GOOD

MORNING
THE URINARY SYSTEM

ARACELI G. DIZON, MD, DPPS, DPSAi

Department of Human Anatomy:
Section of Histology
 OBJECTIVES
 Identify the parts of the Urinary System.
 Identify the functions of the Urinary System
 Discuss the histologic composition of the major structures
of the Urinary System as to their:
- Epithelium
- Cell composition
- Layers (Adrenal cortex)
- Nephron (Ducts, Tubules & the Glomerulus)
 Discuss conditions and diseases associated with the
Urinary System.
 INTRODUCTION
 The Urinary system
consists of the
following:
1. Paired Kidneys
2. Paired Ureters
3. Urinary Bladder
4. Urethra
FUNCTIONS OF THE URINARY
SYSTEM
 FUNCTIONS OF THE URINARY
SYSTEM
1. Regulation of the balance between water & electrolytes
(inorganic ions) & the acid-base balance.
2. Excretion of metabolic wastes along with excess
water & electrolytes in urine.
3. Excretion of many bioactive substances, including
many drugs.
4. Regulation of arterial blood pressure by secretion of
RENIN.
 THE URINARY SYSTEM
 RENIN
- Is a protease, an enzyme secreted into the blood that helps
regulate blood pressure by cleaving circulating
Angiotensinogen to Angiotensin.

 URINE
- Is the excretory product of the Kidneys, passes through the
Ureters to the Urinary bladder for temporary storage.
- It is then released to the exterior through the Urethra.
 OTHER FUNCTIONS
1. Secretion of ERYTHROPOIETIN , a glycoprotein growth
factor that stimulates Erythrocyte production in Red
marrow when the blood O₂level is low.

2. Conversion of the steroid prohormone Vitamin D,

initially produced in the Epidermis, to the active form
( 1,25-Dihydroxyvitamin D or CALCITROL)
3

3. Gluconeogenesis during starvation or periods of

prolonged fasting, making Glucose from Amino acids
to supplement this process in the Liver.
THE KIDNEYS
 KIDNEYS
 Each Kidney has a
concave medial
border, the HILUM —
where Nerves enter,
the Ureter exits,
Blood & Lymph
vessels enter.
 It exits in a convex
lateral surface, both
covered by a thin
fibrous capsule.
 KIDNEYS
 It has the following
major parts:
1. OUTER CORTEX
(red arrow)
- A region with many
corpuscles & cross
sections of tubules.
2. INNER MEDULLA
(black arrow)
RENAL CORTEX AND MEDULLA
 KIDNEYS
 Consist of straight, aligned
structures.
 In humans, the Renal
medulla consists of 8-12
conical structures called
RENAL PYRAMIDS (red
arrow) , separated by
extensions from the cortex
called RENAL COLUMNS
(black arrow).
 Each pyramid plus the
cortical tissue at its base &
along its sides constitutes a
RENAL LOBE (yellow
bracket).
RENAL LOBES & RENAL PYRAMID
 KIDNEYS
 STRIATIONS extending from the
Medulla into the Cortex are
called MEDULLARY RAYS (these
+ the attached cortical tissue are
considered RENAL LOBULES.

 The tip of each pyramid, called

the RENAL PAPILLA (projects
into a MINOR CALYX) that
collects urine formed by tubules
in the Pyramid.
MEDULLARY RAYS
 KIDNEYS
 The Apical Papilla of each
Renal Pyramid inserts into a
MINOR CALYX (red arrow), a
subdivision of two or three
MAJOR CALYCES (blue arrow)
extending from the Renal
Pelvis (black arrow).

 The URETER carries Urine

from the Renal Pelvis & exits
the RENAL HILUM, where the
RENAL ARTERY & VEIN are
also located.
THE NEPHRONS
 NEPHRONS
 The functional unit of the Kidney.
 Consists of the following:
- Renal corpuscle
- Proximal tubule
- Loop of Henle
- Distal tubule
- Collecting duct
 Each Kidney contains around 1M
– 1.2M functional units.
 Made up of simple, single
layered epithelium along their
entire lengths.
NEPHRONS
 NEPHRONS
 MAJOR DIVISIONS OF A
NEHPRON

1. Renal corpuscle
2. Proximal tubule
3. Loop of Henle
4. Distal tubule
5. Collecting tubule
NEPHRONS
 NEPHRONS
 RENAL CORPUSCLE
- A. k. a. MALPHIGIAN BODY
- Composed of :
1. Glomerulus
- An initial dilated part
enclosing a tuft of Capillary
Loops & the site of blood
filtration, always located in
the Cortex.
2. Bowman’s capsule
- Double-walled capsule
RENAL CORPUSCLE OF THE
NEPHRON
 NEPHRONS
 PROXIMAL TUBULE
- A long convoluted part.
- Located entirely in the Cortex.
- With a shorter straight part that
enters the Medulla.
- Lined by Simple cuboidal
epithelium.
- With abundant dark pink cytoplasm
(Mitochondria).
- With prominent brush
border/microvilli (to increase the
surface area for reabsorption).
PROXIMAL CONVOLUTED
TUBULES
 NEPHRONS
 LOOP OF HENLE
- A. k. a the NEPHRON
LOOP
- Located in the Medulla
- With a thin Descending
& a thin Ascending limb.
- Each segment has different
permeability to Water &
ions.
- Composed of Simple
Cuboidal cells.
THICK & THIN LOOP OF HENLE
 NEPHRONS
 DISTAL TUBULE
- Consisting of a thick
straight part.
- Ascending from the
loop of Henle back
into the Cortex.
- The Convoluted part
is completely in the
Cortex.
DISTAL CONVOLUTED TUBULES
 NEPHRONS
 COLLECTING TUBULES
- A short final part linking the
Nephron to the Collecting ducts.
- A. k. a. Duct of Bellini
- Any of the long narrow tubes in
the Kidney that concentrate &
transport Urine from the
Nephrons, to larger ducts that
connect with the Renal calyces,
cavities in which Urine gathers
until it flows down.
 NEPHRONS
 Connecting tubules from several Nephrons merge
to form Collecting tubules that then merge as
larger COLLECTING DUCTS.
 These converge in the RENAL PAPILLA, where
they deliver Urine to a MINOR CALYX.
 Cortical Nephrons are located almost completely in
the Cortex while Juxtamedullary (about 1/7 of the
total) lie close to the Medulla & have long Loops of
Henle.
MEDICAL APPLICATION
 POLYCYSTIC KIDNEY DISEASE
 An inherited disorder in
which normal cortical
organization of both
Kidneys is lost due to the
formation of multiple, large,
fluid-filled cysts.
 Cysts may arise from any
epithelial cells of the
Nephron.
 Can lead to gross Kidney
enlargement & loss of renal
function.
POLYCYSTIC KIDNEY DISEASE
RENAL CIRCULATION
 RENAL CIRCULATION
 As expected for an organ
specialized to process
the blood, the Kidney’s
vasculature is large,
well-organized, & closely
associated with all
components of the
Nephron.
 Blood vessels of the
Kidneys are named
according to their
locations or shapes.
 RENAL CIRCULATION
 Each Kidney’s RENAL
ARTERY divides into two
or more SEGMENTAL
ARTERIES at the Hilum.
 Around the Renal pelvis,
these branch further as
the INTERLOBAR
ARTERIES, which extend
between the Renal
pyramids toward the
Corticomedullary
junction.
 RENAL CIRCULATION
 Then the interlobar arteries
divide again to form the
ARCUATE ARTERIES that
run in an arc along this
junction at the base of each
renal pyramid.

 Smaller INTERLOBULAR
ARTERIES (a. k. a. Cortical
Radial arteries) radiate from
the Arcuate arteries,
extending deeply into the
Cortex.
 RENAL CIRCULATION
 From the Interlobular
arteries arise the
microvascular AFFERENT
ARTERIOLES, which divide
to form a plexus of capillary
loops called the
GLOMERULUS, each of
which is located within a
Renal corpuscle where the
blood is filtered.
 RENAL CIRCULATION
 Blood leaves the glomerular capillaries, not via venules, but via
EFFERENT ARTERIOLES, which at once branch again to form
another capillary network, usually the PERITUBULAR CAPILLARIES
profusely distributed throughout the cortex.
 From the Juxtaglomerular corpuscles near the Medulla, Efferent
arterioles do not form peritubular capillaries, but instead branch
repeatedly to form parallel tassel-like bundles of capillary loops
called the VASA RECTA that penetrate deep into the medulla in
association with the Loops of Henle & Collecting ducts.
 Collectively, the Cortex receives over 10X more blood than the
Medulla.
 RENAL CIRCULATION
 Blood leaves
the Kidney in
veins that
follow the same
courses as
arteries & have
the same
names.
 RENAL CIRCULATION

 The outermost Peritubular capillaries & capillaries

in the Kidney capsule converge into small
STELLATE VEINS that empty into the
INTERLOBULAR VEINS.
MEDICAL APPLICATION
 MEDICAL APPLICATION
 There are many different Glomerular diseases
involving the renal corpuscles, with different
causes calling for different treatments.

 Accurate diagnoses of such disorders by

pathologists require sampling of the Cortex & may
involve examination of the Renal corpuscles by
Immunofluorescence light microscopy or even by
TEM.
RENAL FUNCTION:
FILTRATION,
SECRETION, &
REABSORPTION
 RENAL FUNCTION: FILTRATION,
SECRETION, & REABSORPTION

 All the major functions of the Kidneys - the

removal of metabolic wastes & excess water &
electrolytes from blood — are performed by
various specialized epithelial cells of the
Nephrons & collecting systems.
 RENAL FUNCTIONS & SPECIFIC
ACTIVITIES
 Filtration
- Water & solutes in the blood leave the vascular space & enter the
lumen of the Nephron.
 Tubular Secretion
- Substances move from Epithelial cells of the tubules into the
lumens, usually after uptake from the surrounding interstium
& capillaries.
 Tubular Reabsorption
- Substances move from the tubular lumen across the Epithelium
into the interstium & surrounding capillaries.
 RENAL FUNCTIONS & SPECIFIC
ACTIVITIES

 Along the length of the Nephron tubule &

collecting system, the filtrate receives various
secreted molecules while others are reabsorbed
& then enters the minor calyces as Urine &
undergoes excretion.
 RENAL FUNCTIONS & SPECIFIC
ACTIVITIES
 The number of Nephrons decreases slightly in older
adults, a process accelerated by high blood pressure (BP)
& other diseases like Diabetes mellitus (DM).

 If a kidney is donated for transplant (unilateral

nephrectomy), the remaining kidney undergoes
compensatory growth, with Cellular hypertrophy in the
proximal parts of the nephron tubules & an increase in the
rate of filtration, which allow normal renal function to
continue.
MEDICAL APPLICATION
 GLOMERULONEPHRITIS
 Inflammation within the Glomeruli.
 The course can be acute or chronic.
 Usually stems from Humoral immune reactions.
 Varieties of this condition involve the Deposition of
circulating Ab-Ag complexes within Glomeruli or
circulating Abs binding to either Glomerular Ags or
Extrarenal Ags deposited in the Glomeruli.
 Regardless of the source the accumulating immune
complexes can then elicit a local inflammatory response.
RENAL CORPUSCLES &
BLOOD FILTRATION
 RENAL CORPUSCLES & BLOOD
FILTRATION
 At the beginning of each
Nephron is a Renal corpuscle.
 It is about 200 μm in diameter
 Containing a tuft of
Glomerular capillaries,
surrounded by a double-
walled epithelial capsule
called the Glomerular
(Bowman) capsule.
RENAL CORPUSCLE
BOWMAN’S CAPSULE OF THE
GLOMERULUS
 RENAL CORPUSCLES & BLOOD
FILTRATION
 An internal or Visceral
layer of the capsule
closely envelops the
Glomerular capillaries,
which are finely
fenestrated.
 An outer Parietal layer
forms the surface of the
capsule.
 RENAL CORPUSCLES & BLOOD
FILTRATION
 Between the two capsular layers
is the Capsular (or urinary)
space, which receives the fluid
filtered through the capillary wall
& visceral layer.
 Each renal corpuscle has a
VASCULAR POLE (red arrows),
where the Afferent arteriole
enters & the Efferent arteriole
leaves, & a tubular pole, where
the proximal convoluted tubule
(PCT) begins.
 GLOMERULUS
 A ball of capillaries
surrounded by the Bowman's
capsule into which urine is
filtered.
 The filtration barrier consists
of 3 components:
1. Endothelial cells of
Glomerular capillaries.
2. Glomerular basement
membrane.
3. Epithelial cells of
Bowman's Capsule
(Podocytes).
 GLOMERULUS
 The outer Parietal layer (PL)
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 forms the
proximal tubule.
 THIS IS A KIDNEY, SHOWING A GLOMERULUS WITHIN BOWMAN'S CAPSULE,
MAKING UP THE RENAL CORPUSCLE. NOTE THE SIMPLE SQUAMOUS EPITHELIUM
OF THE PARIETAL LAYER OF BOWMAN'S CAPSULE, AS WELL AS THE BLOOD
CELLS IN THE GLOMERULAR CAPILLARIES.
 RENAL CORPUSCLE
 The visceral layer of a renal
corpuscle consists of unusual
stellate epithelial cells called
PODOCYTES , which together
with the capillary endothelial
cells compose the apparatus
for renal filtration.

 From the cell body of each

Podocyte several primary
processes extend & curve
around a length of Glomerular
capillary.
PODOCYTES
 RENAL CORPUSCLE
 Each primary process
gives rise to many
parallel, interdigitating
secondary processes or
PEDICELS.
 Pedicels cover much of
the capillary surface, in
direct contact with the
basal lamina.
 FILTRATION SLIT PORES
 Between the
interdigitating
pedicels are
elongated
spaces, or
Filtration Slit
(FS) pores.
 25 to 30 nm in
diameter.
 SLIT DIAPHRAGMS
 Spanning adjacent
Pedicels & bridging the slit
pores are zipper-like SLIT
DIAPHRAGM
 Slit diaphragms are
modified & specialized
occluding or tight
junctions composed of
NEPHRINS, other proteins,
Glycoproteins, &
Proteoglycans important
for renal function.
 RENAL CORPUSCLE
 Capillaries of each Glomerulus have a total length
of approximately 1cm.

 They are uniquely situated between two

arterioles—Afferent & Efferent—the muscle of
which allows increased hydrostatic pressure in
these vessels, favoring movement of plasma
across the glomerular filter.
 GLOMERULAR FILTRATION RATE (GFR)

 Glomerular Filtration Rate (GFR) is constantly regulated by

neural & hormonal inputs affecting the degree of
constriction in each of these arterioles.
 The total Glomerular filtration area of an adult has been
estimated at 500 cm² & the average GFR at 125 mL/min or
180 L/d.
 Because the total amount of circulating plasma averages
3L, it follows that the kidneys typically filter the entire
blood volume 60X every day.
MEDICAL APPLICATION
 MEDICAL APPLICATION
 In Diabetes Mellitus (DM) & Glomerulonephritis
(GN)
- Glomerular filter is altered.
- It becomes much more permeable to proteins,
with the subsequent release of protein into the
urine (Proteinuria).
- Proteinuria is an indicator of many potential
Kidney disorders.
 MESANGIAL CELLS
 In addition to
Capillary
Endothelial cells
& Podocytes,
Renal
Corpuscles also
contain
Mesangial cells.
 MESANGIAL CELLS
 Most mesangial
cells resemble
vascular
Pericytes in
having
contractile
properties &
producing
components of
an external
lamina.
MESANGIAL CELLS & MESAGIUM
 They are difficult to
distinguish in routine
sections from Podocytes ,
but often stain more
darkly.
 Their surrounding matrix
comprise the Mesangium,
which fills interstices
between Capillaries that
lack Podocytes.
FUNCTIONS OF THE MESANGIUM
 Physical support of Capillaries within the Glomerulus.
 Adjusted contractions in response to blood pressure (BP)
changes, which help maintain an optimal filtration rate.
 Phagocytosis of protein aggregates adhering to the
glomerular filter, including Ab-Ag complexes abundant in
many pathological conditions.
 Secretion of several Cytokines, Prostaglandins, & other
factors important for immune defense & repair in the
Glomerulus.
 NEPHRONS
 The 1st tubular part, the
Proximal Convoluted
Tubule (PCT), is mainly
cortical, has Simple
Cuboidal cells with long
microvilli in the lumen,
abundant mitochondria,
large, interdigitating
basolateral folds.
 NEPHRONS
 In the proximal
convoluted tubule, all
glucose & other organic
nutrients, all small
proteins & peptides
(which are degraded to
amino acids), & much
water & electrolytes are
reabsorbed from the
filtrate & transferred to
the peritubular capillaries.
 NEPHRONS
 From the PCT filtrate
flows into the Loop of
Henle, located in the
medulla, which has
squamous thin
descending &
ascending limbs; the
latter extends as a
Thick Ascending Limb
(TAL) back into the
cortex.
 NEPHRONS
 In the cortex the TAL
(a. k. a. the Distal
Straight Tubule)
contracts the
arterioles at the
vascular pole of its
parent renal
corpuscle & there
thickens focally as
the macula densa
 NEPHRONS
 Tall epithelial cells of the
Macula densa &
specialized smooth
muscle cells in the
adjacent afferent arteriole
called juxtaglomerular
cells , which secrete
RENIN , comprise a
juxtaglomerular apparatus
(JGA) that is an important
regulator of blood
pressure.
JUXTAGLOMERULAR CELLS
 NEPHRONS
 Beyond the macula
densa, the tubule
continues as the Distal
Convoluted Tubule
(DCT), where electrolyte
levels of the filtrate are
adjusted further &
which lead to short
connecting tubules.
 NEPHRONS
 Connecting tubules from
several nephrons join to
form the Cortical
Collecting Ducts , lined by
simple cuboidal
epithelium, which enter
the medulla in parallel
with the Loops of Henle
& Vasa recta & become
larger with more
columnar cells.
URETERS, BLADDERS &
URETHRA
 URINARY TRACT
 PRINCIPAL CELLS
- Found in the collecting ducts
- Pale-staining cells with
relatively few mitochondria.
- With distinct cell membranes
that are rich in Aquaporins
(water channels) for passive
water reabsorption.

 The largest collecting ducts

deliver filtrate into the Minor
calyces, where it undergoes no
further modification & is called
URINE.
 HISTOLOGIC FEATURES & MAJOR
FUNCTIONS OF THE RENAL TUBULES
 URINARY TRACT
 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.

 The Calyces, Renal pelvis, Ureter, & Bladder have

somewhat similar histologic structure, with the
walls becoming gradually thicker closer to the
bladder.
 URINARY TRACT

 The mucosa of
these organs is
lined by the
unique Stratified
Transitional
epithelium or
Urothelium
URETERS
CROSS SECTION OF THE URETER
URETERS
 URINARY TRACT
 Cells of this epithelium are organized
as three layers:
1. A single layer of small basal cells
- Resting on a very thin basement
membrane.
2. An intermediate region
- Containing from one to several
layers of more columnar cells.
3. A superficial layer of very large,
bulbous cells - umbrella cells
- Occasionally bi- or multinucleated &
are highly differentiated to protect
underlying cells against the cytotoxic
effects of urine.
 URINARY BLADDER
 Plaques are hinged together by
more narrow regions of typical
membrane.
 When the bladder is emptied,
not only does the mucosa fold
extensively, but individual
Umbrella cells decrease their
apical surface area by folding
the membrane at the hinge
regions and internalizing the
folded plaques in discoidal
vesicles.
 URINARY BLADDER
 As the Bladder fills again, the
discoidal vesicles rejoin the
apical membrane, increasing
its surface area as the cell
shape changes from round to
flat.

 The Urothelium becomes

thinner, apparently the result of
the intermediate cells being
pushed & pulled laterally to
accommodate the increased
volume of urine.
 URINARY BLADDER
 Urothelium is surrounded
by a folded lamina propria
& submucosa, followed by
a dense sheath of
interwoven smooth
muscle layers & adventia.
 Urine moved from the
renal pelvises to the
bladder by peristaltic
contractions of the
ureters.
 URINARY BLADDER
 The bladder’s lamina
propria & dense irregular
CT of the submucosa are
highly vascularized.
 Average adult bladder
capacity: 400 - 800 ml of
urine.
 With the urge to empty
appearing at about 150 -
200 ml.
 URINARY BLADDER
 The muscularis consists of
three poorly delineated
layers, collectively called the
DETRUSOR MUSCLES,
which contract to empty the
bladder.

 Three muscular layers are

seen most distinctly at the
neck of the bladder near the
urethra.
MEDICAL APPLICATION
 CYSTITIS
 Inflammation of the
bladder mucosa.
 The most frequent problem
involving this organ.
 Such inflammation is
common during Urinary
Tract Infections (UTIs).
 But it can also be caused
by immunodeficiency,
urinary catheterization,
radiation, or chemotherapy.
 HEMORRHAGIC CYSTITIS DUE TO
CYTOMEGALOVIRUS IN AN AIDS PATIENT
 MEDICAL APPLICATION
 CHRONIC CYSTITIS
- It can cause an unstable
urothelium, with benign
urothelial changes
involving hyperplasia or
metaplasia.
 URINARY BLADDER CANCER
- It is usually some form of
transitional cell carcinoma
arising from unstable
urothelium.
NORMAL UROTHELIUM OF THE TRANSITIONAL CARCINOMA OF
BLADDER THE BLADDER

URINARY BLADDER CANCER

 URETHRA
 Drains the urinary
bladder.
 Lined by unusual
Stratified Columnar &
Pseudostratified
Columnar epithelium
 In males, the Urethra is
divided into three (3)
regions: Prostatic
Membranous
Penile/Spongy
 REGIONS OF THE MALE URETHRA
 1. PROSTATIC
URETHRA
- 3 to 4 cm long
- Extends through
the prostate gland.
- Is lined by
Urothelium
PROSTATIC URETHRA
 REGIONS OF THE MALE URETHRA
 2. MEMBRANOUS URETHRA
- A short segment
- Passes through an
EXTERNAL
SPHINCTER of striated
muscle
- Lined by stratified
columnar &
pseudostratified
epithelium
 REGIONS OF THE MALE URETHRA
 3. SPONGY URETHRA/PENILE
URETHRA
- About 15 cm in length.
- Enclosed within erectile
tissue of the penis
- Is lined by stratified
columnar &
pseudostratified
columnar epithelium
with stratified squamous
epithelium distally.
PENILE URETHRA
 URETHRA
 In women, the Urethra is
exclusively a urinary
organ.
 Female Urethra is a 4cm-
5cm long tube.
 Lined initially with
Transitional epithelium in
the proximal urethra, then
by Stratified Squamous
epithelium in the distal
Urethra.
URETHRA
 The middle part of the
Female Urethra is
surrounded by the
External Striated
muscle sphincter:
IUS
 1. Internal urethral
sphincter (IUS)
 2. Externa urethral
EUS sphincter (EUS)
 MEDICAL APPLICATION
 Urinary tract infections (UTI), usually involving
coliform bacteria or Chlamydia, often produce
urethritis & in women often lead to cystitis because
of the short urethra.

 Such infections are usually accompanied by a

persistent or more frequent urge to urinate, &
urethritis may produce pain or difficulty during
urination (dysuria).
REVIEW OF SLIDES
 REFERENCES

 Mescher, A. L., Mescher, A. L., & Junqueira, L. C.

U. (2016). Junqueira's basic histology: Text and atlas
(Fourteenth edition.). New York: McGraw-Hill Education.

 (2014). Wheater's functional histology: A text and colour

atlas (Sixth edition.). Philadelphia, PA: Churchill
Livingston/Elsevier.
THANK YOU FOR
LISTENING