal
function.
● POLYANIONIC GLYCOPROTEINS AND
PROTEOGLYCANS
○ Projecting from the cell membrane on
each side of the filtration slit.
○ These interact to form a series of
openings within the slit diaphragm, with
a surface that is negatively charged.
● GLOMERULAR BASEMENT MEMBRANE
○ Thick
○ In between the highly fenestrated
endothelial cells of the capillaries and
the covering podocytes.
○ Most substantial part of the filtration
barrier that separates the blood from the
capsular space and forms by fusion of
the capillary- and podocyte-produced
basal laminae.
○ LAMININ AND FIBRONECTIN
■ Bind integrins of both the
podocyte and endothelial cell
membranes in this fused
basement membrane.
○ POLYANIONIC GAGs
■ Abundant in the glomerular
membrane and their negative
charges, like those of the slit
diaphragms, tend to restrict
filtration of organic anions.
● FILTRATION occurs through a structure with
three parts:
○ The fenestrations of the capillary
endothelium, which blocks blood cells
and platelets.
 ○ The thick, combined basal laminae, or ○Regulated continuously by neural and
GBM, which restricts large proteins and hormonal inputs affecting the degree of
some organic anions. constriction in two arterioles.
○ The filtration slit diaphragms between ○ The total glomerular filtration area of an
pedicels, which restrict some small adult has been estimated at 500 cm2
proteins and organic anions. and the average GFR at 125 mL/min or
● Normally about 20% of the blood plasma 180 L/d.
entering a glomerulus is filtered into the capsular ○ The total amount of circulating plasma
space. averages 3 L, it follows that the kidneys
typically filter the entire blood volume 60
times every day.
● MESANGIAL CELLS
○ mesos, in the midst + angion, vessel
○ Most of which resemble vascular
pericytes in having contractile properties
and producing components of an
external lamina.
○ Difficult to distinguish in routine sections
from podocytes, but often stain more
darkly.
○ They and their surrounding matrix
comprise the mesangium.
● MESANGIUM
○ Fills interstices between capillaries that
● INITIAL GLOMERULAR FILTRATE
lack podocytes.
○ Has a chemical composition similar to
○ Functions of the mesangium include the
that of plasma except that it contains
following:
very little protein.
■ Physical support of
● GLOMERULAR FILTER
capillaries within the
○ Blocks filtration of most plasma proteins,
glomerulus;
but smaller proteins, including most
■ Adjusted contractions in
polypeptide hormones, are removed into
response to blood pressure
the filtrate.
changes, which help maintain
● GLOMERULAR FILTRATION BARRIER
an optimal filtration rate;
consists of three layered components:
■ Phagocytosis of protein
○ Fenestrated capillary endothelium
aggregates adhering to the
○ Glomerular basement membrane
glomerular filter, including
(GBM)
antibody-antigen complexes
○ Filtration slit diaphragms between
abundant in many pathological
pedicels
conditions;
● FILTRATE
■ Secretion of several cytokines,
○ Includes water, glucose, amino acids,
prostaglandins, and other
ions, urea, many hormones, vitamins B
factors important for immune
and C, ketones, and very small amounts
defense and repair in the
of protein.
glomerulus.
● CAPILLARIES OF EACH GLOMERULUS
○ Each totaling approximately 1 cm in
length.
○ Uniquely situated between the two
arterioles, afferent and efferent.
○ Contractile activity of these arterioles
causes hydrostatic pressure in the
glomerular capillaries to remain higher
than the osmotic pressure exerted by
their contents.
● GLOMERULAR FILTRATION RATE (GFR)

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 B. PROXIMAL CONVOLUTED TUBULE is continuous with the simple cuboidal
● Cells in many parts of the nephron tubule and epithelium of the proximal convoluted
collecting system reabsorb water and tubule (PCT)
electrolytes, but other activities are restricted ○ These long, tortuous tubules fill most of
mainly to specific tubular regions. the cortex.
○ PCT CELLS
Histologic Features and Major Functions of ■ Specialized for both
Regions Within Renal Tubules reabsorption and secretion.
○ Over half of the water and electrolytes,
Region of Histologic Locations Major and all of the organic nutrients (glucose,
Tubule Features functions
amino acids, vitamins, etc), filtered from
PCT Simple Cortex Reabsorption of plasma in the renal corpuscle are
cuboidal all organic normally reabsorbed in the PCT.
epithelium; nutrients, all
cells proteins, most ○ These molecules are transferred directly
well-stained, water, and across the tubular wall for immediate
with numerous electrolytes;
uptake again into the plasma of the
mitochondria, secretion of
prominent organic anions peritubular capillaries/
basal folds and and cations, H+, ● TRANSCELLULAR REABSORPTION
lateral and NH4 +
interdigitations;
○ Involves both active and passive
long microvilli, mechanisms, with the cells having a
lumens often large variety of transmembrane ion
occluded
pumps, ion channels, transporters,
Loop of enzymes, and carrier proteins.
Henle ○ Water and certain solutes can also move
passively between the cells (paracellular
Thin Limbs Simple Medulla Passive
squamous reabsorption of transport) along osmotic gradients
epithelium; few Na+ and Cl− through leaky apical tight junctions.
mitochondria ● ORGANIC ANION AND CATION
TRANSPORTERS
TAL Simple Medulla and Active
cuboidal medulla reabsorption of ○ Allow the kidneys to dispose of such
epithelium; no rays various substances at a higher rate than by
microvilli, but electrolytes
glomerular filtration alone.
many
mitochondria ● CELLS OF THE PROXIMAL TUBULES
○ Have central nuclei and very acidophilic
DCT Simple Cortex Reabsorption of
cuboidal electrolytes cytoplasm because of the abundant
epithelium; mitochondria.
cells smaller
than in PCT,
○ Because the cells are large, each
short microvilli transverse section of a PCT typically
and basolateral contains only three to five nuclei.
folds, more
empty lumens ○ Besides their major roles in reabsorption
and secretion, cells of the proximal
Collecting tubule also perform hydroxylation of
System
vitamin D and release to the capillaries.
Principal Most Medulla Regulated ● BRUSH BORDER
cells abundant, rays and reabsorption of ○ Formed by very many long microvilli of
cuboidal to medulla water &
electrolytes; the cell apex.
columnar;
pale-staining, regulated ○ In routine histologic preparations, the
distinct cell secretion of K+ long brush border may be disorganized
membranes
and give the lumens a fuzz-filled
Intercalated Few and Medullary Reabsorption of appearance.
cells scattered; rays K+ (low-K+ diet); ● PERITUBULAR CAPILLARIES
slightly darker help maintain ○ Abundant in the sparse surrounding
staining acid-base
balance connective tissue interstitium, which fills
only about 10% of the cortex.
● PROXIMAL CONVOLUTED TUBULE (PCT) ● PITS AND VESICLES
○ At the tubular pole of the renal ○ Numerous, located in the apical
corpuscle, the simple squamous cytoplasm of the cells of the proximal
epithelium of the capsule’s parietal layer tubules, near the bases of the microvilli

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 indicating active endocytosis and
pinocytosis.
○ These vesicles contain the small,
reabsorbed proteins that will be
degraded in lysosomes, with the amino
acids released to the circulation.
● BASAL MEMBRANE INVAGINATIONS AND
LATERAL INTERDIGITATIONS
○ Many, long, found in proximal tubular
cells.
○ Both the brush border and the
basolateral folds contain the many types
of transmembrane proteins that mediate
tubular reabsorption and secretion.
○ Long mitochondria concentrated along
the basal invaginations supply ATP
locally for the membrane proteins
involved in active transport.
○ Because of the extensive interdigitations
of the lateral membranes, discrete limits
between cells of the proximal tubule are
difficult to see with the light microscope.
● FIBROBLASTIC INTERSTITIAL CELLS
○ Found in cortical areas near the
proximal tubules.
○ Produce erythropoietin, the growth
factor secreted in response to a
prolonged decrease in local oxygen
concentration.
C. LOOP OF HENLE
● LOOP OF HENLE
○ The PCT continues with the much
shorter proximal straight tubule, which
enters the medulla and continues as the
nephron’s loop of Henle.
○ A U-shaped structure with a thin
descending limb and a thin ascending
limb, both composed of simple
squamous epithelia.
○ The straight part of the proximal tubule
narrows abruptly in the thin limbs of the
loop.
○ The wall of the thin segments consists
only of squamous cells with few
organelles (indicating a primarily passive
role in transport) and the lumen is
prominent.
○ The loops of Henle and surrounding
interstitial connective tissue are involved
in further adjusting the salt content of the
filtrate
● THIN ASCENDING LIMB OF THE LOOP
○ Becomes the thick ascending limb
(TAL), with simple cuboidal epithelium
and many mitochondria again, in the
outer medulla and extends as far as the
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macula densa near the nephron’s
glomerulus.
○ Reabsorb sodium chloride (NaCl) but
are impermeable to water.
● CUBOIDAL CELLS OF THE LOOPS’ TALs
○ Actively transport sodium and chloride
ions out of the tubule against a
concentration gradient into the
hyaluronate-rich interstitium, making that
compartment hyperosmotic.
○ This causes water to be withdrawn
passively from the thin descending part
of the loop, thus concentrating the
filtrate.
● GRADIENT OF OSMOLARITY
○ The countercurrent flow of the filtrate
(descending, then immediately
ascending) in the two parallel thin limbs
establishes a gradient of osmolarity in
the interstitium of the renal pyramids, an
effect that is “multiplied” at deeper levels
in the medulla.
● DESCENDING AND ASCENDING LOOPS OF
THE VASA RECTA
○ Countercurrent blood flow in the
descending and ascending loops of the
vasa recta helps maintain the
hyperosmotic interstitium.
● INTERSTITIAL OSMOLARITY
○ The interstitial osmolarity at the pyramid
tips is about four times that of the blood.
● COUNTERCURRENT MULTIPLIER SYSTEM
○ Established by the nephron loop and
vasa recta, is an important aspect of
renal physiology in humans.
D. DISTAL CONVOLUTED TUBULE &
JUXTAGLOMERULAR APPARATUS
● The ascending limb of the nephron is straight as
it enters the cortex and forms the macula densa,
and then becomes tortuous as the distal
convoluted tubule (DCT).
● DISTAL CONVOLUTED TUBULE (DCT)
○ Much less tubular reabsorption occurs
here than in the proximal tubule.
○ Cells of the DCT also have fewer
mitochondria than cells of proximal
tubules, making them less acidophilic
○ The rate of Na+ absorption here is
regulated by aldosterone from the
adrenal glands.
● JUXTAGLOMERULAR APPARATUS
○ MACULA DENSA
■ Where the initial, straight part of
the distal tubule contacts the
arterioles at the vascular pole of
the renal corpuscle of its parent
nephron, its cells become more
 columnar and closely packed,
forming the macula densa.
■ This is part of the specialized
sensory structure of the
juxtaglomerular apparatus
(JGA) that utilizes feedback
mechanism to regulate
glomerular blood flow and keep
the rate of the glomerular
filtration constant.
● JUXTAGLOMERULAR GRANULAR (JG)
CELLS
○ Modified smooth muscle cells
○ With a secretory phenotype including
more rounded nuclei, rough ER, Golgi
complexes, and granules with the
protease renin.
○ Also at the vascular pole are lacis cells,
which are extraglomerular mesangial
cells that have many of the same
supportive, contractile, and defensive
functions as these cells inside the
glomerulus.
● Decreased arterial pressure leads to
increased autonomic stimulation to the JGA
as a result of baroreceptor function, including
local baroreceptors in the afferent arteriole,
possibly the JG cells themselves. This causes
the JG cells to release renin, an aspartyl
protease, into the blood.
● There renin cleaves the plasma protein
angiotensinogen into the inactive decapeptide
angiotensin I.
● Angiotensin-converting enzyme (ACE) on lung
capillaries clips this further to angiotensin II, a
potent vasoconstrictor that directly raises
systemic blood pressure and stimulates the
adrenals to secrete aldosterone.
E. COLLECTING DUCTS
● CONNECTING TUBULE
○ Last part of each nephron.
○ Carries the filtrate into a collecting
system that transports it to a minor calyx
and in which more water is reabsorbed if
needed by the body.
● CONNECTING DUCTS
○ A connecting tubule extends from each
nephron and several join together in the
cortical medullary rays to form
collecting ducts of simple cuboidal
epithelium and an average diameter of
40 μm.
○ In the medulla these merge further,
forming larger and straighter collecting
ducts with increasingly columnar cells
and overall diameters reaching 200 μm.
● PAPILLARY DUCT
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○ Approaching the apex of each renal
pyramid, several medullary collecting
ducts merge again to form each
papillary duct (or duct of Bellini),
which delivers urine directly into the
minor calyx.
○ Running parallel with the descending
and ascending limbs of the loops of
Henle and vasa recta, medullary
collecting ducts lie in the area with very
high interstitial osmolarity.
● PRINCIPAL CELLS
○ Collecting tubules and ducts are
composed mainly of pale staining
principal cells with few organelles,
sparse microvilli, and unusually distinct
cell boundaries.
○ Have basal membrane infoldings,
consistent with their role in ion transport,
and a primary cilium among the microvilli
○ The medullary collecting ducts are the
final site of water reabsorption from the
filtrate.
○ AQUAPORINS
■ Principal cells are particularly
rich in aquaporins, the integral
membrane pore proteins
functioning as specific channels
for water molecules, but here
most aquaporins are
sequestered in membranous
cytoplasmic vesicles.
○ INTERCALATED CELLS
■ Scattered among the principal
cells are variably darker.
■ More abundant mitochondria
and projecting apical folds.
■ Some of which also occur in the
DCTs, help maintain acid-base
balance by secreting either H+
(from type A or α intercalated
cells) or HCO3 (from type B or β
intercalated cells).
V. URETERS, BLADDER, & URETHRA
● Urine is transported by the ureters from the renal
pelvis to the urinary bladder where it is stored
until emptying by micturition via the urethra.
● URETERS
○ The walls of the ureters are similar to
that of the calyces and renal pelvis, with
mucosal, muscular, and adventitial
layers and becoming gradually thicker
closer to the bladder.
● UROTHELIUM
○ The mucosa of these organs is lined by
this uniquely stratified urothelium or
transitional epithelium.
 ○Cells of this epithelium are organized as
three layers:
■ A single layer of small basal
cells resting on a very thin
basement membrane,
■ An intermediate region
containing from one to several
layers of cuboidal or low
columnar cells, and
■ A superficial layer of large
bulbous or elliptical umbrella
cells, sometimes binucleated,
which are highly differentiated
to protect the underlying cells
against the potentially cytotoxic
effects of hypertonic urine.
○ The thick muscularis of the ureters
moves urine toward the bladder by
peristaltic contractions and produces
prominent mucosal folds when the
lumen is empty.
● UMBRELLA CELLS
○ These are especially well developed in
the bladder where contact with urine is
greatest.
○ Up to 100 μm in diameter,
○ Have extensive intercellular junctional
complexes surrounding unique apical
membranes.
○ Most of the apical surface consists of
asymmetric unit membranes in which
regions of the outer lipid layer appear
ultrastructurally to be twice as thick as
the inner leaflet.
■ These regions are composed of
lipid rafts containing mostly
integral membrane proteins
called uroplakins that
assemble into paracrystalline
arrays of stiffened plaques 16
nm in diameter.
● PLAQUES
○ These are hinged together by more
narrow regions of typical membrane.
● BLADDER
○ The thickness of the full bladder’s
urothelium is half that of the empty
bladder (2-3 cell layers vs 5-7 layers).
○ UROTHELIUM
■ Surrounded by a folded lamina
propria and submucosa,
followed by a dense sheath of
interwoven smooth muscle
layers and adventitia.
○ URINE
■ Moved from the renal pelvises
to the bladder by peristaltic
contractions of the ureters.
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○The bladder’s lamina propria and dense
irregular connective tissue of the
submucosa are highly vascularized.
○ In an average adult can hold 400-600
mL of urine, with the urge to empty
appearing at about 150-200 mL.
○ DETRUSOR MUSCLE
■ Three poorly delineated layers
that constitute the muscularis of
the bladder.
■ Contract to empty the bladder.
■ These three muscular layers
are seen most distinctly at the
neck of the bladder near the
urethra.
○ All the urinary passages are covered
externally by an adventitial layer, except
for the upper part of the bladder that is
covered by the serous peritoneum.
● URETHRA
○ A tube that carries the urine from the
bladder to the exterior
○ The urethral mucosa has prominent
longitudinal folds, giving it a distinctive
appearance in cross section.
○ The male urethra is longer and consists
of three segments:
■ The prostatic urethra, 3-4 cm
long, extends through the
prostate gland and is lined by
urothelium.
■ The membranous urethra, a
short segment, passes through
an external sphincter of striated
muscle and is lined by stratified
columnar and pseudostratified
columnar epithelium.
■ The spongy urethra, about 15
cm in length, is enclosed within
erectile tissue of the penis and
is lined by stratified columnar
and pseudostratified columnar
epithelium, with stratified
squamous epithelium distally.
○ In women, the urethra is exclusively a
urinary organ:
■ 3- to 5-cm-long tube
■ Lined initially with transitional
epithelium
○ The middle part of the urethra in both
sexes is surrounded by the external
striated muscle sphincter.
VI. ASSESS YOUR KNOWLEDGE
1. Blood in the renal arcuate arteries flows next into
which vessels?
a. Afferent arterioles
b. Efferent arterioles
 c. Glomerular capillaries by laboratory at 8.0 g/dL and 0.95 g/dL,
d. Interlobar arteries respectively. A renal biopsy is prepared for light
e. Interlobular arteries microscopy, and an infiltrate containing
2. Which cell type comprises the visceral layer of lymphocytes, plasma cells, and eosinophils is
Bowman capsule? found among tubules having cells with prominent
a. Endothelial cells brush borders. Which one of the following
b. Juxtaglomerular cells statements correctly pertains to these epithelial
c. Mesangial cells cells?
d. Podocytes a. Impermeable to water despite presence
e. Extraglomerular mesangial (or Lacis) of ADH
cells b. The primary site for the reduction of
3. Which type of epithelium lines the thick the tubular fluid volume
ascending limb of the loop of Henle? c. The site of the countercurrent multiplier
a. Pseudostratified columnar d. The site of action of aldosterone
b. Simple columnar e. Indirectly involved in the release of renin
c. Simple cuboidal 9. A 45-year-old man presents with nephrolithiasis
d. Simple squamous or kidney stones. The process of calcium oxalate
e. Transitional (urothelium) stone formation as seen in this patient begins
4. Which cell is a modified smooth muscle cell that with Randall plaques found in the basement
secretes renin? membranes of which one of the following
a. Macula densa cells structures found only in the renal medulla?
b. Mesangial cells a. Proximal convoluted tubules
c. Podocytes b. Distal convoluted tubules
d. Juxtaglomerular cells c. Thin loops of Henle
e. Endothelial cells d. Afferent arterioles
5. Epithelial cell membrane domains containing e. Collecting ducts
many stiffened plaques of protein are an 10. A 15-year-old male presents with hematuria,
important feature in which part of the urinary hearing loss, lens dislocation, and the onset of
system? cataracts. Genetic analysis reveals a mutation in
a. Juxtaglomerular apparatus the COL4A5 gene. Transmission EM
b. Bladder mucosa examination of a renal biopsy confirms that the
c. Collecting ducts disorder has affected a component of the renal
d. Renal pyramids corpuscles in which damage disrupts normal
e. Membranous urethra glomerular filtration. Which one of the following
6. An immunohistochemical technique using structures would most likely be abnormal in the
antibodies against aquaporins to stain a section TEM of this patient’s biopsy?
of kidney would be expected to stain cells in a. Pedicels
which structures most intensely? b. Filtration slits
a. Collecting ducts c. Slit diaphragms
b. Lining of the major and minor calyces d. Glomerular basement membranes
c. Proximal convoluted tubules e. Fenestrated endothelium of
d. Distal convoluted tubules glomerular capillaries
e. Glomeruli
7. What type of epithelium lines the prostatic
urethra?
a. Simple columnar
b. Pseudostratified columnar
c. Stratified squamous
d. Simple squamous
e. Transitional (urothelium)
8. A 14-year-old patient presents in the nephrology
clinic with fatigue, malaise, anorexia, abdominal
pain, and fever. She reports a loss of 6 lb in the
past 2 months. Serum gamma globulin and the
immunoglobulins IgG, IgA, and IgM are all
elevated. Her serum creatine is 1.4 mg/dL
(normal 0.6-1.2 mg/dL) and urinalysis of glucose
and protein are 2+ on a dipstick test, confirmed

ENOC, LEBRILLO, PAUNON, & SORIANO | SPC MLS 2F | 10 of 10