CHAPTER 25-THE URINARY SYSTEM I. THE URINARY SYSTEM A. Includes the kidneys, ureters, urethra and urinary bladder.

B. The kidneys are the primary excretory in the human body. They function by removing toxins from the body while returning necessary compounds back to the body. 1. The kidneys filter approximately 200 liters of fluid from the body everyday. C. The Primary Functions of the Urinary System include: 1. Filtering wastes from the blood and removing the wastes from the body via the urine. 2. Glucogenesis-during times of fasting. 3. Producing the enzyme Renin which regulates blood pressure and proper kidney functioning. 4. Producing the hormone Erythropoietin which regulates and stimulates red blood cell production. 5. Metabolizing vitamin D to its active form. II. EXTERNAL KIDNEY ANATOMY A. The Kidney is bean-shaped and located in the lumbar region of the body. The kidney is described as being Retroperitoneal-that is, it is located between the dorsal body wall and the parietal peritoneum. 1. An average human kidney weighs about 5 ounces. 2. Sitting on top of each kidney is a single adrenal gland that essentially has no influence on the kidney. B. The Renal Hilum-vertical cleft on the medial surface of the kidney, that leads into an internal space within the kidney known as the Renal Sinus. 1. The ureter, the renal blood vessels, lymphatics and nerves all join each other at the hilum and occupy the renal sinus. C. There are Three Layers of Support Tissue Surrounding each kidney. The layers are: 1. The Fibrous Capsule-a capsule-like layer that prevents infections in surrounding regions from spreading to the kidney. 2. The Perirenal Fat Capsule-a thick layer of adipose tissue that attaches the kidney to the posterior body wall and cushions it against blows. a. What is renal ptosis? 3. The Renal Fascia-an outer layer of fibrous connective tissue that anchors the kidney and adrenal glands to surrounding tissues. III. INTERNAL ANATOMY OF THE KIDNEY A. Three Distinct Internal Segments in the Human Kidney: 1. The Renal Cortex-light colored, superficial region of the kidney. This area has a granular appearance. 2. The Renal Medulla-a dark red or brown colored region in the kidney. The medulla contains cone-shaped areas known as the Medullary or Renal Pyramids. a. The base of each pyramid faces towards the cortex and the apex (Papilla) points internally. b. The pyramids contain bundles of microscopic urine-collecting tubules and capillaries. Structures known as the Renal Columns separate the

pyramids from each other. c. Each pyramid and its surrounding tissue makes up one of eight lobes of a kidney. 3. The Renal Pelvis-a funnel-shaped tube that is continuous with the ureter leaving the hilum. a. Branching extensions of the Pelvis form two or three Major Calyces, each of which subdivides to form several Minor Calyces. b. The Minor Calyces are cup-shaped areas that enclose the papillae of the pyramids. 1) The calyces collect urine, which drains from the papillae, and empty into the renal pelvis. The urine then flows through the renal pelvis and into the ureter which moves it to the bladder where it is stored. 2) Smooth muscle lines the walls of the calyces, the pelvis and the ureter. Urine is pushed through these areas via peristalsis. c. What is Pyelitis? Pyelonephritis? IV. BLOOD AND NERVE SUPPLY TO THE KIDNEY A. Obviously, the kidneys have a huge blood supply. The renal artery carries one fourth of the total cardiac output to the kidneys (1200ml) each minute! B. As the renal arteries reach the kidney, they branch into smaller arteries in the following fashion: 1. Renal artery Segmental arteries (to the renal sinus) Interlobar arteries Arcuate arteries (to the base of the renal pyramids) Cortical radiate arteries (to the renal cortex) C. Renal Plexus-a network of autonomic nerve fibers that provide much of the nerve supply to the kidney and its ureter. V. NEPHRONS-structural and functional units of the kidney. There are over 1 million of these structures in each kidney. They are responsible for cleansing the blood to produce urine. A. Each Nephron Consists of: 1. A Glomerulus-which is a tuft of capillaries. 2. A Renal Tubule-parts: a. Glomerulur Capsule (Bowmans Capsule)-cup-shaped end of the renal tubule.

b. Collectively, the glomerular capsule and the enclosed glomerulus are called the renal corpuscle. c. Proximal convoluted tubule (PCT)-coiled structure that leaves the glomerular capsule. The PCT makes a hairpin loop known as The Loop of Henle which then twists (via ascending and descending limbs) again as the Distal Convoluted Tubule (DCT). The DCT empties into a collecting duct. B. Glomerular capillaries are described as being fenestrated (containing many pores). This allows large amounts of solute-rich materials to pass from the blood into the glomerular capsule. This material, known as filtrate, is the material that the renal tubules process to form urine. C. The external parietal layer of the glomerular capsule is simple squamous epithelial tissue. The visceral layer, which attaches to the glomerular capillaries, consists of podocytes that cling to the glomerulus. The podocytes form filtration slits through which filtrate enters the capsular space within the glomerular capsule. D. Collecting Ducts-receive filtrate from many nephrons, run through the medullary pyramids and give them their striped appearance. As the collecting ducts approach the renal pelvis, they fuse to form the large papillary ducts which deliver urine into the minor calyces via papillae of the pyramids. E. The walls of the PCT are covered by cuboidal epithelial cells that contain microvilli; thus, these cells offer a great surface area for reabsorbing water and solutes from the filtrate. The walls of the DCT are also covered by cuboidal epithelial cells, however, microvilli are less abundant in this region. F. Cortical Nephrons-are located entirely within the cortex of the kidney. G. Juxtamedullary Nephrons-are located close to the cortex-medulla junction and they play a role in producing concentrated urine. H. Every nephron is closely associated with two capillary beds: the glomerulus and the peritubular capillaries. 1. In the glomerulus, the capillaries run parallel and are specialized for filtration. a. The glomerulus is fed by and drained by arterioles-the afferent arteriole and the efferent arteriole. This is different from all other capillary beds in the body. b. The afferent arterioles arise from the interlobular arteries and run through the renal cortex. c. Blood pressure in the glomerulus is extremely high for a capillary bed. This pressure forces fluid and solutes out of the blood into the glomerular capusule. Much of this filtrate is reabsorbed by the renal tubule cells and returned to the blood in the peritubular capillaries. d. What creates this great pressure in the arterioles of the glomerulus? 1) Arterioles are highly resistant vessels 2) The afferent arteriole has a larger diameter than the efferent arteriole. 2. Peritubular capillaries-arise from the efferent arterioles draining the glomeruli. a. These attach to renal tubules and empty into venules. b. These capillaries are low pressure vessels that specialize in absorbing solutes and water that is reclaimed from filtrate produced in the tubules.

c. Juxtamedullary nephrons do not contain peritubular capillaries. Instead, they contain straight vessels known as the vasa recta, that specialize in concentrating urine. 3. In general, nephrons contain two capillary beds that are separated by efferent arterioles. The glomeruli produces filtrate and the peritubluar capillaries reclaim much of the filtrate. I. Every nephron contains a region known as the Juxtagomerular Apparatus (JGA). This is a region where the DCT lies against the afferent arteriole. 1. Juxtaglomerular cells (JG)-line the walls of arterioles in the nephron. These cells can store and secrete renin. These cells also act to monitor blood pressure in the afferent arteriole. 2. The Macula Densa-cells that lie adjacent to the JG cells. These respond to the solute concentration of filtrate. These two sets of cells play a role in regulating the rate of filtrate formation and systemic blood pressure. 3. The Filtration Membrane-lies between the blood and the interior of the glomerular capsule. It is extremely porous and allows water and small solutes to pass through. a. The capillary pores of this membrane allow passage of all plasma components but not blood cells. VI. KIDNEY PHYSIOLOGY A. Our kidneys filter the volume of our plasma more than 60 times each day. Our kidneys require 20-25% of all oxygen used by the body at rest to accomplish this. B. Filtrate vs. Urine 1. Filtrate contains everything found in blood plasma except for proteins. As filtrate moves into the collecting ducts, it has lost most of its water, ions and nutrients. The material that remains at this point is known as urine a. Urine contains metabolic wastes and unneeded compounds. C. Urine formation proceeds through three major processes in the kidney: 1. Glomerular filtration-by the glomeruli. 2. Tubular reabsorption and secretion in the renal tubules. 3. Tubular secretion D. Glomerular Filtration-passive process in which hydrostatic pressure forces fluids and solute through a membrane. 1. This is an extremely efficient process at filtering the blood. This efficiency is in part due to the high permeability of the filtration membrane and the great surface area that this membrane offers. 2. In glomerular filtration, small molecules (water, glucose, nitrogen wastes) can pass from the blood into the renal tubule. Larger molecules tend to remain in blood capillaries, thus maintaining appropriate vessel pressures to prevent the complete loss of water form the capillaries. a. Protein in the urine is often an indicator of problems with the filtration membrane. 3. Net Filtration Pressure (NFP)-refers to the forces acting at the glomerular beds. a. Glomerular Hydrostatic Pressure (HPg)-is essentially glomerular blood pressure. This is the primary force involved in pushing water and

solutes out of blood and across the filtration membrane. b. Colloid osmotic pressure of glomerular blood and capsular hydrostatic pressure both act to counter the effects of glomerular hydrostatic pressure. In the end, the NFP responsible for producing renal filtrate is 10mmHg. 4. Glomerular Filtration Rate-the volume of filtrate formed each minute by the activity of all 2 million glomeruli of the kidneys. In adults, the GFR is 120-125ml/min. a. Any changes in pressure on the filtration membrane may lead to a change in NFP. 5. Factors That Regulate Glomerular Filtration a. Intrinsic Controls: 1) Renal Autoregulation-refers to the ability of the kidney to adjust its own resistance to blood flow. This allows for a constant GFR. This is created by: a) The Myogenic Mechanism-the ability of vascular smooth muscle to contract when stretched. This contraction reduces blood flow into the glomerulus and prevents an increase in glomerular blood pressure, thus avoiding damage to the kidney. The smooth muscle can relax when systemic pressure is low, thus increasing blood flow and raising pressure in the glomerulus. b) Tubuloglomerular Feedback Mechanism-involves macula densa cells which can promote either dilation or constriction of afferent arterioles to increase or decrease blood flow as needed. 2) Intrinsic controls do not work when systemic blood pressure drops below 90 mmHg. b. Extrinsic Controls-involves neural and hormonal devices that seek to maintain systemic blood pressure. 1) Sympathetic Nervous System Controls-this portion of the ANS can act to slow the flow of blood to the kidneys during times of of extreme stress or emergency. This reduces filtrate formation. 2) Renin-Angiotensin Mechanism-can be triggered by several stimuli, including the Sympathetic Division of the ANS. a) In this system, JG cells are stimulated to release renin which is an enzyme that acts on the protein angiotensinogen to produce a compound known as angiotensin II. This compound is a powerful vasoconstrictor; therefore it acts to raise blood pressure. 1) Angiotensin II also stimulates the kidney to release aldosterone which forces the renal tubules to reclaim more sodium ions. Water follows the sodium via osmosis, thus, blood pressure increases due to the increase in blood volume. 3) What is anuria?

E. Tubular Reabsorption-this process involves the reclamation of much of the material that collects in the renal tubule during glomerular filtration. 1. Reabsorption begins when filtrate reaches the proximal tubules. 2. For reabsorption to occur, transported substances pass through three barriers: a. The Luminal Membrane of the Tubule Cells b. The Basolateral Membrane of the Tubule Cells c. Endothelium of the Peritubular Capillaries 3. Under normal conditions, most organic nutrients (including glucose, amino acids) are reabsorbed into the plasma. However, water and ion absorption is often regulated by hormones. 4. Reabsorption can be passive (no ATP required) or active (requiring ATP to occur). 5. Sodium Reabsorption-is almost always an active process. a. Sodium ions are the most abundant cation in the filtrate. b. Typically, sodium ions enter tubule cells from the filtrate and are pumped via a Sodium-Potassium Pump out of the tubule cells. 1) Sodium ions are then swept into the peritubular capillaries by the bulk flow of water. 6. Water, Nutrient and Ion Reabsorption-these materials are typically reabsorbed via passive process such as diffusion, osmosis, and facilitated diffusion. a. As noted earlier, water moves into peritubular capillaries via osmosis. 1) This occurs due to the presence of abundant sodium ions in the peritubular capillaries. b. Aquaporins-water filled channels located at certain areas along the PCT. 1) In areas where these are located, water is automatically reabsorbed, no matter the bodys water requirement (under or overhydrated). This is known as Obligatory water reabsorption. 2) As water exits the tubules, the concentration of solutes in the filtrate increases. Many of these compounds follow their concentration gradients into the peritubular capillaries. c. Some substances, including amino acids, glucose and vitamins are reabsorbed via Secondary Active Transport. This often involves the cotransport of the above materials out of the filtrate. The substances are often carried by cotransport into the peritubular capillaries. d. Some materials are not reabsorbed because they are too large or because they do not attach efficiently to a carrier molecule. 1) Nitrogenous compounds produced during the metabolism of proteins and nucleic acids are compounds that are generally not reabsorbed. Specifically, this includes substances such as urea, uric acid and creatinine. 7. Absorptive Capabilities of the Renal Tubules and Collecting Ducts a. The entire renal tubule is involved in reabsorption, however, the PCT cells are the most active reabsorbers in the renal tubules. What is reabsorbed in this region of the renal tubules?

b. The Loop of Henle 1) The general rule here is that water exits the descending limb but not the ascending limb. The opposite is true for solutes. c. The Distal Convoluted Tubule and Collecting Ducts 1) Typically, reabsorption in these regions is regulated by hormonesincluding aldosterone for sodium reabsorption and PTH for calcium reabsorption. F. Tubular Secretion 1. As stated before, some compounds are not reabsorbed into the peritubular capillaries. In tubular secretion, some substances (creatinine, certain organic compounds) either move into the filtrate from the peritubular capillaries or they are synthesized by tubule cells and secreted into the filtrate. Urine, therefore, contains filtered and secreted substances. 2. The PCT is the primary site of secretion. The collecting ducts are also involved in secretion. 3. Tubular Secretion is important for the following reasons: a. Disposing of substances that are not easily filtered from the blood. This includes certain drugs and substances that are tightly attached to plasma proteins. b. Eliminating toxic compounds that have been reabsorbed by passive processes. This would include urea and uric acid. c. Removing excess potassium ion from the body. d. Regulating blood pH. 1) When blood pH drops towards the acidic end, the renal tubules secrete more hydrogen ions into the filtrate and retain bicarbonate. As a result, the blood pH increases and the urine removes excess hydrogen ions. The opposite also occurs to reduce pH. G. Regulation of Urine Concentration and Volume 1. One of the primary functions of the kidneys is to maintain a constant solute level in body fluids (at about 300milliOsmol). This is accomplished by the kidney as it regulates the concentration and volume of urine. a. Recall that Osmolality is the number of solutes dissolved in 1 kg of water and it reflects the solutions ability to cause osmosis. 2. The kidneys regulate the concentration and volume of urine along with the solute level in body fluids via countercurrent mechanisms. 3. The term countercurrent refers to the flow of fluid through adjacent tubes in opposite directions. 4. Countercurrent mechanisms are found in two primary areas in the kidneys: a. Between the ascending and descending limbs of the loops of Henle of Juxtamedullary nephrons (this system is known as the countercurrent multiplier). b. Between the ascending and descending portions of the vasa recta blood vessels (this system is known as the countercurrent exchanger). 5. Countercurrent mechanisms function by creating an osmotic gradient from the

cortex of the kidney through the medulla. This gradient allows the kidney to vary urine concentrations as needed. 6. The Countercurrent Multiplier-this involves filtrate processing in the loops of Henle in Juxtamedullary Nephrons. a. The Countercurrent Multiplier works because of three factors: 1) The descending limb of the loop of Henle is relatively impermeable to solutes and freely permeable to water. a) The osmolality of medullary interstitial fluid increases along the length of the descending limb. Therefore, water passes out of the filtrate all along this limb. b) The filtrate osmolality reaches its highest point at the bend of the loop (approximately 1200 mOsm). 2) The ascending limb is permeable to solutes but not water. a) As filtrate rounds the bend into the ascending limb, the tubule permeability changes, becoming impermeable to water and permeable to salt. b) Na+ and Cl- concentrations are high in the filtrate entering the ascending limb. c) Since sodium and chloride ions are removed from the filtrate, the filtrate becomes more dilute due to the presence of water. Remember that the filtrate is not losing water through the ascending limb of the loop of Henle. d) As water diffuses out of the descending limb and Na+ and Cl- diffuses out of the ascending limb, the filtrate in the descending limb becomes saltier. Overall, this creates a positive feedback system that regulates the osmolality of fluids in the descending limb and in medullary tissues. 3) Urea recycling contributes to the medullary osmotic gradient. a) Urea enters the filtrate via facilitated diffusion. This urea does not move out of the ascending limb or the collecting ducts. b) When the filtrate reaches the collecting duct deep in the medullary region, it contains highly concentrated urea. c) This urea is transported out of the tubule via facilitated diffusion. This urea aids in increasing osmolality in the medulla. d) Antidiuretic hormone (ADH)-stimulates the excretion of highly concentrated urine. When this hormone is present, urea recycling is enhanced which increases the medullary osmolality; therefore, more concentrated urine is produced. 7. The Countercurrent Exchanger-is associated with the vasa recta. a. This system involves the cycling of salt. b. Blood flow through the vasa recta is sluggish. These blood vessels are also freely permeable to water and NaCl. As blood flows deep into the medulla, it loses water and gains salt (hypertonic). As blood emerges from the medulla, this process is reversed.

1) Blood entering and leaving the vasa recta; therefore, has the same solute concentration. This system does not create an osmotic gradient, but it protects it by preventing the rapid removal of salt from the tissue spaces of the medulla and by removing reabsorbed water. c. Formation of Dilute Urine 1) Filtrate is diluted as it travels through the ascending limb of the loop of Henle. This filtrate is allowed to travel to the renal pelvis to produce dilute urine. This process occurs when ADH is not released. a) This essentially stops water reabsorption. d. Formation of Concentrated Urine 1) Antidiuretic hormone (ADH) inhibits urine output (diuresis). 2) ADH functions by allowing aquaporins to insert into the luminal membrane. Due to this, water passes through the cells into the interstitial space. Overall, water and urea leave the filtrate and pass into the medulla. 3) The amount of water exiting the filtrate is related to the amount of ADH that is released. With maximal ADH secretion, as much as 99% of the water in the filtrate may be reabsorbed; thus producing highly concentrated urine. 4) Facultative water reabsorption refers to water uptake influenced by the presence of ADH. e. Diuretics-chemicals that enhance urinary output. 1) Osmotic diuretics are compounds that are not reabsorbed and that carry water out with it (for example, the high glucose level in the urine of a diabetes mellitus patient). 2) Alcohol acts as a diuretic by inhibiting the release of ADH. 3) Caffeine and certain drugs act as diuretics by interfering with sodium reabsorption. H. Renal Clearance-refers to the volume of plasma that is cleared of a particular substance in a given time (usually 1 minute). 1. Renal clearance tests are often done to examine the GFR. 2. What is the equation for Renal Clearance (RC)? VII. CHARACTERISTICS OF URINE A. Color and Transparency-freshly voided urine ranges in color from clear to deep yellow. 1. The yellow color is the result of urochrome, a pigment that results from the breakdown of hemoglobin (bilirubin, bile pigments). The more concentrated the urine, the deeper the yellow color. 2. Abnormal colors such as pink or brown urine or smoky urine may result from eating certain foods (beets, rhubarb). Additionally, some drugs and vitamins may alter the color of urine. B. Odor-freshly voided urine may have a slight smell. If allowed to stand, it will begin to develop an ammonia smell as bacteria metabolize urea in the urine. Some drugs, foods

and illnesses may alter the odor of urine. For example, the urine of an individual with diabetes mellitus may smell fruity because of its acetone content. C. pH-urine is slightly acidic. Changes in urine pH may indicate a variety of issues including, bacterial infection, an extreme protein diet, a vegetarian diet. D. Specific Gravity-refers to the mass of a substance to the mass of an equal volume of water. Urine has a fairly high specific gravity. E. Chemical Composition of Urine-water accounts for about 95% of the volume of urine. 1. Other compounds in urine include urea and the nitrogenous wastes uric acid and creatinine. VIII. THE URETERS-tubes that carry urine from the kidneys to the bladder. A. When the bladder fills, the distal ends of the ureters are compressed and closed. B. The Walls of the Ureters are Trilayered: 1. Mucosa-inner layer. 2. Muscularis-middle layer, composed of smooth muscle. This layer contracts to force urine into the urinary bladder. 3. Adventitia-covers the external surface of the ureters. C. What are renal calculi? IX.THE URINARY BLADDER-collapsible muscular sac that temporarily stores urine. A. The interior of the bladder has opening for both ureters and the urethra. This region of the bladder outlines by the three openings is known as the Trigone. B. The Urinary Bladder has three Layers: 1. Mucosa-inner layer. 2. Thick muscular layer-known as the Detrusor Muscle, is composed of smooth muscle. 3. Adventitia-outer covering. C. When empty, the bladder has a triangular shape. The bladder expands as urine accumulates. The maximum capacity of the bladder is approximately 1000ml (2 pints). X. THE URETHRA-thin muscular tube that drains urine from the urinary bladder out of the body. A. Internal Urethral Sphincter-thickening of the detrusor muscle at the bladder-urethra junction. This involuntary sphincter keeps the urethra closed when urine is not being passed and prevents leaking between voiding. 1. This sphincter is unusual in that contraction opens it and relaxation closes it. B. What is urethritis? What is cystitis? XI. MICTURITION-the act of emptying the bladder. Is also known as voiding or urination. A. When about 200 ml of urine accumulates in the bladder, impulses are transmitted to the brain, creating the urge to void. We can fight this urge up to a point. 1. Micturition occurs when urine volume exceeds 500-600ml, whether one wants it to or not. B. About 10 ml of urine remains in the bladder after micturition. C. What is incontinence? What is urinary retention? XII. RELATED CLINICAL TERMS-at end of chapter.