Urinary System Introduction

Dr Sami Abdo Radman

Urinary system
‡ ‡ ‡ ‡ ‡ ‡ Includes: Two kidneys, Two ureters, The urinary bladder, Two sphincter muscles, and The urethra

Urinary System ± Anterior/Posterior Views

Costovertebral Angle (renal angle)
T11
R. Kidney

T12 L1

L. Kidney

12th Rib

Costovertebral Angle

Kidney anatomy
‡ Kidney is reddish-brown ‡ Lie in the superior lumber region of the posterior abdominal wall ‡ weight about 300 g ‡ Looks like a bean ‡ Approximately 4 inches x 2 inches ‡ Extend from the level of the 11th or 12th thoracic vertebra to the 3rd lumber vertebra ‡ Hilus ± indentation where blood vessels and structures enter or exit the kidney

Kidney anatomy
±Two parts : ±Cortex: Glomerular apparatus ±Medulla: Consists of about 1 million filtering units called nephrons (basic structural and functional unit)

Renal Medulla
‡ Dark, triangular structure ‡ Form small cone shaped regions called renal pyramids ‡ Each pyramid is separated by renal columns ‡ The lower ends of the pyramids point to the renal pelvis ‡ 5-11 pyramids in each kidney

Renal pelvis
‡ The major function of the renal pelvis is to act as a funnel for urine flowing to the ureter. ‡ The renal pelvis represents the funnel-like dilated proximal part of the ureter. ‡ It is the point of convergence of two or three major calices. ‡ Each renal papilla is surrounded by a branch of the renal pelvis called a calyx. ‡ Infection of renal pelvis is called pyelitis

Ureters
‡ Urine is collected in the renal pelvis ‡ renal pelvis connects to the ureters, which carry urine to the bladder. ‡ The ureters are about 200 to 250 mm long. ‡ Smooth muscular tissue in the walls of the ureters peristaltically force the urine downward.

Urinary bladder
‡ The urinary bladder is a hollow muscular organ shaped like a balloon. ‡ It is located in the pelvic fossa and held in place by ligaments attached to the pelvic bones. ‡ Located behind the symphasis pubis ‡ The bladder stores urine - up to 500 ml of urine comfortably for 2 to 5 hours. ‡ Sphincters (circular muscles) regulate the flow of urine from the bladder.
± Internal urethral sphincter = in the beginning of urethra smooth muscle ± not under our voluntary control ± External urethral sphincter = skeletal muscle ± we can control it

Urethra
‡ The urethra has an excretory function in both sexes, to pass urine to the outside ‡ A reproductive function in the male, as a passage for sperm. ‡ The external urethral sphincter is a striated smooth muscle that allows voluntary control over urination. ‡ Urethral sphincters:
± Internal ± External

‡ In males the internal and external urethral sphincters are more powerful, able to retain urine for twice as long as females

Nephron
‡ Each kidney contains about 1 million nephron units ‡ The number does not increase after birth ‡ They cannot be replaced if damaged ‡ 2 parts
± Renal curpuscles (Glomerulus, Bowmans capsule) ± Renal Tubules

‡ Renal curpuscles  Glomerular capsule (Bowman¶s Capsule) ± ³C´ shaped capsule surrounding the glomerulus  Glomerulus ± cluster of capillaries ‡ Renal Tubules
± Proximal convoluted tubule ± Loop of Henle ± ascending and descending limb ± Distal Convoluted tubule ± Collecting duct

Renal Vasculature
‡ ‡ ‡ ‡ ‡ Receives blood from the renal artery Renal artery branches into the afferent arterioles Afferent arterioles feed into Bowman¶s capsule The efferent arterioles exit Bowman¶s capsule The efferent arterioles form the peritubular capillaries ‡ The peritubular capillaries empty into the venules, large veins, and then into the renal veins ‡ .

Function of urinary system
‡ Excretion ‡ Keeping homeostasis ‡ Keeping acid-base balance PH ‡ Regulation of blood pressure (rennin) ‡ Formation of RBCs (erythropoiesis) by secretion of erythropoetin) ‡ Vitamin D synthesis Excreted products: ‡ Product of the metabolism (It clears urea, a nitrogenous waste product) ‡ Water ‡ Hormones ‡ Vitamins ‡ Toxic substances

‡ Regulation of blood volume: The kidneys conserve or eliminate water from the blood, which regulates the volume of blood in the body . ‡ Regulation of blood pressure: ‡ Adjusting the volume of blood in the body (by regulating the quantity of water in the blood ‡ Action of the enzyme renin. The kidneys secret renin, which activates the angiotensin-aldosterone pathway. ‡ Regulation of the pH of the blood: The kidneys excrete H+ ions (hydrogen atoms that lack their single electron), into urine. At the same time, the kidneys also conserve bicarbonate ions (HCO3-), which are an important buffer of H+. ‡ pH 7.4.

‡ The process of separating wastes from the body fluids and eliminating them, is known as excretion

Formation of Urine
‡ Three processes are involved in urine formation
± Glomerular filtration ± Tubular reabsorption ± Tubular secretion

(1)Glomerular Filtration
‡ The diameter of the afferent (incoming) arteriole is greater than the diameter of the efferent arteriole ‡ The pressure of the blood inside the glomerulus is increased due to the difference in diameter of the incoming and out-going arterioles. ‡ This increased blood pressure helps to force the following components of the blood out of the glomerular capillaries: ‡ Most of the water ; ‡ Most/all of the salts ; ‡ Most/all of the glucose ; ‡ Most/all of the urea .

‡ Blood cells and plasma proteins are not filtered through the glomerular capillaries. . Presence of cells and protein indicate a kidney dysfunction ‡ The water and salts that have been forced out of the glomerular capillaries pass into the Bowman's Capsule and are called the glomerular filtrate. ‡ Renal blood flow= 1200- 1300 ml/ min, (cardiac output=5600 ml/min) ‡ This glomerular filtrate is formed at a rate of above 125 cm3 (mL) per minute (glomerular filtration rate) =7.5 L/h =180L/day ‡ This volume is approx. 20% of the plasma delivered during that time ‡ Urine volume=1L/day (depends on «««««)

(2)Tubular Reabsorption
‡ Only about 1% of the glomerular fitrate actually leaves the body because the rest (the other 99%) is reabsorbed into the blood while it passes through the renal tubules ‡ Most of the volume of the fitrate solution is reabsobed in the proximal convoluted tubule (PCT)

(3)Tubular Secretion
‡ Substances being added to the tubular fluid from the efferent arterioles

CLEARANCE
‡ The GFR can be measured by measuring the excretion and plasma level of a substance that is freely filtered through the glomeruli and neither secreted, nor reabsorbed by the tubules ‡ Amount per unit of time ‡ GFR = (UX) V/ PX
± (UX) = concentration of X in the urine ± V= urine flow per unit of time ± PX = concentration of X in the plasma
Eg . Inulin

CLEARANCE
‡ ‡ ‡ ‡ ‡ Example: UIN=35 mg/Ml V= 0.9 mL/min PIN= 0.25 mg/Ml CIN=35 0.9/0.25 = 126ml/min

(Micturition)
‡ The process of disposing urine from the urinary bladder through the urethra to the outside of the body. ‡ The process of urination is usually under voluntary control. ‡ Urinary incontinence is the inability to control urination, and is more common in women than men. ‡ Urinary retention refers to the inability to urinate. ‡ Enuresis nocturnia = incontinence during the night

Urine Characteristics
‡ Amount ± 1500 ml in 24 hours ‡ pH ± average 6.0 ‡ Specific Gravity ± heavier than water (1.001-1.035) ‡ Color ± yellow (amber, straw colored, concentrated, orange, brown, red, sediment, clear or cloudy) ‡ Dehydrated = deep yellow, dark ‡ Overhydrated = pale yellow, colorless

‡ Light yellow color of urine is due to a pigment called urochrome ‡ Urochrome is formed from the breakdown of hemoglobin in the liver

Urine Testing
‡ ‡ ‡ ‡ ‡ ‡ Urinalysis Microscopic exam Culture and sensitivity Urine dipstick Urine Drug and alcohol screening 24 hour urine testing

Abnormal Constituents of Urine
‡ ‡ ‡ ‡ ‡ ‡ ‡ Albumin (protein) Glucose Red blood cells Hemoglobin White blood cells Ketone bodies Bilirubin

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