The Urinary System

Dr RNgt Amin Samiasih,SKp.Msi.Med

· Kidneys (2)
· Ureters (2)
· Urinary bladder (1)
· Urethra (1)
 Location of the Kidneys
· Dimensions
· Reddish-brown, bean shaped
· 12cm long, 6cm wide, 3cm thick
· High on posterior abdominal wall
· at the level of T12 to L3- superior lumbar region
· Retroperitoneal & against the dorsal body wall
· The right kidney is slightly lower than the left ,convex
laterally
· Attached to ureters, renal blood vessels, and nerves
at renal hilus (medial indention)
· Atop each kidney is an adrenal gland
Regions of the Kidney
· Three regions of kidneys
· Renal cortex – outer region, forms
an outer shell
· Renal columns – extensions of
cortex- material inward
· Renal medulla – inside the cortex,
contains medullary (renal) pyramids
· Medullary pyramids – triangular
regions of tissue in the
medulla, appear striated
· Renal pelvis – inner collecting tube,
divides into major and minor
calyces
· Calyces – cup-shaped
structures enclosing the tips of
the pyramids that collect and
funnel urine towards the renal
pelvis
Functions of the Urinary System
· Elimination of waste products
· filtering gallons of fluid from the bloodstream every day
creating “filtrate”
· “filtrate” includes: metabolic wastes, ionic salts, toxins, drugs
· Maintenance of blood
· Red blood cell production- by producing hormone
erythropoietin to stimulate RBC production in bone
marrow
· Blood pressure (vessel size)- by producing renin which
causes vasoconstriction
· Blood volume (water balance)- ADH released from
Anterior Pituitary targets the kidney to limit water loss
when blood pressure decreases or changes in blood
composition
· Blood composition (electrolyte balance)- water follows
salt; aldosterone reclaims sodium to the blood
· Blood pH- regulates H+ ions and HCO3- ions
Nephrons
· The structural and functional units of the kidneys
· Over 1 million
· Responsible for forming urine
· Consist of renal corpuscle and renal tubule
·Renal corpuscle composed of a knot of capillaries
called the Glomerulus (a.k.a. Bowman’s Capsule)
·Renal tubule- enlarged, closed, cup-shaped end
giving rise to the PCT, dLOH, aLOH, DCT, and CD.
Glomerulus
· A specialized capillary bed fed and
drained by arterioles.
· Glomerular capillaries filter fluid from
the blood into the renal tubule
· GC is attached to arterioles on both
sides in order to maintain high pressure
· Large afferent arteriole-arises from
interlobular artery (feeder vessel);
large in diameter, high resistance
vessels that force fluid & solutes
(filtrate) out of the blood into the
glomerular capsule.
· 99% of the filtrate will be reclaimed
by the renal tubule cells and
returned to the blood in the
peritubular capillary beds(blood
vessels surrounding renal tubule) .
· Narrow efferent arteriole-merges to
become the interlobular vein; draining
vessel.
Glomerulus
· Glomerular capillaries are covered with
podocytes from the inner (visceral) layer
of the glomerular capsule.
· Podocytes have long, branching
processes called pedicels that
intertwine with one another and cling to
the glomerular capillaries.
· Filtration slits between the pedicels
form a porous membrane around the
glomerular capillaries.
· The glomerular capillaries sit within a
glomerular capsule (Bowman’s capsule)
· Expansion of renal tubule
· Receives filtered fluid
· Renal tubule coils into the PCT, then
the dLOH, aLOH, DCT and finally, the
CD.
· Along the PCT, much of the filtrate is
reclaimed
Renal Tubule
· Glomerular (Bowman’s) capsule
enlarged beginning of renal tubule
· Proximal convoluted tubule- lumen
surface (surface exposed to filtrate) is
covered with dense microvilli to increase
surface area.
· The descending limb of the nephron -
Loop of Henle
· The ascending limb of the nephron coils
tightly again into the distal convoluted
tubule
· Many DCT’s merge in renal cortex to
form a collecting duct
· Collecting ducts not a part of nephron
· Collecting ducts receive urine from
nephrons and deliver it to the major
calyx and renal pelvis.
· CD run downward through the
medullary pyramids, giving them their
striped appearance.
Urine Formation Processes
· Filtration- Water & solutes
smaller than proteins are forced
through the capillary walls and
pores (of the glomerulus) into the
renal tubule (Bowman’s capsule).
· Reabsorption- Water, glucose,
amino acids & needed ions are
transported out of the filtrate into
the peritubular capillary cells and
then enter the capillary blood.
· Secretion- Hydrogen ions,
Potassium ions, creatinine & drugs
are removed from the peritubular
capillaries (blood) and secreted by
the peritubular capillary cells into
the filtrate.
Filtration
· Beginning step of urine formation
· Occurs at the glomerulus, nonselective passive process
· Water and solutes smaller than proteins are forced through
capillary walls of the glomerulus, which act as a filter.
· Fenestrations – (openings in glomerular walls) make
glomerulus more permeable than other arterioles.
· Podocytes cover capillaries, make membrane impermeable to
plasma proteins.
· Blood cells cannot pass
out to the capillaries; filtrate
is essentially blood plasma
w/o blood proteins, blood cells.
· Filtrate is collected in the
glomerular (Bowman’s) capsule
and leaves via the renal tubule
Filtration pressure
· Hydrostatic pressure of blood forces substances through
capillary wall.
· Net filtration pressure normally always positive
· Hydrostatic pressure of blood is greater than the hydrostatic
pressure of the glomerulus capsule and the osmotic
pressure of glomerulus plasma
· If arterial blood pressure
falls dramatically, the glomerular
hydrostatic pressure falls below
level needed for filtration.
· The epithelial cells of renal
tubules lack nutrients and
cells die. Can lead to renal failure.
Filtration rate
· Rate of filtration is directly proportional to net filtration pressure.
· Regulation of filtration rate
· Rate typically constant; may need to increase or
decrease to maintain homeostasis
· 1. Sympathetic nervous system reflexes
· Respond to drops in blood pressure and blood volume
· As pressure drops, sympathetic nerves cause
vasoconstriction of afferent arterioles.
· Decreases rate of filtration
· Less urine produced, water is conserved
· As pressure rises, sympathetic nerves cause
vasoconstriction of efferent arterioles.
· Increases rate of filtration
· More urine produced, water is removed
Filtration rate
· 2. Renin production by JGA
· Renin is an enzyme controlling filtration rate
· Juxtaglomerular cells secrete renin in response to 3 stimuli
· Sympathetic stimulation (fast response)
· Specialized pressure receptors in afferent arterioles
sense decrease in blood pressure
· Macula densa senses decrease in chloride, potassium,
and sodium ions reaching distal tubule
· Released renin reacts with angiotensinogen in bloodstream
to form angiotensin I  which is converted into angiotensin
II by the angiotensin I converting enzyme, ACE
· Angiotensin II acts to vasoconstrict efferent arteriole
· Blood backs up into glomerulus, increasing pressure and
maintains filtration rate
· Angiotension II also stimulates secretion of aldosterone
from adrenal glands
· Stimulates tubular reabsorption of sodium & H2O follows
Reabsorption
· The composition of urine is different than the composition of
glomerular filtrate.
· Tubular reabsorption returns substances to the internal
environment of the blood by moving substances through
the renal tubule walls into the peritubular capillaries (99%)
· Some water, ions, glucose, amino acids
· Some reabsorption is passive = water  osmosis
= small ions diffusion
· Most is active using protein carriers  by active transport
· Most reabsorption occurs in the proximal convoluted tubule,
where microvilli cells act as transporters, taking up needed
substances from the filtrate and absorbing them into the
peritubular capillary blood.
· Substances that remain in the renal tubule become more
concentrated as water is reabsorbed from the filtrate.
Reabsorption – sodium and water
· The sodium potassium pump reabsorbs 70% of sodium ions
in the PCT.
· The positive sodium ions attract negative ions across the
membrane as well
· Water reabsorption occurs passively across the membrane
to areas of high solute concentration
· Therefore, more sodium reabsorption = more water
reabsorption
· Active transport of sodium
ions occurs along remainder
of nephron and collecting duct
· Almost all sodium ions
and water are reabsorbed.
Materials Not Reabsorbed
· Nitrogenous waste products
·Urea – formed by liver; end product of
protein breakdown when amino acids are
used to produce energy
·Uric acid – released when nucleic acids are
metabolized
·Creatinine – associated with creatine
metabolism in muscle tissue
· Excess water
 Secretion – Reabsorption in Reverse
· Some materials move from the peritubular capillaries
into the renal tubules to be eliminated in urine.
· Example:
·Hydrogen ions; potassium ions
·Creatinine
·Drugs; penicillin; histamine
· Process is important for getting rid of substances not
already in the filtrate or for controlling pH.
· Materials left in the renal tubule move toward the
ureter
 Formation of Urine
Summary:
• glomerular filtration of
materials from blood
plasma
•Reabsorption of
substances, including
glucose; water, sodium
•Secretion of substances,
including penicillin,
histamine, hydrogen and
potassium ions
Maintaining Water Balance
· Normal amount of water in the human
body
·Young adult females – 50%
·Young adult males – 60%
·Babies – 75%
·Old age – 45%
· Water is necessary for many body
functions and levels must be maintained
Distribution of Body Fluid

· Intracellular fluid
(inside cells)
· Extracellular fluid
(outside cells)
·Interstitial fluid
·Blood plasma
Regulation of Water and Electrolyte Reabsorption
· Regulation is primarily by hormones
·Antidiuretic hormone (ADH) prevents excessive water
loss in urine
· Neurons in the hypothalamus produce ADH, which are
released by the anterior pituitary gland in response to a
decrease in blood volume or water concentration
· ADH increases the water permeability of the distal convoluted
tubule epithelium to the peritubular capillaries
· Decreases volume of urine, increasing concentration of
solutes
· Negative feedback control
·Aldosterone regulates sodium ion content of
extracellular fluid
· Triggered by the renin-angiotensin mechanism
· Stimulates the DCT to reabsorb sodium and excrete
potassium
· Cells in the kidneys and hypothalamus are active monitors
Characteristics of Urine Used for
Medical Diagnosis
· Colored somewhat yellow due to the
pigment urochrome (from the
destruction of hemoglobin/bilirubin by-
product) and solutes
· Sterile
· Slightly aromatic
· Normal pH of around 6
· Specific gravity of 1.001 to 1.035
Urine composition
· Composition differs considerably based upon diet,
metabolic activity, urine output.
· ~95% water, contains urea and uric acid,
electrolytes and amino acids (trace amount)
· Volume produced ranges from 0.6-2.5 liters per day
(1.8L average).
·Depends on fluid intake, body and ambient air
temperature, humidity, respiratory rate, emotional
state
· Output of 50-60ml per hour normal, less than 30ml
per hour may indicate kidney failure
 Ureters
· Slender tubes attaching the kidney to the bladder 10-12” long & ¼”
diameter
· Superior end is continuous with the renal pelvis of the kidney
· Mucosal lining is continuous with that lining the renal pelvis and
the bladder below.
· Enter the posterior aspect of the bladder at a slight angle
· Runs behind the peritoneum
· Peristalsis aids gravity in urine transport from the kidneys to the
bladder.
· Smooth muscle layers in the ureter walls contract to propel urine.
· There is a valve-like fold of bladder mucosa that flap over the ureter
openings to prevent backflow.
· Renal calculi= calculus means little stone; result of precipitated uric
acid salts created by bacterial infections, urinary retention, and
alkaline urine. Lithotripsy or surgery are common treatments.
Urinary Bladder
· Smooth, collapsible, muscular sac
· Temporarily stores urine
· Located retroperitoneally in the pelvis
posterior to the pubic symphysis.
Urinary Bladder
· Trigone – three openings
· Two from the ureters (ureteral orifices)
· One to the urethra (internal urethral orifice) which drains the
bladder.
· Common site for bacterial infections
· In males, prostate gland surrounds the neck of the bladder where it
empties into the urethra.
Urinary Bladder Wall
· Three layers of smooth muscle (detrusor muscle)
· Mucosa made of transitional epithelium
· Walls are thick and folded in an empty bladder 2-3” long
· Bladder can expand significantly without increasing
internal pressure
· As it fills, the bladder rises superiorly in the abdominal
cavity becoming firm and pear shaped.
· A moderately full bladder can hold ~500mL (1 pint) of
urine.
· A full bladder can stretch to hold more than twice that
amount.
 Urethra
· Thin-walled tube that carries urine from the bladder to
the outside of the body by peristalsis
· Release of urine is controlled by two sphincters
· Internal urethral sphincter (involuntary) – a thickening
of smooth muscle at the bladder-urethra jxn. keeps
urethra closed when urine is not being passed.
·External urethral sphincter (voluntary) --
skeletal muscle that controls urine as the
urethra passes through the pelvic floor.
Urethra Gender Differences
· Length
·Females – 3–4 cm (1-1.5 inches)
·Males – 20 cm (7-8 inches)
· Location
·Females – along wall of the vagina
·Males – through the prostate and penis
· Function
·Females – only carries urine
·Males – carries urine and is a passageway for
sperm cells
 Urethra Gender Differences
Females:
•Feces can enter urethral opening causing
• Uretritis-inflammation of the urethra
• Pyelitis or pyelonephritis-inflammation of the kidneys
• Urinary tract infections-bacterial infection
• Dysuria
• Urgency
• Frequency
• Fever
• Cloudy urine
• Bloody urine

Males:
•Prostatic, membranous and spongy (penile) urethrae
•Enlargement of the prostate gland causes urinary retention
• can be corrected with a catheter
Micturition (Voiding)
· Both sphincter muscles must open to allow
voiding
·The internal urethral sphincter is relaxed after
stretching of the bladder ~200mL
·Activation is from an impulse sent to the spinal
cord and then back via the pelvic nerves
·The external urethral sphincter must be
voluntarily relaxed
·Incontinence-inability to control micturition
·Retention-inability to micturate