URINARY SYSTEM

PRESENTED BY GROUP 5
Urinary System
The urinary system performs the main part of
the excretory function in the body.

The urinary system functions largely as an

excretory agent as nitrogenous wastes, salts
and water.
After the cells of the tissue have used the food
and oxygen needed for the growth and repair,
the waste products must be taken away and
excreted from the body. It is accompanied by
the excretory organs which elimination takes
place.
According to the Clinical and Laboratory
Standards Institute (CLSI), urinalysis is the
“testing of urine with procedures commonly
performed in an expeditious, reliable, accurate,
safe, and cost-effective manner.
Functions of Urinary System
Performs excretion, which is the process of
01 removing nitrogenous waste materials, certain
salts, and excess water from the blood
Aids in maintaining acid-base balance by
evaluating elements in the blood and selectively
02 reabsorbing water and other substances to
maintain pH balance
The kidneys produce the enzyme renin, which
03 helps maintain blood pressure through the
filtration process

The kidneys produce erythropoietin, a hormone

04 that stimulates red blood cells production in the
bone marrow

05 Secretes waste products in the form of urine

Eliminates urine from the bladder where it is

06 stored
Urinary System
Urine is normally 95% water and 5% solutes.

Urea – metabolic waste product produced by

the liver from the breakdown of protein and
amino aids, accounts for nearly half of the total
dissolved solids in urine.
Urine volume depends on the amount of water
that the kidneys excrete.
Elimination of Waste Products

Lungs Kidneys Skin Intestines

Exhalation Urination Perspiration Defecation
Carbon dioxide and Nitrogenous wastes Dissolved salts Solid wastes and
water vapor and salts dissolved water
in water to form
urine
History and Importance
Study of urine can be found in the drawings of
cavemen and in Egyptian hieroglyphics, such
as the Edwin Smith Surgical papyrus.
To obtain a basic observation such as the color,
turbidity, odor, volume, viscosity, and even
sweetness.
Hippocrates – in the 5th century BCE, he wrote
a book “uroscopy”.
In the middle ages, physician concentrated
their efforts very intensely on the art of
uroscopy, receiving instruction in urine
examination as part of their training.
In 1140 CE, color chats had been developed
that described the significance of 20 different
colors.
History and Importance
Chemical testing progressed from “ant testing”
and “taste testing” for glucose to Frederik
Dekkers’ discovery in 1694 of albuminuria by
boiling urine.
The charlatans, called “pisse prophets”,
became the subject of book published by
Thomas Bryant in 1627.
In the 17th century, Thomas Addis developed a
methods for quantitating the microscopic
sediment.
In 1827, Richard Bright introduced the concept
of urinalysis as part of a doctor’s routine
patient examination.
In 1930, urinalysis had reached a point of
impracticality, and began to disappear from
routine examinations.
Unique Characteristics of Urine specimen

01 Urine is readily available and

easily collected specimen.

02 Urine contains information,

which can be obtained by
inexpensive laboratory tests,
about many of the body’s
major metabolic functions.
 Path of the Formation of Urine
Blood enters the Passes through To Bowman’s Proximal
filtrate convoluted
afferent arteriole the glomerulus capsule
tubule

Loop of Henle
Major calyces

Distal
1 mL of urine Approximately Collecting
Minor convoluted
goes to the 1mL of urine is tubule tubule
calyces renal papillae formed per
minute

Pelvis Urethra
Ureter Bladder
Urinary meatus
KIDNEYS
The most important excretory organs

It is a temporary storage sac for urine,

from which is excreted through the urethra.
Each kidney has a long, tubular ureter that
carries urine to the urinary bladder.
A bean-shaped organs resting high
against the dorsal wall of the abdominal
cavity. Since the kidneys are located
behind the peritoneum, they are said to be
retroperitoneal.
Each kidney and its blood vessel is
enclosed within a mass of fat tissue called
the adipose capsule. It is covered by a
though, fibrous tissue called the renal
fascia.
The hilum is a
They are position
passageway for the
between the twelfth
lymph vessels,
thoracic and the
nerves, renal artery
third lumbar
and vein, and the
vertebrae.
ureter.

At the hilum the The right kidney is

fibrous capsule situated slightly
continues downward, lower than the left
forming the outer due to the large area
layer of the ureter. occupied by the liver.

The upper end of They lie on either

each ureter. flares side of the vertebral
into a funnel-shaped column, between the
structure known as peritoneum and the
the renal pelvis. back muscles.
MEDULLA AND CORTEX
Divided into two layers: an outer, granular later called
the cortex; and an inner , striated layer called the
medulla
 Medulla – a red and consists of
radially striated cones called the renal
pyramids
 Cortex – a reddish brown and consists
of million of microscope functional
units of the kidney called nephrons

The base of each renal pyramid faces the cortex, while

its apex, the renal papilla, empties into surrounding
cuplike cavities called minor calyces.
Each minor calyx collects urine from the ducts of the
Cortical tissue is interspersed between
pyramids. Minor calyces join to form major calyces. the renal pyramids, separating and
Then, the major calyces join to form the large collecting supporting them. These interpyramidal
funnel, the renal pelvis. cortical supports are the renal columns.
NEPHRON
It is the basic structural and functional unit of the
kidney. Each kidney has more than 1 million nephrons,
which altogether comprise 14 miles of filters and
tubes.
 Urine Formation in the Nephron

1. FILTRATION of the blood by the

glomerulus,
2. REABSORPTION by the renal
tubules, and
3. SECRETION by the peritubular
capillaries returning select
substances to the glomerular filtrate.

FILTRATION REABSORPTION SECRETION

FILTRATION FILTRATION REABSORPTION SECRETION

It consists of water, glucose, amino acids,

some salts and urea

It does not contain plasma proteins or RBC

because they are too large to pass through the
pores of the capillary membrane

The Bowman’s capsule filters out 125 mL of

fluid from the blood in a single minutes. In hour,
7500 mL of filtrate leave the blood; this
amounts to some 180 liters in a 24-hour period.

The nephric filtrate continue along the tubules,

99% of fluid is reabsorbed back into the
bloodstream; therefore, only 1 to 2 liters (1000
– 2000 mL) of urine are excreted per day.
REABSORPTION FILTRATION REABSORPTION SECRETION

It consists of water, glucose, amino acids,

vitamins, bicarbonate ions (HCO3-), and the
chloride salts of calcium, magnesium, sodium
and potassium.
It starts in the proximal convoluted tubules; it
continues through the loop of Henle, the distal
convoluted tubules, and the collecting tubules.
It reabsorbs approximately 80% of the water
filtered out of the blood in the glomeruli. While,
glucose, amino acids, vitamins and some
sodium ions are actively transported back in
the blood.

When levels exceed normal limits, the

selective cells lining the tubules no longer
reabsorb substances such as glucose but
allow them to remain in the tubule to be
eliminated in the urine. (“Threshold”)
SECRETION FILTRATION REABSORPTION SECRETION

It transports substances from the blood in the

peritubular capillaries into the glomerular
filtrate in the distal and collecting tubules.

Substances that are secreted are ammonia,

creatinine, hydrogen ions (H+), potassium ions
(K+), and some drugs.

Electrolytes are selectively secreted to

maintain the body’s acid-base balance.
URETERS
There are two ureters, one from each
kidney, that carry urine from kidney to the
urinary bladder.

They are long, narrow tubes, less than ¼

inch wide and 10 – 12 inches long.

Mucous membrane lines both renal pelvis

and the ureters

Beneath the mucous membrane lining of

the ureters are smooth muscle fibers

When the muscles contract, peristalsis is

initiated, and pushes the urine down the
ureter into the urinary bladder.
URINARY BLADDER
A hollow muscular organ made of elastic
fibers and involuntary muscle, acts like a
reservoir.

It stores the urine until about 1 pint (500

mL) is accumulated.

Capacity: 500 mL

When amount of urine reaches 200 mL to

400 mL impulses are sent to the lower
portion of the spinal cord to expel urine.
URETHRA
A thin-walled tube leading from the bladder to
the outside of the body.
Transports urine by peristalsis
There are two urinary sphincter one located at
each end.
 Urinary meatus – is the eternal
opening of the urethra
The female urethra is approximately 1.5
inches long and the meatus is located
between the clitoris and the opening of the
vagina.
The male urethra is approximately 8 inches
long and the opening is located at the tip of
the penis.
 Osmoreceptors – sensitive to the osmotic pressure of
blood plasma.
CHEMICAL An increase in the osmotic blood pressure due to
salt retention causes an increase in ADH
CONTROL secretion. This will inhibit normal urine formation.
Aldosterone – secreted by the adrenal cortex, that
promotes the reabsorption of sodium ions; chloride ions
and water.
As the blood passes through the glomerulus to
Bowman’s capsule, specialized cells are able to
detect a drop in blood pressure.

Antidiuretic Renin – an enzyme

hormone released by the kidneys
into the bloodstream.
(ADH) and It stimulates the
aldosterone release of
aldosterone by the
help maintain adrenal cortex and
balance of constricts the
body fluids blood vessels.
NERVOUS Indirect nerve control is achieved
through the stimulation of certain
CONTROL endocrine glands, where
hormonal secretion will control
urinary secretion.

It is accomplished directly
through the action of nerve
impulses on the blood
vessels to the kidney, and on
those within the kidney
leading to the glomeruli.
URINATION
“Micturition” or voiding and is the
normal process of emptying the
bladder

It requires the coordinated

contraction of the bladder muscles
and the relaxation of the sphincter

When the bladder reaches between

200 to 400 mL, stretch receptors in
the bladder wall transmit nerve
impulses to the spinal cord, relaying
the conscious desire to urinate
 URINALYSIS VALUE
Urinalysis – an examination of the urine, can
determine the presence of blood cells, bacteria,
acidity level, specific gravity (weight), and
physical characteristics such as color, odor and
clarity.
The amount of urinary output is between
1000 – 2000 mL every 24 hours, with an
average of 1500 mL per day.

Volume will vary with diet, fluid intake,

temperature and physical activity.

Urine is normally a transparent clear fluid,

but the color will vary from pale yellow to
dark amber depending on its concentration
Cloudy urine is usually considered
abnormal and may be result of the
pressure of blood, pus, or bacteria.
SPECIMEN COLLECTION
Specimens must be collected in a clean,
dry, leak-proof containers. Disposable
containers should be used. Improperly labeled and collected
specimens should be rejected by the
The recommended capacity of the laboratory, and appropriate personnel
container is 50 mL, which allows 12 mL of should be notified to collect anew
specimen needed for microscopic specimen.
analysis.
If the urine is to be cultured, it should be
All specimens must be labeled properly refrigerated during transit and kept
with the patient’s name and identification refrigerated until cultured up to 24 hours.
number, the date and time of collection
and additional information.
Specimens should be delivered to the
laboratory promptly and tested within 2
Labels must be attached to the container,
hours.
not to the lid and should not become
detached if the container is refrigerated or
frozen.
ACUTE KIDNEY FAILURE
It exhibits a sudden loss of renal function
and is frequently reversible.
CAUSES SYMPTOMS

Nephritis Oliguria

Shock Anuria

Injury Uremia

Bleeding
 Nephritis – inflammation of the nephron
 Oliguria – a scanty or diminished production of the urine Sudden heart
 Anuria – absence of urine formation failure
 Uremia – excessive amounts of urea in the blood
Poisoning
CHRONIC RENAL FAILURE

A condition where there is a gradual

loss of function of the nephrons.
GLOMERULONEPHRITIS
An inflammation of the glomerulus of the
nephron, where the filtration process is
affected.

It refers to a sterile, inflammatory process

that affects the glomerulus and is
associated with the finding of blood,
protein, and casts in the urine.

Variety of types of glomerulonephritis exist,

and the condition also may progress from
one form to another.
ACUTE GLOMERULONEPHRITIS
Occurs in some children about 1 to 3
weeks after a bacterial infection, usually a
Group 1 streptococcus that contain M
protein in the cell wall.

It can be treated with antibiotics and

recovery will just take place.

Blood Urea Nitrogen (BUN) may be

elevated during the acute stages but, like
the urinalysis, it returns to normal.
CRESENTIC GLOMERULONEPHRITIS
It is a more serious form of acute
glomerular disease which is rapidly
progressive and has a much poorer
prognosis, often terminating in renal failure.

Symptoms are initiated by deposition of

immune complexes such as systematic
lupus erythematosus (SLE).

Laboratory results are similar to acute

glomerulonephritis but it become more
abnormal a the disease progresses,
including markedly elevated protein levels
and very low glomerular filtration rates.
CHRONIC GLOMERULONEPHRITIS
It occurs when the filtration membrane has
been permanently affected.

Gradually worsening symptoms include

fatigue, anemia, hypertension, edema and
oliguria.
Examination in the urine reveals hematuria,
proteinuria, glucosuria as a result of
tubular dysfunction.

There is a decrease in glomerular filtration

rate in conjunction with increased BUN
and creatinine levels and electrolyte
imbalance.
HYDRONEPHROSIS
Occurs when the renal pelvis and calyces
become distended due to an accumulation
of fluid.
The urine backs up because of a blockage
in the ureter or pressure on the outside of
the ureter, which may narrow the
passageway.
Cause of this disease are pregnancy or an
enlarged prostate gland.
PYELONEPHRITIS
It is the inflammation of the kidney tissue
and the renal pelvis. It resulted from an
infection that has spread from the ureters.

It can be a cause of pyuria.

Pyuria – presence of pus in the urine.

Pyelitis – an inflammation of the renal

pelvis.
KIDNEY STONES
It is when stagnation occurs, microscopic
crystals of calcium phosphate, along with
the uric acid and other substances, may
clump together to for kidney stones.
They eventually fill the renal pelvis and
obstruct the urine flow in the ureter.

Symptoms can be is the extreme pain,

nausea and vomiting, burning, frequent
urge to void, chills, fever and weakness,
and can also be hematuria.
CYSTITIS (UTI)
Inflammation of the mucous membrane
lining of the urinary bladder.

It is cause by E. coli, that can be found in

the rectum.

It can be lead to painful urination (dysuria)

or a frequent urination.

The treatment for this disease involves

antibiotic and urinary antiseptics with
increased fluids.
INCONTINENCE
It is also known as involuntary micturition.

Occurs in babies prior to toilet training,

because they lack control over the eternal
sphincter muscle of the urethra.

Example would be a person who has

suffered a stroke or whose spinal cord has
been severed may have no bladder control.
NEUROGENIC BLADDER
It is a condition caused by damaged
nerves that control the urinary bladder.

This results in dysuria and urinary

retention, which is the inability to empty
the bladder completely, and incontinence.
OVERACTIVE BLADDER
It is a condition where there is a problem in
the urinary bladder storage that causes a
sudden urge to urinate, which may lead to
incontinence.

It occurs when the nerve signals between

the bladder and brain are not coordinated
and it may also occur when the bladder
are not overactive.
Dialysis
It is a treatment used for kidney failure.

It involves the passage of blood through a

semipermeable membrane to rid the blood of
harmful wastes, extra salt, and water.

It serves as a substitute kidney.

Two forms of dialysis: Hemodialysis &

Peritoneal dialysis
Hemodialysis
It is a process for purifying blood by passing it
through thin membrane and exposing it to a
solution that continually circulates around the
membrane

Dialyzer - a glass tube that is part of the unit

that actually substitutes for the kidney, which
is filled with thousands of minute hollow fibers
attached firmly at both ends.

It is usually done two to three times a week,

and each treatment lasts from 2 to 4 hours.
Peritoneal dialysis
It used the patient’s own peritoneal lining
instead of a dialyzer to filter the blood.

A cleansing solution called dialysate travels

through a catheter implanted into the abdomen.

The most common type of peritoneal dialysis is

continuous ambulatory peritoneal dialysis
(CAPD). This stays in the abdomen for 6 hours.

For the process of draining, the dialysate

replaces it with fresh solution that takes about
30 minutes.
Automated Peritoneal dialysis – a type of
dialysis that can be done at night while the
patient is asleep, take 6 to 8 hours.
Kidney Transplant
It is a surgical operation treatment that are
done in cases of prolonged chronic
debilitating diseases and the renal failure
involving both kidneys.

Two kinds of kidney transplant: Use of kidney

from a living donor and use of kidney from an
unrelated donor who has died

To have this treatment, the blood and other

cellular material must match in order to ensure
the greatest potential for success in a
transplant.