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The Urinary System

Dr. Bidhya Bhusan Tamrakar (MD)

General Functions
Serves as a blood filter Toxins, metabolic wastes leave the body in urine H2O, glucose, and amino acids are returned to blood

Organs of the Urinary System


Kidneys (paired)
Perform filtering functions and manufacture urine

Ureters (paired)
Transport urine

Urinary bladder (single)


Stores urine

Urethra (single)
Transports urine

The Urinary System

Kidney
Move as much as 1 inch during respiration The kidneys lie in a retroperitoneal position on the posterior abdominal wall in the superior lumbar region T12-L3 The right kidney is lower than the left The lateral surface is convex; the medial surface is concave - hilum Renal vein, 2 branches of the renal artery, the ureter, another branch of renal artery Lymph vessels and sympathetic fibres also pass through hilum

Location and Relations Right Kidney


Anteriorly Adrenal gland, the liver, 2nd duodenum, right colic flexure Posteriorly Diaphragm (and costodiaphragmatic recess), 12th rib, psoas, subcostal (T12) iliohypogastric and ilioinguinal nerves (L1) run downwards and laterally

Location and Relations Left Kidney


Anteriorly Adrenal, spleen, stomach, pancreas, left colic flexure Posteriorly Diaphragm (and costodiaphragmatic recess), 11th and 12th rib, psoas, subcostal (T12) iliohypogastric and ilioinguinal nerves (L1) run downwards and laterally

Coverings of the Kidneys


Renal / fibrous capsule - that prevents kidney infection Perirenal fat fatty mass that cushions the kidney and helps attach it to the body wall Renal fascia outer layer of dense fibrous connective tissue that anchors the kidney Pararenal fat external to the renal fascia

The Urinary System

External Structure of the Kidney


Renal capsule
Connective tissue

Renal artery
Blood (oxygenated) to the kidney

Renal vein
Receives blood from kidney

Ureter
Drains urine

Renal Structure
Cortex the light colored, granular superficial region Medulla exhibits dozen coneshaped medullary (renal) pyramids separated by columns Each apex of renal pyramid projects into minor calyces 2-3 minor calyces major calyx

Major calyces large branches of the renal pelvis Collect urine draining from papillae Empty urine into the renal pelvis Renal pelvis flat funnel shaped tube expanded upper end of the ureter The renal sinus space within the hilum which contains the renal pelvis and vessels Urine flows through the pelvis and ureters to the bladder

Structure of the Kidney

Blood Supply of the Kidney


Approximately 1/4 (1200 ml) of systemic cardiac output flows through the kidneys each minute Arterial flow into and venous flow out of the kidneys follow similar paths Renal artery segmental arteries (2-4 ant, 1 post) lobar arteries (1 per pyramid) Renal vein emerges at hilum anterior to arteries Lymph drainage to lateral aortic lymph nodes

Blood Supply of the Kidney

Nerve Supply
The nerve supply is via the renal plexus Sympathetic, Parasympathetic, Visceral afferent From thoracic and lumbar splanchnics and vagus nerve The afferent fibres that travel through the renal plexus enter T10-12 Referred pain to small of back, flank (lumbar quadrant, and genitals (calculi)

Ureters
Retroperitoneal, muscular tubes Pass over the pelvic brim at bifurcation of common iliac arteries Run on lateral walls of pelvis Opposite ischial spine, curve anteromedially Oblique entrance into bladder one way flap valve posterosuperior angles of the bladder

Ureters
Ureters have a trilayered wall Transitional epithelial mucosa Smooth muscle muscularis Fibrous connective tissue adventitia Ureters actively propel urine to the bladder via response to smooth muscle stretch

Urinary Bladder
Smooth, collapsible, muscular sac that stores urine It lies retroperitoneally on the pelvic floor posterior to the pubic symphysis It is connected anteriorly to the umbilicus median umbilical ligament (urachus) The bladder is distensible and collapses when empty As urine accumulates, the bladder expands without significant rise in internal pressure

Male Bladder
2 vas deferentia lie posterior surface of bladder between seminal vesicles Peritoneum rectovesical pouch prostate gland surrounds the neck inferiorly

Urinary Bladder Internal Anatomy


The bladder wall has three layers Transitional epithelial mucosa A thick muscular layer A fibrous adventitia Trigone triangular area outlined by the openings for the ureters and the urethra Clinically important because infections tend to persist in this region

Urethra
Muscular tube that: Drains urine from the bladder Conveys it out of the body Sphincters keep the urethra closed when urine is not being passed Internal urethral sphincter involuntary sphincter at the bladder-urethra junction External urethral sphincter voluntary sphincter surrounding the urethra as it passes through the urogenital diaphragm Levator ani muscle voluntary urethral sphincter

Urethra
The female urethra is tightly bound to the anterior vaginal wall Its external opening lies anterior to the vaginal opening and posterior to the clitoris

Micturition (Voiding or Urination)


The act of emptying the bladder Distension of bladder walls initiates spinal reflexes that: Stimulate contraction of the external urethral sphincter Inhibit the detrusor muscle and internal sphincter (temporarily) Voiding reflexes: Stimulate the detrusor muscle to contract Inhibit the internal and external sphincters

Nephrons and Urine Formation


Nephrons form the urine product
Filtration Reabsorption Secretion

Each kidney contains about 1 million nephrons

Structure of a Nephron
2 main structures
Glomerulus a knot of capillaries Renal tubule (about 2 inches long)
Bowmans capsule surrounds the glomerulus Proximal convoluted tubule Henles Loop Distal convoluted tubule

Renal tubule enters collecting duct


Receives urine from nephrons Delivers final urine product into the calyces

A Typical Nephron

A Typical Nephron

Renal Corpuscles

A Renal Corpuscle

Blood Supply of the Nephron

Urine Formation
Filtration
Blood in afferent arteriole is under high pressure Glomerulus acts as a filter Filtrate = the substance that is filtered from the blood into the renal tubule Blood leaves the glomerulus through the efferent arteriole

Reabsorption
Filtrate contains useful substances which are returned to the blood Most occurs in the proximal convoluted tubules

Secretion
Substances move from blood (capillaries) into the filtrate Important in controlling pH of blood

URINE FORMATION
GLOMERULAR FILTRATION: MEMBRANE CAPILLARY FLUID EXCHANGE WATER AND SOME SOLUTES PASS FROM BLOOD INTO CAPSULAR SPACE OF NEPHRON BARRIERS
FENESTRATED CAPILLARY ENDOTHELIUM
PORES EXCLUDE CELLS, ETC.

BASEMENT MEMBRANE
OBSTACLE TO ANIONS

FILTRATION SLITS
OBSTACLE TO ANIONS

URINE FORMATION
GLOMERULAR FILTRATION: MEMBRANE SMALL MOLECULES PASS THROUGH
WATER ELECTROLYTES GLUCOSE AMINO ACIDS NITROGENOUS WASTES VITAMINS ETC. NORMALLY NOT RBCs, PLASMA PROTEINS

URINE FORMATION
GLOMERULAR FILTRATION: PRESSURE SIMILAR TO CAPILLARY FILTRATION ELSEWHERE DIFFERENCES:
BLOOD HYDROSTATIC PRESSURE (BHP) MUCH HIGHER (~60 mmHg)
AFFERENT ARTERIOLE LARGER THAN EFFERENT

BHP DROPS VERY LITTLE


NO REABSORPTION AT VENOUS END

URINE FORMATION
GLOMERULAR FILTRATION: RATE ~20% OF FLUID REMOVED FROM BLOOD VIA FILTRATION 180 LITERS OF FILTRATE PER DAY 60 X PLASMA IN BODY ~99% REABSORBED

URINE FORMATION
TUBULAR REABSORPTION GLOMERULAR CAPILLARIES INVOLVED IN FILTRATION
FILTRATION INTO GLOMERULAR CAPSULE

PERITUBULAR CAPILLARIES INVOLVED IN REABSORPTION


REABSORPTION FROM PROXIMAL CONVOLUTED TUBULE, ETC.

URINE FORMATION
TUBULAR REABSORPTION PERITUBULAR CAPILLARIES
HIGH OSMOTIC PRESSURE
RESULT OF WATER LOSS

LOW HYDROSTATIC PRESSURE


RESULT OF EFFERENT ARTERIOLE DIAMETER

CONTACT WITH PROXIMAL CONVOLUTED TUBULE, ETC. THESE FACTORS FAVOR REABSORPTION

URINE FORMATION
TUBULAR REABSORPTION PROXIMAL CONVOLUTED TUBULE
BLOOD REABSORBS ~65% OF FILTRATE
LONG NUMEROUS MICROVILLI

RETURNS FLUID TO PERITUBULAR CAPILLARIES ENERGY-REQUIRING


NUMEROUS MITOCHONDRIA ~6% OF RESTING ATP REQUIREMENT

URINE FORMATION
TUBULAR REABSORPTION IN PCT
PCT EXTRACELLULAR FLUID PERITUBULAR CAPILLARIES

ROUTES OF REABSORPTION
TRANSCELLULAR
THROUGH EPITHELIAL CELLS OF PCT

PARACELLULAR
BETWEEN EPITHELIAL CELLS OF PCT LEAKY TIGHT JUNCTIONS

URINE FORMATION
TUBULAR REABSORPTION IN PCT WHAT GETS REABSORBED?
SODIUM, CHLORIDE, & OTHER ELECTROLYTES GLUCOSE AMINO ACIDS WATER PROTEIN NITROGENOUS WASTES ETC.

URINE FORMATION
TUBULAR REABSORPTION IN PCT SODIUM (Na+)
MOST ABUNDANT CATION IN FILTRATE TRANSCELLULAR REABSORPTION
SIMPLE & FACILITATED DIFFUSION INTO EPITHELIAL CELL (PASSIVE TRANSPORT) FROM EPITHELIAL CELL ECF (ACTIVE TRANSPORT)

PERICELLULAR REABSORPTION ECF PERITUBULAR CAPILLARIES (PASSIVE) SODIUM CONCENTRATION GRADIENT DRIVES REABSORPTION OF OTHER SUBSTANCES

URINE FORMATION
TUBULAR REABSORPTION IN PCT GLUCOSE & AMINO ACIDS
TRANSCELLULAR REABSORPTION
SODIUM-GLUCOSE COTRANSPORT (ACTIVE TRANSPORT) SODIUM-AMINO ACID COTRANSPORT (ACTIVE TRANSPORT) PASSIVE TRANSPORT FROM EPITHELIAL CELL TO EXTRACELLULAR FLUID

PASSIVE UPTAKE BY PERITUBULAR CAPILLARIES

URINE FORMATION
TUBULAR REABSORPTION IN PCT WATER
TUBULAR FLUID HYPOTONIC TO INTRACELLULAR AND EXTRACELLULAR FLUIDS TRANSCELLULAR REABSORPTION
PASSIVE TRANSPORT

PERICELLULAR REABSORPTION
PASSIVE TRANSPORT

PASSIVE UPTAKE BY PERITUBULAR CAPILLARIES CONSTANT RATE OF WATER REABSORPTION


MODULATED RATES ELSEWHERE IN NEPHRON

URINE FORMATION
TUBULAR REABSORPTION IN PCT CHLORIDE (Cl-)
TRANSCELLULAR AND PARACELLULAR REABSORPTION TYPICALLY FOLLOWS SODIUM ION (Na+)

URINE FORMATION
TUBULAR REABSORPTION IN PCT OTHER ELECTROLYTES K+, Mg+, Ca++
PARACELLULAR & TRANSCELLULAR REABSORPTION

SO42-, PO42-, NO3 NOT REABSORBED

URINE FORMATION
TUBULAR REABSORPTION IN PCT PROTEIN
SMALL AMOUNT IN FILTRATE TRANSCELLULAR REABSORPTION
ENTERS EPITHELIAL CELLS VIA PINOCYTOSIS (ENDOCYTOSIS) HYDROLYSIS INTO AMINO ACIDS PASSIVE TRANSPORT OF AMINO ACIDS INTO EXTRACELLULAR FLUID

PASSIVE UPTAKE BY PERITUBULAR CAPILLARIES

URINE FORMATION
TUBULAR REABSORPTION IN PCT NITROGENOUS WASTES
UREA
PASSIVELY REABSORBED WITH WATER ~50% OF UREA REABSORBED (INADVERTENTLY)

URIC ACID
MOST REABSORBED (SECRETED LATER)

CREATININE
NOT REABSORBED

PASSIVE UPTAKE BY PERITUBULAR CAPILLARIES

URINE FORMATION
TUBULAR REABSORPTION IN NEPHRON LOOP CONCENTRATE URINE, CONSERVE WATER
REABSORB ~20% OF WATER IN FILTRATE
THIN SEGMENTS PASSIVE TRANSPORT THICK SEGMENT IMPERMEABLE TO WATER

REABSORB ~25% OF Na+, K+, Cl-

COTRANSPORT PROTEINS IN THICK SEGMENTS ACTIVE TRANSPORT

URINE FORMATION
TUBULAR REABSORPTION IN DCT CONCENTRATE URINE, CONSERVE WATER
36 LITERS/DAY ENTERS DCT REABSORB WATER FROM FILTRATE

REABSORB SALTS SUBJECT TO HORMONAL CONTROL


ESP. ALDOSTERONE, ANTIDIURETIC HORMONE (ADH), ATRIAL NATRIURETIC FACTOR (ANF) PCT AND NEPHRON LOOP ARE NOT SUBJECT TO HORMONAL CONTROL

URINE FORMATION
TUBULAR SECRETION CHEMICALS EXTRACTED FROM PERTUBULAR CAPILLARIES CAPILLARIES RENAL TUBULE FUNCTIONS
WASTE REMOVAL
ESP. NITROGENOUS WASTES, DRUGS

ACID-BASE BALANCE
SECRETION OF H+, HCO3 REGULATION OF pH OF BODY FLUIDS

URINE FORMATION
WATER CONSERVATION COLLECTING DUCT RECEIVES FROM SEVERAL NEPHRONS REABSORBS H20, CONCENTRATES URINE BEGINS ISOTONIC TO BLOOD PLASMA BECOMES UP TO 4 TIMES MORE CONCENTRATED CONCENTRATION OF URINE DEPENDENT UPON BODYS STATE OF HYDRATION

Control of Blood Composition by Kidneys


Excretion of nitrogen-containing compounds
Urea Uric acid

Water and electrolyte balance


Regulated by hormones
ADH increases water reabsorption Aldosterone increases sodium reabsorption Second effect of aldosterone increase water reabsorption. Acid-base balance of blood Blood pH must be 7.35 7.45 (very narrow range) Tubule cells secrete whatever is necessary into filtrate Urine pH = 4.5 8.0

Summary of Urine Flow


Kidneys produce urine
Filtration Reabsorption (active transport) Secretion

Ureters Bladder Urethra

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