Human Anatomy, First Edition

McKinley & O'Loughlin

Renal /Urinary System

Dr.G.Anwer Khan
MS Anatomy
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Kidneys
 The kidney are paired of excretory organs
situated on the posterior abdominal wall.
 On each side of vertebral column behind the
peritoneum, there fore it is retro peritoneal
organ.
 They remove waste products of metabolism
and excess of water and salt from blood and
maintained its pH
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kidneys
 Each kidney is bean shaped.
 It has upper and lower pole, medial and
lateral border, anterior and posterior
surface.
 Upper pole is broad and is in close contact
with the corresponding suprarenal gland.
The lower pole is pointed. Anterior surface
is said to b irregular and posterior surface is
flat.
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 kidneys
 The lateral border is convex, the medial border is
concave. Its middle parts shows a depression, known as a
hilus or hilum. From anterior to posterior side RV, RA,
RP seen.
 The kidneys occupy the epigastric, hypochondriac,
lumber and umbilical regions.
 Vertically they extend from upper border of T12 to the
center of the body of L3 vertebra.
 The right kidney is slightly lower then left and left kidney
is little nearer to the median plan then right.
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kidneys
 The transpyloric plane passes through the
upper part of the hilus of the right kidney,
and through the lower part of the hilus of
the left kidney.
 Each kidney is about 11cm long, 6cm,
broad, 3 cm thick.

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 Relations of kidneys
 Relations common to the two kidneys:
a. Upper pole: suprarenal gland
b. Medial border: ureter below the hilus.
c. Posterior relations: posterior surface of both
kidney related to :
diaphragm , medial and lateral arcuate ligaments,
psoas major, quadratus lumborum,transverse
abdominis, sub costal vessels.
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 Relations of the Right kidney
Anterior Relations:
 Right suprarenal gland
 Liver
 Second part of duodenum
 Hepatic flexure of colon
 Small intestine

Lateral border:
 Right lobe of the liver
 Hepaic flexure of the colon

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 Relations of the left kidney
Anterior relations:
 Left suprarenal galnd
 Spleen
 Stomach
 Pancreas
 Splenic vessels
 Splenic flexure and desending colon
 Jejunum

Lateral border:
 Spleen
 Descending colon
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 Covering of kidney
 Fibrous capsule (true capsule)
 Perinephric fat (adipose capsule)
 Renal fascia (fascia of gerota)
 Paranephric fat

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Covering of kidney:
 Fibrous capsule: it is thin membrane which
closely invests the kidney and lines the renal
sinus.
 Perinephric fat: this is a layer of adipose tissue
lying outside the fibrous capsule.
 Renal fascia: this is a fibroareolar sheath which
surrounds the kidney and perinephric fat. It
consists of an anterior layer (fascia of Told) and
posterior layer (fascia of zuckerkandl).
 Paranephric fat: it consists of variable amount
of fat lying outside the renal fascia. 27-14
General Structure and Functions
of the Urinary System
 The kidneys filter waste products from the bloodstream and
convert the filtrate into urine.
 The ureters, urinary bladder, and urethra are collectively known
as the urinary tract because they transport the urine out of the
body.

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Functions of the Urinary System
 Removing waste products from the bloodstream.
 Storage of urine.
 the urinary bladder is an expandable, muscular sac that can

store as much as 1 liter of urine

 Excretion of urine.
 Blood volume regulation.
 the kidneys control the volume of interstitial fluid and blood

under the direction of certain hormones

 Regulation of erythrocyte production.
 as the kidneys filter the blood, they are also indirectly

measuring the oxygen level in the blood

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 Internal
Anatomy

Cortex: outer layer, light reddish brown,

granular appearance (due to many
corpuscles)

Medulla: darker striped appearance

(due to tubules) Subdivided into
distinct renal pyramids, terminating
with a papilla. Separated by renal
columns from the cortex.

Pelvis: Expanded proximal ureter

Compare to Fig 23.3

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Blood Supply to the Kidney

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Blood Supply to the Kidney
 Blood plasma is filtered across the glomerulus into
the glomerular space.
 Once the blood plasma is filtered, blood leaves the
glomerulus and enters an efferent arteriole.
 Note that the efferent arteriole is still carrying
oxygenated blood because a gas and nutrient
exchange with the kidney tissues has not yet
occurred.

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Blood Supply to the Kidney
 The efferent arterioles branch into one of two types of
capillary networks:
 peritubular capillaries or

 vasa recta

 these capillary networks are responsible for the

actual exchange of gases and nutrients

 Peritubular capillaries primarily reside in the cortex of
the kidney.
 Vasa recta surround the thin tubes that project into
the medulla.

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Microscopic structure of kidney

 Microscopic structure of kidney

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Nephrons
 The functional filtration unit in the kidney.
 Consists of the following components:
 a renal corpuscle, a proximal convoluted tubule, a nephron
loop, and a distal convoluted tubule and are collectively
known as the renal tubule
 Together, both kidneys house approximately 2.5
million nephrons.
 These microscopic structures measure less than 5
centimeters in total length.

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Nephron = functional unit
(>106/kidney)
Fig 23.6
 Nephron =
 Renal Corpuscle
 Glomerulus
 Bowman’s (Renal) Capsule
 PCT (proximal convoluted
tubule)
 LOH (loop of Henle)
 DCT (distal convoluted
tubule)
Renal Corpuscle
 Uriniferous Tubule p 691

 Nephron + Collecting Duct (tubule)

 Renal Corpuscle
 PCT
 LOH
 DCT
 CD
This diagram has
an important
inaccuracy!
See Fig
23.4
 Two Types of Nephrons
Fig 23.9

 Cortical nephrons (85%)

shorter, mostly in cortex
of kidney, produce
"standard" urine
 Juxtamedullary nephrons
(15%), "juxta = next to"
the medulla - responsive
to ADH, can produce
concentrated urine due to
longer Loops of Henle
The Renal Corpuscle
Filtration: Passage across three
barriers
1. Capillary endothelium
Fenestrated
What gets through?

2. Basement membrane

3. Glomerular epithelium (= visceral

layer of Bowman’s capsule)
slit pores between pedicles of podocytes

Note: Capsular Epithelium is simple

squamous epithelium
Juxtaglomerular (JG) Apparatus
Juxtaglomerular Apparatus =
Macula densa +
Juxtaglomerular cells (smooth
muscle fibers from afferent arteriole)
Macula densa monitors BP

JG cells produce renin and

EPO
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Proximal Convoluted Tubule
 The proximal convoluted tubule originates at the
tubular pole of the renal corpuscle.
 The cells of the proximal convoluted tubule actively
reabsorb almost all nutrients (glucose and amino
acids), electrolytes, and any plasma proteins from
the tubular fluid.
 Approximately 60% to 65% of the water in the
tubular fluid is reabsorbed by osmosis.
 The solutes and water are returned to the vascular
system via the peritubular capillaries.

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Nephron Loop
 The nephron loop (loop of Henle) originates at a
sharp bend in the proximal convoluted tubule and
projects internally toward and into the medulla.
 Each loop has two limbs.
 descending limb extending from the cortex toward and into
the medulla
 ascending limb returns back to the renal cortex

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Distal Convoluted Tubule
 The distal convoluted tubule originates in the renal
cortex at the end of the thick ascending limb of the
nephron loop adjacent to the afferent arteriole.
 The primary function of the distal convoluted tubule
is secretion.
 Its cells secrete ions such as potassium (K+) and
acid (H+) into the tubular fluid.
 Reabsorption of water also occurs here under the
influence of two hormones, aldosterone and
antidiuretic hormone.

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Collecting Tubules and Collecting
Ducts
 If an individual is well hydrated, the collecting ducts
simply transport the tubular fluid into the papillary
duct and then into the minor calyx.
 However, if an individual is dehydrated, water
conservation must occur, and more-concentrated
urine is produced.
 ADH may act on the collecting duct epithelium,
making it more able to absorb water from the tubular
fluid.

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Innervation of the Kidney
 Each kidney is innervated by a mass of autonomic
nervous system fibers collectively called the renal
plexus.
 The renal plexus accompanies each renal artery and
enters the kidney through the hilum into the renal
sinus.

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Urinary Tract
 The ureters are long, fibromuscular tubes that conduct
urine from the kidneys to the urinary bladder.
 Each tube averages 25 centimeters in length and is
retroperitoneal.
 The ureters originate at the renal pelvis as it exits the
hilum of the kidney, and then extend inferiorly to enter
the posterolateral wall of the base of the urinary bladder.
 The wall of the ureter is composed of three concentric
tunics.
 From innermost to outermost, these tunics are the
mucosa, muscularis, and adventitia.

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Urinary Tract – Urinary Bladder
 The urinary bladder is an expandable, muscular container that
serves as a reservoir for urine. It is positioned immediately
superior and posterior to the pubic symphysis.
 In females, the urinary bladder is in contact with the uterus
posterosuperiorly and with the vagina posteroinferiorly.
 In males, it is in contact with the rectum posterosuperiorly and
is immediately superior to the prostate gland.
 The urinary bladder is a retroperitoneal organ.
 When empty, the urinary bladder exhibits an upside-down
pyramidal shape.
 Filling with urine distends it superiorly until it assumes an oval
shape.

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Urinary Tract – Urinary Bladder
 A posteroinferior triangular area of the urinary
bladder wall, called the trigone is formed by
imaginary lines connecting the two posterior ureteral
openings and the anterior urethral opening.
 The trigone remains immovable as the urinary
bladder fills and evacuates.
 It functions as a funnel to direct urine into the
urethra as the bladder wall contracts to evacuate the
stored urine.
 The four tunics that form the wall of the bladder are
the mucosa, submucosa, muscularis, and adventitia.

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Micturition (Urination)
 The expulsion of urine from the bladder.
 Initiated by a complex sequence of events called the
micturition reflex.
 The bladder is supplied by both parasympathetic and
sympathetic nerve fibers of the autonomic nervous
system.

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Urethra
 Fibromuscular tube that exits the urinary bladder through the
urethral opening from its anteroinferior surface and conducts
urine to the exterior of the body.
 The luminal lining of the urethra is a protective mucous
membrane that houses clusters of mucin-producing cells called
urethral glands.
 Bundles of primarily smooth muscle fibers surround the mucosa
and help propel urine to the outside of the body.
 Two urethral sphincters restrict the release of urine until the
pressure within the urinary bladder is high enough and
voluntary activities needed to release the urine are activated.

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Urethra
 The internal urethral sphincter is the involuntary,
superior sphincter surrounding the neck of the
bladder, where the urethra originates.
 a circular thickening of the detrusor muscle and is controlled
by the autonomic nervous system
 The external urethral sphincter is inferior to the
internal urethral sphincter and is formed by skeletal
muscle fibers of the urogenital diaphragm.
 a voluntary sphincter controlled by the somatic nervous
system
 this is the muscle children learn to control when they
become “toilet-trained”

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Female Urethra
 Has a single function:
 to transport urine from the urinary bladder to the vestibule,
an external space immediately internal to the labia minora
 3 to 5 centimeters long, and opens to the outside of
the body at the external urethral orifice located in the
female perineum.

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Male Urethra
 Urinary and reproductive functions:
 passageway for both urine and semen
 Approximately 18 to 20 centimeters long.
 Partitioned into three segments:
 prostatic urethra is approximately 3 to 4 centimeters long and is the most
dilatable portion of the urethra
 extends through the prostate gland, immediately inferior to the male
bladder, where multiple small prostatic ducts enter it
 membranous urethra is the shortest and least dilatable portion
 extends from the inferior surface of the prostate gland through the
urogenital diaphragm
 spongy urethra is the longest part (15 centimeters)
 encased within a cylinder of erectile tissue in the penis called the
corpus spongiosum
 extends to the external urethral orifice

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Aging and the Urinary System
 Changes in the size and functioning of the kidneys begin at 30.
 Gradual reduction in kidney size.
 Reduced blood flow to the kidneys.
 Decrease in the number of functional nephrons.
 Reabsorption and secretion are reduced.
 Diminished ability to filter and cleanse the blood.
 Less aldosterone or antidiuretic hormone.
 Ability to control blood volume and blood pressure is reduced.
 Bladder decreases in size.
 More frequent urination.
 Control of the urethral sphincters—and micturition—may be
lost.

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