URINARY SYSTEM

RUPERTO A. BESINGA III, RN. MD.

URINARY SYSTEM

CONSISTS OF:
Two kidney
Two ureters
Urinary bladder
Urethra
FUNCTIONS

 Excretion
 Regulation of blood volume and
pressure
 Regulation of the concentration of
solutes in the blood.
 Regulate the concentration of: Na+, Cl−,
K+, Ca2+, HCO3−, and HPO4
FUNCTIONS

 Regulation of extracellular fluid pH

 secrete H+
 Regulation of red blood cell synthesis
 ERYTHROPOIETIN
 Regulation of vitamin D synthesis
ANATOMY AND HISTOLOGY

 Bean-shaped
 Behind the peritoneum
 Posterior abdominal wall
 Lateral borders of the psoas major
muscles
 Extend from (T12) to (L3) vertebrae in
erect position
ANATOMY AND HISTOLOGY
EXTERNAL ANATOMY

 Right kidney to be slightly lower than

the left
 11 cm long, 5 cm wide, and 3 cm thick
 Weighs about 130 g
ANATOMY AND HISTOLOGY
EXTERNAL ANATOMY

 RENAL CAPSULE: Layer of fibrous connective

tissue, surrounds each kidney.*
 RENAL FASCIA:
 Surrounds the adipose tissue
 Anchor the kidneys the abdominal wall.
 HILUM
 Medial side of the kidney
 Renal artery and nerves ENTER
 Renal vein and ureter EXIT
ANATOMY AND HISTOLOGY
EXTERNAL ANATOMY

 HILUM
 Medial side of the kidney
 Renal artery and nerves ENTER
 Renal vein and ureter EXIT
ANATOMY AND HISTOLOGY
EXTERNAL ANATOMY
 RENAL SINUS
 Area where the hilum opens to
 Cavity filled with adipose tissue & connective
tissue
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY
 Kidneys are organized into two major
regions:
1. OUTER CORTEX
2. INNER MEDULLA
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY
RENAL MEDULLA
 RENAL PYRAMIDS: composed of cone
shaped structure*
 RENAL COLUMNS: cortical tissue, project
between the renal pyramids
 RENAL PAPILLAE: tips of the pyramid point
toward the renal pelvis
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY

MINOR CALYCES
 Funnel-shaped chambers into which the renal
papillae extend
MAJOR CALYCES
 Merging of minor calyces*
RENAL PELVIS
 Convergence of major calyces
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY NEPHRON
NEPHRON
 Histological and functional unit of the kidney

1. Renal corpuscle
 Filters the blood
2. Renal tubules
Proximal convoluted tubule
 Returns filtered substances to the blood
Loop of henle (nephron loop)
 Conserve water and solutes
Distal convoluted tubule
 Remove additional wastes
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY NEPHRON
Types of Nephrons
1. JUXTAMEDULLARY nephrons
 Renal corpuscles lie near the medulla
 Loops of Henle extend deep into medulla

2. CORTICAL nephrons
 Loops of Henle do not extend deep into

medulla
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY NEPHRON
Renal Corpuscle
1. BOWMAN CAPSULE
 double-walled chamber
2. GLOMERULUS
 Filtration unit of the nephron

Fluid is filtered from the glomerulus into the

Bowman capsule
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY NEPHRON

RENAL CORPUSCLE

BOWMAN CAPSULE
 Outer layer: PARIETAL LAYER
simple squamous epithelial cells cuboidal
 Inner layer: VISCERAL LAYER
Specialized cells :PODOCYTES
 wrap around the glomerular capillaries
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY NEPHRON

RENAL CORPUSCLE

GLOMERULUS*
1. Fenestrae
 Endothelial cells
 Window like openings
2. Filtration slits
 Gaps between the cell processes of the podocytes
3. Basement membrane
 Between the endothelial cells and podocytes
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY NEPHRON

FILTRATION MEMBRANE
 Capillary endothelium
 Basement membrane
 Podocytes of the Bowman capsule
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY NEPHRON

The Renal Tubule

PROXIMAL CONVOLUTED TUBULE
 Simple cuboidal epithelium
 Possess a large number of microvilli
LOOP OF HENLE
DESCENDING limb and the ASCENDING limb
 Simple squamous epithelium
ANATOMY AND HISTOLOGY
INTERNAL ANATOMY NEPHRON

The Renal Tubule

DISTAL CONVOLUTED TUBULE
 Simple cuboidal
 Not possess a large number of microvilli
COLLECTING DUCT
 Simple cuboidal epithelium
BLOOD SUPPLY
URINE PRODUCTION
URINE PRODUCTION
URINE PRODUCTION
FILTRATION
 Crude separation of some water and small solutes from
blood cells and other large molecules,
 Driving force : BLOOD PRESSURE
 FILTRATE is collected in the Bowman capsule
URINE PRODUCTION
FILTRATION

A. Filtration Membrane
 Prevents blood cells and proteins from entering the lumen of the Bowman capsule on the basis of size
and charge, but it allows other blood components to pass*

1. The fenestrae of the glomerular capillary

2. The basement membrane between the capillary wall and the visceral layer of
the Bowman capsule
3. Podocytes of the visceral layer of the Bowman capsule
URINE PRODUCTION
FILTRATION
RENAL BLOOD FLOW
 25% of the cardiac output
 Directly proportional to the pressure difference of renal artery and the renal vein
 Inversely proportional to the resistance of the renal vasculature
URINE PRODUCTION
FILTRATION

GLUMERULOFILTRATION RATE(GFR)
 Amount of plasma that enters the Bowman capsule per minute
 Both BUN and serum [creatinine] increase when GFR decreases
URINE PRODUCTION
FILTRATION A. FILTRATION PRESSURE
 Pressure gradient in the renal corpuscle
URINE PRODUCTION
FILTRATION
AUTOREGULATION
 Maintenance of a very stable GFR*
1. MYOGENIC MECHANISM
 Intrinsic properties of smooth muscle in afferent and efferent arterioles
 Stretch receptors
2. TUBULOGLOMERULAR FEEDBACK
 Correlates filtrate flow past the macula densa of the juxtaglomerular apparatus
 The macula densa senses the increased load and causes constriction of the nearby
afferent arteriole, increasing resistance tomaintain constant blood flow.
URINE PRODUCTION
TUBULAR REABSORPTION

 Return of water and solutes filtered from the blood at

the renal corpuscle to the blood.*
 Solutes reabsorbed from the lumen of the nephron to the
interstitial fluid include amino acids, glucose, and fructose,
Na+, K+, Ca2+, HCO3 −, and Cl−.

 Filtered load > Excretion rate  NET REABSORPTION

 Filtered load < Excretion rate  NET SECRETION
URINE PRODUCTION
TUBULAR REABSORPTION

 PROXIMAL CONVOLUTED TUBULE

 Responsible for the majority of reabsorption.
 Reabsorbs 67%, of the filtered K+, Na+ and H2O, more
than any other part of the nephron.
• Apical surface- inside surface of the nephron
• Basal surface- outer wall of the nephron

 Na+ as main concentration gradients

 Proximal convoluted tubule is permeable to water
URINE PRODUCTION
TUBULAR REABSORPTION

EARLY PROXIMAL TUBULE

 Na+ is reabsorbed by COTRANSPORT with glucose,
amino acids, phosphate, and lactate
 These co-transport processes account for the
reabsorption of all of the filtered glucose and amino
acids.
 Na+ is also reabsorbed by countertransport via Na+–H+
exchange
URINE PRODUCTION
TUBULAR REABSORPTION

CARBONIC ANHYDRASE INHIBITORS

 (e.g., acetazolamide) are diuretics that act in the early proximal tubule by
inhibiting the reabsorption of filtered HCO3

LATE PROXIMAL TUBULE

 Na+ is reabsorbed with Cl–.
URINE PRODUCTION By the time the filtrate has
reached the end of the proximal
TUBULAR REABSORPTION convoluted tubule, its volume has
been reduced by approximately
65%.
URINE PRODUCTION
TUBULAR REABSORPTION

 LOOP OF HENLE
Descending limb
 As the loop of Henle descends into the
medulla simple squamous epithelial
 Highly permeable to water and moderately
permeable to urea, Na+, other ions
 Water moves out: by OSMOSIS
 15% reduction after passing the DLH
URINE PRODUCTION
TUBULAR REABSORPTION

 LOOP OF HENLE
Ascending limb
 Thin segment of the ascending limb
 Permeable to solutes but impermeable to
water
 As the filtrate flows through the thin segment of
the limb, solutes diffuse into the interstitial fluid,
making the filtrate less concentrated
URINE PRODUCTION
TUBULAR REABSORPTION

 LOOP OF HENLE
Ascending limb
 Reabsorbs 25% of the filtered na+
 Reabsorbs 20% of the filtered K+.
■ Reabsorption involves the Na+–K+–2Cl–
cotransporter in the luminal membrane of cells
 Site of action of the loop diuretics.
 Solutes: na+, K+, and cl−
must be actively transported
from the thick segment of the
ascending limb of the loop of
henle into the interstitial fluid
URINE PRODUCTION
TUBULAR REABSORPTION

DISTAL CONVOLUTED TUBULE AND COLLECTING DUCT

Some solutes (Na+, Cl−, H+) are reabsorbed together reabsorb 8% of the filtered Na+.
Early distal tubule
 Reabsorbs NaCl by a Na+-Cl- cotransporter.
 Site of action of thiazide diuretics.
 Impermeable to water, as is the thick ascending limb
URINE PRODUCTION
TUBULAR REABSORPTION
DISTAL CONVOLUTED TUBULE AND
COLLECTING DUCT
LATE DISTAL TUBULE AND COLLECTING DUCT
1. Principal cells
 Reabsorb Na+ and H2O.
 Secrete K+
 Aldosterone increases Na+ reabsorption and increases K+
secretion.
 Antidiuretic hormone (ADH) increases H2O permeability
 K+-sparing diuretics
URINE PRODUCTION
TUBULAR REABSORPTION
DISTAL CONVOLUTED TUBULE AND
COLLECTING DUCT
LATE DISTAL TUBULE AND COLLECTING DUCT
2. α-Intercalated cells
 secrete H+ by an H+-adenosine triphosphatase (ATPase),
which is stimulated by aldosterone.
 Reabsorb K+ by an H+,K+-ATPase
URINE PRODUCTION
TUBULAR REABSORPTION

DISTAL CONVOLUTED TUBULE AND COLLECTING DUCT

Under hormonal control
+ ADH  Reabsorption of water is via osmosis
 Small volume of concentrated urine is produced

- ADH  Not permeable to water and water stays in the

filtrate
 Large volume of dilute urine is produced.
URINE PRODUCTION
TUBULAR SECRETION
 Movement of nonfiltered substances,
toxic by-products of metabolism, and
drugs or molecules not normally
produced by the body from the blood
into the filtrate
 either active or passive
 REGULATION OF URINE
CONCENTRATION AND VOLUME
 *Filtrate reabsorption in PCT and
DLH
 NOT affected by hormones
 CONSTANT
 DCT and collecting ducts
 Affected by hormones**

 AUTOREGULATION
THE SYMPATHETIC NERVOUS SYSTEM
 REGULATION OF URINE
CONCENTRATION AND VOLUME

Two major hormonal mechanisms

1) Renin-angiotensin-aldosterone hormone mechanism
2) Antidiuretic hormone (ADH)
 Renin-angiotensin-
aldosterone hormone
mechanism

RENIN
 Enzyme secreted by cells of the
juxtaglomerular apparatus
 Response to decrease:
1. Stretch to efferent afferent atrioles
2. Na+ Concentration
 Antidiuretic Hormone Mechanism
DIABETES INSIPIDUS
 Insufficient ADH secretion
 Produce 10–20 L of urine
per day
 Develop major problems,
such as dehydration and ion
imbalances
URETERS AND URINARY BLADDER
URETERS
 Tubes through which urine flows from the
kidneys to the urinary bladder
 Extend inferiorly and medially from the renal
pelvis at the renal hilum of each kidney to the
urinary bladder

URINARY BLADDER
 Hollow, muscular container that lies in the
pelvic cavity just posterior to the symphysis
pubis
 Males: anterior to the rectum
 Females: anterior to the vagina
URETERS AND URINARY BLADDER
URINARY BLADDER
 DETRUSOR (DĪ-TROO′SER) MUSCLE
 Contraction of this smooth muscle forces
urine out of the urinary bladder
URETERS AND URINARY BLADDER
URETHRA,
 Transports urine to the outside of the body
 Exits the urinary bladder inferiorly and
anteriorly
TRIGONE
 Triangular area of its wall between the two
ureters posteriorly and the urethra anteriorly
URETERS AND URINARY BLADDER
HISTOLOGY
Transitional epithelium
 lines both the ureters and the urinary
Bladder
INTERNAL URINARY SPHINCTER
 Males: the elastic tissue and smooth muscle
 Females: none
EXTERNAL URINARY SPHINCTER
 Composed of skeletal muscle
 Acts as a valve that controls the flow of urine
through the urethra.
END….